254 - DISEASES OF THE TEETH, ETC. 



the scalpel requires to be handled with considerable caution 

 as well as skill. Recollecting that the oesophagus, after pro- 

 ceeding down one third of the neck, inclines to the left of 

 the trachea, and before it reaches the chest gets quite round 

 to the left of that tube, had we our choice, we should un- 

 doubtedly select the left side of the neck, and below the 

 upper third of it, for the operation. Supposing we take the 

 middle of the neck, our first incision— on which much of 

 our ultimate success will de]>end — should be three inches in 

 length, and be directed along the inferior border of the 

 jugular vein ; which vessel had better be kept distended 

 the while by pressure from the hand of an assistant. The 

 lips of the wound being then kept apart by the assistant, the 

 operator carefully prosecutes his dissection through the cel- 

 lular tissue with which this hollow abounds, keeping his 

 knife from wounding the jugular on his right, and guarding 

 against the carotid artery and nerves which lie enveloped in 

 the cellular substance contiguous to the windpipe, whose 

 situation he will best ascertain by feeling for the pulsations 

 of the artery. His object now is to get behind the carotid, 

 and there to feel for the windpipe ; and this being found, will 

 guide him to a firm, chordiform, shining, red substance, in 

 close apposition with it, which is the oesophagus. In case 

 any injection into it be required, the oesophagus must be 

 drawn forward with a blunt hook, and opened by a longi- 

 tudinal incision, and an appropriate tube introduced. But 

 where the extraction of a foreign body is our object — a cir- 

 cumstance that will render the operation much more facile, 

 the tumor being our guide for incision, — nothing remains to 

 be done, after this exposure, but to liberate the imprisoned 

 substance, whatever it may be, and afterwards to close the 

 wound in the oesophagus with a common continued suture 

 of silk-thread, and unite the lips of the external wound with 

 pins and tow twisted round them, in the same manner as the 

 wound after bleeding is closed ; or, if preferred, the zinc wire 

 suture may be employed. Lastly, a compress upon the 

 wound, confined by a roller round the neck, will give sup- 

 port, and for a day or two, perhaps, be found serviceable. 



