the oesophagoscope.

CONDITIONS CAUSING DIFFICULTY IN SWALLOWING

Difficulty in swallowing may arise from a wide variety of causes which
it is convenient to consider together.

#Impaction of Foreign Bodies# has already been discussed, and
attention has been drawn to the importance of the history given by the
patient and to the various sources of fallacy or deception--in
children it may be artful reticence or misrepresentation, in adults,
the possibility of nightmare and of dreams.

#Compression of the Gullet from without.#--Any one of the numerous
structures in relation to the gullet may, when enlarged as a result of
disease, give rise to narrowing of its lumen, for example a
lymph-sarcoma at the root of the lung, or any enlargement of the
thyreoid or of the mediastinal lymph glands. The possibility of
aneurysm must always be kept in mind because of the risk attending the
passage of instruments for diagnostic purposes.

#Spasm of the Muscular Coat.#--As in other tubular structures
containing circular muscular fibres, sudden contraction or spasm may
occur in the oesophagus and cause narrowing of the lumen, attended
with difficulty in swallowing. This spasmodic dysphagia includes such
widely varying conditions as the "globus hystericus" of neurasthenic
women, the spasm of chronic alcoholics, and the affection known as
_cardiospasm_ or "hiatal oesophagismus."

In contrast with other affections causing difficulty in swallowing,
spasmodic dysphagia usually has a sudden and unexplained onset, the
progress of symptoms is irregular and erratic, while the remission of
symptoms common to all affections of the oesophagus, and the influence
of mental impressions, such as excitement, hurry in the presence of
strangers, are exaggerated.

In testing the calibre of the gullet it is found that on one occasion
a full-sized bougie may pass easily and be completely arrested at
another.

Apart from the treatment of the neurosis underlying the dysphagia,
reliance is placed upon dilatation of the portion of gullet affected.

#Cardiospasm# is the name given to "a recurrent interference with
deglutition by spasmodic contraction of the lower end of the
oesophagus." As there is no muscular or nervous mechanism at the
cardiac end of the oesophagus forming a true sphincter, the term
"oesophagospasm" would be more accurate (D. M. Greig).

According to H. S. Plummer, who has had an experience of 130 cases,
there are three stages in th