532 THE DIGESTIVE SYSTEM. 



gus, due to the ingestion of irritating poisons, may induce cicatricial 

 stenosis. A few cases of stenosis due to syphilitic inflammation have 

 been reported. 



INFLAMMATION. ((Esophagitis.) 



Catarrhal (Esophagitis niay be either acute or chronic. The chronic 

 form may lead to ulceratiou, or relaxation and dilatation of the walls, 

 or to hypertrophy of the muscular coat. 



Pseudo-Membranous (Esophagitis may occur with a similar process in 

 the pharynx, with the exanthemata and other severe diseases, or under 

 other conditions. It may be diphtheritic in character or due to other 

 excitants than the diphtheria bacillus. 



Tuberculous (Esophagitis may occur in generalized miliary tuberculosis 

 or by local infection from tuberculous sputa, either with or without 

 obvious predisposing local lesion, or through an extension of a tubercu- 

 lous process from adjacent structures. Ulceratiou is apt to occur. 1 



Other Forms of Inflammation of the (Esophagus. Foreign bodies which 

 are swallowed and become fixed in the oesophagus may incite inflamma- 

 tion of the mucous membrane and of the adjoining soft parts. Abscesses 

 may form around the resophagus, or destroy the wall of the canal, and 

 the foreign body may find its way into the trachea, aorta, or pericardium. 



Inflammation of the submucous tissue of the ossophagus, apart from 

 the cases just mentioned, is not common. It may result in abscess or 

 the formation of fibrous tissue, causing stenosis. 



Irritating and caustic acids and alkalies may destroy larger or smaller 

 portions of the mucous membrane. The necrosed portions are of a black 

 or whitish color, surrounded by a zone of intense congestion. If the pa- 

 tient recover, the patches of membrane which have been destroyed slough 

 and fall off, leaving a surface covered by granulation tissue. As this 

 assumes cicatricial characters and contracts, serious stenosis of the 

 cesophagus may be produced. 



TUMORS. 



Small Papillomata may occur singly or in considerable numbers 

 throughout the entire length of the ossophagus. Large papillary tumors 

 are more rare. Small submucous fibromata and lipomata, and leiomyomata 

 of considerable size may occur in the oesophagus. Sarcomata are rare. 2 

 Adenomata have been observed. 



Carcinoma may originate at any part of the wall of the pharynx and 

 oesophagus. The tumor may encircle the tube ; it may remain as a flat 

 infiltration (Fig. 306), or project inward in large, fungous masses. In 

 either case it is prone to ulceration. The growth may extend up and down 

 the oesophagus, and even involve the pharynx or stomach. The ulcerative 



1 For bibliography of tuberculous cesophagitis see Flexner, Johns Hopkins Hospital 

 Bulletin, vol. iv., p. 4, 1893; and also Cone, ibid., vol. viii., p. 229, 1897. 



* Livingood, Johns Hopkins Hosp. Bull., vol. ix., p. 159, 1898, bibliography. 



