SEMIOLOGY OF THE DIGESTIVE APPARATUS. 



109 



with or without the formation of false membranes, and of ulcerations, 

 polypi, etc. 



(Esophagus. In consequence of its anatomical formation, situation 

 and course, the oesophagus may be divided into two distinct parts — viz., 

 the cervical, which can be examined from the outside, and the thoracic, 

 which cannot so be examined. 



The cervical part may be examined by inspection, by palpation from 

 one side, or by palpation with both hands and from both sides. 



Inspection leads to the detection of changes in the shape of the 

 oesophagus and of the jugular furrow. In fat subjects, however, it is of 



Fig. 59. — Examination of the pharynx. 



little value. As the position and the course of the oesophagus are known, 

 unilateral palpation, or, better still, bilateral palpation, employing both 

 hands, is of very much greater service. These methods reveal the 

 presence of swellings, infiltrations, changes in shaj)e and sensibility, the 

 presence of foreign bodies, the existence of dilatations or contractions 

 of the tube, etc. 



Auscultation and percussion, though recommended by some prac- 

 titioners, are not of much -service. 



Inability to swallow^ due to change in the oesophagus, is also detected 

 by inspection. Its existence suggests a number of possible conditions, 

 such as fissure or ulceration of the oesophagus, compression in the 

 mediastinal region as a result of tuberculous or other disease, contraction 

 or dilatation of the oesophagus, etc. Furthermore, inspection will betray 



