RADICAL OPERATION AGAINST CHOKE IN SOLIPEDS 419 



ing position, with the twitch to the nose and cocaine solu- 

 tion injected into the seat of operation. 

 INSTRUMENTS, ETC. 

 i. Scalpel., 



Dissecting forceps. 



3. Artery forceps. 



4. Rubber stomach tube, nine feet long. 



5. Force pump with attachment to fit the stomach 

 tube 



6 



A piece of tape one foot long. 

 Needles and silk sutures. 

 Clipper and razor. 

 Antiseptics. 



TECHNIQUE.— First Step.— Exposing the CEsophagus 

 in the Middle Third of the Cervical Region. — After a space 

 of two inches wide and four inches long, in the jugular groove 

 about the middle of the left side of the neck has been clipped, 

 shaved and disinfected, an incision four inches long is made 

 over and parallel to the oesophagus through the skin and 

 underlying muscles. The dissection is continued until the 

 finger can be easily hooked around the oesophagus, in the 

 center of the incision. 



Second Step. — Passing the Stomach Tube. — The stomach 

 tube, previously oiled, is passed into the oesophagus by way 

 of the left nostril until its buried extremity reaches the im- 

 paction. 



Third Step. — Ligating the CEsophagus. — The tape is 

 passed around the oesophagus where it has been exposed in 

 the depths of the cervical incision, and tied firmly with an 

 easily released bow-knot. The object of the ligature is to 

 prevent flooding the air passages with the water pumped 

 into the tube to dislodge the mass. 



Fourth Step. — Washing Out and Aspirating the Im- 

 pacted Mass. — The pump is now attached to the tube and 

 .water is slowly pumped into it until the intra-oesophageal 

 tension, determined with the finger below the tape, is suffi- 

 cient to force the water through the mass and yet not suffi- 

 cient to threaten rupture of the weakened walls around it. 

 As the tension diminishes by the downward dissemination of 

 the water the pumping is resumed and the tension is eagerly 

 guarded to forestall possible rupture. If the water fails to 

 flow downward it is syphoned out by disconnecting the tube 

 from the pump. The syphoned liquid will disclose the 

 character of the impacted mass, which is now dislodged by 

 alternate pumping and syphonage until the water finally 

 flows freely downward into the stomach. The success or 



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