372 OPERATIONS ON THE DIGESTIVE APPAEATUS. 



the posterior face of the velum palati, with both thumbs he pushes 

 it from above downward and from behind forward; the effect 

 of this is to depress the base of the tongue, and to enlarge the 

 isthmus of the throat sufficiently for the impact to pass through 

 it, back in the mouth, and drop it to the ground. If, however, the 

 pressure required in this step of the operation could not, for one 

 reason or another, such as excessive thickness of the lower border 

 of the neck, for instance, be maintained, then the impact is ex- 

 tracted with the hand. 



Courioux has advised the application of a cord aroirnd the 

 neck, below the impact to be moved upwards with it, as the dis- 

 placement is accompHshed. The object of this is to retain what- 

 ever progress may be gained by preventing the mass from re- 

 ceding again. It forms a substitute for the fingers in holding it 

 in position. 



The extraction by the mouth of many substances arrested 

 in the oesophagus has also been effected with instruments. 

 Forceps long and curved, hooks and hollow sounds, having metal- 

 lic nippers or jaws, Uke that of Baujin, have been recommended. 

 That of Wegerer is probably entitled to the highest commenda- 

 tion of aU. But with all their ingenuity and perfection their use 

 is not vdthout danger of causing lacerations of the oesophageal 

 walls, and they are constantly liable to get out of order. 



Cbushing the Foeeign Body. 



At times the obstruction takes place in the cervical portion of 

 the oesophagus, and attempts to displace it, either toward the 

 mouth or the stomach, have failed. To meet this emergency 

 various means have been sought for, either to crush the impact, or 

 cut it in small pieces. One suggestion for the first object is to 

 break it with blows of a mallet, a piece of wood, or other object 

 held by an assistant, furnishing the point of resistance. But this 

 is obviously a dangerous process, nearly certain to produce 

 bruises and lacerations of the soft structures, with probably sub- 

 sequent gangrene. At best it can be available only when the im- 

 pact is in the form of a comparatively soft mass, such as ripe fruit 

 or the Kke. 



Professor Lafosse had in 1846 suggested subcutaneous incis- 

 ion, and this was put in practice in 1855 by Chapard for the relief 

 of a cow choked by a piece of a beet. A simple puncture of the 



