Peroral endoscopy and laryngeal surgery . e screw mechanism, great care being used to avoid pinch-ing the mucosa as the blades close. If there is any teudeucy to this, theblades should be re-e\panded slightly and the divulsor rotated gently. Di-vulsion is somewhat painful and the use of ether anesthesia is a<lvisable,not onlv for this reason, but especially to prevent xomiting while the di-vulsor is expanded winch cause tr;uim;i. IVom one to sixdivulsions at intervals of a week are necessary. 520 DISEASES OF THE ESOPHAGUS. It is necessary after any form of treatment to instru
Peroral endoscopy and laryngeal surgery . e screw mechanism, great care being used to avoid pinch-ing the mucosa as the blades close. If there is any teudeucy to this, theblades should be re-e\panded slightly and the divulsor rotated gently. Di-vulsion is somewhat painful and the use of ether anesthesia is a<lvisable,not onlv for this reason, but especially to prevent xomiting while the di-vulsor is expanded winch cause tr;uim;i. IVom one to sixdivulsions at intervals of a week are necessary. 520 DISEASES OF THE ESOPHAGUS. It is necessary after any form of treatment to instruct the patientto eat very slowly and to masticate very thoroughly. It is altogetherprobable that very rapid eating and insufficient mastication may, in someinstances, be one of the factors contributing to the cause of spasm of theesophagus, because we know that in certain instances small foreign bodieswill cause a spasm, as evidenced by complete obstruction of the esoph-agus by a foreign body too small to block up the canal. Liquid foods. Fig. 416.—Divulser fully expanded (24 mm.) in the living patient, a man 01twenty-one years. The double image is due to respiratory movement. taken in very small (|uantitifs frequently repeated are best during thetreatments and for a month or longer thereafter in order to permit reso-lution of the macerated, inflamed esophagus. Lndoubtedly there are afew cases that are prone to recur, and the most stubborn are those ex-isting since childhood, with consequent infantile stomach and long-estab-lished nerve cell habit. The neurologist should be called in consultationin cases that do not yield promptly to divulsion. DISEASES OF TIIK ESOPHAGUS. 521 The foregoing is the method that has yielded the author the bestresuhs. There are a number of otlicr methods successfully used by Plum-mer, Jesse Meyer, Lerche and others, ?.nd their writings, reference towhich will be found in the Bibliography, should be consulted. Dilating bags filled with air or water
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