MALIGNANT DISEASE OF THE (ESOPHAGUS. 351 



inches from the teeth. The actual opening of the O3sophagus 

 into the stomach is an inch lower down. The oesophagus pierces 

 the diaphragm at the level of the tenth dorsal vertebra, at a point 

 immediately to the left of the tip of the ninth dorsal spine. 



In the neck the oesophagus is loosely connected by areolar 

 tissue with the posterior membranous wall of the trachea; the 

 recurrent laryngeal nerve of each side ascends in the groove 

 between the two. The carotid sheaths and the lobes of the 

 thyroid gland lie laterally, the relation being more intimate on 

 the left side owing to the deviation of the oesophagus to the left 

 at the root of the neck. A malignant growth of the cervical 

 portion of the oesophagus may cause oedema of the larynx, 

 simulating an inflammatory condition, or actually invade it. The 

 trachea may be compressed or perforated ; one or both recurrent 

 nerves may be paralysed ; the thyroid gland may be invaded, or, 

 more rarely, the growth may ulcerate into the adjacent blood 

 vessels or give rise to suppuration in the prevertebral connective 

 tissue, the layers of which separate the oesophagus from the 

 vertebral column and the longus colli muscles. 



The thoracic portion of the oesophagus traverses the superior and 

 posterior mediastina. The trachea lies in front above, but lower 

 down the air tube deviates to the right and the left bronchus 

 crosses the gullet. Either this bronchus or the lower part of the 

 trachea may be compressed or perforated by a new growth in 

 this situation. Below the trachea, the pericardium, and lower 

 still the diaphragm, are in anterior relation and are sometimes 

 invaded. The lateral relations of first importance in the thorax 

 are the lungs and pleurae. The oesophagus is in much more 

 extensive relation with the right pleural sac than with the left, 

 because the thoracic aorta intervenes between it and the latter. 

 The former sac not only forms a continuous lateral relation, but 

 below the level of the eighth dorsal vertebra becomes posterior 

 as well. There is therefore a greater probability of invasion of 

 the right pleural sac and lung than of the left. Gangrenous 

 processes may be the outcome of such invasion, since the food 

 passages easily convey infections. The left pleural sac is in 



