Rough manipulation with improvised sounds may tear, fissure, or perforate the muscular and mucous coats, producing the gravest consequences.
IV. Crushing. The crushing of an obstruction in the cervical region was long ago suggested, and is still greatly commended by empirics and farriers. It is performed by means of a little mallet and a piece of board. The method is barbarous, and exposes the animal to such grave complications as crushing of the œsophageal walls, followed by necrosis, laceration of the connective tissue, and interstitial hæmorrhage, injuries of the superficial or deep-seated jugulars, of the carotid artery, pneumo-gastric nerve, etc. It should never be practised, even although attempts have been made to improve it by replacing the mallet and board by specially formed forceps intended for crushing potatoes or roots. Only in the rare cases where one is certain that the foreign body consists of a very ripe fruit could crushing be justified, and in this case there is no need to have recourse to special instruments, for the hands alone suffice.
Injection of alkaloids. The practitioner occasionally finds himself in the embarrassing position of having vainly tried all the above methods. Before adopting the last resource, viz., œsophagotomy, it is then worth while to test the action of certain alkaloids, injected subcutaneously, after having punctured the rumen.
We know that pilocarpine and eserine stimulate secretion and the action of the bowels. Injected under the skin they cause frequent swallowing efforts, and intense peristalsis extending throughout the length of the digestive tract. Doses of 1½ to 2 grains of pilocarpine and 1 to 1½ grains of eserine, according to the size of the animal, sometimes produce excellent results, and rapidly remove obstructions.
Apomorphine, the effects of which are, so to speak, inverse, because they tend to produce anti-peristalsis and vomiting, may be tried in doses of 2 or 3 grains.
Œsophagotomy. The last resource is œsophagotomy, which, however, is only applicable in cases of obstruction of the cervical portion of the œsophagus. It should be performed as described in the section hereafter on operative manipulation. (See also Möller and Dollar’s “Regional Surgery,” p. 166.)
The point selected is necessarily governed by the position of the obstacle. There is no need to enter into full details. We may remark that it is not always necessary to perform the complete operation, and the third and fourth stages can sometimes be avoided by substituting for them attempts to break down the foreign body by submucous manipulation. The œsophagus, having been exposed and isolated, is punctured with a straight tenotome immediately below the obstacle. A curved tenotome is then introduced, and the root, potato, or fruit divided. As a rule, a little pressure from the outside then causes one or other of the fragments to move onwards and deglutition becomes normal.
Attempts have also been made to divide the obstructing body directly without previous incision and without isolating the œsophagus. It is much more difficult, for the least movement of the patient changes the relationships of the superposed layers and introduces obstacles to the manipulation of the blunt-pointed tenotome which is employed. More success often attends attempts to puncture the object with a fine trocar.
RUPTURES AND PERFORATIONS OF THE ŒSOPHAGUS.
Causation. Wounds of the œsophagus caused by external violence are rare, or at least secondary; lacerations produced from within, on the contrary, as a result of clumsy manipulation are relatively frequent. They may extend throughout the length of the tube, but in a far greater number of cases are found near the entrance to the stomach at the point where the œsophagus turns towards the left.