lure of the diaphragmatic pinchcock to open, as
in the normal deglutitory cycle, rather than a spasmodic tightness,
that obstructs the food. The presence of organic stenosis at the
hiatus may remove the case altogether from the spasmodic class, or a
cicatricial or infiltrated narrowing may be the result of static
esophagitis. A compressive stenosis due to hepatic abnormality may
simulate spasmodic stenosis as shown by Mosher, who believes that 75
per cent of so-called cardiospasms are organic.

_Treatment of hiatal esophagismus (so-called cardiospasm)_ consists in
the over-dilatation of the "diaphragmatic pinchcock" or hiatus
esophageus, and in proper remedial measures for the removal of the
underlying neurosis. The simple passage of the esophagoscope suffices
to cure some cases. Further dilatation by endoscopic guidance may be
obtained by the introduction of Mosher's divulsor through the
esophagoscope, by which accurate placement is obtained. The distension
should not usually exceed 25 mm. Numerous water and air bags have been
devised for stretching the hiatus, and excellent results have been
obtained by their use. Possibly some of the cures have been due to the
dilatation of organic lesions, or to the crowding back of an enlarged
malposed, or otherwise abnormal left lobe of the liver, which Mosher
has shown to be an etiologic factor.

Certain cases prove very obstinate of cure, and require esophageal
lavage for the esophagitis, and feedings through the stomach tube to
increase nutrition and to dilate the contracted stomach. Gastrostomy
for feeding rarely becomes necessary, for a stomach tube can always be
placed with the esophagoscope if it will not pass otherwise.
Retrograde dilatation with the fingers through a gastrostomy opening
has been done, but seems hardly warranted in view of the excellent
results obtainable from above. Instructions should be given concerning
the proper mastication of food, and during treatment the frequent
partaking of small quantities of liquid foods is recommended. Liquids
and foods should be neither hot nor cold. The neurologist should be
consulted in cases deemed neurotic.

[96a.-Functional hiatal stenosis. Cramp of the diaphragmatic pinchcock
(so-called cardiospasm).]

Endocrine imbalance should be investigated and treated, as urged by
MacNab.

_Esophageal antiperistalsis_ is the name given by the author to a
heretofore undescribed disease associated with regurgitation of food
fr