hile the surgeon,
inserting his finger up into the esophagus from the stomach, can feel
the end of the esophagoscope. An incision through the tissue barrier
is then made from below, passing the knife along the finger as a
guide. A soft rubber stomach-tube is pulled up from below and left in
situ, being replaced at intervals by a fresh one, pulled up from the
stomach, until epithelialization of the new lumen is complete.
Catheters are used in children. In replacing the catheter or stomach
tube the fresh one is attached to the old one by stitching in a loop
of braided silk. Frequent esophagoscopic bouginage will be required to
maintain the more or less fistulous lumen until it is epithelialized,
and in occasional cases, for a long time thereafter.

In cases of absolute atresia the saliva does not reach the stomach. No
one realizes the quantity of normal salivary drainage, nor its
importance in nutritive processes. Oral insalivation is of little
consequence compared to esophagogastric drainage. Gastrostomized
children with absolute atresia of the esophagus do not thrive unless
they regurgitate the salivary accumulations into the funnel of the
gastrostomic feeding tube. This has been abundantly proven by
observations at the Bronchoscopic Clinic. My attention was first
called to this clinical fact by Miss Frances Groves who has charge of
these cases.

_Intubation of the esophagus_ with soft rubber tubes has occasionally
proven useful.

[260] CHAPTER XXXIII--DISEASES OF THE ESOPHAGUS (_Continued_)

DIVERTICULUM OF THE ESOPHAGUS

Diverticula may, and usually do, consist in a pouching by herniation,
of the whole thickness of the esophageal wall; or they may be
herniations of the mucosa between the muscular layers. They are
classified according to their etiology, as traction and pulsion
diverticula.

[FIG. 99.--Traction diverticulum of the esophagus rendered visible in
the roentgenogram by a swallowed opaque mixture. Case of H. W.
Dachtler, Am. Journ. Roentgenology.]

_Traction diverticulum of the esophagus_ (Fig. 99) is a rare
condition, usually occurring in the thorax, and as a rule constituting
a one-sided enlargement of the gullet rather than a true pouch
formation. It is supposed to be formed by the pulling during cough,
respiration, and swallowing, on localized adhesions of the esophagus
to periesophageal structures, such as inflammatory peribronchial
glands.

_Diagnosis_ is often incidental to examination