486 AFFECTIONS OF THE (ESOPHAGUS. 



consistence. This composition is suited to the natural digestive 

 power of the rectum. It should be preceded by a cleansing enema.] 



CHAPTER III. 



DILATATION OF THE (ESOPHAGUS. 



ETIOLOGY. The dilatation of the cesophagus is sometimes total, 

 affecting the entire organ, sometimes partial, limited to a short sec- 

 tion. In partial dilatation sometimes only one wall is affected, then 

 enlargements form, which often develop to large sacs, communicat- 

 ing with the O3sophagus ; they are called diverticuli ; their walls 

 are sometimes formed of the mucous membrane, which protrudes 

 hernia-like between the muscular filaments, and of the external con- 

 nective-tissue layer. 



Besides the diverticuli, dilatations of the oesophagus are most 

 frequently found 1. Above a constricted portion ; in stricture of 

 the cardiac orifice there is total, when the stricture is higher up 

 there is partial dilatation. 2. In other cases the total dilatation ap- 

 pears to depend on a chronic catarrh and on the muscular paralysis 

 induced by it. 3. In many cases the causes are unknown. Roki- 

 tansky^s hypothesis, that concussions of the body, and Oppolzer's, 

 that the treatment of gout with large quantities of warm water, 

 may cause enormous dilatation of the whole cesophagus, appear to 

 me very problematical. 



The diverticuli are formed 1. By foreign bodies which have 

 stuck in the walls of the cesophagus, and are constantly driven far- 

 ther in by the food which passes down. 2. They are sometimes 

 formed by the shrinkage of bronchial glands, which have become 

 adherent to the mucous membrane while they were swollen, and 

 which on contracting draw the mucous membrane after them. 3. 

 In other cases we can discover no cause. 



ANATOMICAL APPEARANCES. In total dilatation of the cesopha- 

 gus, the entire canal has been found dilated to the size of a man's 

 arm ; the walls are usually hypertrophied, more rarely thinned. 



In partial dilatation, the portion immediately above the constric- 

 tion is usually largest. The dilatation gradually decreases as we 

 go upward, so that an elongated sac is formed, at whose fundus 

 there is a second, narrow exit. 



Diverticuli usually form near the bifurcation of the trachea, or 

 at the point where the pharynx becomes the cesophagus ; they are 

 at first roundish, but later they form cylindrical or conical append- 



