The problem of cardiospasm (preventriculosis; achalasia) is one not only of etiology but of management. The cause being controversial, prevention has not as yet been possible. There has, however, been more or less widespread agreement in regard to the best method of treatment, which consists of instrumental dilation. The great majority of patients do well and seldom require operation.
Cure of this ailment is usually obtained, and in my experience it is lasting. However, it should not be assumed that restoration to normal function is always easily or promptly effected. The obstruction of the esophagus takes place at the diaphragm rather than at the cardiac end of the stomach, as is generally thought, and is commonly believed to be a consequence of the failure of the "diaphragmatic pinchcock"1 to open properly.
It is obvious that roentgenologic study and esophagoscopic visualization are required before actual treatment is undertaken. Only in this