80
years of age.

_Water starvation_ makes the patient a very bad surgical subject, and
is a distinct contraindication to esophagoscopy. Water must be
supplied by means of proctoclysis and hypodermoclysis before any
endoscopic or surgical procedure is attempted. If the esophageal
stenosis is not readily and quickly remediable, gastrostomy should be
done immediately. _Rectal feeding_ will supply water for a limited
time, but for nutrient purposes rectal alimentation is dangerously
inefficient.

_Preliminary examination of the pharynx and larynx with tongue
depressor_ should always precede esophagoscopy, for any purpose,
because the symptoms may be due to laryngeal or pharyngeal disease
that might be overlooked in passing the esophagoscope. A high degree
of esophageal stenosis results in retention in the suprajacent
esophagus of the fluids which normally are continually flowing
downward. The pyriform sinuses in these cases are seen with the
laryngeal mirror to be filled with frothy secretion (Jackson's sign of
esophageal stenosis) and this secretion may sometimes be seen
trickling into the larynx. This overflow into the larynx and lower air
passages is often the cause of pulmonary symptoms, which are thus
strictly secondary to the esophageal disease.

ANOMALIES OF THE ESOPHAGUS

_Congenital esophagotracheal fistulae_ are the most frequent of the
embryonic developmental errors of this organ. Septic pneumonia from
the entrance of fluids into the lungs usually causes death within a
few weeks.

_Imperforate esophagus_ usually shows an upper esophageal segment
ending in a blind pouch. A lower segment is usually present and may be
connected with the upper segment by a fistula.

_Congenital stricture_ of the esophagus may be single or multiple, and
may be thin and weblike, or it may extend over a third or more of the
length of the esophagus. It may not become manifest until solids are
added to the child's diet; often not for many months. The lodgment of
an unusually large bolus of unmasticated food may set up an
esophagitis the swelling of which may completely close the lumen of
the congenitally narrow esophagus. It is not uncommon to meet with
cases of adults who have "never swallowed as well as other people,"
and in whom cicatricial and spasmodic stenosis can be excluded by
esophagoscopy, which demonstrates an obvious narrowing of the
esophageal lumen. These cases are doubtless congenital.

_Webs in the upper third