140 SURGICAL APPLIED ANATOMY. [Chap. ix. 



The diameter at each of these points was a little over 

 half an inch (14 mm.); the diameter elsewhere 

 was about f inch (17 mm. to 21 mm.). By for- 

 cible distension the two upper narrow parts could 

 be distended to a diameter of 18 to 19 mm., the 

 lower part to 25 mm., and the rest of the gullet to a 

 diameter of nearly 1| inches (35 mm.). It follows 

 that foreign bodies when swallowed are most apt to 

 lodge either at the commencement of the gullet or at 

 the spot where it passes the diaphragm. The same 

 parts also are those most apt to show the effects of 

 corrosives that have been swallowed. 



Among the relations of the oesophagus, the follow- 

 ing may be noted as receiving illustration in surgical 

 practice. The gullet is in nearly all its course in 

 close relation with the front of the vertebral column. 

 In the neck the trachea is immediately in front of it. 

 In the thorax it is in close connection with the aorta, 

 and has the vena agygos behind it and on its right- 

 hand side. It is, moreover, partly in contact with 

 both pleurae, but more especially with the membrane 

 of the right side; and, lastly, the recurrent laryngeal 

 nerve ascends between it and the trachea. (See Figs. 

 33 and 35.) 



Now, foreign bodies impacted in the gullet are 

 very apt to lead to ulcerations that may open adjacent 

 parts. Thus, in the Musee Dupuytren is a specimen 

 showing a five-franc piece that had stuck in the 

 gullet, and had produced an ulcer that had opened 

 the aorta. In another instance a " smasher" swallowed 

 a counterfeit half-crown piece. Eight months after 

 he died of haemorrhage. The coin had sloughed into 

 his aorta. In another case (Lancet, 1871), a fish-bone, 

 lodged in the gullet opposite the fourth dorsal vertebra, 

 had caused two perforating ulcers ; one on the right 

 side had caused plugging of the vena azygos major, 

 while the other on the left had made a hole in the aorta. 



