Article VII.-Observations on the Removal of Foreign Bodies 
lodged in the (Esophagus. Read before the Philadelphia Col- 
lege of Physicians 30 July 1828. By Henry Bond, M.D. 
[With a Plate.] 
There are few medical practitioners who have not been per- 
plexed with cases of a foreign body lodged in the passage from the 
mouth to the stomach. And it must be admitted, that the subject 
has been treated of by surgical writers more vaguely than would 
seem to us consistent with its importance ; whether we regard, on 
the one hand, the surgeon's perplexities and failures, or, on the other, 
the patient's distress and danger. Cases often occur where the 
result is fatal; and perhaps there is no one where the practitioner is 
oftener unsuccessful in fulfilling a clear indication. This is not, 1 
apprehend, owing to any intrinsic and insurmountable difficulty; 
and had it received as much attention as some others of not more 
importance, the practitioner might be charged with mal-practice, 
who should fail of giving prompt relief to his patient. Some who 
have written systems of practical surgery have wholly omitted the 
subject. One reason of this neglect perhaps may be, that in the 
treatment of these cases reputation is neither acquired nor lost. 
They are much less attractive to popular admiration than those 
cases where there is a display of knives, and gashes, and blood. As 
one proof of this, it may be remarked, that the dealers in terrible BOND ON REMOVING BODIES FROM THE (ESOPHAGUS. 
279 
accidents and operations seldom deem these cases worthy of a place 
in their chronicles. 
Foreign bodies are usually arrested so high in the fauces or pha- 
rynx, that they are visible upon depressing the tongue, and looking 
into the throat. In such cases relief is usually afforded without 
difficulty by means of the fingers or a dressing forceps. But when 
the body has passed into the oesophagus, beyond the reach of the 
eye and the finger, the difficulty is much increased. The difficulty 
and danger of the case will abo depend very much upon the size, 
form, and composition of the body. In some instances if relief be 
not afforded by the prompt removal o ' it, the patient is suffocated, 
and perishes immediately. Does this result depend upon the mechani- 
cal obstruction to the trachea, or upon the spasmodic constriction of 
the muscles of the glottis ? Mr Charles Bell says, (and the opinion 
was adopted by Dr Dorsey) that, "it is not the mechanical obstruc- 
tion to the traclfea which we have to dread from bodies sticking 
either in the trachea or oesophagus; it is the spasmodic contraction 
of the muscles of the glottis." After enumerating all the substances 
which are liable to lodge in the throat, he says, "aZZ these endanger 
suffocation by exciting the muscles of the glottis." This opinion 
may be true so far as it applies to foreign bodies in the trachea ; 
but as it regards the pharynx and oesophagus, it is confirmed neither 
by my observation, nor by the cases which I have found recorded, 
or which have otherwise come to my knowledge. In nearly or 
quite all of those cases where immediate suffocation takes place, the 
body is of sufficient magnitude to produce a mechanical obstruction. 
The patient, through fright or voraciousness, attempts to swallow a 
large piece of tough meat, or other substance; the epiglottis falls 
down; the foreign body descends upon it, and becomes impacted 
between the horns of the os hyoides and those of the thyroid carti- 
lage, where it is held by the efforts of the muscles of the pharynx to 
carry it down. Where there is a spasmodic closure of the glottis 
produced by the irritation of a foreign body, there will be a spas- 
modic effort of the chest to throw it off by coughing. If coughing 
could be induced in the case we are contemplating, there is very 
little doubt but the body would thereby be dislodged. But the me- 
chanical pressure upon the epiglottis prevents the inspiration, with-' 
out which coughing cannot take place, at least with any considera- 
ble impetus. 
When suffocation takes place, in consequence of the inflammation 280 
OJUG INAL COMMUNICATIONS. 
and tumefaction caused by the pressure of a foreign body, the result 
is not attributable to the irritability of the glottis, but to the mecha- 
nical obstruction produced by the swelling. Where death occurs 
suddenly, after the lodgement of a large body at the top of the 
larynx, the glottis does probably contract spasmodically; but if the 
body did not act mechanically, in the manner above described, 
coughing would be induced, and the body dislodged. A barb of 
rye or wheat, or other small body, may become fixed in or near 
the glottis, and irritate so much as to lead to a fatal result by cough- 
ing or otherwise ; but I know of no instances where suffocation has 
been produced by pins, needles, fish bones, or the like, irritating 
the glottis to contract spasmodically. 
