DISEASES OF THE CESOPHAGUS (Corrosive (Esophagitis) unfortunate cases in which caustic chemical poisons are swallowTd by children, causing burns in the oesophagus, are fairly common. The substance most commonly swallowed is lye, in the form of washing fluid.
Pathological burns do not produce cicatrices, but only necrosis of the epithelium. Severe lesions destroy the entire thickness of the mucous membrane, sometimes even the msophageal walls. Extensive ulceration is produced, which heals'by cicatricial tissue, resulting in the formation of strictures.
Symptoms.—After the poison is swallowed, masses of bloody mucus are expelled, which in severe MSC'S may contain portions of mucous membrane.
Deglutition becomes very painful, and the general condition is influenced by the severity of the infection. Seri 0118 collapse occasionally occurs with a fatal termination. In the other cases, recovery, which may be interrupted by other serious symptoms, such as sloughing of the tissues, erosions of the blood vessels and haunorrhages, perforation, with pnlegmon of the neck, or mediastinitis, with emphysema of the skin or pyopneumothorax, ensues. In the milder cases such compli cations do not occur, but after several weeks, lleW symptoms, caused by the formation of cicatricial tissue with stricture, develop. According
to von Hacker, one quarter of the patients die as a result of swallowing lye, while sulphuric acid poisoning causes a mortality rate of fifty per cent. In more than one-half the cases, serious strictures result; of the other cases some develop slight and others no strictures at all. About one-third of the patients with stricture die.
Treatment.—Immediately a?ter the poison is taken antidotes ;chalk, magnesia, vegetable acids) should be given.
The further treatment consists in quieting the pain and looking after the collapse which may ensue. Hypodermics of morphine accord ing to the age of the patient may be used. Ice may be administered internally. Non-polsonons local amcsthetics like amcsthesin may be tried. It is useful, used in an oily solution in eases of lye poisoning. Nourishment should be liquid and if necessary rectal. Instruments for dilating the stricture should not be employed for from two to four weeks after poisoning. If a sudden occlusion of the oesophagus takes plaee as a result of sudden swelling, gastrotomy may have to be performed (v. Hacker).