, whether being fed through the mouth or
the gastrostomic tube, it is very important to remember that milk and
eggs are not a complete dietary. A pediatrist should be consulted.
Prof. Graham has saved the lives of many children by solving the
nutritive problems in the cases at the Bronchoscopic Clinic. Fruit and
vegetable juices are necessary. Vegetable soups and mashed fruits
should be strained through a wire gauze coffee strainer. If the saliva
is spat out by the child because it will not go through the stricture
the child should be taught to spit the saliva into the funnel of the
abdominal tube. This method of improving nutrition was discovered by
Miss Groves at the Bronchoscopic Clinic.

_Esophagoscopic bouginage_ with the author's silk-woven steel-shank
endoscopic bougies (Fig. 40) has proven the safest and most successful
method of treatment. The strictured lumen is to be centered in the
esophagoscopic field, and three successively increasing sizes of
bougies are used under direct vision. Larger and larger bougies are
used at the successive treatments which are given at intervals of from
four to seven days. No anesthesia, general or local, is used for
esophagoscopic bouginage. The tightness of the grasping of the bougie
by the stricture on withdrawal, determines the limitation of sizes to
be used. When the upper stricture is dilated, lower ones in the series
are taken seriatim. If concentric, two or more closely situated
strictures may be simultaneously dilated. For the use of bougies of
the larger sizes, the special esophagoscopes with both the
light-carrier canal and the drainage canal outside the lumen of the
tube are needed. Functional cure is obtained with a relatively small
lumen at the point of stenosis. A lumen of 7 mm. will allow the
passage of any well masticated food. It is unwise and unsafe to
attempt to restore the lumen to its normal anatomic size. In
cicatricial stricture cases it is advisable to examine the esophagus
at monthly periods for a time after a functional cure has been
obtained, in order that tendency to recurrence may be early detected.

_Divulsion_ of an upper stricture may be deemed advisable in order to
reach others lower down, especially in cases of multiple eccentric
strictures (Fig. 97). This procedure is best done with the author's
esophagoscopic divulser, accurately placed by means of the
esophagoscope; but divulsion requires the utmost care, and a gentle
hand. Even then it is