part ao ae can be observed on iook 
the funnel of the throat, they are easily removed by common { 
but when they have passed entirely out of the funnel and are | 
deep in the gullet, this cannot be done; in such circumstances w 
are obliged either to allow the substance to remain where it is fixed ; 
to push it into the stomach; or to extract it by laying the gullet 
open. 
When ne substance resting in the gullet is of a soft nature, as 
bread, cheese, or flesh, the easiest and best method of getting free 
of it is to push it into the stomach with an instrument, termed a Pron 
bang, which is made of a smooth piece of whalebone, fifteen « ogee 
teen inches long, and a soft piece of sponge fastened to the end of 
it. This is much safer and easier than to bring it up, as is frequent- 
ly advised, by a strong emetic ; for when this does not succeed, the 
exertion of vomiting, in this obstructed state, is apt to do harm. 
But when a pin, a piece of sharp bone, or any other firm sub- 
stance, is fixed in the passage, we should by no means attempt to- 
push it down; for, by doing so, if it does not go into the stomach, 
any point-or roughness with whieh it is furnished, might be pushed — 
directly into the substance of the gullet. ee 
{t is necessary to observe, however, that in every case, where 
pain is not great, the breathing not much affected, and the pa: 
still so pervious as to permit the food to get down into the stomach, 
no attempt should be made for removingit ; for we know, from ex: 
perience, that in most imstances every thing of this kind is at last 
earried down, either by the action of the gullet, by some degree 
dissolution taking place in the substance, or by some partial s 
ration taking place, which loosens it. 
But when the obstruction is complete, and cannot be sathusd by 
other means, it becomes necessary to attempt to take it out by inei- 
sion. As the gullet lies deep, being covered with the windpipe, and 
as different blood-vessels and nerves of magus and importance ~ 
lie near it, it has always been very justly considered as dangerous to 
make an incision into it. But although no practitioner would ad- 
vise this operation without some reason of importance, yet in such — 
instances as those to which I allude, where much danger must ensue 
from any material interruption being formed, either to the passage of — 
the food or air, it would surely be preferable | to give the patient a 
chance, even from this doubtful remedy, than to allow him to meet 
a certain and miserable death. Besides the obstructions I have men- 
tioned, instances sometimes occur of the gullet being so ipa soien 
stopped by constrictions and tumors, that all communication between — 
the mouth and stomach is cut off. ‘These are generally irreme- 
diable. 
As the gullet is supposed to incline rather to the left side of the 
neck, this consideraton would render the left side of the windpi 
re proper for the operation. ‘The method of performing it 
ee 
The patient being secured, as before, and his head drawn back 
nd firm by an assistant, an incision should be made wi 
a ee 