These views seem to me to be legitimate deductions from the ana- 
tony and physiology of the parts, and from the history of cases as 
far as they have come to my knowledge. But I forbear any further 
discussion of this point, as I began this communication with the 
intention of making only some practical remarks on the means and 
methods of treatment. This will necessarily vary, according to the 
properties of the body, and the part of the canal in which it is 
arrested. This most commonly takes place in the middle or lower 
part of the pharynx, but it may occur at any point between the pala- 
tine arches and the cardia. If the body be large, it will not descend 
to the narrower or lower part of the pharynx, but will be fixed at, or 
near the top of the larynx. It is the lodgement of a large body at 
this part, which occasions nearly all the sudden deaths which occur 
from foreign bodies lodged in this canal. Death occurs so suddenly 
in these cases that medical aid is seldom obtained until the patient 
is beyond its reach. Were a person at hand at the occurrence of 
the accident, who understood the nature of the case and the remedy, 
relief would be easy and certain ; for in these imminently dangerous 
cases, the body will be found, as before stated, locked between the 
cornua of the os hyoides and thyroid cartilage. From this position 
it may be removed by the finger or by the common dressing forceps, 
if the curved forceps are not at hand. If the foreign body be in any 
other part of the pharynx, there will be much less immediate danger. 
In most cases where a foreign body is to be removed from the 
throat by the fingers or by other means, it would be advisable to 
put a piece of soft wood or cork between the teeth. This advice 
is, however, of less importance to be observed, than that of Mr C. 
Bell, who says, " we ought not in an impressive and rapid manner BOND ON REMOVING BODIES FROM THE (ESOPHAGUS. 
281 
to seize upon the patient; for this puts him into terror and anxiety, 
that increases the difficulty of breathing. Without much loss of 
time, it is possible to sit down before him in that composed manner 
which will give him confidence of relief." 
If the body is to be removed by the fingers, let the patient's head 
be erect, and held in such a manner as to make the chin project as 
little as possible beyond the pomum Adami. This will enable the 
operator to carry his finger considerably farther into the pharynx 
than when held in the natural position, and he can with ease reach 
that part where the body lodges. If the body descend beyond the 
reach of the finger when held in this manner, it will be too low to 
endanger an immediately fatal result, unless it lodge directly opposite 
to the top of the sternum. By pressing on the posterior-part of the 
thyroid and cricoid cartilages, a large foreign body may produce 
some difficulty in respiration, but very seldom to a dangerous extent, 
as those cartilages have so much firmness, that they would be shoved 
forward or to one side, before they would be so compressed as to 
stop respiration. The trachea is much more easily compressed, 
but it is also surrounded by parts so loose and lax, that a foreign 
body in the oesophagus would displace the trachea, before it would 
compress it so as to interrupt respiration, except at the top of the 
sternum, where it might take place to a dangerous extent. This 
view is supported by a case recorded in the 3d volume of the Dub- 
lin Hospital Reports. Something had stuck in the throat of an 
aged woman while eating, which nearly produced fatal suffocation ; 
and on inquiring where she felt the distress, she pointed to a parti- 
cular part of the throat which appeared to be directly opposite to 
the top of the sternum. Mr Howship " passed a probang down her 
throat to the piece of meat forming the obstruction, and pushed this 
substance nearly down into the stomach, when relief was immedi- 
ately obtained, it being evident that the mechanical pressure of the 
trachea had been the sole cause of the severe symptoms." I might, 
with propriety, have referred to this case as confirmative of the 
views which I advanced when examining Mr Bell's opinion of the 
cause of suffocation. The efforts of the finger may be aided when 
the body is large by grasping the trachea and oesophagus with some 
firmness immediately below the point where the body rests, and at 
the same time shoving the hand upwards. This grasp, for obvious 
reasons, should not be long continued. If the body cannot be re- 
moved by means of the finger alone, let the tongue be depressed by 282 
ORIGINAL COMMUNICATIONS. 
the fore finger of the left hand on a spoon handle, and the operator 
will be able to see the body and grasp it with a forceps. If a gula- 
forceps is not at hand, the common dressing forceps will answer the 
purpose. Any person with self-possession and an ordinary share 
of manual dexterity might be very readily taught how to afford re- 
lief in such cases, although possessed of no anatomical knowledge 
or surgical skill. 
