. Operative surgery. Tix; advance the instrument with gentleness,heeding the presence of spasm or other obstruction, until finally the instru-ment passes readily along the oesophagus into the stomach. Other Metliods of Introduction.—Instead of grasping the tongue theindex finger can be introduced as a guide to the advancing instrument, as iscommonly practiced in the introduction of an oesophageal bougie, conductingit safely over the larynx to the posterior aspect of the pharynx (Fig. 847).Solis-Cohen recommends the drawing of the larynx forward with the thumband fingers applied without. The ac
. Operative surgery. Tix; advance the instrument with gentleness,heeding the presence of spasm or other obstruction, until finally the instru-ment passes readily along the oesophagus into the stomach. Other Metliods of Introduction.—Instead of grasping the tongue theindex finger can be introduced as a guide to the advancing instrument, as iscommonly practiced in the introduction of an oesophageal bougie, conductingit safely over the larynx to the posterior aspect of the pharynx (Fig. 847).Solis-Cohen recommends the drawing of the larynx forward with the thumband fingers applied without. The accomplishment by this method requiresthe employment of a firm and somewhat painful pressure (except perhaps inthe presence of anaesthesia) that is out of proportion to the demands of theU. Fig. 847.—Introducing tube into cesophagus. QQQ OPERATIVE SURGERY. case. The location of the obstruction can be estimated by recalling the factthat in the average-sized adult the distance from the diaphragmatic narrow-ing of the oesophagus to the upper incisor teeth is about fourteen inchesand a half, and from the aorta and from the upper end of the oesophagus tothe same teeth is nine and five and a half inches respectively. These factsare of immense importance as bearing on the relation of the obstructingagent to important organs and the liability of serious complications fromthe passage and from the effects of the means employed for relief. The Precautions.—The introduction into and passage along the oesopha-gus of a probang, bougie, etc., and the manipulation of the foreign bodyshould be conducted with great care and a minimum expenditure of force,otherwise perforation will ensue, and especially is this true in those casescharacterized by the structural changes incident to dise
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