CESOPH'AGIIS (Neo-Lat.. from Gk. oicocttyos, oisuphayos, gullet, from °limp, oisein, to be about to carry + Oa-yelp, ph(ycin, to cat), or GULLET. A membranous canal, about 9 inches in length, extending from the pharynx to the stom ach, and thus forming a part of the alimentary canal. It coma:awes at the lower border of the ericoid cartilage of the larynx, descends in a nearly vertical direction along the front of the spine, passes through an opening in the dia phragm, and thus enters the abdomen, and ter minates in the cardiac orifice of the stomach opposite the ninth dorsal vertebra. It has three coats—viz. an external or muscular coat (con sisting of two strata of fibres of considerable thickness—an external. longitudinal, and an in ternal, circular) ; an internal or mucous eoat, which is covered with a thick layer of squall:0ns epithelium: and an intermediate cellular coat, uniting the muscular and mucous coats. in this tissue are a large number of (esophageal glands. which open upon the surface by a long excretory duet, and are most numerous round the cardiac orifice, where they form a complete ring.
The (esophagus is liable to a considerable num ber of morbid changes, none of which are, how ever, of very common occurrence.
The most prominent symptom of irRophivitia, or inflammation of the (esophagus. is pain be tween the shoulders, or behind the trachea or sternum, augmented in deglutition. which is usually more or less difficult, and sometimes im possible. The affection is regarded as a very rare one, unless when it originates from the direct application of irritating or very hot sub stances, or from meehnnical violence.
Spasm of the msophagus—a morbid muscular contraction of the tube. producing more or less difficulty of swallowing—is a 11111011 more com mon affection than inflammation. The spasm generally conies on suddenly during a meal. Upon an attempt. to swallow, the fond is arrested, and is either immediately rejected with considerable force, or is retained for a time, and then brought 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 eases solids can lie swal lowed. while liquids excite spasm; while in other cases the opposite is observed: hut in general either solids or liquids suffice to excite the con traction, when a predisposition to it exists. The predisposition usually consists in an excitable state of the nervous system, suet as exists in Hysteria. hypoehondrinsis. and especially in hy drophobia. An 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 establish ment of the general health. A temporary cure often follows the passage of a bougie.
Paralysis of the asophayus is present in cer tain forms of organic disease of the brain or spinal cord which are seldom amenable to treat ment. In this affection there is inability to swallow, but no pain or other symptom of spasm; and a bougie may be passed without ob struction. The patient must be fed by the stomach-pump.
Permam nt or organic stricture of the crsoph ugus may arise from inflammatory thickening and induration of its coats. The most common seat of this affection is at its upper part. The symptoms are persistent and gradually increasing difficulty of swallowing, occasionally aggravated by spasm: and a bougie, when passed, always meets with resistance at the same spot. When the contraction is due to inflammatory thicken ing, it may arise from the abuse of alcoholic drinks or from swallowing boiling or corrosive fluids. If unrelieved. the disease must prove fatal, either by ulceration of the tube around the seat of the stricture, or by sheer starvation. When the affection is due to chronic inflamma tory thickening, some advantage may be derived from dilatation by means of the (esophageal bougie. If it is dependent upon nmlignant dis ease. and the tissues have become softened by the infiltration of the morbid deposit, the bougie must be directed with the greatest care through the stricture, as a false passage may be easily made into important adjacent cavities.
Foreign bodies not very infrequently pass into the cesophag,us, and become impacted there, giv ing rise to a sense of choking and fits of suffoca tive cough, especially when they are seated in its upper part. If the body is small and sharp (a fish-bone, for example), it may often be got rid of by making the patient swallow a large mouth ful of bread; if it is large and soft (such as too large a mouthful of meat), it may generally he pushed down into the stomach with the prohang,; while large hard bodies (such as pieces of bone) should he brought up either by the action of an emetic or by long curved forceps. If the offend ing body can neither be brought up nor pushed down, it must be extracted by the operation of crsophagotomy—an operation which can only he performed when the impacted body is not very low down, and which it is unnecessary to describe in these pages.
Rupture of the a-sophugus has occurred from violent vomiting during a state of intoxication and following a heavy meal. It is a fatal, but exceedingly rare accident.