(ESOPHAGUS. 
being in great part or altogether deficient. In 
some cases the pharynx does not terminate in 
a cul-de-sac, but opens by a small orifice at 
the side of the neck. Another congenital mal- 
formation more rare than the last consists in 
the division of a portion of the esophagus into 
two canals placed side by side. 
Acquired malformation —One of the most 
common kinds of acquired malformation is 
dilatation either general or partial. In the 
Museum of King’s College there is a remark- 
_ able specimen of a dilated esophagus. At each 
extremity it is healthy and of the natural size ; 
the intermediate part is enlarged to an extra- 
ordinary degree of dilatation ; the lining mem- 
brane is thickened and opaque, ae a the 
a e of having partially yielded from 
aaiatico. The eo fibres were of the 
natural colour and thickness. The dysphagia 
_ in this case was as great as in a case of stric- 
 ture.* Dilatation is a common consequence 
of stricture. In such cases the dilatation 
‘usually occupies the whole circumference of 
‘the canal. Insome rare cases dilatation occurs 
in the form of a pouch projecting on one side 
of the canal. Occasionally the mucous mem- 
brane alone becomes pouched, protruding as a 
hernia between the muscular fibres, but more 
‘commonly the muscular coat also dilates and 
expands over the pouch. Bleuland mentions 
‘a case in which a large pouch containing ali- 
Mentary matters compressed the canal below 
so as completely to close it, and to prevent the 
assage of food into the stomach. These 
pouches are most common at the upper ex- 
tremity of the esophagus, probably in con- 
sequence of the sudden constriction which the 
anal undergoes at this point, and partly too in 
eonsequence of the muscular coat being thinner 
here than in any other part. 
_ Structural changes.—Among the most com- 
/mon are those which result from inflam- 
“ation, which however is seldom idiopathic, 
but generally the consequence of swallowing 
itating substances, hot liquids, the strong 
s or alkalies. The effects in such cases 
jary in degree from slight redness and sofien- 
ig of the mucous membrane, to ulceration 
id sloughing of the “Whole circumference of 
he tube. The Museum at King’s College con- 
ins a aaa of an esophagus and of a 
Slough discharged from it, which was taken from 
young woman who had swallowed oil of vitriol. 
week afterwards she brought up a slough 
aving a tubular form, and consisting of the 
ole lining membrane of the gullet. Some 
the muscular fibres were plainly visible on | 
e outside of the slough, in its recent state.{ 
r. Baillie gives a drawing of a false mem- 
rane lining the pharynx and cesophagus, taken 
om a patient who had thrush. 
E The esophagus is very frequently the seat of 
ricture, the causes of which are various. Not 
anfrequently it depends on the contraction of 
a cicatrix after sloughing produced by the con- 
oo = 
= 
ee 
n> Gr jel et Oe ee a 
| * This case has been fully described by Mr. Mayo 
jm the third volume of the Medical Gazette. 
+ Meckel, Manuel d’ Anatomie. 
| } Dr, Watson’s lectures, vol. ii. p. 332. 
761 
tact of some irritating agent. The constriction 
in these cases appears to go on continually in- 
creasing. Sir ¢: Bell mentions-a case in which 
starvation was the consequence of stricture of 
the esophagus, twenty years after swallowing 
a quantity of soap lees. Another common 
cause of stticture is cancerous disease. This 
is generally confined to the lower extremity, 
but occasionally it pervades every part of the 
cesophagus.* A more rare case of stricture is 
described by Sir E. Home.t In this case a 
membranous partition extended across the canal ; 
in the centre of the partition was a narrow 
passage ; the coats of the esophagus surround- 
ing the stricture were but slightly changed. 
In cases of simple imflammatory stricture all 
the coats of the esophagus are thickened and 
indurated at the seat of stricture, lymph is 
effused between them, and the bloodvessels 
are enlarged and distended. In consequence 
of stricture the esophagus above becomes 
much dilated; sometimes ulceration and abscess 
occur. Dr. Monro mentions a case in which 
death occurred suddenly in’ consequence of 
purulent matter escaping into the trachea. 
Morbid growths are occasionally found in 
the esophagus. Dr. Monroj describes the 
dissection of a man aged 68, in whom the 
cesophagus was dilated by a large fleshy excre- 
scence or polypus. It was attached three 
inches below the epiglottis and reached down 
to the upper orifice of the stomach. Haller§ 
gives an account of the dissection of a man, 
in whom was found a polypus about seven 
fingers’ breadth long, and of the thickness of 
a worm, which in its general appearance it 
very much resembled; it had a carneo-fibrous 
appearance, a soft consistence, and a deep red 
colour. Fatty and steatomatous tumours have 
occasionally been found in the gullet. In 
other cases a portion of the canal has been 
found converted into bone, or cartilaginous 
tumours have grown from.it. 
An aneurism springing from the posterior 
part of the arch of the aorta may compress 
the csophagus against the spine. The imme- 
diate consequence is difficulty of swallowing 
and other symptoms of stricture, and at length 
in many cases ulceration and sloughing of the 
cesophagus with escape of blood from the aneu- 
rism either into the mouth or the stomach. 
BIBLIOGRAPHY.—WMeckel, Manuel d’Anatomie. 
Cruveilhier, Anatomie Descriptive. Bleuland, De 
sana et morbosa cesophagi structura. Todd and 
Bowman, Physiological Anatomy and Physiology 
of Man. Miiller, Physiology, by Dr. Baly. Monro, 
Morbid Anatomy of the haman gullet, stomach, 
and intestines. Sir E. Home, Practical observa- 
tions on strictures. Haller, Disputationes ad 
morbos. 
( Geo. Johnson. ) 
OLFACTORY NERVES. See Noss and 
SMELL. 
* Monro’s Morbid Anatomy of the Haman Gul- 
let, Stomach, and Intestines. 
+ Practical Observations on Strictures, vol. ii. 
p- 407, 3d ed. 
FOpsicies) 
§ Disputationes ad Morb. tom. iii. p. 596. 
