1240 



THE ORGANS OF DIGESTION 



gotomy is performed. If the foreign body is lodged in the lower one-third of the gullet, the 

 stomach is opened (gastrotomy) and the foreign body is extracted. If the foreign body is allowed 

 to remain lodged in the oesophagus, extensive inflammation and ulceration may ensue. In one 

 case the foreign body ultimately penetrated the intervertebral substance, and destroyed life 

 by inflammation of the membranes and substance of the spinal cord. 



The operation of aesophagotomy is thus performed: The patient being placed upon his back, 

 with the head and shoulders slightly elevated, an incision, about four inches in length, should 

 be made on the left side of the trachea, from the thyroid cartilage downward, dividing the skin, 

 Platysma, and deep fascia. The edges of the wound being separated, the Omohyoid muscle 

 should, if necessary, be divided, and the fibres of the Sternohyoid and Sternothyroid muscles 

 drawn inward; the sheath of the carotid vessels, being exposed, must be drawn outward, and 

 retained in that position by retractors; the resophagus will now be exposed, and should be divided 

 over the foreign body, which can then be removed. Great care is necessary to avoid w r ounding 

 the thyroid vessels, the thyroid gland, and the laryngeal nerves. 



The oesophagus may be obstructed not only by foreign bodies, but also by changes in its coats, 

 producing stricture, or by pressure on it from without of newgrowths or aneurisms, etc. 



The different forms of stricture are: (1) the spasmodic, occurring in neurotic individuals, and 

 intermittent in character, so that the dysphagia is not constant. Spasmodic stricture of the 

 O3sophagus sometimes occurs in cases of cancer of the stomach and cancer of the liver ; (2) 

 fibrous, due to cicatrization after injuries, such as swallowing corrosive fluids or boiling water; 

 and (3) malignant, usually epitheliomatous in its nature. Cancer is most common either at 

 the upper end of the tube, opposite to the cricoid cartilage, or at its lower end at the cardiac 

 orifice. Cicatricial stricture may be treated by gradual dilatation. If a stricture is impassable 

 from above, the stomach may be opened, an instrument passed from below, and a string used 

 to divide the stricture. The operation of ossophagostomy has occasionally been performed, but 

 if any operative interference is undertaken for stricture, with the idea of forming an orifice for 

 the introduction of food, it is better to perform gastrostomy. In malignant stricture, gastrostomy 

 is th'e only operation to be thought of. 



THE ABDOMEN. 



The abdomen is that portion of the trtink which lies below the Diaphragm, and 

 it contains the largest cavity in the body. It is of an oval form, the extremities 

 of the oval being directed upward and downward; the upper one is formed 

 by the under surface of the Diaphragm, the lower end is limited by the structures 



A 



Male Type 



Infantile Type 



A B 



FIG. 957. Schematic outlines of the abdomen. 



which clothe the inner surface of the bony pelvis, principally the Levatores ani 

 and the Coccygei muscles on either side. These muscles are sometimes termed 

 the Diaphragm of the pelvis. In order to facilitate description, it is artificially 

 divided into two parts, an upper and larger part, the abdomen proper, and a lower 

 and smaller part, the pelvis. The cavities of these divisions are not separated 

 from each other, but the limit between them is marked by the brim of the true 

 pelvis. The cavity is wider above than below, and measures more in the vertical 

 than in the transverse diameter. 



The abdomen proper differs from the other great cavities of the body in being 

 bounded for the most part by muscles and fasciae, so that it can vary in capacity 

 and shape according to the condition of the viscera which it contains; but, in 



