obtainable, but their use is objectionable for a number of reasons,
chief of which is the danger of overriding a foreign body or a lesion,
or of perforating a lesion, or even the normal esophageal wall. The
slanted end on the esophagoscope obviates the necessity of a mandrin
for introduction. The longer the slant, with consequent acuting of the
angle, the more the introduction is facilitated; but too acute an
angle increases the risk of perforating the esophageal wall, and
necessitates the utmost caution. In some foreign-body cases an acute
angle giving a long slant is useful, in others a short slant is
better, and in a few cases the squarely cut-off distal end is best. To
have all of these different slants on hand would require too many
tubes. Therefore the author has settled upon a moderate angle for the
end of both esophagoscopes and bronchoscopes that is easy to insert,
and serves all purposes in the version and other manipulations
required by the various mechanical problems of foreign-body
extraction. He has, however, retained all the experimental models, for
occasional use in such cases as he falls heir to because of a problem
of extraordinary difficulty.
* A 9 mm. X 45 cm. esophagoscope will reach the stomach of almost all
adults and is somewhat easier to introduce than the 10 mm. X 53 cm.,
which may be omitted from the set if economy must be practiced.
[FIG. I.--Author's laryngoscopes. These are the standard sizes and
fulfill all requirements. Many other forms have been devised by the
author, but have been omitted from the list as unnecessary. The infant
diagnostic laryngoscope (C) is not for introducing bronchoscopes,
and is not absolutely necessary, as the larynx of any infant can be
inspected with the child's size laryngoscope (B).
A Adult's size; B, child's size; C, infant's diagnostic size; D,
anterior commissure laryngoscope; E, with drainage canal; 17,
intubating laryngoscope, large lumen. All the laryngoscopes are
preferred without drainage canals.]
[FIG. 2.--The author's bronchoscopes of the sizes regularly used.
Various other lengths and diameters are on hand for occasional use
for special purposes. With the exception of a 6 mm. X 35 cm. size
for older children, these special bronchoscopes are very rarely
used and none of them can be regarded as necessary. For special
purposes, however, special shapes of tube-mouth are useful, as,
for instance, the oval end to facilitate the getting of both
points of a staple into the tube-mouth The illustrated instruments
are as follows:
A, Infant's size, 4 mm. X 30 cm.; B, child's size, 5 mm. X 30 cm.;
C, adolescent's size, 7 mm. X 40 cm.; D, adult's size, 9 mm. X 40 cm.;
E, aspirating bronchoscope made in all the foregoing sizes, and in a
special size, 5 mm. X 45 cm.]
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