_ BOTANIC PHYSICIAN. 
mmencing about half an inch above the seat of the obstruetin, 
‘substance, when this can be done; and when this is impracticable 
by the obs on being within the cavity of the chest; the incision 
should commence about an inch and a half above the breast bone. — 
he cellular substance being freely divided, the breast and shield, 
east and tongue.muscles, together with a portion of the shield 
land, will be brought into view: with a flat blunt hook, one assistant — 
hould pull the muscles gently to the left side, while another does the 
on the right, so as to admit of the gullet being brought to view, | 
ny large blood-vessel is thus unavoidably divided, it. should now 
be secured ; and this being done, the operator is to proceed to open 
_ the gullet. When the piece of bone, or substance, fixed in the pas: 
_ ‘Sage, is discovered by the finger, the perforation should be made — 
rectly upon it, and the cut, which should always be lengthwise, 
, made of a sufficient size for extracting it, this should be ime 
done with small forceps. But when the cause of obstruc- _ 
found to lie within the cavity of the chest, which must add 
greatly tothe hazard of the operation, the gullet ought in this case — 
o be opened immediately above its entrance into the chest; care 
being taken, in order to give sufficient room for what is to follow, 
_ that the opening in the gullet be extended upwards to-the full height — 
of the external incision. This being done, a large firm probe should — 
Se introduced, in order to determine the seat of the obstruction, 
n, by means of long small forceps, the substance producing the — 
ms hief should be cautiously laid hold of, and slowly extracted. e 
_ * The operation being in this manner finished, all our attention is 
to be given to the treatment of the sore and the nourishment o 
the patient. When the operation is performed for some disease 
per part of the gullet, till this is either removed by medi- 
an operation, the incision must be kept open, for the con- 
‘of nourishment to the stomach. But when the obstruction 
id we have removed this in the Operation, ne- 
be 0 d that can tend to promote an immediate re- 
union: the divided parts. If, in such circumstances, the patient is 
allowed either to eat or drink much, the opening in the gullet. will be 
found difficult to heal, and may become fistulons. It will therefore 
_ be more prudent to recommend total abstinence from solid food for 
veral days, and to convey nourishment, in the form of strong 
by the anus, and allowing very small quantities of milk or soup 
swallowed from time to time ; by preventing the patient fr 
his neck, and treating the wound in the common way, a cure 
» While the ski 
-*. 
eases, though without pain. At. 
elite ait: 
em + 
