STRICTURES OF THE (ESOPHAGUS. 4.33 



ANATOMICAL APPEARANCES. Compression of the ossophagus may 

 arise in various ways. Among the most frequent causes we may men- 

 tion : swelling of the thyroid bodies or of the lymphatic glands of the 

 neck or mediastinum ; dislocation of the hyoid bone ; exostoses of the 

 vertebrae ; abscesses or tumors between the trachea and oesophagus ; 

 carcinoma of the lungs or pleura ; aneurism. Not unfrequently the 

 diverticuli, to be described in the next chapter, compress the section of 

 the oesophagus immediately below them. In some cases where, during 

 life, there were signs of compression of the oesophagus, on post-mortem 

 examination, the right subclavian artery has been found morbidly di- 

 lated, arising from behind the left subclavian, and running to the right 

 between the oesophagus and trachea, or oesophagus and vertebrae. 

 The difficulty of swallowing thus caused has been named dysphagia 

 lusoria. 



In Chapter IV. we shall speak of the new formations on the inner 

 wall of the oesophagus, which are the most frequent causes of its con- 

 traction. 



Strictures of the oesophagus, in the exact sense of the word, de 

 pend 1, on cicatricial contractions of the membrane which have oc- 

 curred after considerable losses of substance ; they remain most fre- 

 quently after corrosion or extensive ulceration ; 2, on hypertrophy of 

 the muscular and intermuscular connective tissue, induced by chronic 

 catarrh of the oesophagus. On a longitudinal section through the wall 

 of the oesophagus, which, in such cases, is frequently much thickened, 

 there is often a peculiar fan-like appearance, as the hypertrophied mus- 

 cular filaments are grayish red, while the hypertrophied connective 

 tissue between them presents white fibrous bands, and the mucous 

 membrane is thickened and irregular. Lastly, strictures may be due 

 to hypertrophy and subsequent cicatricial shrinkage of the submucous 

 tissue. 



Sometimes the contraction is almost unnoticeable, at others so de- 

 cided that the oesophagus is completely closed. The most frequent 

 seat of stricture is the lower third, but it may occur in ,any part. 

 Above the stricture, the walls are almost always hypertrophied, and 

 the canal dilated ; below it, the walls are often thinned, and the canal 

 collapsed. 



SYMPTOMS AND COURSE. As strictures of the oesophagus from 

 any cause develop gradually, the disease is at first apparently without 

 danger, and does not cause much inconvenience. For a long time the 

 sole symptom is a slight impediment in swallowing large morsels, 

 which is overcome when the patient drinks or makes new efibrts to 

 swallow. Although the patients become more careful, and chew all 

 their food very fine, they gradually find it more and more difficult to 