Besides the larger bodies, to which the preceding remarks have 
more special reference, other bodies, such as needles, pins, bones, 
&c. may lodge in the fauces or pharynx without endangering suf- 
focation. These cases are, however, not always free from difficulty 
and danger, as may be seen by referring to baron Larrey's ac- 
count of the case of M. Esteve*. The difficulty in such cases 
arises principally from the smallness of the body allowing it to be 
concealed in some sinus. This at least was the fact in the case re- 
ferred to; but there are, 1 apprehend, few such lurking places about 
the fauces, which could not be explored by the finger or the eye. 
When the foreign body descends into the bottom of the pharynx, 
or into the oesophagus, although the immediate danger is lessened, 
the operator's task becomes more difficult, and the difficulty in- 
creases in proportion to the depth to which it descends, unless the 
body be such as may with safety be forced into the stomach by 
means of a probang. So great, indeed, has the difficulty been con- 
sidered, that the idea of extracting a body from the oesophagus 
through the mouth by instruments seems to have been almost hope- 
less among surgeons. When a body has passed out of sight, or out 
of the pharynx into the oesophagus, Mr B. Bell says, " No advan- 
tage can be derived from the forceps; and we are in such circum- 
stances reduced to the necessity of either allowing it to remain 
where it is; of pushing it into the stomach; or of extracting it by 
laying the oesophagus open." " In every case of obstruction of the 
oesophagus," proceeding from a foreign body being fixed in it, he 
says, " it is almost the universal practice to endeavour to push it 
into the stomach." 
Mr Bell indicates the cases where he thinks this would be " the 
most prudent method of getting free from it;" at the same time 
pointing out the danger of the indiscriminate use of the probang, as 
* See Hall's translation of Larrey's Memoirs of Military Surgery, Vol. I. 
p. 142. BOND ON REMOVING BODIES FROM THE (ESOPHAGUS. 
283 
well as the mischief which may result from the use of strong vomits. 
It will be seen by referring to his Surgery, that he never contem- 
plated the removal of a foreign body from the oesophagus by for- 
ceps, or any other instrument except the scalpel ; and we are 
directed to make no attempts to remove it unless the symptoms are 
very urgent. We must wait for the body to decompose, or until 
the oesophagus ulcerates enough to give it an outlet. If however 
the symptoms are too urgent to admit of this delay, we must, as he 
thinks, proceed to oesophagotomy. Mr Allan Burns entertained 
nearly the same opinion as Mr B. Bell of those cases where a 
foreign body gets below the pharynx. " But if it stick just at the 
top of the oesophagus," he says, " it is there too low to be laid hold 
of by the fingers; and even the curved forceps can hardly be so 
applied as to extract the foreign body; neither will the probang 
enable us to force it into the stomach; or granting that it would, 
we may have reasons for not wishing to place it there." If, in such 
a case, the foreign body occasions very unpleasant symptoms, he 
says, "there ought to be no hesitation in performing the operation 
of oesophagotomy." It was the opinion of Dr Dorsey (which we 
presume was also that of Dr Piiysick) that foreign bodies can be 
extracted through the mouth, only when they are situated high up 
near the fauces. " If near the stomach, they must," says Dr Dor- 
sey, " be pushed down, and the risk of the consequences incurred." 
Some surgeons, on account of the dread which they attach to the 
operation of cutting into the oesophagus, which they think should 
almost never be performed, have proposed several instruments or 
contiivances for the extraction of foreign bodies from this canal. 
The success of practice in these cases shows that the patient is 
very often obliged to trust to vis medicatrix naturce^ rather than to 
these contrivances for his safety. I shall first notice in a brief 
manner the means which have been proposed for extracting foreign 
bodies from the oesophagus, and then propose some of my own, 
which I venture to hope may be considered improvements in the 
treatment of such cases. 
The instruments which have been recommended, or are now in 
use in such cases, are forceps, hooks, compressed sponge, and 
loops of thread or horse hair. 
It is hardly proper to include the forceps among the instruments 
employed for extracting foreign bodies from the oesophagus, as I 
have already shown that it is generally concluded to be inapplica- 284 
ORIGINAL COMMUNICATIONS. 
