_Operation._--Unless there is a very decided projection of the foreign body on the right, the left side of the neck should be chosen, as the oesophagus normally lies rather on the left of the middle line. An incision similar to that required for ligature of the carotid above the omohyoid should be made over the inner edge of the sterno-mastoid muscle; with it as a guide, the omohyoid may be sought and drawn downwards and inwards, the sheath of the vessels exposed and drawn outwards, the larynx slightly pushed across to the right, the thyroid gland drawn out of the way by a blunt hook, the superior thyroid either avoided or tied. The oesophagus is then exposed, and if the foreign body is large, it is easily recognised; if the foreign body be small, a large probang with a globular ivory head should then be passed from the fauces down to the obstruction; this will distend the walls of the oesophagus, and make it a much more easy and safe business to divide them to the required extent. The wound in the oesophagus should be longitudinal, and at first not larger than is required to admit the finger, on which as a guide the forceps may be introduced to remove the foreign body, or, if necessary, a probe-pointed bistoury still further to dilate the wound. For some days or even weeks the patient must be fed through an elastic catheter introduced through the nose and retained, or by an ordinary stomach-tube through the mouth. In introducing the latter there is always a risk of opening the wound. No special sutures for the wound in the oesophagus are required, nor is it advisable too closely to sew up the external wound. FOOTNOTES: [127] _Leçons sur la Trachéotomie_, p. 10. [128] Rough diagram of larynx and trachea:--A, crico-thyroid space, _laryngotomy_; B B, dotted outline of thyroid isthmus and lobes, defines the upper and lower positions for _tracheotomy_; C, thyroid--D, cricoid cartilages; E, dotted outline of thymus gland in child of two years; F F, outline of clavicles and jugular fossa. [129] _Surgical Observations_, p. 335. See also Harrison _On the Arteries_, vol. i. p. 16. [130] _Leçons sur la Trachéotomie_, p. 9. [131] _Lectures on Surgery_, 3d ed., vol. ii. p. 900. [132] _Clinical Surgery in India_ (1866), p. 143. [133] Mr. John Wood, _Path. Soc. Trans._, vol. xi. p. 20. [134] South's _Chelius_, vol. ii. p. 400; and case recorded by Spence, in _Ed. Med. Journal_, for August 1862. [135] _Med. Chir. Transactions of London_, 1872. [136] _British Med. Journal_ (Nos. 643, 644), 1873. [137] Gross's _Surgery_, 6th ed., vol. ii. p. 342. [138] _Guy's Hospital Reports_ for 1858. CHAPTER X. OPERATIONS ON THORAX.