An attempt should first be made to remove the body with the fingers, and if this is unsuccessful pharyngeal forceps must be called into use. In some cases where the impaction is very firm it may be necessary to perform pharyngotomy.
A foreign body in the œsophagus will cause dysphagia, and will probably give rise to constant pain; if it is situated in the upper part it will in all probability give rise to dyspnœa. On applying the stethoscope over the region of the œsophagus, a gurgling sound will be heard when the patient swallows fluids. The presence of a foreign body may be definitely ascertained by passing a bougie; this step will also enable the surgeon to determine the position in which the foreign body is lodged.
If impacted in the upper part of the œsophagus, an attempt may be made to remove the impacted body with forceps; this failing, œsophagotomy must be performed.
If lodged near the cardiac end of the œsophagus an attempt may be made with a bougie to push the foreign body into the stomach; this failing, gastrotomy should be performed.
If a foreign body becomes impacted at the pyloric opening of the stomach, it will give rise to gastric dilatation. Under such circumstances the stomach must be emptied of its contents, and gastrotomy then performed.
A foreign body going through the isthmus of the fauces will as a rule pass into the œsophagus, then into the stomach, and will give rise to no trouble.
The details of such operations as gastrotomy, œsophagotomy, &c., do not lie within the scope of this book, and should be sought for in works dealing with general surgery.
The necessity of being ready for such emergencies as the above cannot be too fully emphasised, and all who administer anæsthetics should be provided with the instruments necessary to perform laryngotomy. These should be kept in a little case, and no anæsthetic should be administered without the case being near at hand. Adherence to this rule is important.
(5) MISCELLANEOUS DIFFICULTIES, COMPLICATIONS AND SEQUELÆ.
(a) Uterine pain.—A case is quoted by Mr. Sercombe where extraction of a tooth was followed by paroxysmal uterine pain, followed by the cure of an obstinate leucorrhœa.[23]