e compressive mass
will require for its determination the aid of the roentgenologist,
internist, and clinical laboratory. Compression by the enlarged left
auricle has been observed a number of times. The presence of aneurysm
is a distinct contraindication to esophagoscopy for diagnosis except
in case of suspected foreign body.

_Treatment of compressive stenosis of the esophagus_ depends upon the
nature of the compressive lesion and is without the realm of
endoscopy. In uncertain cases potassium iodid, and especially mercury,
should always be given a thorough and prolonged trial; an occasional
cure will result. Esophageal intubation is indicated in all conditions
except aneurysm. Gastrostomy should be done early when necessary.

DIFFUSE DILATATION OF THE ESOPHAGUS

This is practically always due to stagnation ectasia, which is
invariably associated with either organic or "spasmodic" stricture,
existing at the time of observation or at some time prior thereto. The
dilating effect of the repeatedly accumulated food results in a
permanent enlargement, so that the esophagus acts as the reservoir of
a large funnel with a very small opening. When food is swallowed the
esophagus fills, and the contents trickle slowly through the opening.
Gases due to fermentation increase the distension and cause substernal
pressure, discomfort, and belching. A very large dilatation of the
thoracic esophagus indicates spastic stenosis. Cicatricial stenoses do
not result in such large dilatations and the dilatation above a
malignant stenosis is usually slight, probably because of its
relatively shorter duration.

The _treatment of diffuse esophageal dilatation_ consists in dilating
the "diaphragmatic pinchcock" that is, the hiatal esophagus. Chronic
esophagitis is to be controlled by esophageal lavage, the regulation
of the diet to liquefiable foods and the administration of bismuth
subnitrate. The patient can be taught to do the lavage. The local
esophagoscopic application of a small quantity of a 25 per cent watery
solution of argyrol may be required for the static esophagitis. The
redundancy probably never disappears; but functional and subjective
cures are usually obtainable.

[245] CHAPTER XXXI--DISEASES OF THE ESOPHAGUS (_Continued_)

SPASMODIC STENOSIS OF THE ESOPHAGUS

_Etiology_.--The functional activity of the esophagus is dependent upon
reflex action. The food is propulsed in a peristaltic wave by the same
mechanism as,