164 Anatomy Applied to Medicine and Surgery. 



up through the stricture and the latter divided by a saw- 

 ing motion. Should, however, the foreign body or the 

 stricture be situated between these points, viz., between 

 the arch of the aorta and the cesophagal opening into the 

 stomach, then it may be necessary to carry out Bryant's 

 plan of operating through the posterior mediastinum. 

 This surgeon showed that the distances from the upper 

 incisor teeth to the first, second, third, fourth, fifth and 

 tenth vertebrae were eight, eight and five-eighths, nine and 

 three-eighths, ten and one-eighth, eleven and fifteen 

 inches, respectively, in a person whose stature was five 

 feet eight inches. After establishing the vertebra oppo- 

 site which the obstruction was, he made a flap, three 

 inches square, including all the tissues down to the ribs, 

 and with the centre rib corresponding to the seat of the 

 obstruction. Dividing three ribs carefully, he ex- 

 posed the oesophagus and demonstrated the possibility of 

 incising the tube through the posterior mediastinum. 

 Should the obstruction be above the level of the fourth 

 dorsal vertebra, the opening into the mediastinum should 

 be made on the left side of the vertebral column. If, 

 however, it be below the fourth vertebra, then the opening 

 should be made on the right side, and the reason for this 

 is, that the oesophagus lies on the left side of the verte- 

 bral column about the level of the fourth vertebra, but 

 on the right side below this point. The same method 

 might be employed in the removal of foreign bodies from 

 the trachea or bronchi where intra-tracheal means failed. 



