test
with potassium iodid and especially mercury in any case of esophageal
ulceration unassociated with stasis.

_Treatment of Acute and Subacute Inflammation and Ulceration of the
Esophagus_.--Bismuth subnitrate in doses of about one gramme, given
dry on the tongue and swallowed without water, has a local antiseptic
and protective action. Its antiseptic power may be enhanced by the
addition of calomel to the powder, in such amount as may be tolerated
by the bowels. If pain be present the combination of a grain or two of
anesthesin or orthoform with the bismuth will be grateful. The local
application of argyrol in 25 per cent watery solution is also of great
value. The mouth and teeth are to be kept clean with a mouth wash of
Dakin's solution, 1 part, to peppermint water, 6 parts. The esophagus
must be placed at rest as far as possible by liquid diet or, if need
be, by gastrostomy.

CHRONIC ESOPHAGITIS

This is usually a result of stagnation of food or secretion, and will
be considered under spasmodic stenosis and diffuse dilatation of the
esophagus.

A very marked case with local distress and pain extending through to
the back was seen by the author in consultation with Dr. John B.
Wright who had made the diagnosis. The patient was a sufferer from
ankylostomiasis.

[243] COMPRESSION STENOSIS OF THE ESOPHAGUS

The esophagus may be narrowed by the pressure of any periesophageal
disease or anomaly. The lesions most frequently found are:
1. Goiter, cervical or thoracic.
2. Malignancy of any of the intrathoracic viscera.
3. Aneurysm.
4. Cardiac and aortic enlargement.
5. Lymphadenopathies. Hodgkins' disease.
Leukemia.
Lues.
Tuberculosis.
Simple infective adenitis.
6. Lordosis.
7. Enlargement of the left hepatic lobe.

Endoscopically, compression stenosis of the esophagus is manifested by
a slit-like crevice which occupies the place of the lumen and which
does not open up readily before the advancing tube. The long axis of
the slit is almost always at right angles to the compressive mass, if
the esophageal wall be uninvolved. The covering mucosa may be normal
or it may show signs of chronic inflammation. Malignant compressions
are characterized by their hardness when palpated with the tube.
Associated pressure on the recurrent laryngeal nerve often makes
laryngeal paralysis coexistent. The nature of th