PARALYSIS OF THE CESOPHAGUS. 



Causes : nervous lesions and disorders ; arytenectoni}- ; over distension ; 

 stricture ; parasites. Symptoms : dysphagia ; regurgitation ; cough ; dys- 

 pnoea ; hard packed gullet. Inhalation pneumonia. Lesions. Treatment : 

 remove cause ; liquid food ; dilatation ; nerve sedatives and stimulants ; 

 electricit}- ; counter-irritants. 



Causes. This ha.s been noticed in a number of cases in soli- 

 peds, and attributed to central nervous lesions, cerebral concus- 

 sion (Straub), encephalitis (Hering, Bornhauser), paralysis of 

 the fore extremities (Meier), pharyngeal paralysis (Pnschmann). 

 Moller has seen it several times consequent on arytenectomy, 

 while Dieckerhoff and Graf have seen it occur without atiy 

 clearly defined cause. In a case referred to above, the present 

 writer found it connected with the attachment of larvae of oestri 

 in the lower end of the gullet. Stricture and impaction may be 

 a further cause. 



Symptoms and lesions. There is more or less interference with 

 deglutition, culminating in complete inability to swallow, and the 

 rejection of morsels of masticated food by the nose. Cough may 

 also occur from the descent of food toward the lungs, with more 

 or less dy.spnoea and oppression of the breathing. Manipulation 

 along tlie left jugular furrow, detects the oesophagus as a promi- 

 nent hard, rope-like mass which fills up the groove unduly. 

 When death occurs rapidlj' the gullet is found gorged with masti- 

 cated food throughout its entire length. In certain instances 

 gangrenous pneumonia is found, the result of the penetration of 

 food into the bronchia. In other cases there are lesions of the 

 medulla oblongata, or of the vagus or glosso-pharyngeal nerves 

 or their oesophagean branches. 



Death usually results from obstruction, inanition, or, in case 

 the paralysis is partial, from pneumonia or exhaustion. 



Treatment. First remove or correct the existing cau.se of the 

 disease. Impaction may be broken up by the use of the wire 

 loop, or pincer probang ; parasites may be expelled by passing a 

 cupped probang ; the impactions following arytenectomy can be 

 obviated by feeding gruels, milk and other liquid foods only, 

 and from a bucket set on the ground ; stricture may be dilated 

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