1236 



THE ORGANS OF DIGESTION 



be easily evacuated by an incision, with a guarded bistoury, through the mouth, but, for aseptic 

 reasons, it is desirable that the abscess should be opened from the neck. In some instances this 

 is perfectly easy; the abscess can be felt bulging at the side of the neck and merely requires an 

 incision for its relief; but this is not always so, and then an incision should be made along the 

 posterior border of the Sternomastoid and the deep fascia should be divided. A director is now 

 to be inserted into the wound, the forefinger of the left hand being introduced into the mouth and 

 pressure made upon the swelling. This acts as a guide, and the director is to be pushed onward 



until pus appears in the groove. A pair of sinus forceps 

 are now inserted along the director and the opening into 

 the cavity dilated. 

 V . Foreign bodies not infrequently become lodged in the 



* ] mm pharynx and most usually at its termination at about 



the level of the cricoid cartilage, just beyond the reach 

 of the finger, as the distance from the arch of the teeth 

 to the commencement of the oesophagus is about six 

 inches. 



Hypertrophy of the lymphoid tissue of the naso- 

 pharynx produces groups of hypertrophic masses known 

 as adenoids. A child with adenoids has a cough, and 



19 mm when awake or asleep, breathes noisily and with the 



mouth open. The voice is muffled, the hearing is im- 

 paired, the expression is vacant, the mind is dull, and 

 the tonsils are enlarged. 



-15 

 -16 



-14 mm 



20 mm. 



THE (ESOPHAGUS (Figs. 952, 953). 



The oesophagus, or gullet, is a musculomembra- 

 nous canal, about nine or ten inches in length, 

 extending from the pharynx to the stomach. 

 It commences at the upper border of the cricoid 

 cartilage, opposite the sixth cervical vertebra, 

 descends along the front of the vertebral column 

 through the posterior mediastinum, passes 

 through the Diaphragm, and, entering the 

 abdomen, terminate^ at the cardiac orifice of 

 the stomach, opposite the eleventh thoracic 

 vertebra, about an inch to the left of the median 

 plane. The general direction of the oesophagus 

 is vertical, but it presents two or three slight 

 curves in its course. At its commencement it is 

 placed in the median line, but it inclines to the 

 left side as far as the root of the neck, gradually 

 passes to the middle line again, and finally 

 deviates to the left as it passes forward to the 

 cesophageal opening of the Diaphragm (hiatus 

 oesophageus). The oesophagus also presents 

 antero-posterior flexures, corresponding to the 

 curvature of the cervical and thoracic portions 

 of the vertebral column. It is the narrowest 

 part of the alimentary canal, being most con- 

 tracted at its commencement, at about the level 

 of the third thoracic vertebra, and at the point 

 where it passes through the Diaphragm (Fig. 

 952). 



When empty, the oesophagus is collapsed so that its anterior and posterior walls 

 come in contact and the lumen is stellate on account of the longitudinal foldings 

 of the inelastic mucous membrane loosely held by the submucosa. The calibre 



12-14 mm 



1-40 



FIG. 952. Contour of the oesophagus. 

 On the left the distances of the constric- 

 tions from the incisor teeth are given in 

 centimeters; on the right are given the 

 diameters in millimeters. (Half natural 

 size.) 



