OPEKATIONS ON THE CESOPHAGUS. 371 



place he proceeds like the others to remove the impact with the 

 hand passed through the speculum. 



Schaack operates also in the standing position, the hind legs 

 being hobbled above the hocks, the head is kept, as much as pos- 

 sible, in a horizontal position, and a speculum placed in the 

 mouth. The operator takes his place on the left side, in front of 

 the shoulder, the right hand on one side of the neck, the left on 

 the other. If the impact is rather low down, or near the chest, 

 the extremities of the fingers are brought together and employed 

 to push it upward, with careful manipulations. If it is situated 

 higher up, near the oesophagus where it is less surrounded by 

 muscles, the pressure is made with the fingers closed. In either 

 case, however, when it has reached the throat, Schaack holds it 

 there, while an assistant with his hand boldly introduced into the 

 mouth, seizes it and draws it out of the pharynx. 



According to Peuch and Toussaint, Mr. G. Tisserand, in cases 

 of jabot, operates as follows : Making a point of support on the 

 neck with the right hand, with the left he violently shakes the 

 part where the projection of the jabot is most prominent, and 

 then applies alternate movements, up and down, with a lateral 

 shaking of the enlargement until the patient voluntarily lowers 

 his head, and as he snuffles throws out through the nostrils and 

 the mouth, abundant mucosities, mixed with alimentary detritus. 

 If the first manipulations fail, Tisserand advises the occasional ad- 

 ministration of mucilaginous decoctions, or oU, or even plain water. 



The method of Martin is one which is also held in high esteem, 

 and at the hazard of needless repetition and unnecessary minutiae 

 we give it in detail. Instead of extending the head, which has a 

 tendency to stretch the oesophagus and diminish its diameter, he 

 keeps the head of the patient low down, at about a foot from 

 the ground, and placing himself on the left side of the neck, he 

 passes his right arm over the neck, in such a manner that envelop- 

 ing the neck between both arms, his hands can join on the lower 

 border of the neck, and both thumbs pressed in the jugular 

 grooves, one on the right, the other on the left. It is by succes- 

 sive pressures from behind forward, that he succeeds in pushing 

 the impact in the pharynx. Then comes a peculiar step of the 

 operation : As by its presence the soft palate closes somewhat the 

 posterior opening of the mouth, the impact cannot re-enter this 

 cavity, and thus, while the mass is in the pharynx and resting on 



