s of other important structures in the neck,
which may rapidly prove fatal. It is more common to meet with wounds
inflicted from within, for example by the swallowing of rough and
irregularly shaped foreign bodies, or by unskilful attempts to remove
such bodies or to pass bougies along the oesophagus. The severity of
the lesion varies from a scratch of the mucous membrane to a
perforation of the tube. The less severe injuries are attended with
pain on swallowing and a sensation as if something had lodged in the
oesophagus. In more severe cases there is bleeding, followed by
attacks of coughing and expectoration of blood-stained mucus. When the
oesophagus is perforated, diffuse cellulitis of the neck or of the
posterior mediastinum may ensue. In the treatment of these injuries
the chief point is to give the oesophagus rest by feeding the patient
entirely by the rectum or through an opening made in the
stomach--gastrostomy.

#Rupture# of the oesophagus has occurred during violent vomiting, and
during lavage. The tear is longitudinal and is usually near the
cardiac orifice. It is probably due to increased pressure within the
gullet. The accident has usually been met with in alcoholics, and has
proved fatal by setting up left-sided empyema or cellulitis.

#Swallowing of Corrosive Substances.#--The oesophagus is damaged by
the swallowing of strong chemicals, such as sulphuric acid, nitric
acid, carbolic acid, or caustic potash. These substances produce their
worst effects at the two ends of the oesophagus, but in some cases the
whole length of the tube suffers. The mucous membrane alone may be
destroyed, or the muscular and even the fibrous coats may also be
implicated. The damaged tissue undergoes necrosis, and when the
sloughs separate, raw surfaces are left, and are very slow to heal.

If not rapidly fatal from shock and oedema of the glottis, these
injuries are usually attended with intense pain, severe thirst, and
vomiting, the vomit containing shreds of mucous membrane and blood.
Complications, such as cellulitis, perforation of the oesophagus, or
peri-oesophageal abscess, may follow. Later, cicatricial contraction
takes place at the injured portions, producing the most intractable
form of fibrous stricture.

The _treatment_ consists in administering solutions of carbonate of
potash, of soda, or of magnesia when an acid has been swallowed, or
vinegar diluted with water in the case of an alkali. When carbolic
acid