tuberculous
cicatrices have no recognizable characteristics.

_Treatment_.--The maintenance of nutrition to the highest degree, and
the institution of a strict antituberculous regime are demanded. Local
applications are of no avail. Gastrostomy for feeding should be done
if dysphagia be severe, and has the advantage of putting the esophagus
at rest. The passage of a stomach-tube for feeding purposes may be
done, but it is often painful, and is dangerous in the presence of
ulceration. Pain is not marked if the lesion be limited to the
esophagus, though if it is present orthoform, anesthesin, or
apothesin, in powder form, swallowed dry, may prove helpful.

VARIX AND ANGIOMA OF THE ESOPHAGUS

These lesions are sometimes the cause of esophageal hemorrhage, the
regurgitated blood being bright red, and alkaline in reaction, in
contradistinction to the acid "coffee ground" blood of gastric origin.
Esophageal varices may coexist with the common dilatation of the
venous system in which the veins of the rectum, scrotum, and legs are
most conspicuously affected. Cirrhosis and cancer of the liver may, by
interference with the portal circulation, produce dilatation of the
veins in the lower third of the esophagus. Angioma of the esophagus is
amenable to radium treatment.

ACTINOMYCOSIS OF THE ESOPHAGUS

_Esophageal actinomycosis_ has been autoptically discovered. Its
diagnosis, and differentiation from tuberculosis, would probably rest
upon the microscopic study of tissue removed esophagoscopically,
though as yet no such case has been reported.

ANGIONEUROTIC EDEMA

_Angioneurotic edema_ involving the esophagus, may produce
intermittent and transient dysphagia. The lesions are rarely limited
to the esophagus alone; they may occur in any portion of the
gastrointestinal, genitourinary, or respiratory tracts, and
concomitant cutaneous manifestations usually render the diagnosis
clear. The treatment is general.

DEVIATION OF THE ESOPHAGUS

_Deviation of the esophagus_ may be marked in the presence of a
deformed vertebral column, though dysphagia is a very uncommon
symptom. The lack of esophageal symptoms in deviation of spinal
production is probably explained by the longitudinal shortening of the
spine which accompanies the deflection. Compression stenosis of the
esophagus is commonly associated with deviations produced by a
thoracic mass.

[PLATE IV

A, Gastroscopic view of a gastrojejunostomy opening drawn patulous by