Diseases of the larynx / by J. Gottstein ; translated and added to by P. McBride.

  • Gottstein, J.
Date:
[1885]
Catalogue details

Licence: Public Domain Mark

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

    36/288 page 24
    CJENEHAI. DIAGNOSIS. as not to irritate toiiguo or pliarynx, and placed in sucli a position that it reflects the interior of the larynx. 1. The Position of the Patient.—Tlie patient sits opposite the observer with his back against the edge of the table, or better so that the table is to his right. The lani]) stands near his shoulder, so that it approaches the latter as much as possible and is situated in the plane corresponding to the front of the shoulder. If it be not desired to use the image of a flame which is equal to it, but the diminished image, the lamp must be placed behind the patient, and its distance must be greater in proportion to the focal distance of the reflector. The flame should be on the same level as the mouth of the patient. In order to make this possible for patients of different heights one may use either a chair which can easily be made higher or lower, or a lamp which can be adjusted to any desired elevation. The patient bends the head a little back, opens his mouth as far as he can, stretches out his tongue, surrounds it with a linen cloth, and holds it, with his thumb underneath and two fingers above. He should be directed to sit straight, not to bend his back, and not to inchue his head to either side. The observer must, of course, accommodate his head to the height of the patient so that he can see into tlie mouth. After the position has been regulated in this wa.y, the next point must be attended to. 2. Illumination.—The reflector, Avhich is so attached to the head that one eye can conveniently see through tlae central opening, is turned so that the centre of the disc of light (or image of the flame) falls on the uvula. The reflector may also be placed in position before the tongue is put out and taken hold of, and the condition of the pharynx examined while the tongue is depressed with a spatula or with the handle of a laryngeal mirror. We prefer to inspect the fauces by means of daylight before beginning a laryngoscopic examination. Having satisfied himself that the illumination is sufiicient, and properly adjusted, the observer passes to the next or third step. .3. Introduction of the Laryngeal Mirror.—The mirror is now warmed over a lamp on its reflecting surface, so that the moisture of the expired air may not dim it,* and after the observer has assured himself that it is not too hot by pressing it against the back of his hand, he takes the handle like a penholder between the thimib index and middle finger of his right hand, and, while the patient is made to say eh, introduces it into the pharynx in the following manner. At first the handle is held oblitpiel}' downwards in the direction of the operator's hand, the mirror is kept in the middle line, as far as possible away from the tongue, and pushed on with its bacli parallel to the palate, without, however, touching it until it reaohes the uvula which * If the miiTov be heUl over a laiiii) until iv film has formed anil a^ain disjinpeareil the projjer a'.uuunt of warmth is usually attained (Translator).
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