three ways: 1. Actual
"corking" of the strictured lumen by a fragment of food, in which case
intermittency may be due to partial regurgitation of the "corking"
mass with subsequent sinking tightly into the stricture. 2. The "cork"
may dissolve and pass on through to be later replaced by another. 3.
Reactionary swelling of the esophageal mucosa due to stagnation. Here
again the obstruction may be prolonged, or it may be quite
intermittent, due to a valve-like action of the swollen mucosal
surfaces or folds intermittently coming in contact. Cancerous stenosis
is accompanied by infiltration of the periesophageal tissue, and
usually by projecting bleeding fungations. Cancer may, however,
develop on a cicatrix, favored no doubt by chronic inflammation in
tissue of low resistance. Compression stenosis of the esophagus is
characterized by the sudden transition of the lumen to a linear or
crescentic outline, while the covering mucosa is normal unless
esophagitis be present. The compressive mass can be detected by the
sensation transmitted to the touch by the esophagoscope.

_Treatment_.--Blind bouginage should be discarded as an obsolete and
very dangerous procedure. If the stenosis be so great as to interfere
with the ingestion of the required amount of liquids, gastrostomy
should be done at once and esophagoscopic treatment postponed until
water hunger has been relieved. Gastrostomy aids in the treatment by
putting the esophagus at rest, and by affording the means of
maintaining a high degree of nutrition unhampered by the variability
or efficiency of the swallowing function. Careful diet and gentle
treatment will, however, usually avoid gastrostomy. The diet in the
gastrostomy-fed patients should be as varied as in oral alimentation;
even solids of the consistency of mashed potatoes, if previously
forced through a wire gauze strainer, may be forced through the tube
with a glass injector. Liquids and readily liquefiable foods are to be
given the non-gastrostomized patient, solids being added when
demonstrated that no stagnation above the stricture occurs. Thorough
mastication and the slow partaking of small quantities at a time are
imperative. Should food accumulation occur, the esophagus should be
emptied by regurgitation, following which a glassful of warm sodium
bicarbonate solution is to be taken, and this also regurgitated if it
does not go through promptly. The esophagus is thus lavaged and
emptied. In all these cases