om the esophagus, the food not having reached the stomach. It may be
continuous or paroxysmal and may be of so serious a degree as to
threaten starvation. The best treatment in severe cases is gastrostomy
to put the esophagus at rest. Milder cases get well under liquid diet,
rest in bed, endocrine therapy, cure of associated abdominal disease,
etcetera.

[251] CHAPTER XXXII--DISEASES OF THE ESOPHAGUS (_Continued_)

CICATRICIAL STENOSIS OF THE ESOPHAGUS

_Etiology_.--The accidental swallowing of caustic alkali in solutions
of lye or proprietary washing and cleansing powders, is the most
frequent cause of cicatricial stenosis. Commercial lye preparations
are about 95 per cent sodium hydroxide. The cleansing and washing
powders contain from eight to fifty per cent of caustic alkali,
usually soda ash, and are sold by grocers everywhere. The labels on
their containers not only give no warning of the dangerous nature of
the contents nor antidotal advice, but have such directly misleading
statements as : "Will not injure the most delicate fabric," "Will not
injure the hands," etc. Utensils used to measure or dissolve the
powders are afterward used for drinking, without rinsing, and thus the
residue of the powder remaining is swallowed in strong solution. At
other times solutions of lye are drunk in mistake for water, coffee,
or wine. These entirely preventable accidents would be rare if they
were as conspicuously labelled "Poison" as is required by law in the
case of these and any other poisons, when sold by druggists. The
necessity for such labelling is even greater with the lye preparations
because they go into the kitchen, whereas the drugs go to the medicine
shelf, out of the reach of children. "Household ammonia," "salts of
tartar" (potassium carbonate), "washing soda" (sodium carbonate),
mercuric chloride, and strong acids are also, though less frequently,
the cause of cicatricial esophageal stricture. Tuberculosis, lues,
scarlet fever, diphtheria, enteric fever and pyogenic conditions may
produce ulceration followed by cicatrices of the esophagus. Spasmodic
stenosis with its consequent esophagitis and erosions, and, later,
secondary pyogenic infection, may result in serious cicatrices. Peptic
ulcer of the lower esophagus may be a cause. The prolonged sojourn of
a foreign body is likely to result in cicatricial narrowing.

[FIG. 97.--Schematic illustration of a series of eccentric strictures
with interstrictural