Treatment. 229 



the esophagus, except in ruminants; masses vomited from the 

 stomach, smell sour, contain free HCl, and true vomiting occurs 

 within a certain interval after feeding and with participation 

 of the abdominal muscles. In dogs the possibility of rabies 

 must be considered, since disturbances of deglutition'^are so com- 

 mon in this disease. 



Treatment. Removal of a foreign body wedged in the first 

 portion of the esophagus is best accomplished by the hand or 

 by a suitable instrument introduced into the buccal cavity. 



For this purpose the head of cattle is stretched forward, the mouth is opened 

 by the aid of the mouth gag or simply by drawing the tongue out and to the 

 side, next the right hand is introduced into the pharynx and the foreign body is 

 withdrawn by the fingers of the operator. Since attempts at deglutition are fre- 

 quently caused by this manipulation, and since the former might move the foreign 

 body towards the stomach, it is best to have an assistant fix the latter from the 

 outside. The removal of the foreign body may also be brought about in such a 

 manner that the fingers introduced into the esophagus are spread out, the assistant 

 pushes the obstruction towards the buccal cavity and lowers the head of the animal 

 at the same time. In this manner the foreign body usually slides between the 

 fingers into the palm of the hand of the operator "(Eolfes). The procedure is 

 usually applied to the standing animal; it becomes necessary only exceptionally 

 to have the animal lie down; in such a case it should lie on the right side; horses 

 must be thrown. Foreign bodies in the first portion of the esophagus of smaller 

 animals are best removed by appropriate forceps. 



Since the animals get excited during this manipulation and since the hand 

 introduced into the pharynx interferes with respiration, it is necesi-ary to act 

 quickly. Tf the procedure has not been successful, it is advisable not to prolong 

 the attempt but to wait for some time and then try again. Such repeated attempts 

 are however not without danger and Deneubourg has seen an inflammatory cervical 

 edema follow them, which disappeared only after one month. 



When the foreign body is located in the cervical portion of 

 the esophagus, one should always attempt to dislocate it to- 

 wards the buccal cavity unless there is danger of suffocation. 



For this inirpose the operator grasps the neck of the animal at the sides 

 from above with both arms, and approaches both hands immediately behind the 

 foreign body. He tries to move it forward by alternate pressure, made best with 

 the thumbs. Tf the procedure appears to be successful, it is continued until the 

 foreign body has been pushed in front of the larynx. It must then be fixed in this 

 position by an assistant, to be removed through the pharynx as described above. 

 This is sometimes not necei-sary, because the animal begins to gag and expels the 

 foreign body through the mouth without any further aid. To assist in the removal 

 of the foreign body, it is advisable to press it and the larynx forward and down- 

 ward and to lower the head and approach it to the thorax before the hand is 

 introduced into the mouth. This causes a depression of the root of the tongue, 

 and an enlargement of the space between it and the soft palate so that the foreign 

 body can fall out more easily (Martin). It is also well to oi)en the mouth as 

 much as possible (Favreau). Chapellier uses two devices similar to hoof -forceps; 

 with one he compresses the jugular gutters behind the foreign liody to prevent its 

 sliding backward ; with the other he presses upon the postei'ior end of the 

 foreign body and pushes it upward. The two forceps are alternately moved forward 

 until the foreign body has been brought into the pharynx. T'liminger removes 

 foreign bodies in the most anterior portions of the esophagrs by introducing 

 a small trochar into their center from the left side of the neck; with this he then 

 moves them up gradually. 



Opinions differ as to how the head of the animal should be held during 

 the operation. When the head is stretched and helil high the esophagus forms 

 an almost completely straight line with the pharyngeal and buccal cavity; but 

 this also sti'etches and narrows the esophagus. In view of this fact it appears 

 more advantageous to bend the head downward and backAvard ; this certainly is 



