46 



DISEASES OF THE DIGESTIVE APPARATUS. 



the epithelial desquamations of the skin, and the papillary hyper- 

 plasias met with so frequently in chronic inflammation of the 

 cutaneous derma. Unfortunately, most authors have not taken 

 into account this construction of the œsophageal mucous mem- 

 brane, consequently our knowledge of the pathological anatomy^ 

 in the various affections of which it is the seat, is as yet very 

 incomplete. 



Symptoms. They are usually obscure and do not permit us 

 to make a correct diagnosis, at least at the onset. Dysphagia, 

 nausea, and abnormal sensibility to pressure exerted in the jugular 

 groove may nevertheless afford guidance. We have observed 

 whining, ptyalism, cough, and an absolute dysphagia in a case 

 of croupous œsophagitis ; a cast of the size of the œsophagus and 

 about 35 centimetres long was rejected after a few days. 



Treatment. A direct refrigerating action must be exerted upon 

 the mucous membrane, by means of very cold drinks and broken 

 ice; the patients must be sustained with cooling, non-exciting 

 liquid nourishment; astringent solutions may be used (tannin, 

 nitrate of silver, chloride of potassium, etc.), but not at the risk 

 of interfering with digestion. Blistering frictions on the lower 

 edge of the neck and shoulder, and jugular regions, produce no 

 effect. Œsophageal stricture, happening sometimes after cicatri- 

 zations of croupous ulcerations, may be prevented by introducing 

 the oesophageal sound periodically. 



2. Dilatations of the Œsophagus. 



Etiology. Dilatations can be divided into the diffused, occu- 

 pying the whole periphery of the œsophagus, and the circumscribed 

 dilatations, or jabots. Ectases of the œsophagus are generally 

 accompanied by constrictions; they are produced by the same 

 mechanism as the eccentric hypertrophies of the heart when there 

 is valvular constriction (stenosis). In order to induce a move- 

 ment of the alimentary substances through the constricted part of 

 the œsophagus, more intense peristaltic contractions must be per- 

 formed by the muscular fibres of the region lying immediately 

 above, when the œsophagus becomes enlarged, its muscular fibres 

 atrophied, and its walls pale and thin. 



Ectases without contractions are rare and seem to be caused by 

 local inflammations. It may be that the psorospermic utricles 



