1. Inflammation

Catarrhal inflammation: - This is rarely seen very intense in the acute, but certainly not uncommonly in the chronic form. The appearances produced in that case are oedema of the mucous membrane, with a dirty-brown or slate-colored tinge, enlargement of the follicles, blennorrhoea, and an exuberant formation of epithelium, and hypertrophy of the muscular coat. It is possible that when the cardiac orifice is the seat of inflammation, the consequent hypertrophy of the circular fibres, and the narrowing of the passage, may give rise to those enormous dilatations of the oesophagus, of which we have already spoken. It frequently occurs as an idiopathic, but also as a secondary affection, and in the latter case chiefly in connection with impetigo.1

Croupy (exudative) inflammation - occurs as an aphthous process in children, as true diffused croup, coexistent with, or unaccompanied by, croup of the tracheal, bronchial, and pulmonary (pneumonia) mucous membrane, mainly in typhoid cholera, but also as a secondary affection and as an abortive exanthematic and typhoid process, the product of a purulent condition of the blood, brought on by tubercular and cancerous cachexia.

Pustular inflammation: - To this class belongs the rare occurrence of varioloid pustules, the pustules of metastatic herpes, and the pustules which occur at the lower third of the oesophagus in consequence of the internal administration of tartar emetic in large doses.

In addition to the above varieties, we meet with inflammation, which is produced by the corrosion of caustic substances; the coexistent affection of the oral cavity and the fauces being commonly of a lower, that of the gastric mucous membrane of a" higher degree. We refer the reader, for an investigation of this process and its consequences, to the following pages, as we purpose examining it among the diseases of the stomach, in reference to all the tissues we have alluded to; at present we merely add, that in those cases in which the mucous membrane has been destroyed by the energetic action of the poison, it is replaced by a serous and sero-fibrous tissue, which gives rise to peculiar valvular and annular strictures of the oesophagus, somewhat analogous to those consequent upon dysentery.

2. Softening

Softening occurs at the lower third of the oesophagus, and is commonly associated with softening of the stomach. On account of the identity of the two affections, we refer the reader to the section on the Diseases of the Stomach; the more, since the process is observed more frequently in the latter, if not in a more fully developed form. We must however add, that it is particularly liable to affect the left side of the oesophagus, and then to cause perforation, in consequence of which we have destruction of the cellular tissue and the left mediastinum, and effusion of the gastric contents into the left pleura.

3. Morbid Growths

a. Anomalous fibrous and fibro-cartilaginous tissue occurs as a fibroid or fibro-chondroid tumor, in the shape of a movable bluish-white concretion, varying in size from a pin's head to a kidney bean, and occupying the submucous cellular tissue of the oesophagus; and also as a fibrous polypus, attached by a neck to the perichondrium of the cricoid cartilage, and depending from it into the oesophagus; the free surface is frequently lobulated, and it is invested by mucous membrane.1 b. Tubercular deposits are rarely, if ever, found in the oesophagus, and they must not be confounded with the tubercular degeneration of the neighboring lymphatic glands.

1 [To render this passage intelligible, it may be well to remind the reader of the theory-very prevalent among German pathologists, which attributes the majority of chronic diseases to dormant or suppressed cutaneous eruptions. Autenrieth may be mentioned as the chief supporter of this doctrine. - Ed].

c. Carcinomatous affections, in the shape of scirrhus and medullary sarcoma, are more frequent. This is generally a primary disease, though the oesophagus may become secondarily involved in carcinomatous degeneration of the mediastina. In the former case the cancer may be found in every portion of the pharynx and oesophagus; but the upper part of the thoracic portion of the latter, and the inferior part of the former appear to be more frequently attacked than the cardiac portion of the tube. The degeneration generally affects the circumference of the passage, and thus gives rise to annular stricture, the extent of which must correspond to the extent of the carcinomatous deposit. The oesophagus soon becomes fixed by the adhesion of the diseased mass to the spinal column. The metamorphosis of the morbid product frequently gives rise to the formation of large sanious cavities, the carcinomatous parietes of which are covered with fungoid granulations, and with which the oesophagus communicates above and below in a transverse or slanting direction. The sanious discharge frequently causes ulcerative destruction of the neighboring tissues, by which means communications are established with the trachea and the bronchi; occasionally even the arterial coats, which are otherwise endowed with great power of resisting such influences, become involved, and communications with the arterial trunks in the vicinity, and more especially with the aorta and the right pulmonary artery, are established.

Cancer of the oesophagus generally occurs in an isolated form, i. e. without a coexistence of the disease in other organs.