492 AFFECTIONS OF THE (ESOPHAGUS. 



vary in swallowing solid or fluid substances. Where there is mere- 

 ly paresis of deglutition, firm morsels, especially if large, pass down 

 with some delay and difficulty ; if there be complete paralysis, they 

 stick in the pharynx or oesophagus, and may press on the air-passages 

 so as to cause dyspnoea, unless immediately vomited, or washed 

 down by swallowing liquids, or pushed down by a bougie. In 

 simple paresis, liquids are readily " swallowed the wrong way ; " 

 but when the patient is erect, they pass into the stomach with a 

 peculiar sound. In complete paralysis of deglutition in dying pa- 

 tients, the attempt to make them swallow liquids is dangerous from 

 the liability of their running into the larynx. 



The diagnosis is usually easy from the concomitant symptoms, 

 and in doubtful cases may be verified by introducing the cesophageal 

 sound. 



The prognosis depends on the original disease, but in central 

 paralysis is mostly unfavorable. 



Besides treatment suited to the cause, the most varied anti- 

 paralytic treatment has been advised, such as internal and hypoder- 

 mic use of strychnia, ergot, and arnica, irritants to the skin, intro- 

 duction of sounds, hot baths, cold-water treatment, and especially 

 electricity. Duchenne faradized the pharyngeal muscles. Bene- 

 dict galvanized the spine, applying the zinc pole to the front of the 

 neck, the copper to the spine.] 



