482 AFFECTIONS OF THE (ESOPHAGUS. 



don is extensive, there may also be fever. When the disease runs a 

 favorable course, the symptoms disappear gradually ; after the perfora- 

 tion of a submucous abscess, they may pass away suddenly ; in other 

 cases stricture remains ; occasionally, even death is caused by perfora- 

 tion or rupture of the oesophagus (see Chapter V.). 



During life, the slighter cases of acute and chronic catarrh do not 

 have any recognizable symptoms. The same is true of pustular in- 

 flammation. The croupous form also is usually overlooked, unless 

 pseudomembranes are vomited up; if it accompanies croup of the 

 larynx and fauces, the dyspnoea and other symptoms of these affec- 

 tions throw into the background the pain and difficulty of swallowing ; 

 when it comes as a secondary croup in typhus and similar diseases, 

 the patients usually lie in a perfectly apathetic state, so that they 

 utter no complaints. 



Chronic ulcers occasionally cause pain at some circumscribed spot, 

 and permanently interfere with swallowing ; they can only be distin- 

 guished from strictures by introducing an cesophageal bougie, which, 

 in case of ulcers, finds no obstruction, and often brings up mucous, 

 bloody masses. As the ulcers cicatrize, the symptoms of stricture 

 may occur. 



TREATMENT. The question of treatment can only arise in the 

 more severe forms of cesophagitis, as the slighter cases are not recog- 

 nized. Foreign bodies exciting the inflammation are to be removed 

 according to the laws of surgery. In corrosion by mineral acids and 

 caustic alkalies, antidotes can only be used in very recent cases. For 

 the rest, in acute catarrh, we may limit ourselves to giving the patient 

 ice-water to swallow, or let him take pieces of ice in the mouth. Gen- 

 eral and local bleeding are only injurious ; the employment of medi- 

 cines is difficult, and promises little benefit. If the patient can swal- 

 low, he should take only fluids. If swallowing be totally impossible, 

 the patient may be nourished through the stomach-tube, or by ene- 

 mata. In chronic ulcers of the oesophagus, the numerous remedies 

 recommended remain without effect, and careful nourishment of the 

 patient is the chief object of treatment. 



OHAPTEK II. 



STRICTURES OF THE (ESOPHAGUS. 



ETIOLOGY. Contractions of the oesophagus may be due 1, to com- 

 pression ; 2, to the protrusion of new growths into its canal ; 3, to 

 structural changes of its walls. The latter form are strictures in the 

 exact sense of the word ; they result from the inflammations described 

 in the last chapter. 



