ESOPHAGUS, Spasm of.
(Esophagismus is usually met with in neurotic women and alcoholics, and is sometimes accompanied by marked emotional disturbance arising from the complete temporary obstruction of the gullet.
Drugs are not to be relied upon to control the spasm, though Bromides and Belladonna are generally recommended as a routine, and they are harmless. Electricity often aggravates the condition. Remedies suit able for the hysterical condition should be persevered with. The only satisfactory form of treatment is the passage of a full-sized Bougie, pre ferably of a large tapered firm gum-elastic instrument, which may be kept in situ as long as the patient can tolerate it at each seance, which should be repeated every or every other day for a few weeks.
Where the obstruction occurs at the termination of the gullet in the stomach, the condition is recognised as Cardio-spasm and is associated with a considerable degree of oesophageal dilatation, as demonstrable by the X rays and Bismuth emulsion. There are good grounds for regard ing this as the result, not of spasm, but of inco-ordinating power. Mikulicz
has carried out an operative procedure in these cases which proves satisfactory. An opening is made into the stomach and the narrowed cardiac orifice is dilated by manual pressure or by introducing a Bougie surrounded by a rubber jacket which is capable of being distended by fluid pressure. Jordan treats this condition by causing; the patient to swallow a long roll of ligature silk with a leaden shot at its extremity; this passes down the intestine to the anus: an acorn-shaped is threaded or guided through on the end of the silk protruding from the mouth, and by this means the contracted part of the gullet is freely dilated.
The opposite condition of paralysis of the gullet is usually a sequela of diphtheria, and is associated with loss of power in the constrictors of the pharynx. It is to be met by feeding through the soft rubber tube till the return of muscular power.