530 THE DIGESTIVE SYSTEM. 



The occurrence of cartilage and bone in the tonsil has been described by 

 Stoeltzner. 



Sarcoma, carcinoma, 1 and various tumors of mixed type are of fre- 

 quent occurrence in the pharynx." 



The (Esophagus. 



Malformations. 



The oesophagus may be entirely absent, or its lower portion may be present and 

 joined to the pharynx by a solid cord ; or the pharynx, or the lower part of the oesoph- 

 agus, may be continuous with the trachea; or the entire oesophagus may be represented 

 by a solid cord. Dilatations of the oesophagus and division of the middle portion of the 

 oesophagus into two branches have been observed. 



PERFORATION AND RUPTURE. 



Foreign bodies in the oesophagus may, as already mentioned, perfo- 

 rate its wall. Perforation of the oesophagus from without may be pro- 

 duced by inflamed bronchial glands, by the extension of cavities and 

 gangrene of the lungs, by abscesses in the mediastinum, by abscesses 

 accompanying caries of the vertebrae, and by aneurisms of the aorta. 

 Rupture of the wall of the oesophagus by violent coughing and vomiting 

 has been described, but it seems improbable that this should occur with- 

 out some previous local lesion. 3 A few cases of perforating ulcer of the 

 oesophagus have been recorded. 



HAEMORRHAGE. 



Aside from injuries, ulceration, etc., haemorrhage may take place 

 from the veins of the oesophagus, which, especially in atrophic cirrhosis, 

 may be much dilated." 



DILATATION. 



Simple Cylindrical Dilatations of the oesophagus are usually the result 

 of long-continued stenosis of the oesophagus or of the cardiac end of the 

 stomach, although not nearly all the stenoses are followed by dilatation. 

 These dilatations are formed at first immediately above the stenosis and 

 then extend upward. Dilatation may occur below the stricture. Only 

 in rare cases does the dilatation involve the whole length of the tube. 

 The entire wall of the dilated portion of the oesophagus is thickened, and 

 there may be polypoid growths from the mucous membrane. 



1 For a study of carcinoma originating in the branchial cleft see Powers, Annals of 

 Surgery, February, 1898. 



*For literature of malignant disease of the tonsils consult Newman, Am. Jour. Med. 

 Sciences, vol. ciii., p. 487, 1892; also Housell, Beitr. zur. klin. Chirurgie, Bd. xiv. 



3 For a study of rupture of oesophagus see McWeeney, Lancet, 1900, vol. ii., p. 158, 

 bibliography. 



4 See Preble, Am. Jour. Med. Sciences, vol. cxix., p. 263, 1900. 



