tirely loose from
its surroundings, traction is made upon the sac as shown at H and the
esophagoscope is inserted down the lumen of the esophagus as shown at
C. The esophagoscope now occupies the lumen which the patient will
need for swallowing. It only remains for the surgeon to remove the
redundancy, without risk of removing any of the normal wall. The
esophagoscope here shown is of the form squarely cut off at the end.
The standard form of instrument with slanted end will serve as well.]

_After-care_.--Feeding may be carried on by the placing of a small
nasal feeding tube into the stomach at the time of operation.
Gastrostomy for feeding as a preliminary to the esophageal operation
has been suggested, and is certainly ideal from the viewpoint of
nutrition and esophageal rest. The decision of its performance may
perhaps be best made by the patient himself. Should leakage through
the neck occur, the fistula should be flushed by the intake of sterile
water by mouth. Oral sepsis should, of course, be treated before
operation and combated after operation by frequent brushing of the
teeth and rinsing of the mouth with Dakin's solution, one part, to ten
parts of peppermint water. A postoperative barium roentgenogram should
be made in every case as a matter of record and to make certain the
proper functioning of the esophagus.

[268] CHAPTER XXXIV--DISEASES OF THE ESOPHAGUS (_Continued_)

PARALYSIS OF THE ESOPHAGUS

The passage of liquids and solids through the esophagus is a purely
muscular act, controlled, after the propulsive usually voluntary start
given to the bolus by the inferior constrictor, by a reflex arc having
connection with the central nervous system through the vagus nerve.
Gravity plays little or no part in the act of deglutition, and alone
will not carry food or drink to the stomach. Paralysis of the
esophagus may be said to be motor or sensory. It is rarely if ever
unassociated with like lesions of contiguous organs.

_Motor paralysis of the esophagus_ is first manifested by inability to
swallow. This is associated with the accumulation of secretion in the
pyriform sinuses (the author's sign of esophageal stenosis) which
overflows into the larynx and incites violent coughing. Motor
paralysis may affect the constrictors or the esophageal muscular
fibers or both.

_Sensory paralysis of the esophagus_ by breaking the continuity of the
reflex arc, may so impair the peristaltic movements as to produc