

NERVOUS AFFECTIONS OF THE (ESOPHAGUS. 491 



There can hardly be ancesthesia (that is, diminished or lost ex- 

 citability of the sensory nerves) of the oesophagus, because the nor- 

 mal sensitiveness is so very slight. 



Hyper kinesis, increased excitability of the motor nerves, oesopha- 

 gismus, or dysphagia spastica, occurs more frequently, although, 

 doubtless, many cases classed under this head have been misinter- 

 preted. Spasm of the oesophagus is most frequently of reflex origin ; 

 it is often excited by irritation of the uterus, hence is most frequently 

 met in hysterical women ; occasionally it is of central origin, and 

 forms one symptom of disease of the brain or upper part of the spinal 

 marrow; it may also be induced by poisoning with narcotic substances 

 or alcohol. Like most neuroses, spasm of the oesophagus runs its 

 course with paroxysms and free intervals. The attacks most fre- 

 quently occur during eating ; the patient suddenly becomes unable 

 to swallow, and feels as if there were a foreign body in the oesopha- 

 gus. If the spasm be at the upper end of the organ, the food re- 

 turns as soon as introduced ; if at the lower end, it does not regur- 

 gitate for a short time. There are usually, at the same time, attacks 

 of oppression and suffocation, and sometimes spasmodic contractions 

 of the muscles of the neck. After lasting for a while, the attack 

 usually passes oft* ; in other cases, a slight) amount of spasm remains 

 for weeks or months as a permanent affection, called " spastic strict- 

 ure." During the interval, if we examine with the bougie, we find 

 no obstacle ; if we examine during the attack, the stricture occa- 

 sionally disappears during the probing. Besides a proper treatment 

 of the original disease, it is advisable to use narcotics, particularly 

 belladonna, or the so-called antispasmodics, such as valerian, asa- 

 foetida, musk, etc. If the patient cannot swallow, these remedies 

 should be used by enema. Repeated careful introduction of the 

 oesophageal bougie promises the best results. 



[Akinesis, which is diminution or loss of sensibility of the mo- 

 tor nerves of the pharynx or oesophagus (inability to swallow, dys- 

 phagia paralytica), is said to occur occasionally from cold, concus- 

 sion, fright, lead-poisoning, and unknown causes. Sometimes it is 

 consecutive to physical changes of structure in the muscles after 

 total or partial dilatation. Its most frequent cause is some affection 

 of the central nervous system, as at the origin of the glosso-pharyn- 

 geal, vagus, and accessory nerves, or at the coordinating centre of 

 deglutition, as occurs in some cerebral and spinal diseases, such as 

 apoplexy, progressive bulbar paralysis, muscular atrophy, tabes dor- 

 salis, etc. Paralysis of deglutition, which occurs late in severe dis- 

 eases, and which even the laity regard as an ominous sign, may be 

 due to neglect of innervation from this centre. The symptoms 



