_Treatment_.--Blind bouginage should be discarded as an obsolete and
very dangerous procedure. If the stenosis be so great as to interfere
with the ingestion of the required amount of liquids, gastrostomy
should be done at once and esophagoscopic treatment postponed until
water hunger has been relieved. Gastrostomy aids in the treatment by
putting the esophagus at rest, and by affording the means of
maintaining a high degree of nutrition unhampered by the variability
or efficiency of the swallowing function. Careful diet and gentle
treatment will, however, usually avoid gastrostomy. The diet in the
gastrostomy-fed patients should be as varied as in oral alimentation;
even solids of the consistency of mashed potatoes, if previously
forced through a wire gauze strainer, may be forced through the tube
with a glass injector. Liquids and readily liquefiable foods are to be
given the non-gastrostomized patient, solids being added when
demonstrated that no stagnation above the stricture occurs. Thorough
mastication and the slow partaking of small quantities at a time are
imperative. Should food accumulation occur, the esophagus should be
emptied by regurgitation, following which a glassful of warm sodium
bicarbonate solution is to be taken, and this also regurgitated if it
does not go through promptly. The esophagus is thus lavaged and
emptied. In all these cases, whether being fed through the mouth or
the gastrostomic tube, it is very important to remember that milk and
eggs are not a complete dietary. A pediatrist should be consulted.
Prof. Graham has saved the lives of many children by solving the
nutritive problems in the cases at the Bronchoscopic Clinic. Fruit and
vegetable juices are necessary. Vegetable soups and mashed fruits
should be strained through a wire gauze coffee strainer. If the saliva
is spat out by the child because it will not go through the stricture
the child should be taught to spit the saliva into the funnel of the
abdominal tube. This method of improving nutrition was discovered by
Miss Groves at the Bronchoscopic Clinic.
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