by the hiatal muscular
diaphragmatic closure (called by the author the "diaphragmatic
pinchcock") plus the kinking of the abdominal esophagus.

In the author's opinion there is no spasm in the disease called
"cardiospasm." It is simply the failure of the diaphragmatic pinchcock
to open normally in the deglutitory cycle. A better name is functional
hiatal stenosis.

At retrograde esophagoscopy the cardia and abdominal esophagus do not
seem to exist. The top of the stomach seems to be closed by the
diaphragmatic pinchcock in the same way that the top of a bag is
closed by a puckering string.

[63] CHAPTER III--PREPARATION OF THE PATIENT FOR PERORAL ENDOSCOPY

The suggestions of the author in the earlier volumes in regard to
preparation of the patient, as for any operation, by a bath, laxative,
etc., and especially by special cleansing of the mouth with 25 per
cent alcohol, have received general endorsement. Care should be taken
not to set up undue reaction by vigorous scrubbing of gums
unaccustomed to it. Artificial dentures should be removed. Even if no
anesthetic is to be used, the patient should be fasted for five hours
if possible, even for direct laryngoscopy in order to forestall
vomiting. Except in emergency cases every patient should be gone over
by an internist for organic disease in any form. If an endolaryngeal
operation is needed by a nephritic, preparatory treatment may prevent
laryngeal edema or other complications. Hemophilia should be thought
of. It is quite common for the first symptom of an aortic aneurysm to
be an impaired power to swallow, or the lodgment of a bolus of meat or
other foreign body. If aneurysm is present and esophagoscopy is
necessary, as it always is in foreign body cases, "to be fore-warned
is to be forearmed." Pulmonary tuberculosis is often unsuspected in
very young children. There is great danger from tracheal pressure by
an esophageal diverticulum or dilatation distended with food; or the
food maybe regurgitated and aspirated into the larynx and trachea.
Therefore, in all esophageal cases the esophagus should be emptied by
regurgitation induced by titillating the fauces with the finger after
swallowing a tumblerful of water, pressure on the neck, etc. Aspiration
will succeed in some cases. In others it is absolutely necessary to
remove food with the esophagoscope. If the aspirating tube becomes
clogged by solid food, the method of swab aspiration mentioned under
bronchosco