Symptoms. Prognosis. Diagnosis. 239 



the propulsion of the contents becomes more and more incom- 

 plete in spite of stronger efforts at deglutition. The patients 

 cease to take food much sooner, because they become tired 

 out earlier, and they leave more and more food untouched. 

 When the occlusion has become complete the ingestion of food 

 and water becomes impossible, or the wall of the ectatic portion 

 becomes gangrenous, or it ruptures with the production of 

 fatal ichorous inflammation. 



Rupture of the dilatation or the diverticulum manifests 

 itself in a sudden aggravation of the condition, the pulse be- 

 comes rapid, respiration forced, the temperature rises, and 

 symptoms of ichorous inflammation of the cervical connective 

 tissue or the pleura follow; ingested water and food can now 

 get directly from the esophagus into the pleural cavity and 

 with the symptoms of pleuritis there develops a horizontally 

 rising area of dullness in both thoracic cavities or in one of 

 them (Hora). The disturbances of deglutition may at any 

 time produce an aspiration pneumonia with subsequent gan- 

 grene. 



Dilatation of the esophagus, subsequent to obstruction, 

 takes the same course as the latter. Such an ectasia has this 

 in common with obstruction, that the former, like the latter, 

 leads to swelling in the jugular depression if it is situated in 

 the cervical portion of the esophagus. 



Prognosis. Diffuse ectasias of the esophagus, as well as 

 diverticula, are, as a rule, progressive affections which termi- 

 nate fatally. While the prognosis is influenced by the degree 

 of nutritive disturbance, there is always danger of perforation 

 or of gangrene, which, of course, makes the prognosis still 

 more unfavorable. Even if perforation should exceptionally 

 lead only to the production of an abscess which breaks towards 

 the outside world, the morbid changes in the wall of the esoph- 

 agus and the subsequent cicatricial contractions would later 

 on make conditions gradually worse. 



Diagnosis. The sjmiptoms presenting during the ingestion 

 of food and water suggest the character of the disease, but 

 it can be diagnosticated definitely only when we find a tem- 

 porary swelling in the neck in the jugular depression which 

 diminishes on pressure. This disting-uishes the disease from 

 inflammation of the esophagus, abscesses in the cervical con- 

 nective tissue (but these may develop from an ectasia), and 

 simple stenosis from spasm of the esophagais. Paralysis of 

 the esophagus can be excluded by its sudden appearance and 

 short duration. A sign of diagnostic importance is the fact 

 that the esophageal sound can sometimes be easily pushed into 

 the stomach, at other times, that is, if it slips into the ectatic 

 portion or into the diverticulum, it is arrested and does not 

 enter the stomach. 



