68 SURGERY. 



passage of a bougie, together with a weak solution of nitrate of sil- 

 ver applied to the surface. 



Foreign bodies in the CEsophagi/s produce a sense of choking and 

 suffocation, and may prove fatal. 



Treatment. — The patient should be seated in a chair, with his 

 head thrown back, and his mouth wide open ; the surgeon should 

 then introduce his finger, regardless of the attempts to vomit, ascer- 

 tain the position of the substance, and if possible remove it by the 

 finger, or by the assistance of curved forceps. A small sharp body, 

 such as a fish-bone, may be got rid of by swallowing a large 

 mouthful of bread ; a large soft mass, such as a piece of meat, may 

 be pushed down into the stomach with a probang ; a rough and 

 angular body, such as a piece of bone or glass, should be brought 

 up, if possible, by long and curved forceps, or with a piece of 

 whalebone, armed with a flat, blunt hook, or with a skein of thread, 

 so as to form a number of loops. I'i the stomach is full, it should 

 be emptied by an emetic, with the hope that the foreign body may 

 be ejected with the food. It may be necessary to resort to the ope- 

 ration of oesophagotomy, which should be performed by making an 

 incision as nearly opposite the foreign body as possible, through the 

 skin, platysma and fascia, and between the sterno-mastoid muscle 

 and trachea. Care must be taken to avoid the carotid and thyroid 

 arteries, and the recurrent nerve. A small opening should be made 

 in the oesophagus, by cutting it upon a silver catheter, which should 

 be passed down the throat, and made to project into the wound ; the 

 opening should be dilated, so as to prevent hemorrhage. 



Foreign Bodies in the Larynx and Ti'achea.—Yoodi may get into 

 the rima glottidis, whilst a person is laughing and talking at a meal ; 

 and unless immediate relief is afforded, death will result. The sur- 

 geon may sometimes be enabled to remove it with his finger ; but 

 if not, the larynx or trachea should be opened, and a probe intro- 

 duced through the wound, so as to push the foreign substance up 

 into the mouth. A foreign body may be impacted in the ventricle 

 of the larynx, or be loose in the trachea, producing spasmodic cough, 

 difficulty of breathing, and pain ; a small body may even pass into 

 the bronchial tube, generally the right one. Laryngotomy, or tra- 

 cheotomy, may be necessary. The larynx is opened by a longi- 

 tudinal incision through the middle crico-thyroid ligament. The 

 trachea is opened in the median line through the skin, fat, and fascia, 

 at the lower portion of the neck. After the tracheal rings are made 

 bare, the patient is directed to swallow; and while the windpipe is 

 thus rendered tense and elongated, the scalpel is made to penetrate 

 the lower pnrt of the wound, with its back towards the sternum, and 

 the rings are to be divided by cutting upwards. Care should be 

 taken, in this operation, to avoid opening large veins, or any part 

 of the thyroid gland. This operation is sometimes necessary for 



