A manual of diseases of the throat and nose : including the pharynx, larynx, trachea, œsophagus, nose and naso-pharynx / by Morell Mackenzie.

  • Mackenzie, Morell, 1837-1892.
Date:
1884
Catalogue details

Licence: Public Domain Mark

Credit: A manual of diseases of the throat and nose : including the pharynx, larynx, trachea, œsophagus, nose and naso-pharynx / by Morell Mackenzie. Source: Wellcome Collection.

    24/610 (page 12)
    of the pliarynx, and is thus unlikely to enter the larj'nx. Tlie patient should sit with his neck stretched out and his head thrown slightly back, whilst the operator standing in front depresses the tongue Avith the forefinger of his left hand, and directs the point of the instrument downwanls in a slanting direction against the middle of the posterior wall of the pharynx at its loAvest part. In introducing the bougie about four inches of its length .shovdd extend lieyond the hand, and it should be pu.shed slowly and gently doAm the throat. A^Hieii the instrument is judged to haA'e entered the oesophagus, it is a good plan to teU the patient to l>end his head a little forAA^ards, and to perform the act of swalloAving. Should any obstruction to its coui-se be encountered, the instrument should be AvithdraAA’n and again carefully passed into the gullet. If it be again arrested at the .same point and the employ- ment of viiri/ cjentle ]}vessure and manijnilation fail to pass it beyond the obstacle it should be altogether Anthdrawn, and a bougie several sizes smaller introduced. Prc>cee<iing in the same manner and Avith like precaution, the ojAerator should, if the attempt does not cause any great discom- fort or irritation, try a third or fourth instrument, as the case may be, until he either penetrates the stricture or concludes that it is impermeable. Should the bougie be found to pass beyond the point at Avhich the first instrument Avas arrested, it should be pushed steadily dowiiAvanls until it reaches the stomach, AA’hilst the character of the surface OA'^er Avhich it glides, the direction in AA’hich it goes, the distance traA’ersed, and the contractile ]>OAver of the oeso- phagus at ditferent IcA^els should be carefully notetl. It is necessary to take the precaution of passing the instniment quite doAvn to the stomach, as there sometimes exists a second stricture below the first. On AA'ithdraAving the bougie the distance froih the patient’s teeth to its extremity should alAA-ays be measured. It should be remembered, hoAvever, that the distance from the incisor teeth to the orifice of the oesojihagus varies from l.'il to 17 centimetres, and in estimating the situation of an obstruction this length must be alAA’ays de- ducted from the length of the bougie ]>a.ssed into the body. If a good-sized bougie can be ])a.sseil AA'ithont encountering any obstacle, a larger one may be emjiloyed at the next visit if any symptoms of ob.struction continue. If, hoAveA-er, a Xo. Ifi (see scale, ]>. 11) can be ])a.ssed through the AA-hole length of the canal it may be concluded that there is no mechanical