[242] Mixed infection gives to all esophageal ulceration a certain uniformity of appearance, so that laboratory studies of smears or histologic and bacteriologic study of tissue specimens taken from fungations or thickened edges are often required to confirm the endoscopic diagnosis. If the edges are thin and flat, the taking of a specimen involves some risk; fungations can be removed without risk; so can nodules, but care must be taken that projecting folds are not mistaken for nodules. It is always wise to push the therapeutic test with potassium iodid and especially mercury in any case of esophageal ulceration unassociated with stasis. _Treatment of Acute and Subacute Inflammation and Ulceration of the Esophagus_.--Bismuth subnitrate in doses of about one gramme, given dry on the tongue and swallowed without water, has a local antiseptic and protective action. Its antiseptic power may be enhanced by the addition of calomel to the powder, in such amount as may be tolerated by the bowels. If pain be present the combination of a grain or two of anesthesin or orthoform with the bismuth will be grateful. The local application of argyrol in 25 per cent watery solution is also of great value. The mouth and teeth are to be kept clean with a mouth wash of Dakin's solution, 1 part, to peppermint water, 6 parts. The esophagus must be placed at rest as far as possible by liquid diet or, if need be, by gastrostomy. CHRONIC ESOPHAGITIS This is usually a result of stagnation of food or secretion, and will be considered under spasmodic stenosis and diffuse dilatation of the esophagus. A very marked case with local distress and pain extending through to the back was seen by the author in consultation with Dr. John B. Wright who had made the diagnosis. The patient was a sufferer from ankylostomiasis. [243] COMPRESSION STENOSIS OF THE ESOPHAGUS The esophagus may be narrowed by the pressure of any periesophageal disease or anomaly. The lesions most frequently found are: 1. Goiter, cervical or thoracic. 2. Malignancy of any of the intrathoracic viscera. 3. Aneurysm. 4. Cardiac and aortic enlargement. 5. Lymphadenopathies. Hodgkins' disease. Leukemia. Lues. Tuberculosis. Simple infective adenitis. 6. Lordosis. 7. Enlargement of the left hepatic lobe.