SPASM OF THE ŒSOPHAGUS. ŒSOPHAGISMUS.
Causes: nervous disorders or lesions, pharyngeal, œsophagean, or gastric disease, œsophagean parasites, choking, tumors, ulcers, cold drinks. Symptoms: extended drooping head, working jaws, frothing, pawing, attempts at swallowing, alkaline regurgitation, cries, rigid gullet, tenderness. May be paroxysmal with intervening dullness. Treatment: by sound; by removal of obstruction; by antispasmodics. Embrocations. Tonics.
Causes. This has been noticed as a concomitant of certain diseases of the nervous centres, such as rabies, tetanus, or epilepsy, and those of the pharynx or stomach. Cadeac has seen it in connection with stricture, and the present writer has observed it as a result of larvæ of œstri hooked on to the mucosa above the cardia. It is an important factor in most cases of choking, and may depend on tumors, ulcers, or even cold beverages. Animals with a specially nervous organization are particularly subject to it and it may thus be an hereditary family trait. It has been especially noticed in solipeds and calves.
Symptoms. A feeding animal suddenly ceases to eat, extends the head on the neck, drops the nose toward the ground, moves the jaws constantly, froths at the mouth or lets the saliva drivel to the ground, moves the fore feet uneasily pushing the litter under the belly, makes efforts at deglutition during which, waves may be seen to descend along the jugular furrow, followed by regurgitation and discharge of the liquid as by emesis. The act is often followed by a slight cry. Manipulations of the left jugular furrow detects the gullet as a firm, rigid cord, unless when liquids are passing as above, and auscultation reveals a rattling or gurgling noise as if in jerks. Pressure on the gullet is often very painful, increasing the spasm and rigidity, and causing the animal to cry out. Wheezing breathing may attend the discharge of saliva through the nose, and violent paroxysms of coughing may be caused by the entrance of this liquid into the larynx.
In the majority of cases no food is swallowed and nothing but saliva is disgorged, which together with the absence of an acid odor distinguishes this from true vomiting. In an exceptional case of the author’s, occurring in a colt, the animal continued to masticate and swallow green food which gradually filled the whole length of the gullet, practically paralyzing it. In ordinary cases a small sound can usually be passed into the stomach. In cases of obstruction, however, by a solid morsel, or by an accumulation of soft solids, the probang will enable one to detect the condition. The acute symptoms may occur in paroxysms of a few minutes in length, between which, the animal remains dull and disspirited until the new attack supervenes. Recovery is at times as sudden as the onset, though there remains, for a length of time, liability to a relapse. Cadeac has seen a succession of such attacks which extended over a year and a half.
Treatment. In many cases the passage of a probang or sound, will, by the mere distension of the gullet, overcome the local spasm, though it may be necessary to repeat the operation several times. In case the sound causes much pain the end of the instrument may be well smeared with solid extract of belladonna, and after passing this as far as the obstruction a short time may be allowed, before its passage is again attempted. In case obstruction by soft solids has taken place, the passage of the wire loop will serve to break up the mass and even to draw it up toward the mouth.
The administration of antispasmodics is the next indication. Chloroform or ether by inhalation or in solution in water, chloral hydrate as an enema, morphia or atropia hypodermically may be used according to convenience. Bromide of potassium and other antispasmodics given by the mouth, too often fail to pass the obstruction and thus prove useless, except in the intervals of the spasms.
Fomentations of the lower border of the neck with warm water, and frictions over the region of the gullet with camphorated spirit, essential oils, ammonia, or in calves with oil of turpentine, often contribute to relieve the spasm.
Finally after the severity of the attack has passed, a course of bitter tonics and above all of nux vomica will fortify the system against a relapse.