ble to such cases. The crooked, or gula-forceps (fig. 2) is well 
adapted for the removal of large foreign bodies from the pharynx ; 
but for extracting bodies from the (esophagus, it is defective in 
several respects. It is too short; its curve is such that it would be 
next to impossible to carry it down that canal if it were long enough, 
being curved in such a manner as to be accommodated to the 
course of the canal when the head is held in a natural position ; the 
blades come into opposition by broad surfaces, terminating in an 
acute prominent edge, like two half cylinders ; so that when the in- 
strument is passed down the throat we are almost sure to pinch 
some of the surrounding soft parts, if we attempt to grasp any 
small body ; if we grasp a^in or needle, the teeth or deep transverse 
grooves in the blades render it necessary either to bring out the 
body transversely, something like dragging a fish-hook through the 
fauces, or to run a great risk of losing our hold of it. On referring 
to a large volume of plates of surgical instruments, published at 
Vienna, by G. A. Brambilla, I find some crooked forceps conside- 
rably longer and heavier than those now in use here and in England, 
but liable to the same objections, and from their shape evidently 
not intended to be carried below the pharynx, The crane-bill for- 
ceps, recommended by Mr C. Bell, is exempt from none of the 
foregoing objections. In short, we may say that these instru- 
ments cannot be trusted out of sight. The forceps recom- 
mended by Mr J. Hunter for extracting foreign bodies from the 
urethra, has been recommended also for extracting small bodies 
from the throat. It would be less liable to pinch the contiguous 
soft parts, but in every other respect it seems to be decidedly infe- 
rior to the common dressing forceps*. The ostagra of professor 
* In the Medico-Chirurgical Transactions, Vol. XI. page 359, there is an 
account of a modification of Mr Weiss's bullet forceps, by which it was con- 
verted into an instrument for the extraction of small calculi from the bladder. Mr 
Samuel Cooper, referring to this instrument in the fifth edition of his Surgical 
Dictionary, says " no instrument seems better calculated for cases in which the 
body lodged in the oesophagus is not too wide." It does not however appear to 
me superior in any respect to Desault's modification of Hunter's foiceps, 
either for extracting urinary calculi from the bladder, or foreign bodies from the 
oesophagus. And, by the way, we cannot forbear to exptess our surprize, that 
Sir Astley Cooper should have been ignorant of the practice of Desault so 
late as 1820, six years after it had been circulated in the United States in an 
English translation. In size and shape, the forceps above recommended by Mr BOND ON REMOVING BODIES FROM THE (ESOPHAGUS. 
285 
Venel was contrived to be employed in these cases; but it is a 
complicated awkward instrument, whose place can, in every in- 
stance, be better supplied by some other. 
Every writer at present, who treats on this subject, recommends 
the use of a hook. It was formerly the custom to attach a small 
steel hook to the handle of a probang, or to a piece of whalebone, 
by means of a piece of watch-spring. But it is of late commonly 
recommended to be made of a doubled and twisted wire, with a 
loop at the end bent into a hook. We find a representation of its 
figure in some surgical works, and nearly the same in each. Fig. 5 
is the same as that in Mr S. Cooper's First Lines, and does not 
differ essentially from that represented in Mr C. Bell's Operative 
Surgery. There are very few cases to which such a hook would 
be well adapted. It is ill suited to extract a coin, as such a body 
would be so liable to slip out of it. It would take no hold of a pin, 
needle, or fish-bone ; for when these bodies are lodged in the oeso- 
phagus, they have descended point foremost; the point catches in 
some ruga or lacuna, and the efforts made to carry them down into 
S. Cooper, has almost an exact resemblance to a large male silver catheter 
bisected longitudinally about three inches and a half from its point. These two 
halves or sections are opened by a stilet sliding in the inside ; and are closed only 
by their own elasticity. Its curvature will not allow it to pass much below the 
bottom of the pharynx; and if it should be forced lower down, the point would 
press so hard against the anterior part of the oesophagus, that there would be very 
little chance of seizing the body, and every probability of embracing a large fold 
of the canal in closing the blades. There is no way to regulate the force applied 
to the body which it embraces, and it must be small, or that stilet would not 
open it. The blades form so large an angle with each other when opened, that 
no body would be held securely except the small calculi, for which it was 
intended, or other small globular bodies. As an oesophagus forceps, it is there- 
fore in no respect superior to the common curved forceps. It is true, it has no 
joint; but when a forceps is carried down into the oesophagus, there is so little 
motion in the joint when the blades are opened or closed, that there is not much 
probability that the soft parts will be injured there. 
In Perret's L' Art du Coutelier, plate 98 is the representation of a forceps 
designed for the removal of foreign bodies from the oesophagus. It is called 
acanthobalon by Paul, Hildet, and others. Excepting its curvature, it is 
made exactly like the common bullet forceps. The instrument is straight until 
we pass an inch and a half beyond the joint. The rest of the blades are bent so 
as to correspond nearly with the quadrant of a circle whose diameter is eight 
inches. Its curve is therefore more favourable to a deep introduction into the 
oesophagus than any other of which I find any account. Its defects may be per- 
ceived from what I have already said of others. 
