Scalenns Anticns 141 



is then made through the skin, platysma, and fasciae along the an- 

 terior border of the left sterno-mastoid, the middle of the incision 

 being over the foreign body. The head is then raised, as in ligation 

 of the common carotid (p. 25), and the sterno-mastoid is drawn out- 

 wards. The omo-hyoid is then seen crossing the carotid sheath, and 

 the sterno-hyoid and thyroid are passing inwards and upwards over 

 the trachea. 



As the oesophagus is imbedded between the trachea and the 

 carotid sheath, the latter must be gently drawn outwards, and the 

 sterno-hyoid and thyroid and the trachea inwards, the omo-hyoid being 

 divided if necessary. The superior and middle thyroid veins "must be 

 tied and divided if they are in the way, but care must be taken not 

 to injure the thyroid body, the inferior thyroid artery, or the recur- 

 rent laryngeal nerve. 



The position of the oesophagus may be definitely shown, if neces- 

 sary, by the introduction of a bougie or of curved forceps from the 

 mouth. Bleeding having been entirely arrested, the gullet is opened 

 and the foreign body extracted. 



If the foreign body be impacted in the lower part of the oesophagus 

 and it is apt to be lodged just before the diaphragm is traversed it 

 may be extracted by gastrotomy, as demonstrated by Dr. Maurice 

 Richardson, of Boston, U.S.A. 



In passing an cesophageal bougie a gag may be needed between 

 the teeth. Then the tube, being warmed and lubricated, is passed to 

 the back of the pharynx, and, guided by the left forefinger, is pushed 

 safely beyond the laryngeal orifice and down towards the stomach. 

 As it passes by the soft palate and fauces the patient chokes, but as 

 soon as the oesophagus is entered the choking ceases. It has happened 

 that a physician, administering beef-tea by the stomach-pump, injected 

 the trachea, and unfortunately set up a fatal pneumonia. 



In diphtheritic paralysis of the palate the patient may conveniently 

 be fed by a soft catheter passed across the floor of the nose and into 

 the oesophagus. 



THE PR^EVERTEBRAL MUSCLES 



The scalenus anticus (o-KaX^j/oy, uneven) arises by a flat tendon 

 from the tubercle upon the inner border and upper surface of the 

 first rib, and, passing upwards and inwards, is inserted into the anterior 

 tubercles of the transverse processes of the third, fourth, fifth, and 

 sixth cervical vetebrae. 



Relations. -In front are the clavicle, and the subclavius, sterno- 

 mastoid, and omo-hyoid ; the subclavian vein ; the supra-scapular 

 and transversalis colli arteries and the phrenic nerve. Behind it are 

 the subclavian artery, the pleura, and the cords of the brachial plexus. 

 On its inner side, between it and the longus colli, is the vertebral 



