1 62 SURGICAL APPLIED ANATOMY. [Chap. ix. 



to 25 mm., and the rest of the gullet to a diameter of 

 nearly 1 inches (35 mm.). It follows that foreign 

 bodies when swallowed are most apt to lodge either 

 at the commencement of the gullet or at the spot 

 where it passes the diaphragm. The same parts also 

 are those most apt to show the effects of corrosives 

 that have been swallowed. 



Among the relations of the oesophagus, the follow- 

 ing may be noted as receiving illustration in surgical 

 practice. The gullet is in nearly all its course in 

 close relation with the front of the vertebral column. 

 In the neck the trachea is immediately in front of it. 

 In the thorax it is in close connection with the aorta, 

 and has the vena azygos behind it and on its right- 

 hand side. It is, moreover, partly in contact with 

 both pleurae, but more especially with the membrane 

 of the right side ; and, lastly, the recurrent laryngeal 

 nerve ascends between it and the trachea. (See Figs. 

 33 and 35.) 



Now, foreign bodies impacted in the gullet are 

 very apt to lead to ulcerations that may open adjacent 

 parts. Thus, in the Musee Dupuytren is a specimen 

 showing a five-franc piece that had stuck in the gullet, 

 and had produced an ulcer that had opened the aorta. 

 In another instance a " smasher " swallowed a counter- 

 feit half-crown piece. Eight months after he died of 

 haemorrhage. The coin had sloughed into his aorta. 

 In another case (Lancet^ 1871), a fish-bone, lodged in 

 the gullet opposite the fourth dorsal vertebra, had 

 caused two perforating ulcers ; one on the right side 

 had caused plugging of the vena azygos major, while 

 the other on the left had made a hole in the aorta. 

 Less frequently impacted foreign substances have 

 found their way into the trachea and into the posterior 

 mediastinum. Dr. Ogle reports a case (Path. Soc. 

 Trans., vol. iv.) where a piece of bone impacted in the 

 gullet induced ulceration of an intervertebral disc and 



