Acute inflammation also occurs as a complication of infectious fevers, ty phoid fever, typhus, pneumonia, pymmia, small-pox, etc., while pseudomembranous cesophagitis may be caused by extension of a disease, such as diphtheria, in which a false membrane is present. Various pharyngeal disorders complicated with abscess may also extend to and involve the cesophagus in the inflammatory process. Malignant neoplasms, espe cially carcinoma, of the cesophagus may be accompanied by acute cesophagitis. Among the rare causes are: the pro longed administration of tartar emetic (Laennec), vertebral abscess, laryngeal perichondritis, and hysteria.
It is occasionally net with in suck lings without explainable cause.
Pathology.—Desquamation of the epi thelium and erosions are present when comparatively mild caustics or strong solutions of them have been swallowed, but, when such agents as pure carbolic acid, concentrated lye, etc., have been taken, the entire mucous lining may be deprived of its epithelium. It then be comes greatly swelled, and purulent in filtration usually follows the primary serous infiltration. The mucous layer may thus be detached from the tinder lying tissues. Foreign bodies may also cause deep-seated lesions and be sur rounded by a cushion-like mass, causing temporary oesophageal stenosis. Gan grene occasionally follows, necrotic masses being ejected, generally with vomitus. The local disorder occurring as complication of fevers, etc., is usually less marked, though diffuse purulent inflammation occasionally occurs.
Treatment. — Beyond the relief of pain by means of hypodermic injections of morphine there is but little to do in this condition. In cases due to the in gestion of chemical agents the antidotes indicated under each special head are, of course, to be used if the case is seen sufficiently early, but, for the lesions themselves, the administration of demul cents,—the white of egg, for instance,— sips of ice-water, etc., represent about the only means at our disposal. When deglutition causes severe pain, or there is reason to believe that there is much tissue-destruction, it is best to feed the patient entirely by the rectum.
After injuries of the cesophagus cica tricial contraction is a normal sequel. This should be prevented by the use of bougies. The technique of this proced ure is given below.
Stricture of the CEsophagus.
Symptoms.—Narrowing of the ageal lumen—whether due to cicatricial contraction or to tumors, intramural or extramural; aneurisms, etc.—is attended
by gradually-increasing difficulty in swallowing, referable, in the majority of instances, to a particular spot under the sternum. At first solid food is passed with increasing difficulty, and the pa tient finds it necessary to masticate with great care or swallow smaller boluses. A feeling of pressure is usually experi enced as the food gravitates downward, which in some cases enables the patient to gauge the steadily-decreasing rapidity with which the food reaches the stom ach. Later on these masses require the assistance of fluids, and finally only the latter can pass with ease.
The first effort at swallowing at a meal is generally the most arduous, the sub sequent boluses passing with compara tive ease. Various motions of the head are resorted to by the patient in the vain hope to assist the act of deglutition. As the difficulty increases, the patient grad ually becomes weakened and emaciated through deficient nutrition.
In stricture clue to cancer the contrac tion is rapid and death from pneumonia is not uncommon. When this does not occur, the tissues around the oesophagus are gradually implicated by extension, and death occurs from marasmus due to general toxemia, this being greatly en couraged by starvation. The sense of hunger, however, is not acute. The vomited materials are often tinged with blood, and the general facies of the pa tient soon serve to indicate the presence of a malignant neoplasm. Glandular in filtration occurs late in the disease.
Diagnosis.—Certain destructive points serve to locate the seat of the stricture. Regurgitation of the food usually occurs immediately when the stricture is situ ated near the upper orifice. That the rejected food has not reached the stom ach can easily be recognized by the ab sence of the characteristic odor. The material ejected is also alkaline instead of strongly acid: a valuable diagnostic feature. When the narrowing is low down the oesophagus is dilated above, and the food is accumulated in the pouch-like cavity formed. Regurgita tion, instead of occurring promptly after the ingestion of food, only takes place several hours later, and is mixed with considerable mucus. Here, again, the material ejected is not acid, having failed to reach the stomach. The ac cumulated food sometimes causes clysp no2a by pressing upon the trachea.