AN UNUSUAL PAIN SYNDROME ASSOCIATED WITH THE PRESENT WAVE OF INFLUENZA
Journal of the American Medical Association (JAMA)
are forming, would explain the fistula, but not the atresia. In order that both atresia and fistula be caused by one factor, a faulty 'anläge' with resultant malfor¬ mation must have existed." Shattock 4 believes that at the time when the pouch from which the lower air passages develop is formed from the anterior wall of the mesenteron, the posterior wall occasionally participates in the process sufficiently to be drawn forward, thus narrowing the lumen. When, subsequently, the lateral pouching
... he lateral pouching for the forma¬ tion of the larynx develops from the stomodeum just above this region, so much of the already narrowed lumen is consumed that the connection between the upper and lower portions is left communicating with the air passages. Jordan 5 makes an interesting embryologie note when he says that in a series of loggerhead turtle embryos, the esophagus was observed to be solid for a greater or less extent, approximately from the point of origin of the respiratory anläge to its bifurcation in the bronchi, from the twelfth to the thirty-second day of incubation ; probably esophageal atresia persists practically to near the end of the incubation period (eight weeks) at a level just behind the opening of the larynx. Fig. 5.-Atresia of esophagus with the formation of a pouch. The lower end of the sac is about opposite the third dorsal vertebra. Below the shadow of the sac may be seen the shadow of the trachea to its bifurcation and the main and smaller bronchi of the right lung. This is significant because of the relatively longer persistence (normally) of the occlusion than has been described for any other form, and because of the close relation of the atresia to the point of origin of the respiratory anläge, The epithelial obliteration of the esophagus has been described by Kreuter 6 in the human embryo. Lewis 7 describes esophagi pervious in four embryos measuring from 8.4 to 18 mm., and regards atresia of the esoph¬ agus in the human embryo ás abnormal at all stages. SUMMARY 1. Up to July 1, 1920, 146 verified cases of atresia of the esophagus have been reported in infants. 2. The commonest type is a blind upper sac, a lower sac opening into the trachea above the bifurcation; 103 out of 146 are of this type, that is, 70 per cent. 3. Accompanying abnormalities of other parts of the body are common. 4. The most favored embryologie explanation is failure of closure of the tracheo-esophageal septum.