strument known as a "coin-catcher", which is passed
beyond the coin, and on being withdrawn catches it in a hinged flange.
In emergencies a loop of stout silver wire bent so as to form a hook
makes an excellent substitute for a coin-catcher.

In difficult cases the removal of solid objects is facilitated by
carrying out the manipulations in the dark room with the aid of the
X-rays and the fluorescent screen.

Irregular bodies with projecting edges or hooks, such as tooth-plates,
tend to catch in the mucous membrane, and attempts to withdraw them by
forceps or other instruments are liable to cause laceration of the
wall. When situated in the cervical part of the oesophagus, these
should be removed by the operation of _oesophagostomy_ (_Operative
Surgery_, p. 195).

If the foreign body is lodged near the lower end of the gullet, it may
be necessary to perform _gastrostomy_ (_Operative Surgery_, p. 291),
making an opening in the anterior wall of the stomach large enough to
admit suitable forceps, or, if necessary, the whole hand, in order
that the body may be extracted by this route; experience shows that an
impacted body is more easily extracted from below, that is, from the
stomach, than from above.

When the surgeon fails to remove the body by either of these routes,
_gastrostomy_ must be performed both to feed the patient and to place
the gullet at rest. Smooth bodies may lie latent for long periods, but
those with points or hooks damage the mucous membrane, cause
ulceration and perforation with the risk of erosion of vessels and
secondary haemorrhage or of cellulitis of the neck or mediastinum and
empyema.

Other complications include septic broncho-pneumonia from damage to
the air-passage, and suppurative thyreoiditis.

#Infective conditions# due to pyogenic infection (_oesophagitis_ and
_peri-oesophagitis_) are rare.

A _chronic form of oesophagitis_ is occasionally met with in alcoholic
subjects, giving rise to symptoms that simulate those of impacted
foreign body, or of stricture.

In _tuberculous_ lesions the symptoms are pain, dysphagia, and
regurgitation of food mixed with blood, and the condition is liable to
be mistaken for gastric ulcer or for cancer of the oesophagus.

_Syphilitic affections_ of the oesophagus are rare.

#Varix# at the lower end of the oesophagus may give rise to
haematemesis, and be mistaken for gastric ulcer. Bleeding from the
dilated veins may follow the use of bougies or of