426 INJURIES TO THE PHARYNX AND (ESOPHAGUS. 



(2.) INJURIES TO THE PHARYNX AND (ESOPHAGUS 

 ((ESOPHAGEAL FISTULA). 



Injuries to the walls of the pharynx occur in all animals, but 

 most commonly in horses. When rasping the teeth the chisel 

 or rasp, if carelessly handled, may severely injure the pharyngeal 

 wall, and even produce death from bleeding or acute inflammatory 

 processes. Like injuries result from the use of sticks in giving balls ; 

 from awkward employment of pharyngeal sounds, forceps, and 

 other instruments ; and in all animals, and notably in carnivora, 

 from sharp foreign bodies. Merkl found a hairpin in a horse's 

 pharynx. Injuries to the oesophagus are almost invariably caused 

 by sharp foreign bodies, or by oesophageal instruments used for their 

 removal. Injuries from without are uncommon, though Graf and 

 Braun have both seen injuries to the oesophagus in horses caused 

 by kicks from other animals. 



The course of such injuries depends entirely upon their character. 

 As already stated, fatal bleeding may occur, or suffocation from 

 passage of blood into the trachea. Where the inflammatory process 

 is superficial, and foreign bodies have been promptly removed, healing 

 often occurs quickly ; but deep-seated inflammation with oedema 

 of the mucous membrane of the pharynx and adjacent parts may 

 supervene, threatening suffocation. Foreign bodies injuring the 

 mucous membrane of these regions sometimes produce extensive 

 inflammation and the formation of abscesses, which may break 

 externally and cause oesophageal fistula, or into the thorax or 

 abdomen, inducing septic pleuritis or peritonitis, and rapidly leading 

 to death. Laser records, in a remount horse, the rare case of double 

 rupture of the oesophagus — one in the neck portion, the second in 

 the thorax ; death ensued. External perforation is most frequently 

 met with at the upper end of the oesophagus, close to the 

 pharynx ; Moller has several times seen this in horses. The abscess 

 breaks and discharges an exceedingly offensive pus, often mixed 

 with food, after which saliva, food, and water escape during 

 swallowing, proving beyond question that the disease has originated 

 in the oesophagus or pharynx. The wound closes gradually but 

 a small fistulous canal remains, discharging water and saliva, and 

 healing often with the greatest difficulty. This constitutes oesophageal 

 or pharyngeal fistula. Butters recently described such a case. The 

 inflammatory process and consequent swelling produce difficulty 

 in swallowing, and not infrequently febrile symptoms. A swelling 

 develops on the left side, gradually increases, becomes soft, and 



