PARALYSIS OF THE ŒSOPHAGUS.
Causes: nervous lesions and disorders; arytenectomy; over distension; stricture; parasites. Symptoms: dysphagia; regurgitation; cough; dyspnœa; hard packed gullet. Inhalation pneumonia. Lesions. Treatment: remove cause; liquid food; dilatation; nerve sedatives and stimulants; electricity; counter-irritants.
Causes. This has been noticed in a number of cases in solipeds, and attributed to central nervous lesions, cerebral concussion (Straub), encephalitis (Hering, Bornhauser), paralysis of the fore extremities (Meier), pharyngeal paralysis (Puschmann). Möller has seen it several times consequent on arytenectomy, while Dieckerhoff and Graf have seen it occur without any clearly defined cause. In a case referred to above, the present writer found it connected with the attachment of larvæ of œstri in the lower end of the gullet. Stricture and impaction may be a further cause.
Symptoms and lesions. There is more or less interference with deglutition, culminating in complete inability to swallow, and the rejection of morsels of masticated food by the nose. Cough may also occur from the descent of food toward the lungs, with more or less dyspnœa and oppression of the breathing. Manipulation along the left jugular furrow, detects the œsophagus as a prominent hard, rope-like mass which fills up the groove unduly. When death occurs rapidly the gullet is found gorged with masticated food throughout its entire length. In certain instances gangrenous pneumonia is found, the result of the penetration of food into the bronchia. In other cases there are lesions of the medulla oblongata, or of the vagus or glossopharyngeal nerves or their œsophagean branches.
Death usually results from obstruction, inanition, or, in case the paralysis is partial, from pneumonia or exhaustion.
Treatment. First remove or correct the existing cause of the disease. Impaction may be broken up by the use of the wire loop, or pincer probang; parasites may be expelled by passing a cupped probang; the impactions following arytenectomy can be obviated by feeding gruels, milk and other liquid foods only, and from a bucket set on the ground; stricture may be dilated by the use of graduated sounds; and nervous diseases may be dealt with according to their specific nature in each several case. When any definite cause of this kind has been overcome the persistent use of strychnia, subcutem, or by the mouth, may be effectual in overcoming the paresis of the gullet. Hypodermic injections are best made along the left jugular groove, and frictions, stimulating embrocations, and galvanic currents may be employed with excellent effect.