dinarily realized how much normal
salivary drainage passes down the esophagus. The customary treatment
of shock is to be applied. No attempt should be made to remove a
foreign body until the traumatic lesions have healed. This may require
a number of weeks. Decision as to when to remove the intruder is
determined by esophagoscopic inspection.

Subcutaneous emphysema does not require puncture unless gaseous, or
unless pus forms. In the latter event free external drainage becomes
imperative.

ACUTE ESOPHAGITIS

This is usually of traumatic or cauterant origin. If severe or
extensive, all the symptoms described under "Rupture of the Esophagus"
may be present. The endoscopic appearances are unmistakable to anyone
familiar with the appearance of mucosal inflammations. The pale,
bluish pink color of the normal mucosa is replaced by a deep-red
velvety swollen appearance in which individual vessels are invisible.
After exudation of serum into the tissues, the color may be paler and
in some instances a typical edema may be seen. This may diminish the
lumen temporarily. Folds of swollen mucosa crowd into the lumen if the
inflammation is intense. These folds are sometimes demonstrable in the
roentgenogram by the bismuth or barium in the creases between which
the prominence of the folds show as islands as beautifully
demonstrated by David R. Bowen in one of the author's cases. If the
inflammation is due to corrosives, a grayish exudate may be visible
early, sloughs later.

ULCERATION OF THE ESOPHAGUS

Superficial erosions of the esophagus are by no means an uncommon
accompaniment of the stagnation of food and secretions. From the
irritation they produce, spastic stenosis may occur, thus constituting
a vicious circle; the spasm of the esophagus increases the stagnation
which in turn results in further inflammation and ultimate ulceration.
Healing of such ulcers may result in cicatricial contraction and
organic stenosis. Ulceration may follow trauma by instrument, foreign
body, or corrosive.

DIFFERENTIAL DIAGNOSIS OF ULCER OF THE ESOPHAGUS

_Simple ulcer_ requires the exclusion of lues, tuberculosis,
epithelioma, endothelioma, sarcoma, and actinomycosis. Simple ulcer of
the esophagus is usually associated with stenosis, spastic or organic.

_Luetic ulcers_ commonly show a surrounding inflammatory areola, and
they usually have thickened elevated edges, generally free from
granulation tissue, with a pasty center not bleedin