Vol. VI.-No. 12, October 1828. 37 286 
ORIGINAL COMMUNICATIONS. 
the stomach have often driven the point into the side of the canal, 
so as to adhere with considerable firmness. The upper or obtuse 
end of these bodies is generally loose or floating; that is, it is not 
fastened into the opposite side of the oesophagus. This doubtless is 
not always the case, but how often both ends are fastened in oppo- 
site sides of this canal it is not easy to determine. Under either of 
these circumstances there is not a great probability that such a hook 
as that represented by Mr Cooper would dislodge one of these 
bodies, and none that it would extract them by the mouth. All 
that Dr Dorsey says upon the use of hooks, is, " that a hook of 
curved wire is also useful in some cases for extracting foreign mat- 
ters, especially when they are of considerable size." Upon this 
opinion, unsustained by experience as far as I know, it may be 
remarked, that if the body has lodged in consequence of its size, it 
would be very difficult to pass a hook below it, especially if the 
hook were large enough to take hold of " a body of considerable 
size." There is therefore every probability that a hook of the ordi- 
nary form would act as a probang. Besides, let a person attempt 
to apply such a hook to any body of a regular or rounded form, or 
a smooth surface, such as a nut, a peach-stone, a lump of meat or 
potatoe, and he will in a moment see how improbable it is, that 
such a hook would extract such a body. If the body to be removed 
had any holes or projections upon which the hook could fasten, and 
would at the same time allow the hook to pass below it, in such a 
case the hook might be useful; but under this restriction its use 
must be very limited. 
Mr C. Bell says, " Nothing is so good to pull up bodies from the 
oesophagus and pharynx as a piece of wire twisted and bent into a 
hook, as I have represented in the plate. The advantage of this 
simple instrument is, that it can be made of any form, or take any 
curve, enabling us to adapt it so as to operate upon that side 
where the pin or bone is supposed to lodge." We admit the supe- 
riority of the wire-hook over others and for the reason he has as- 
signed ; but we are extremely doubtful of the ability of Mr Bell or 
any one else " to pull up from the oesophagus and pharynx" either 
a pin or stone with the hook he has represented. 
For the extraction of a pin from the oesophagus, he has proposed 
to carry loops of horse hair down to it on the end of a wire through 
a hollow tube, in the expectation of entangling the head of it. The 
probability of the success of this contrivance is sufficient to warrant BOND ON REMOVING BODIES FROM THE (ESOPHAGUS. 
287 
a trial of it, when other more certain means are not at hand. For 
the extraction of needles and fish bones, he offers no rules nor 
means which encourage us with any prospect of success. Neither 
his forceps, nor his hook, nor his loops are applicable to such cases. 
Mr S. Cooper's ingenious method of using compressed sponge 
seems to me more extensively applicable, and to hold out a greater 
prospect of utility, than Mr Bell's loops of hair. It would, how- 
ever, much more frequently dislodge small bodies that become fixed, 
than extract them through the mouth. One objection to it is, that 
if the first trial were not successful, it would require a considerable 
time to prepare the sponge to repeat the experiment. 
It is easy to conceive of cases where it would be hazardous to 
resort to vomiting for the removal of foreign bodies ; for they may 
have such sharp points or edges, or raggedness, that we should run 
a great risk of cutting or lacerating the passage by their violent 
action. A very small portion, however, of those bodies, which 
lodge in the oesophagus, have a form which precludes the use of 
emetics. They promise to be more certainly useful, where the bo Jy 
is of a regular or rounded form and smooth surface, and is arrested 
in the passage on account of its magnitude. If a small body, having 
only one rough or sharp point (such as a pin, or one half of a round 
bone of a bird or chicken), be arrested in the passage, we may 
always presume that it has descended point foremost. In such cases 
emetics may be used with impunity; but, if the descending point be 
so slender as to penetrate with ease the side of the canal to a con- 
siderable depth, we shall use them with small prospect of success. 
