414 VETERINARY SURGICAL OPERATIONS 



elapse before any effort to swallow is attempted. If no at- 

 tempt to swallow is made, after some moments the tube is 

 moved gently forward and backward so as to make an im- 

 pression of its presence upon the pharyngeal walls. When 

 the fingers of the right hand feel the very first impression of 

 an act of deglutition by the forward movement of the throat, 

 the tube is quickly pushed forward the four inches inter- 

 vening between the left hand and the nostril. The end of 

 the tube in the pharnyx thus meets the oesophageal in- 

 fundibulum on its upward movement and thereby passes safe- 

 ly into it. This manipulation is the secret of the successful in- 

 troduction of tubes into the stomach of horses. If ignored by 

 simply pushing the tube onward without ceremony, the end 

 will jsually drop into the larynx and then pass downward 

 through the trachea into the bronchi before the unfortunate 

 diversion is discovered. The successful introduction of a 

 tube into the oesophagus requires the assistance of an act of 

 deglutition. 



Fig. 208— Stomach Pump. 



When the tube has entered the oesophagus, it is quite 

 rapidly swallowed. It requires only a little assistance of the 

 left hand to push it onward foot by foot with each act of 

 deglutition. 



As it approaches the stomach, the gurgling of escaping 

 gas and the sour odor of fermenting ingesta give positive as- 

 surance that it has not passed into the air passage, which 

 accident is indicated by soft blowing sounds, synchronous 

 with the exhalations, heard at the outside end of the tube. 



The entrance of the tube into the stomach is generally 

 announced by an outward gush of semi-liquid chyme or the 

 escape of considerable gas. In the absence of this occur- 

 rence, as for example when the tube is inserted for some 

 other reason than the treatment of acute indigestion, its en- 

 trance is determined by the approach of the five and one- 

 half foot mark to the nostril, allowance being made for 

 variations in the size of the patient. 



Third Step.— Siphonage and Irrigation of the Stomach.— 



