ace of the oesophagus throughout, while the right pleura
passes behind it in its lower part. This accounts for the frequency
with which growths in the oesophagus invade the pleura. The oesophagus
passes through the diaphragm about an inch above the cardiac opening
of the stomach.

There are three points at which the oesophagus shows narrowing of the
lumen: (1) at the lower border of the cricoid--the "mouth of the
oesophagus"; (2) where it is crossed by the left bronchus; and (3)
where it passes through the diaphragm. It is at these points that
foreign bodies tend to become impacted. The mucous membrane of the
oesophagus is insensitive to tactile and painful stimuli, but is
sensitive to heat and cold and to exaggerated peristaltic
contractions.

#Methods of Examination.#--It is sometimes possible to detect an
impacted foreign body, a distended diverticulum, or a new growth in
the cervical portion of the oesophagus by _palpation_.

_Auscultation_ while the patient is drinking sometimes aids in the
diagnosis of stricture; the stethoscope is placed at various points
along the left side of the dorsal spine, and abnormal sounds may be
heard as the fluid impinges against the stricture or trickles through
it.

_Introduction of Bougies._--Oesophageal bougies or probangs are used
for diagnostic purposes in cases of suspected stricture, and to aid in
the detection of foreign bodies. Various forms are employed, of which
the most generally useful are the round-pointed gum-elastic or
silk-web bougie, and the olive-headed metal bougie, consisting of a
flexible whalebone stem, to which one of a graduated series of
aluminium or steel bulbs is screwed. For some purposes, such as
pushing onward an impacted bolus of food, the sponge probang--which
consists of a small round sponge fixed on a whalebone stem--is to be
preferred.

Before passing bougies, it is necessary to make certain that the
symptoms are not due to the pressure of an aneurysm on the oesophagus,
as cases have been recorded in which a thin-walled aneurysm has been
perforated by a bougie. The existence of ulceration or of an abscess
pressing on the gullet also contra-indicates the use of bougies.

For the passage of a bougie the patient should be seated on a chair
with the head thrown back and supported from behind by an assistant,
and he is directed to take full deep breaths rapidly. The bougie,
lubricated with butter or glycerine, and held like a pen, is guided
with