374 OPERATIONS ON THE DIGESTIVE APPAEATUS. 



nature of tetanus and its origin, with tlie complications and con- 

 sequences likely to accompany and to follow it. Marrel lias rec- 

 ommended it in cases of fractures of tlie jaws; but sucli practice 

 would truly furnish an example of the proverbial case in which 

 the remedy is worse than the disease It has also been recom- 

 mended for the relief of jabot, and has been, in some cases, fol- 

 lowed by favorable results. 



The instruments necessary for this operation are a convex and 

 a straight bistoury, a pair of dissecting forceps, a director, a needle 

 and strong thread ; to these may be added a pair of scissors and 

 two blunt tenaculums, with also large forceps to grasp the impact 

 and extract it, close at hand. The animal must be kept in the 

 standing position, and held under thorough control by an assist- 

 ant, with a twitch on the lower lip or on the ear, and either fore 

 foot raised or both fore legs hobbled. 



It must be taken into consideration that the cervical jDortion 

 of the oesophagus is situated immediately behind the trachea, con- 

 tinuing thence as far as the middle of the neck, when it deviates 

 to the left, where it occupies the lower third of the neck ; and 

 again, that this cervical region is surrounded by an abundance of 

 loose connective tissue, having on each side the carotid and its 

 nerves. It will also be observed that the lower third of the neck 

 forms a triangular space, with above it the inferior border of the 

 sub-scapulo-hyoideus muscle, and on the sides the sterno-maxil- 

 laris, levator-humeri and scalenus. In this space it is in connec- 

 tion on the inside \\dth the trachea, upon which it rests ; and on 

 the outside with the scalenus, the carotid, the jugular and the 

 nerves of that region — organs which are aU covered by the cuta- 

 neous colli and the skin. 



The point of separation of the middle and lower third of the 

 neck, in the left jugular groove, is the 'place of election or of ne- 

 cessity for the operation, or where the incision of the skin must 

 begin, a httle above and behind the jugular. If the obstruction 

 is considerably prominent, this incision must be made directly 

 over it. 



Peuch and Toussaint, in their excellent work, divide the oj)er- 

 ation into three steps, which they thus describe : — 



1st. Step. Incision of the skin and dissection of the subja- 

 cent tissues. — Standing on the left side, the operator first deter- 

 mining the situation of the jugular vein, clips the hair from over 



