n cases not demonstrably tuberculous, hemoptysis may
require bronchoscopic examination to determine the origin. Varices or
unsuspected luetic, malignant, or tuberculous lesions may be found to
be the cause. It is mechanically easy to pack off one bronchus with
the author's packs (Fig. 96) introduced through the bronchoscope, but
the advisability of doing so requires further clinical tests.

_Angioneurotic Edema_.--Angioneurotic edema manifests itself by a pale
or red swollen mucosa producing stenosis of the lumen. The temporary
character of the lesion and its appearance in other regions confirm
the diagnosis.

_Scleroma of the trachea_ is characterized by infiltration of the
tracheal mucosa, which greatly narrows the lumen. The infiltration may
be limited in area and produce a single stricture, or it may involve
the entire trachea and even close a bronchial orifice. Drying and
crusting of secretions renders the stenosis still more distressing.
This disease is but rarely encountered in America but is not
infrequent in some parts of Europe. Treatment consists in the
prevention of crusts and their removal. Limited stenotic areas may
yield to bronchoscopic bouginage. Urgent dyspnea calls for
tracheotomy. Radium and roentgenray therapy have been advised, and
cure has been reported by intravenous salvarsan treatment (see article
by S. Shelton Watkins, on Scleroma in Surg. Gynecol. and Obst., July,
1921, p. 47).

_Atrophic tracheitis_, with symptoms quite similar to atrophic
rhinitis is a not unusual accompaniment of the nasal condition. It may
also exist without nasal involvement. On tracheoscopy the mucosa is
thinned, pale and dry, and is covered with patches of thick
mucilaginous secretion and crusts. Decomposition of secretion produces
tracheal "ozena," while the accumulated crusts give rise to the
sensation of a foreign body and may seriously interfere with
respiration, making bronchoscopic removal imperative. The associated
development of tracheal nodular enchondromata has been described. The
internal administration of iodine and the intratracheal injection of
bland oily solutions of menthol, guaiacol, or gomenol are helpful.

[235] CHAPTER XXX--DISEASES OF THE ESOPHAGUS

The more frequent causes of the one common symptom of esophageal
disease, dysphagia, are included in the list given below. To avoid
elaboration and to obtain maximum usefulness as a reminder,
overlapping has not been eliminated.
1. Anomalie