488 AFFECTIONS OF THE (ESOPHAGUS. 



TREATMENT. In dilatations due to stenosis, the primary disease 

 is to be treated. In idiopathic cases, laxity of the muscular coat 

 should be combated by the means mentioned in the chapter on 

 paralysis of the oesophagus. When there are diverticuli, fluid food 

 only should be used ; and such as are in the neck should be kept 

 empty if possible, with a very slight hope that if food no longer 

 enters them they may decrease in size. Hamburger proposes ligat- 

 ing the diverticulum by an operation allied to oesophagotomy.] 



CHAPTER IV. 



MORBID GROWTHS IN THE (ESOPHAGUS. 



ETIOLOGY. Fibroid tumors are rarely, and tubercles almost 

 never, seen in the O3sophagus ; but carcinomata occur quite often. 

 They are usually primary, more rarely carcinomatous growths 

 spread from the mediastinum to the oesophagus. 



The cause of cancerous degeneration of the oesophagus is just as 

 unknown as that of cancer elsewhere. It has been claimed that 

 brandy-drinkers are particularly liable to the disease. 



ANATOMICAL APPEARANCES. The fibroid tumors form movable, 

 bluish-white concretions, of the size of a lentil or bean, in the sub- 

 mucous tissue ; or they appear as pedunculated polypi, often lobu- 

 lated at the free end, which usually originate from the cricoid car- 

 tilage (Rokitansky). 



Of the carcinomatous growths, scirrhus and medullary cancer, 

 and very rarely epithelioma, occur in the oesophagus. They gener- 

 ally affect the upper or lower third, more rarely the middle third ; 

 the whole circumference is usually comprised in the degeneration 

 forming a cancerous stricture. The degeneration always begins in 

 the submucous tissue, but soon attacks the mucous membrane. If 

 the cancer softens and disintegrates, uneven ulcers form, surrounded 

 by a medullary infiltrated wall, and covered with sanies and bleed- 

 ing fungous growths, or black ragged masses. From the external 

 connective-tissue membrane of the oesophagus, the cancer may ex- 

 tend to the neighboring structures, and, when breaking down, cause 

 perforation of the trachea, bronchi, or even of the aorta and pulmo- 

 nary arteries. 



SYMPTOMS AND COURSE. The small movable fibroids of the 

 oesophagus cause no symptoms. Pedunculated fibrous polypi cause 

 the symptoms of stricture of the oesophagus, and may induce haemor- 

 rhage ; the ODSOphageal sound may be passed around them, and, 



