_Treatment of hiatal esophagismus (so-called cardiospasm)_ consists in the over-dilatation of the "diaphragmatic pinchcock" or hiatus esophageus, and in proper remedial measures for the removal of the underlying neurosis. The simple passage of the esophagoscope suffices to cure some cases. Further dilatation by endoscopic guidance may be obtained by the introduction of Mosher's divulsor through the esophagoscope, by which accurate placement is obtained. The distension should not usually exceed 25 mm. Numerous water and air bags have been devised for stretching the hiatus, and excellent results have been obtained by their use. Possibly some of the cures have been due to the dilatation of organic lesions, or to the crowding back of an enlarged malposed, or otherwise abnormal left lobe of the liver, which Mosher has shown to be an etiologic factor. Certain cases prove very obstinate of cure, and require esophageal lavage for the esophagitis, and feedings through the stomach tube to increase nutrition and to dilate the contracted stomach. Gastrostomy for feeding rarely becomes necessary, for a stomach tube can always be placed with the esophagoscope if it will not pass otherwise. Retrograde dilatation with the fingers through a gastrostomy opening has been done, but seems hardly warranted in view of the excellent results obtainable from above. Instructions should be given concerning the proper mastication of food, and during treatment the frequent partaking of small quantities of liquid foods is recommended. Liquids and foods should be neither hot nor cold. The neurologist should be consulted in cases deemed neurotic. [96a.-Functional hiatal stenosis. Cramp of the diaphragmatic pinchcock (so-called cardiospasm).] Endocrine imbalance should be investigated and treated, as urged by MacNab. _Esophageal antiperistalsis_ is the name given by the author to a heretofore undescribed disease associated with regurgitation of food from the esophagus, the food not having reached the stomach. It may be continuous or paroxysmal and may be of so serious a degree as to threaten starvation. The best treatment in severe cases is gastrostomy to put the esophagus at rest. Milder cases get well under liquid diet, rest in bed, endocrine therapy, cure of associated abdominal disease, etcetera. [251] CHAPTER XXXII--DISEASES OF THE ESOPHAGUS (_Continued_) CICATRICIAL STENOSIS OF THE ESOPHAGUS