of the esophagus_ are best determined by the
passage of a large esophagoscope which puts the esophagus on the
stretch. The webs may be broken by the insertion of a closed alligator
forceps, which is then withdrawn with opened blades. Better still is
the dilator shown in Fig. 26. This retrograde dilatation is relatively
safe. A silk-woven esophagoscopic bougie or the metallic tracheal
bougie may be used, with proper caution. Subsequent dilatation for a
few times will be required to prevent a reproduction of the stenosis.

_Treatment of Esophageal Anomalies_.--Gastrostomy is required in the
imperforate cases. Esophagoscopic bouginage is very successful in the
cure of all cases of congenital stenosis. Any sort of lumen can be
enlarged so any well masticated food can be swallowed. Careful
esophagoscopic work with the bougies (Fig. 40) will ultimately cure
with little or no risk of mortality. Any form of rapid dilatation is
dangerous. Congenital stenosis, if not an absolute atresia, yields
more readily to esophagoscopic bouginage than cicatricial stenosis.

RUPTURE AND TRAUMA OF THE ESOPHAGUS

These may be spontaneous or may ensue from the passage of an
instrument, or foreign body, or of both combined, as exemplified in
the blind attempts to remove a foreign body or to push it downwards.
Digestion of the esophagus and perforation may result from the
stagnation of regurgitated gastric juice therein. This condition
sometimes occurs in profound toxic and debilitated states. Rupture of
the thoracic esophagus produces profound shock, fever, mediastinal
emphysema, and rapid sinking. Pneumothorax and empyema follow
perforation into the pleural cavity. Rupture of the cervical esophagus
is usually followed by cervical emphysema and cervical abscess, both
of which often burrow into the mediastinum along the fascial layers of
the neck. Lesser degrees of trauma produce esophagitis usually
accompanied by fever and painful and difficult swallowing.

The treatment of traumatic esophagitis consists in rest in bed,
sterile liquid food, and the administration of bismuth subnitrate
(about one gramme in an adult), dry on the tongue every 4 hours.
Rupture of the esophagus requires immediate gastrostomy to put the
esophagus at rest and supply necessary alimentation. Thoracotomy for
drainage is required when the pleural cavity has been involved, not
only for pleural secretions, but for the constant and copious
esophageal leakage. It is not or