Such a piece of bone as that just mentioned would without much 
doubt be thrown up, as the point would not penetrate far, and it 
would be of such a size, that both the contents of the stomach pass- 
ing up, and the inverted action of the canal would have some power 
over it. When the sharp slender point of such a body as a pin or 
needle penetrates the side of the cesophagus, the direction of the 
body is as nearly transverse to that of the canal as its length will 
admit of; but when an emetic operates, the pin is brought nearly 
parallel to the axis of the canal, which will occasion the point to 
stick more firmly, and at the same time neither the contents of the 
stomach passing up nor the inverted action of the oesophagus can 
act with any force upon it. Hence pins can seldom be removed by 
this means, especially if they have been lodged a considerable 
time, and attempts have been made to carry them into the 
stomach, I have repeatedly employed vomits in such cases, and 288 
ORIGINAL COMMUNICATIONS. 
never with success; but J once removed part of the clavicle of a 
chicken immediately by the use of sulphate of zinc. The above re- 
marks will apply to a needle, except for the circumstance that the 
two ends of it, especially if it be small, may fix in opposite sides of 
the canal. In such a case, an emetic will cause the body to be 
more firmly fixed; but if the needle be long and large we need not 
dread this accident, for it will remain nearly parallel with the course 
of the canal. An irregular rough fragment of bone would perhaps 
never be removed by the mere inverted action of the oesophagus, but 
it might sometimes be forced up by vomiting, if this should be in- 
duced soon after swallowing a considerable quantity of solid food. 
The success attending the use of vomits for the removal of coins 
from the oesophagus is not such, so far as I can learn, as to encou- 
rage a resort to them. A case occurred within a few days in this 
city, where vomits were repeatedly tried without success in the case 
of a child who had swallowed a half cent. After a coin has been 
in the oesophagus for some time, the part where it lodges has, from 
continued distention, lost its contractility; the parts above and below 
contract, perhaps the more on account of the neighbouring irrita- 
tion ; a sort of pouch or sinus is formed for the foreign body, and, 
as the natural position of the coin would be vertical, there would 
be space enough for the contents of the stomach to pass up without 
dislodging the coin. 
Two cases are quoted in the Diet, des Sciences Med. Tom. VII. 
p. 21, 22, in which persons, at the very point of suffocation from 
the lodgement of large pieces of tough meat in the pharynx, were 
relieved by injecting a solution of tartarized antimony into a vein in 
the arm. In Dorsey's Surgery tw'o cases are noticed, in which Dr 
Physick removed peach stones from the pharynx by directing the 
patients to take a solution of tartarized antimony in the mouth and 
to attempt to swallow it. These and other similar cases show that 
it would be very unwise to discard emetics from among the means 
of treating such accidents. 
Another means of relief deserves to be noticed, as it has suc- 
ceeded in cases where other means failed. As professor Richard 
W. Hall, of Baltimore, is the only writer by whom I find it men- 
tioned, I will present it in his own words. It is contained in a note 
to his translation of Larrey's Memoirs of Military Surgery, Vol. I. 
p. 143. " When a small bone is lodged in the fauces or oesophagus, 
it may be decomposed, or rendered so flexible that it will pass into BOND ON REMOVING BODIES FROM THE (ESOPHAGUS. 
289 
the stomach, by taking frequently of diluted mineral acids. They 
should^be taken through a tube to prevent their action on the teeth. 
The strength of the acid should be accommodated to the sensibility 
of the parts over which it must pass. By this means I have suc- 
ceeded in removing a small chicken bone from the oesophagus, 
across which it had remained firmly fixed for several hours, although 
an emetic had been administered, and the curved forcd/s and pro- 
bang had been repeatedly used without success. Experiment shows, 
that even the acetic or acetous acid will decompose the bones of 
fish, and leave them in a pliant and gelatinous state." 
Although forceps have never been carried deep into the oesopha- 
gus, a slight attention to the subject is sufficient to'Satisfy any one, 
that there is nothing in the structure of this passage to prevent the 
introduction of an inflexible instrument to any depth. I have 
already pointed out the defects, as they appear to me, of all the 
forceps which have been recommended for the extraction of foreign 
bodies from this passage; and these defects may all be traced to two 
erroneous ideas, viz. 1, That a forceps cannot be trusted below 
the pharynx for fear of pinching or lacerating the soft parts; and 
2, that the bend of the instrument must be adapted to the course 
of the passage when the head is held in its natural position. 
While held thus it would be impossible to carry an inflexible instru- 
ment to the bottom of the oesophagus; but by carrying the head back 
to no dangerous or painful extent, even a straight instrument may 
be carried down into the stomach, as is evinced in the performances 
of jugglers, who swallow swords, &c. 
I have caused a forceps (fig. 1) to be made, which seems to me 
to possess some advantages which do not belong to any other. 
