king attacks, both due to spasm, sometimes even after the body has
passed on, and the pain is not always referred to the seat of the
injury.

The _diagnosis_ is made by the history, and by the use of the
fluorescent screen, or X-ray photographs (Figs. 283, 284). The
oesophagoscope is also of great value, both for diagnostic purposes
and as an aid in the removal of the impacted body. Bougies are to be
employed with great care, as there is a danger of pushing the foreign
body farther down, or of wedging it more firmly in the oesophagus, and
the information obtained is often misleading.

[Illustration: FIG. 283.--Radiogram of Safety-pin impacted in the
Gullet and perforating the Larynx.

(Professor Annandale's case. Radiogram by Dr. Dawson Turner.)]

[Illustration: FIG. 284.--Denture impacted in Oesophagus.

(Professor F. M. Caird's case.)]

It should be borne in mind that drunkards may suffer from a form of
spasm of the oesophagus, which simulates the impaction of a foreign
body; hospital records also show that the patient may only have dreamt
that he has swallowed a foreign body, usually a denture. These
possibilities should be always excluded before further procedures are
undertaken.

_Treatment._--There being no urgency, a careful examination is carried
out, not only to confirm the impaction of a foreign body, but its site
and its relation to the wall of the gullet. In skilled hands, the
safest and most certain means of removing impacted foreign bodies is
with the aid of the oesophagoscope. If this apparatus is not
available, other measures must be adopted varying with the nature of
the body, its site, and the manner of its impaction.

A bolus of food, for example, or a small smooth object that is likely
to pass safely along the alimentary canal, if it cannot be extracted
with forceps, may be pushed on into the stomach by the aid of a
bulbous-headed or sponge probang. This must be done gently, especially
if the body has been impacted for any time, as the inflammatory
softening of the oesophageal wall may predispose to rupture.

Small, sharp, or irregular objects, such as fish bones, tacks, or
pins, may be dislodged by the "umbrella probang"--an instrument which,
after being passed beyond the foreign body, is expanded into the form
of a circular brush which, on withdrawal, carries the foreign body out
among its bristles.

Coins usually lodge edgewise in the oesophagus, and are best removed
by means of an in