Diseases of the larynx / by J. Gottstein ; translated and added to by P. M'Bride.

  • Jacob Gottstein
Date:
[1885?]
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the larynx / by J. Gottstein ; translated and added to by P. M'Bride. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    is slightly raised upon its posterior surface. At the same moment the handle is raised and likewise turned outwards—that is to say, towards the left angle of the mouth (provided the operator is using his right hand) until the larynx is brought into view. WHiile the operator keeps the handle depressed until the uvula is reached, care must be taken tliat the anterior edge of the mu-ror does not touch the tongue. One cannot be too careful in separating the two positions which have been described, for the beginner is always inclined to introduce the mirror at once ^vith the handle held vertically. To what extent the latter must eventually be raised (that is to say how large an angle the inclination of the mirror should form with the plane of the laryngeal aperture) depends upon the extent to which the i)atient's head is inclined backwards, also upon the angle between the laryngeal apertm-e and the horizon, and in part upon the ])Osition of the patient; although the variations are within very narrow limits, the observer must in each case find the laryngeal image for himself by elevating the handle more or less according to circumstances. The mirror itself must not in the meanwhile be moved from its position in front of the uvula, but its inclination may be changed by slight alterations in the position of the handle. These slight alterations are also necessary in order to bring the various portions of the larynx into view. The handle must not be grasped too tightly, and we recommend that it be rested upon the middle finger whUe only sliglit pressure is exercised by the thumb and index. In this way lightness of touch, together with accuracy, is attained. It is also better for the patient to hold his own tongue. The observer should accustom himself always to look through the central opening of the reflector, whether the latter be attached to the head or to the lamp. The other eye should not be closed, for with it he may, if the oral cavity be large enough, see past the edge of the reflector into the laryngeal mirror. If it be seen after introduction of the mirror that the illumination through faulty position or displacement of the reflector is insufficient, it is better to take out the mirror and readjiist the reflector than to move about the head and to keep the mirror fixed in the patient's throat. It has been assumed that the examination is made with a reflector; but if illumination by means of lenses be used, the only difference is the position of the observer in relation to the lamps, which has been before considered. If sunhght be used the patient sits with his back to the source of light, which is thrown into his mouth by means of a plane or even a concave mirror.* Illumination by means of sunlight gives the most distinct laryngeal images, and we strongly recommend its use when possible, because the jDarts are reflected in normal colours. The employment of diffused daylight concentrated by means of a reflector of .30 cms. focal distance is less to be recommended. SPECIAL OBSTACLES TO LARYNGEAL E.KAMINATION. Cases in which, in spite of dexterity and patience on tlic part of the physician, no satisfactory view of the larynx can be obtained certainly occur, but are very rare ; in most persons a satisfactory result is obtained at the first sitting, and it is only in exceptional cases that special preparation and training are necessary. At the same time, many cases * If a concive mirror be n.se,l cue must bo taken to avoid burning tl.e iilm.ynx (Translator).