OESOPHAGEAL OBSTRUCTIONS. 



155 



extent transversely, the difficulty of displacing the obstacle should be 

 very much less. In this case the operator always stands on the left side 

 of the neck, but with his back towards the animaVs body. The right 

 arm is passed around the neck and the right hand pressed into the 

 right jugular furrow, the left hand being similarly engaged in the left 

 jugular furrow. The method of employing the fingers 

 is identical, or instead of the fingers the thumbs may 

 be used. 



When the obstructing object has been lifted as far 

 as the pharynx it has a tendency to fall out of the 

 mouth, and if it fail to do so it can be fixed in position 

 and removed as in the preceding case. 



II. Extraction. These methods are applicable to 

 cases where the foreign body has become fixed in the 

 cervical region, but more especially to obstructions in 

 the intra-thoracic part of the oesophagus. In the 

 majority of cases they are dangerous, and may lead 

 to pinching, rupture, or perforation of the cesophageal 

 mucous membrane. They should therefore be re- 

 garded as exceptional measures. Theoretically, the 

 instruments described are perfect, but practically they 

 do not secure the results anticipated, because one can 

 never prevent displacement, wrinkling, and involution 

 of the cesophageal mucous membrane. 



The forceps probang has the drawback of seldom 

 grasping smooth foreign bodies with sufficient firm- 

 ness to permit of their extraction. 



The corkscrew sound exposes one to the great 

 danger of completely piercing the oesophagus, because 

 it has to be managed blindly, and because one never 

 knows at what depth the corkscrew portion should be 

 protruded in order to obtain a proper bold of a foreign 

 body. 



III. Passage of the probang. When taxis fails or 



is inapplicable, we are forced to attempt thrusting the foreign body 

 onwards. The method is much safer than the preceding, but, never- 

 theless, demands great tact, prudence, and gentleness. Suitable oeso- 

 phageal sounds are made with cupped extremities, though in cases of 

 emergency an instrument can often be successfully improvised from a 

 cane, whip handle, or flexible stick, about 4| to 5 feet in length, securely 

 wrapped at one end with cloth or tow and freely coated with some greasy 

 material such as lard, vaseline, or oil. 



The end of the sound having arrived in contact with the obstacle, 



I 



Fig. 67. — (Eso- 

 phageal sounds. 

 Probands. 



