STRICTURES OF THE (ESOPHAGUS. 485 



Hamburger, auscultation of the oesophagus during the act of swal- 

 lowing may also be useful in diagnosis ; he auscults the cervical 

 portion of the oesophagus on the left side of the neck with the 

 stethoscope, but the thoracic portion by placing the ear along the 

 vertebral column from the last cervical to the eighth dorsal verte- 

 bra, slightly to the left of the spine. If, on swallowing water, the 

 normal deglutition-sounds are not heard at the lowest point men- 

 tioned, but stop suddenly higher up, it shows that the substance 

 swallowed does not advance, which is most often due to a contrac- 

 tion, a foreign body, rupture of the oesophagus, or a diverticulum. 

 In organic dilatations and paralyses also solids may be arrested. 

 The special nature of the contraction may usually be determined 

 by the coincident circumstances, such as precedent injury from 

 swallowing a sharp body, burning or corrosion, tumors in the neck 

 or chest, diseases of the vertebrae, etc. Spontaneous contractions in 

 persons of mature age are usually due to cancroid.] 



Besides the appearances described, and the other symptoms that 

 a carcinoma or other tumor causes, the impaired nutrition induces 

 gradual emaciation, and the belly sinks in ; there may be no passage 

 from the bowels for weeks, the patient starves, and, as Boerhaave 

 aptly says, " tandem post Tantali poenas diu toleratas lento marasmo 

 contabescunt." 



TREATMENT. The treatment of stricture of the oesophagus be- 

 longs to surgery. By skill, patience, and persistence, surprising 

 results are sometimes attained. In the surgical clinic at Greifswald 

 there was a patient who, without perceptible cause, had a stricture 

 of the oesophagus ; at first only a common elastic catheter could be 

 passed through it, but after four weeks it was so dilated that not only 

 could the largest oesophageal sounds be passed, but ordinary mor- 

 sels of food could be swallowed with ease. 



[Unfortunately, the improvement from dilatation is not usually 

 permanent. Of late successful attempts have been made to treat 

 oesophageal strictures by incision. 



As the constricted oesophagus is always the seat of catarrh, which 

 presents another obstruction to the passage of food, we may pre- 

 scribe as a palliative soda-water or a solution of bicarbonate of 

 soda, of which several spoonfuls may be taken before meals. Where 

 the constriction is great, only fluid food should be used, and in ex- 

 treme cases attempts may be made to feed the patient by a stom- 

 ach-tube. Nutrient enemata may also be resorted to, especially the 

 pancreatic emulsion recommended by Leube, five to ten ounces of 

 lean meat chopped fine, with one-third the quantity of finely-chopped 

 pancreas of beef or hog, and enough warm water to make a pappy 



