156 DISEASES OF THE (ESOPHAGUS. 



the operator exercises moderate but permanent pressure. The obstacle 

 may not move immediately, because of spasm of the oesophagus, which 

 grasps it. It is therefore necessary to wait and to take advantage of a 

 moment when the resistance is less, and even then the obstacle may 

 not move. 



Eough manipulation with improvised sounds may tear, fissure, or 

 perforate the muscular and mucous coats, producing the gravest 

 consequences. 



IV. Crushing. The crushing of an obstruction in the cervical 

 region was long ago suggested, and is still greatly commended by 

 empirics and farriers. It is performed by means of a little mallet and a 

 piece of board. The method is barbarous, and exposes the animal to 

 such grave complications as crushing of the oesophageal walls, followed by 

 necrosis, laceration of the connective tissue, and interstitial haemorrhage, 

 injuries of the superficial or deep-seated jugulars, of- the carotid artery, 

 pneumo-gastric nerve, etc. It should never be practised, even although 

 attempts have been made to improve it by replacing the mallet and board 

 by specially formed forceps intended for crushing potatoes or roots. 

 Only in the rare cases wdiere one is certain that the foreign body consists 

 of a very ripe fruit could crushing be justified, and in this case there is no 

 need to have recourse to special instruments, for the hands alone suffice. 



Injection of alkaloids. The practitioner occasionally finds him- 

 self in the embarrassing position of having vainly tried all the above 

 methods. Before adopting the last resource, viz., oesophagotomy, it is 

 then w^orth w^hile to test the action of certain alkaloids, injected sub- 

 cutaneously, after having punctured the rumen. 



We know that pilocarj)ine and eserine stimulate secretion and the 

 action of the bow^els. Injected under the skin they cause frequent 

 sw^allowing efforts, and intense peristalsis extending throughout the 

 length of the digestive tract. Doses of 1^ to 2 grains of pilocarpine and 

 1 to 11 grains of eserine, according to the size of the animal, sometimes 

 produce excellent results, and rapidly remove obstructions. 



Apomorphine, the effects of which are, so to speak, inverse, because 

 they tend to produce anti-peristalsis and vomiting, may be tried in doses 

 of 2 or 3 grains. 



(Esophagotomy. The last resource is oesophagotomy, which, how- 

 ever, is only applicable in cases of obstruction of the cervical portion of 

 the oesophagus. It should be performed as described in the section here- 

 after on operative manipulation. (See also Moller and Dollar's "Regional 

 Surgery," p. 166.) 



The point selected is necessarily governed by the position of the 

 obstacle. There is no need to enter into full details. We may remark 

 that it is not ahvays necessary to perform the complete operation, and 



