Chap, ix.] THE GULLET. 141 



Less frequently impacted foreign substances have 

 found their way into the trachea and into the posterior 

 mediastinum. Dr. Ogle reports a case (Path. Soc. 

 Trans., vol. iv.) where a piece of bone impacted in 

 the gullet induced ulceration of an inter vertebral 

 disc and subsequent disease of the spinal cord. 

 Carcinoma of the gullet, also, when it spreads, is apt 

 to invade adjacent parts, and especially to open into 

 the trachea or bronchi. If it spreads to the pleura, it 

 will usully involve the right pleura, as being the 

 membrane more in relation with the gullet. Cancer 

 of the gullet has so spread as to invade the thyroid 

 body, the pericardium, and the lung, and has opened 

 up the first intercostal artery in one case, and the 

 right subclavian in another (Butlin's " Sarcoma and 

 Carcinoma," 1882). 



The operation of cesopHag'otoiiiy consists in 

 incising the gullet for the purpose of removing an 

 impacted foreign body. The gullet is usually reached 

 from the left side, since it projects more on that 

 aspect. The incision is made between the sterno- 

 mastoid and the trachea, in the same direction as the 

 incision for ligaturing the common carotid. The cut 

 extends from the top of the thyroid cartilage to the 

 stern o-clavicular joint. The omo-hyoid muscle is 

 drawn outwards, or cut. The great vessels, larynx 

 and thyroid gland, are drawn aside, and care must 

 be taken not to wound these structures nor damage 

 the thyroid vessels or the recurrent nerve. The 

 gullet, when exposed, is opened by a vertical incision. 



In cesophagostomy the opening is made into 

 the gullet through a like incision in cases of stricture 

 of the tube high up, the object being to feed the 

 patient through the opening made, in place of per- 

 forming gastrostomy. The risk, however, of setting 

 up severe diffuse inflammation in the loose planes of 

 connective tissue deep in the neck is very great, and 



