Chap, ix.] THE GULLET 139 



enlarged thyroids have been successfully removed 

 entire), great care should be taken not to tear 

 through this capsule before the vessels are secured. 

 If the capsule be torn, the gland tissue is ex- 

 posed and is apt to bleed profusely. Since the 

 superior thyroid arteries enter at the upper end of 

 each lobe, and the inferior thyroid vessels at the lower 

 end, it is essential, before the actual removal of the 

 mass is commenced, that the vessels be secured en 

 masse at each of the four corners of the body. The 

 posterior border of the thyroid body being in contact 

 with the sheath of the great vessels, it follows that 

 the gland when enlarged may readily receive pulsations 

 from those vessels. It generally touches also the lower 

 part of the pharynx, and the upper part of the gullet 

 behind, and enlargement in this direction may, in con- 

 nection with the interference with the movement of 

 the larynx in deglutition, serve to explain the difficulty 

 in swallowing often noticed in bronchocele. 



The gullet commences opposite the sixth cervical 

 vertebra, and pierces the diaphragm opposite the 

 tenth or eleventh dorsal. It presents three curves : 

 one is antero- posterior, and corresponds to the curve 

 of the spinal column; the other two are lateral. 

 The gullet commencing at the middle line deviates 

 slightly to the left as far as the root of the neck ; 

 from thence, to the fifth dorsal vertebra, it gradually 

 returns to the middle line, and finally it turns again 

 to the left, at the same time passing forwards, to 

 pierce the diaphragm. Its length is from 9 to 10 

 inches. Its transverse diameter has been carefully 

 estimated by Dr. Mouton, by filling the gullet with 

 plaster of Paris in situ, and then measuring the cast 

 thus obtained. Dr. Mouton found that there were 

 three narrow parts in the gullet, one at its com- 

 mencement, one about 2| inches from that point, and 

 a third where the tube passed through the diaphragm. 