1. I have given it such a curve, that when the head is held back 
in a proper position, it may be introduced into the oesophagus to any 
depth, even into the stomach. Whether in this first attempt I have 
succeeded in giving it that curvature which upon further trial shall 
be found best, I cannot assert; but my object was to make it such 
that it would pass down with facility when the head is carried back, 
so as to make the axis of the whole passage from the mouth to the 
stomach approximate as near to a right line as could be done with- 
out giving the patient inconvenience. In some trials with it, I found 
it could be introduced with great ease. An inexperienced hand 
would be less liable to carry its point into the larynx, than that of 
the common curved or gula-forceps. Should experience hereafter 290 
ORIGINAL COMMUNICATIONS. 
indicate any change in its shape, it probably will be to make it less 
curved. 
2. The next advantage which it possesses, is, that the blades 
may be opened and closed in the oesophagus without pinching or 
otherwise injuring the contiguous soft parts. This object is fully 
accomplished by the manner in which the edges are ground or 
beveled o^' and by the sheath of elastic gum which embraces the 
joint without impeding its motion. The blades of the forceps are 
so long and can be opened only so short a distance in the oesopha- 
gus, that there will be very little motion at the joint, and in almost 
every case I should therefore consider the sheath superfluous. 
Should any one consider the instrument unsafe without it, it should 
be a little longer than the joint, and may be made by sewing with the 
glover's stick a thin piece of gum elastic, of the proper dimensions; 
or it may be made more neatly by adopting the method for making 
a tube, which is recommended in Ure's Chemical Dictionary. 
(See Art. Caoutchouc.') 
3. Another advantage is, that by means of the narrow line of 
rough surface by which the blades come in contact, it will hold such 
a body as a pin, needle, fish-bone, &c. more securely than the com- 
mon curved forceps, and extract it with little or no danger of lace- 
rating any part of the passage. At the same time that it holds the 
body fast, it allows it to vibrate freely, and to assume a position nearly 
parallel to the blades. For the extraction of a coin its adaptation 
seems to be perfect. In short, it appears to be more especially 
adapted to the removal of those bodies which are arrested on ac- 
count of their form, and not on account of their volume. When a 
body, without any sharp points or projections, such as a chesnut, a 
small apple, or piece of meat, is lodged in the oesophagus, we may 
presume that the canal, at that point, will be so distended that there 
will be some difficulty in passing the blades below the body. This 
probably will seldom be practicable where the body has been 
forced down by the bold application of the probang. But where 
the body has been carried only so far down as it could be done by 
the action of the muscles, it is probable that by opening the blades 
so as to distend the oesophagus considerably, just before they reach 
the body, they might be carried below it. By opening the blades 
in this manner they would necessarily pass down on opposite sides, 
so as to bring the body between them, and embrace it securely, un- 
less it were vitreous or very hard and polished. But in most cases of BOND ON REMOVING BODIES FROM THE (ESOPHAGUS. 
291 
large, regular, or smooth bodies lodging in the oesophagus, if there 
be any difficulty in extracting with instruments, we may resort to 
emetics with very strong hopes of success ; for it is to such cases 
that they are more especially adapted. 
Although I believe there are few cases where the need of a hook 
will not be superseded by the forceps here presented to the profes- 
sion : yet, as I have pointed out the defects of such a hook as we 
find in the books, I take the liberty to offer some modifications, as 
hooks may be made extemporaneously when a forceps is not attain- 
able. The hook fig. 3 is intended more especially for the extrac- 
tion of pins. It may be made of doubled wire, but I should prefer 
it single, similar to the plate. A single wire is sufficiently firm for 
all the force it would be prudent to employ; it presents a smoother 
surface to the soft parts over which it passes than a doubled and 
twisted wire ; it is more easily bent so as to act in different direc- 
tions ; and perhaps there would be some small difference in its 
favour in the facility with which it would catch the body sought for. 
