(a) The first is carried out in the following way: the animal is fixed to a post or tree so that it cannot struggle, its head being drawn up as high as possible. The operator stands on the left side, with his back turned towards the patient’s head, his left hand is pressed into the right jugular furrow, his right hand is placed on the left jugular furrow immediately below the foreign body. By using the fingers the foreign body is moved, and is progressively thrust towards the pharynx, in spite of the animal’s efforts to swallow. In carrying out this manipulation it is absolutely indispensable not to let slip the obstructing body for a single instant, otherwise the peristaltic action will immediately return it to its former place. When it has been raised as far as the pharynx, an assistant passes his hand into the back of the mouth, as indicated in a former chapter, seizes the object and withdraws it; or, instead, the assistant takes over the operator’s duties, while the latter himself extracts the foreign body.
(b) In the second method the animal is fixed in a different position, the head being held about 10 to 12 inches from the ground, with the neck lowered and inclined towards the earth. As in this position the œsophagus is longitudinally relaxed, and can be dilated to its fullest extent transversely, the difficulty of displacing the obstacle should be very much less. In this case the operator always stands on the left side of the neck, but with his back towards the animal’s body. The right arm is passed around the neck and the right hand pressed into the right jugular furrow, the left hand being similarly engaged in the left jugular furrow. The method of employing the fingers is identical, or instead of the fingers the thumbs may be used.
Fig. 67.—Œsophageal sounds. Probangs.
When the obstructing object has been lifted as far as the pharynx it has a tendency to fall out of the mouth, and if it fail to do so it can be fixed in position and removed as in the preceding case.
II. Extraction. These methods are applicable to cases where the foreign body has become fixed in the cervical region, but more especially to obstructions in the intra-thoracic part of the œsophagus. In the majority of cases they are dangerous, and may lead to pinching, rupture, or perforation of the œsophageal mucous membrane. They should therefore be regarded as exceptional measures. Theoretically, the instruments described are perfect, but practically they do not secure the results anticipated, because one can never prevent displacement, wrinkling, and involution of the œsophageal mucous membrane.
The forceps probang has the drawback of seldom grasping smooth foreign bodies with sufficient firmness to permit of their extraction.
The corkscrew sound exposes one to the great danger of completely piercing the œsophagus, because it has to be managed blindly, and because one never knows at what depth the corkscrew portion should be protruded in order to obtain a proper hold of a foreign body.
III. Passage of the probang. When taxis fails or is inapplicable, we are forced to attempt thrusting the foreign body onwards. The method is much safer than the preceding, but, nevertheless, demands great tact, prudence, and gentleness. Suitable œsophageal sounds are made with cupped extremities, though in cases of emergency an instrument can often be successfully improvised from a cane, whip handle, or flexible stick, about 4½ to 5 feet in length, securely wrapped at one end with cloth or tow and freely coated with some greasy material such as lard, vaseline, or oil.
The end of the sound having arrived in contact with the obstacle, the operator exercises moderate but permanent pressure. The obstacle may not move immediately, because of spasm of the œsophagus, which grasps it. It is therefore necessary to wait and to take advantage of a moment when the resistance is less, and even then the obstacle may not move.