FOREIGN BODIES IN THE (ESOPHAGUS 49 



of the tube, "When making an examination of the tube externally, should 

 we find a part that is painful, we must not consider it the obstruction un- 

 less we find a hard swelling with it, as foreign bodies such as sharp splin- 

 ters of bone or wood often go down the tube, lacerate the mucous mem- 

 brane in its passage, and do not become imbedded. Needles, pins and 

 small pieces of wood may not be detected, even with the probang; in such 

 cases the Rontgcn or X-ray can be used to detect objects of certain den- 

 sity, such as metals, coins, etc., with the greatest certainty. 



The object, if it goes into the stomach, passes through the intestines 

 and is passed through the rectum and causes no further trouble. Some 

 authors have observed needles passed per rectum in the faeces. It may, 

 however, lodge in the stomach and cause irritation and finally convul- 

 sions and death. If it is a sharp body, it may perforate the stomach, even 

 find its way out again by perforating the abdominal wall. If it is in the 

 thoracic portion of the tube, it may penetrate the wall, cause an abscess 

 and escape, or it may penetrate the wall of the thoracic portion and set up 

 septic pleuritis and result fatally. It is also probable that death may 

 occur from the foreign bodies if they are sharp, by penetrating either the 

 heart or one of the large blood vessels in the vicinity, and causing a hemor- 

 rhage, or it may also occur from septic inflammation of the oesophagus. 



Therapeutics. — The treatment differs according to the character and 

 situation of the foreign bodies. If the foreign body is in the pharynx or at 

 the entrance of the oesophagus, it must be removed immediately either 

 with the finger or a pair of curved forceps. If the obstruction is located 

 in the lower portion of the tube, and it cannot be pushed down into the 

 stomach with the probang, it is advisable to attempt to get it up by an 

 emetic — a subcutaneous injection of apomorphia muriate, as per page 21. 

 If that is not successful, then perform oesophagotomy as soon as possible, 

 before the intense swelling interferes with the operation. If this opera- 

 tion cannot be performed on account of the foreign body being situated 

 too deeply in the thorax, it is best to give the animal small quantities of 

 lubricating substances, such as olive oil or any fatty oil. It is better to do 

 this than to use any great force to push the object into the stomach. If 

 the foreign body goes so far into the oesophagus that it lodges in the cardiac 

 portion of the stomach and by manipulation it can be detected, gastrec- 

 tomy can be performed and the foreign body removed in that way. 

 Porcher and Morey performed this operation successfully. 



In very rare instances we also find an inflammation of the oesophagus 

 (oesophagitis) , with or without any ulceration. In the latter case it is due 

 to the irritation of caustic poisons or lacerations of the foreign bodies 

 going down the tube. This is best treated with lubricating oils, such as 

 almond or sweet oil. We may see, occasionally, a constriction of the 

 oesophagus (stenosis oesophagi) or a dilation (ecktasia and diverticulum), 

 4 



