SOPHAGUS (Gr. oio, to convey, and phogein, to eat), or GULLET, a membranous canal, about 9 in in length, extending from the pharynx to the stomach. and thus form ing a part of the alimentary canal. It commences at the lower border of the cricoid cartilage of the larynx, descends in a nearly vertical direction along the front of the spine, passes through an opening in the diaphragm, and thus enters the abdomen, and terminates in the cardiac orifice of the stomach opposite the ninth dorsal vertebra. It has three coats—viz., an external or muscular coat (consisting of two strata of fibers of considerable thickness—an external, loneitudinal, and an internal, circular); au internal or mucous coat, which is covered with a thick layer of squamous epithelium; and an intermediate cellular coat, uniting the muscular and mucous mats. In this tissue are a large number of (esophageal glands, which open upo• the eseace by a long excretory duct, and are most numerous round the cardiac orifice, where they form a complete ring.
The (esophagus is liable to a considerable number of morbid change's, none of which are, however, of very common occurrence.
The most prominent symtom of cesophagitia, or inflammation of the oesophagus, is pain between the shoulders, or behind the trachea or sternum, augmented in deglutition, which is usually more or less difficult, and sometimes, impossible. The affection is regarded as a very rare one, unless when it originates from the direct application of irritating or very hot substances, or from mechanical violence—as, for instauce, from the unskillful application of the stomach-pump or prohang. Dr. Copland. however, is of opinion that it is not unfrequent in children. particularly during infancy, and observes that "when the milk is thrown tip unchanged, we shoula always suspect the existence of of the esophagus. The ordinary treatment employed in inflammatory diseases must be adopted; and if inability to swallow exists, nourishing liquids, such as strong beef-tea, must be injected into the lower bowel.
Spasm of the aeophao us—a morbid muscular contraction of the tube, produeing more or less difficulty of swallowing—is a much more common affection than inflammation.
The spasm generally comes on suddenly during a meal. Upon an attempt to swallow, the food is arrested, and is either immectately rejected with considerable force, or is retained for a time, and then broutsht up by regurgitation; the former happening when the contraction takes place in the upper part of the canal, and the latter when it is near the lower part. In some cases, solids can be swallowed, while liquids excite spasm; while in other cases the opposite is observed; but in general either solids or liquids suffice to excite the contraction, when a_ predisposition to exists. . Time predisposition usually consists in an excitable atateiof time nervous E6-stenii stichlts: exists in hysteria, hypochondriasis, and generally in a debilitated condition of the body. Au attack may consist of a single paroxysm, lasting only a few hours, or it may be more or less persistent for months or even years. The treatment must be directed to the establishment of the general health, by the administration of tonics and antispasmodics, by attention to the bowels and the various secretions, by exercise in the open air, the shower-bath, a nutritious diet, etc.; and by the avoidance of the excessive use of strong tea, coffee, and tobacco. Cure must also be taken not to swallow anything imperfectly masticated or too hot; and the occa sional passage of a bougie is recommended. Brodie relates a case that ceased spontane ously on the removal of bleeding piles. Strychnia is deserving of a trial when other means fail; and if the affection assume a decidedly periodic form, quinia will usually prove an effectual remedy.
Paralysis of the 'esophagus is present in certain forms of organic disease of the brain or spinal cord which are seldom amenable to treatment, and often a very important part of the palsy that so frequently occurs in the and chronic cases of insan ity. In this affection there is inability to swallow, but no pain or other symptom of spasm; and a bougie may be passed without obstruction. The patient must be fed by the stomach-pump, and nutrient injections of strong beef-tea should be thrown into the lower bowel.