Perforation of the esophagus has always been a more serious condition than perforation of any of the intra-abdominal viscera. Prior to the antibiotic era, the complications of such lesions generally proved fatal. More recently, early suture of the lesion has been shown to yield a significantly higher survival rate. During the past ten years Samson,1,2 Weisel and Raine,3 Overstreet and Ochsner,4 Nealon,5 Blades,6 and others7,8,10-13 have stressed the analogy to the treatment of a ruptured hollow viscus elsewhere in the body and have advocated immediate repair of the leak. Samson has criticized the delay in operation because "the patient isn't sick enough or because he is too sick." Early in the present era of surgical attack on these lesions it was felt that suture must be performed within six hours to have any advantage over simple drainage. As the decade advanced, this interval was