OPERATIONS ON THE (ESOPHAGUS. 



375 



the tumor, stretches the skin with the left thumb and index 

 finger, and with the convex bistoury, extends the incision from 

 the initial point, about four fingers' breadth do^NTi, parallel with 

 the blood vessels. The incision divides the skin, and the cuta- 

 neous muscle, and exposes the jugular and carotid and their nerves. 

 The thumb of the left hand is then introduced into the incision 

 and depresses forward the blood vessels and nerves, while the 

 other fingers of the same hand are embracing the tracheal border 

 of the neck. The oesophagus is thus exposed on the lateral 

 border of the trachea, and the cellular tissue which covers the 

 organ is then divided. By raising the upper lip of the incision 

 with a blunt tenaculum the oesophagus may be still more exposed. 

 2d Step. Loosening or isolation of the oesophagus — Cutting 

 away part of the cellular tissue, the cesophagus is seized with 

 the thumb and index of the right hand and drawn outward. The 

 vascvdo-nervous fasciculus are then let loose, the cesophagus is 



Fig. 366.— The (Esophagus Drawn Outward and liaised with the Scissors. 



