52 rilK SURGICAL ANATOMY OF THK HORSE 



Choking 



It is rather important to remember that the a'sophagus appears 

 to be constricted at certain places, either on account of the pressure 

 of the surrounding structures upon it, or on account of a Hcxuous 

 disposition of the oesophagus itself. Thus we find constrictions at 

 its commencement, as it passes into the chest between the first pair 

 of ribs, and also where it passes through the foramen sinistrum of 

 the diaphragm. The importance of this point is in connection with 

 the treatment of choking, for it will be seen that choking from an 

 arrested obstacle is most likely to occur at one of the three positions 

 named. 



If the obstruction should occur at the entrance to the oesophagus, it 

 will be evident from Plate III. (longitudinal section) that its removal with 

 the hand is not a difficult operation, particularly if staphylotomy be first 

 performed, since the hand may be easily placed in the pharynx. In 

 fact, this is the process which should be adopted, the ordinary mouth 

 gag being used. The occipito-atlantal joint is fully extended, the tongue 

 is taken in the left hand and the right hand passed into the mouth. 

 The knuckles should be kept quite close to the hard palate. On 

 arriving at the soft palate (providing the latter be not first slit), this 

 is pressed gently backwards, and the operator's hand narrowed as much 

 as possible to pass through the isthmus of the fauces. Whilst this is 

 being done the epiglottis is pressed over the opening of the larynx, 

 and care is taken not to insinuate the finger-tips into this opening, 

 otherwise violent coughing will ensue. 



Having grasped the obstacle, still greater care should be taken in 

 withdrawing it, and it is frequently advisable to work it into the palm 

 by means of the fingers, the knuckles meanwhile applying pressure to 

 the epiglottis. Should the obstacle be placed at either of the other 

 situations named, the anatomical difficulties, in the way of either 

 external manipulation or of operating from the external cervical region. 



