The Head and Neck 99 



bang a horse catheter may be substituted for propelling the body 

 into the stomach. 



Round or smooth obstructions may be pushed onwards but 

 excessive force must on no account be employed. Sharp bodies 

 should always be extracted by the mouth, when possible. 



Failing in this, if the foreign body is lodged in the cervical por- 

 tion it must be extracted by esophagotomy, but this operation should 

 not be undertaken till evel^ attempt at removal with the probang has 

 failed, unless asphyxia from pressure on the trachea is threatened. 

 Cadiot and Breton say that the operator should temporize with the 

 probang for two or three days and that it is rare tliat the symptoms 

 become alarming enough to render the operation necessary before 

 the fourth day. 



It is sometimes necessary to resort to Gastrotomy in order to 

 deliver foreigfn bodies from the lower third of the esophagus, when 

 such bodies are too large or peculiarly shaped to be voided by vomit- 

 ing, or when it is feared that violent attacks of retching may lead 

 to perforation of the wall. They are extracted with the aid of for- 

 ceps or pushed upward into the mouth. 



ESOPHAGOTOMY. 



Interference with the continuity of the esophagus is borne well 

 by the dog. Billroth has shown that the continuity may be re- 

 established after ablation of a short portion of the tube. Incision 

 of the tube is performed in the following manner: Secure the 

 animal with hopples in the right lateral position with the head 

 extended. Remove the hair with clippers or razor and administer a 

 general anesthetic. Make the skin incision over the obstructing body 

 and on the left side of the neck on account of the inclination of the 

 esophagus to that side. Cut cautiously in between the anterior border 

 of the stemo-cleido mastoideus muscle and the jugular vein until the 

 great vessels of the neck are exposed. The esophagus is asso- 

 ciated with these and is distinguished by its pinkish color and tu- 

 bular muscular appearance. Grasp the organ with one finger and 

 draw it through the wound at the same time pushing the trachea 

 to one side. Incise its wall on its postero-lateral aspect. The ves- 

 sels are disposed mostly longitudinally and are more abundant at 

 the upper than the lower part, and the mucosa is recognized by its 

 folds and whitish color. Vomiting may occur at this point. Extract 



