f the gland--usually the superior on one
side--followed by, if necessary, a partial _thyreoidectomy_.

Crile of Cleveland has organised his clinic in the direction of
arranging that the operation shall be performed without the patient
knowing that it is to take place--what he calls "stealing the
goitre"--the thorough preparation of the patient for the operation,
the minimising the risk from the anaesthetic by the combination of
novocain locally and of nitrous oxide and oxygen; and of diminishing
the risk of absorption of thyreoid secretion by packing the (open)
wound with gauze wrung out of a solution of flavin.

Operations on the cervical sympathetic cord have been abandoned.

The presence of toxic goitre may influence the question of operation
in the treatment of other surgical conditions, and may determine the
selection of one or other form of anaesthesia.

CHAPTER XXVIII

THE OESOPHAGUS

Surgical Anatomy--Methods of examination--Wounds--Rupture--Swallowing
of caustics--Impaction of foreign bodies--Infective conditions:
_Oesophagitis_; _Peri-oesophagitis_; _Tuberculosis_;
_Syphilis_--Varix--Conditions causing difficulty in swallowing:
_Impaction of foreign bodies_; _Compression of the gullet from
without_; _Spasm of the muscular coat_; _Cardiospasm_; _Paralysis
of the gullet_; _Diverticula_ or _pouches of the gullet_;
_Innocent stricture_; _Malignant stricture, including cancer at
the junction of pharynx and gullet and cancer at the lower end of
the gullet_.

#Surgical Anatomy.#--The oesophagus extends from the level of the
cricoid cartilage to about the level of the lower end of the sternum.
The distance from the upper incisor teeth to the commencement of the
oesophagus is about 5 or 6 inches, and the oesophagus measures from 9
to 10 inches. The whole distance, therefore, from the teeth to the
stomach is from 14 to 16 inches.

The cervical portion of the oesophagus, extending from the cricoid
cartilage to the upper edge of the sternum, measures about 2 inches.
It lies behind and to the left of the trachea, and in the groove
between them on each side runs the recurrent nerve. The thoracic
portion is about 7 inches long, and traverses the posterior
mediastinum lying slightly to the left of the middle line. It is
crossed by the left bronchus, and below this level has the pericardium
immediately in front of it. The left pleura is closely related to the
anterior surf