A system of practical medicine. By American authors. Vol. 3 : $b Diseases of the respiratory, circulatory, and hæmatopoietic systems
Science
A system of practical medicine. By American authors. Vol. 3 : $b Diseases of the respiratory, circulatory, and hæmatopoietic systems
Medicine -- Practice
{33} laryngeal image the openings of the bronchi. The distance is,
however, too great for bright illumination, and nothing can be seen
distinctly, so that it is of little value in a diagnostic point of
view. During phonation the glottis is narrowed to a slit by the
approximation of the arytenoid cartilages and inner edges of the vocal
cords, and, as has already been stated, the inter-arytenoid space
becomes obliterated. In the higher notes of the female voice, the
so-called head tones, the cartilaginous portion of the glottis remains
closed entirely, while the membranous portion appears as an elliptical
opening which is diminished in its longitudinal diameter with each rise
in pitch. This becomes possible because of the presence in the vocal
cords of a slender rod-like cartilage attached to the end of the vocal
process, which can readily be seen in the female larynx, but which is
only rudimentary in the male.
This description, intentionally, has been made without reference to the
anatomical relation of the parts, but to give a clear idea of what is
seen in the laryngeal mirror. The reader should therefore always bear
in mind that the laryngeal image, being a reflected one, is reversed,
and that, on account of giving a bird's-eye view of the larynx from a
point above and behind the organ, distances are materially diminished;
and the image is also reversed in an antero-posterior direction, so
that the epiglottis appears to be posterior when in reality it is
anterior.
RHINOSCOPY.--Rhinoscopy, or the art of inspecting the nasal cavities
and the naso-pharyngeal space, is divided into two portions--viz.
anterior and posterior rhinoscopy; and it will be convenient to observe
this division in the following description of the methods employed. But
before proceeding with the description it will be well to briefly
review the topographic anatomy of the parts, because in most works on
general anatomy the nasal and naso-pharyngeal cavities are discussed in
a few sentences, and they are rarely if ever examined in the
dissecting-room, so that the student has but a very imperfect knowledge
of the relation of the parts belonging to these cavities. (See Fig.
11.) The nasal cavities, which are wedge-shaped, with a narrow arched
roof, extend from the nostrils to the upper portion of the vault of the
pharynx. Their outer walls are formed by the nasal process of the
superior maxillary and lachrymal bones in front; in the middle, by the
ethmoid and inner surface of the superior maxillary bones; behind, by
the vertical plate of the palate bone and the internal pterygoid
process of the sphenoid and the turbinated bones. These latter run
before backward, three on each side, and are designated as the
inferior, middle, and superior, the latter being the smallest of the
three. The sinuses or spaces between these turbinated bones are called
meatuses; so that the space between the floor of the nose and the lower
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