INFLAMMATION OF THE (ESOPHAGUS. 



oesophagus is rarely found on post-mortem examination ; when it is 

 seen, the mucous membrane appears very red, swollen, readily torn, 

 and is covered with a mucous secretion. In chronic catarrh, the mu- 

 cous membrane, particularly that of the lower third of the oesophagus, 

 appears thickened, dirty brown, or slate-gray, and is covered with 

 tough mucus. Chronic catarrh may cause dilatation of the oesophagus 

 by relaxation of its muscles, or stricture, by partial hypertrophy of the 

 muscles and submucous tissue (see Chapter III.). 



In croupous inflammation of the oesophagus we find the mucous 

 membrantt dark red, and covered with thick layers of exudation, in 

 spots, or spread out widely. 



In pustular inflammation slight elevations form, fill with pus, burst, 

 and leave a superficial loss of substance ; when caused by tartar emetic, 

 the disease is limited to the lower third of the oesophagus. 



Ulcers of the oesophagus are mostly superficial excoriations, but 

 they may also destroy the entire thickness of the mucous membrane, 

 and attack the muscles and surrounding connective tissue. When 

 chronic, inflammation of the submucous tissue may lead to thickening 

 of the walls of the oesophagus and stricture ; when acute, it may ter- 

 minate in abscess. 



In inflammation of the oesophagus from corrosive substances, the 

 parts affected are changed to a discolored, brown, or black slough, in 

 whose vicinity injection and extensive serous exudation are quickly de- 

 veloped. The sloughs become detached, the loss of substance may be 

 filled up ; if the destruction was extensive, stricture of the oesophagus 

 always remains as a result of the contraction of the cicatricial tissue. 



SYMPTOMS AND COURSE. In swallowing a hot mouthful, we may 

 notice how little sensibility the oesophagus has, particularly at the 

 lower portion. Hence we only have pain in very severe inflammations 

 of the oesophagus, when caused by burns, injuries from pointed or 

 angular bodies, but particularly after corrosion from caustic substances. 

 This pain is felt deep in the breast, and at the back, between the 

 shoulder-blades. In these cases we also find difficulty of swallowing ; 

 for, as soon as the muscles of the oesophagus are inflamed or infiltrated 

 with serum, they cannot pass the morsel downward. This condition, 

 which was formerly described as dysphagia inflammatoria, is always 

 accompanied by oppression and great anxiety. The higher up the 

 morsel is arrested, the more distinctly the patient feels it. If he makes 

 new attempts to swallow, the contractions of the oesophagus may 

 drive upward its contents, which cannot pass downward, so that there 

 will be a regurgitation of the partly-swallowed substance, bloody 

 mucus, and masses of exudation (see Chapter II.), These symptoms 

 are always accompanied by excessive thirst, and, where the inflamma 

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