If it should be thought that the lower end of the hook, on account of 
the shortness of the bend, presents too sharp a point to be passed 
with safety down the cesophagus, cover the point with a drop of 
sealing wax. This precaution would be needless in hands of ordi- 
nary dexterity,-and destitute of it, no one ought to meddle with 
surgery. The space between the ascending and descending parts 
of this hook should be accommodated to the size of body to be ex- 
tracted. In general it should be such as to admit the body of a 
brass pin with ease, without allowing the head to slip through. The 
two parts of the hook should be parallel to each other, about half 
an inch upwards from the bend; otherwise there will be danger, as 
soon as we have caught hold of a pin, that it will slip out and pass 
into the stomach, as I have repeatedly experienced; and, instead of 
extracting, we shall only dislodge it. With this hook there would be 
a better chance of dislodging, if not of extracting, a needle than 
with any other; but even with this it would be a doubtful experi- 
ment, and time ought not to be wasted where the forceps are pro- 
curable. The softer texture and more uneven surface of most other 
long and slender bodies render it much more probable that they 
could be extracted by this hook. To prevent the escape of a body 
from this hook, a very simple addition to it might possibly be found 
useful in some cases. I do not propose it, however, with much con- 
fidence in its utility. Let a wire, similar to that of which the hook 292 
ORIGINAL COMMUNICATIONS. 
is made, be bent at one end into a ring, just large enough to slide 
upon the handle of the hook ; and let the wire to which this ring 
belongs slide through another ring at the top of the handle of the 
hook. By dropping this sliding ring upon a body, when caught in 
the hook, there might, in some cases, be a greater probability of 
extracting it. 
For the extraction of a coin from the oesophagus, the lower part, 
if not the whole of the hook (fig. 4) should be a doubled wire. 
The descending and ascending parts of it should be only far enough 
apart to admit the coin with ease, and the two parts of the wire at 
the bend should be so far apart that it would not be apt to roll out. 
The descending and ascending parts of the hook should be parallel 
to each other, so far as to sustain the coin in a vertical direction ; 
but the point should stand off so far from the handle as to make it 
easy to catch it. A hook made in this manner would have some 
advantage over that which was presented to the profession two or 
three years ago by Dr Nathan Smith of New Haven. A coin 
would be less liable to escape from it, on account of the much 
broader resting place for it at the bottom ; the opening of it is such 
that it would more readily take hold of the body; the handle may be 
readily bent so as to act in any direction ; and it may be made ex- 
temporaneously out of a piece of common wire. 
Although a probang may in some instances be used with safety, 
I apprehend that surgery would sustain no essential loss if it were 
entirely discarded from its apparatus; for in every case where it 
would be applicable, the patient would be relieved with more ease 
and safety by the forceps, or by vomits. In those cases to which a 
a hook is applicable, the probang should seldom or never be em- 
ployed. Whether, therefore, it be advisable to retain among our 
apparatus an instrument which is never necessary, and which is 
so liable to be used in improper cases, it is not for me to decide ; 
and whether any thing contained in this communication be entitled 
to the distinction of an improvement in surgery, I leave to be deter- 
mined by this very competent tribunal, and by a profession whose 
test is experiment. 
Fig. 1 is drawn from a forceps twelve and a half inches in length, 
which will reach two or three inches below the top of the sternum. 
For reaching the bottom of the oesophagus in the adult, the instru- 
Explanation of the Plate. BOND ON REMOVING BODIES FROM THE .ESOPHAGUS. 
293 
ment should be two to four inches longer. The curve corresponds 
nearly to a circle, whose diameter is twenty-four inches. It does 
not, however, exactly correspond to a circle, for the curvature les- 
sens in passing from the handle to the point. The joint should be 
distant from the point not more than three-fifths of the length of the 
instrument, and be made long, in order that the blades may with 
more certainty come exactly in opposition. The edges of each blade 
are ground away with such a bevel that the blades present to each 
other, where they come in contact, an obtuse angle of about 130 
degrees. This angle on each blade is made rough by cutting it 
into a row of teeth, either by a chisel or a file. The point of each 
blade is ground off like the edges, so that the row of teeth is not 
continued quite to the point. This figure is half size. 
Fig. 2 is an outline of the common curved or gula-forceps, pre- 
sented here to illustrate its defects by contrasting it with my own. 
The curvature commences two inches beyond the joint; and from that 
point it forms the sextant of a circle, whose diameter is six inches. 
This might with propriety be named the fauces forceps. It is half 
size. See page 284. 
Fig. 3 is the hook which I propose for the extraction of pins,&c. 
It is of the full size, and sufficiently explained at page 291. 
Fig. 4 is the hook proposed for the extraction of coins from the 
oesophagus, and is of the full size. See page 292. 
Fig. 5 is copied from the hook represented in Cooper's First 
Lines. See page 285 of this communication. 
Fig. 6 represents a transverse section of the blades of the forceps 
fig. 1. WT Makoti, del. 
C.Toppan,Sculp ?