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Treatment Of Affections Of The Nervous Centres
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Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
It is not uncommon to find a stricture of the
bronchus superjacent to a foreign body that has been in situ for a
period of months. In order to remove the foreign body, this stricture
must be dilated, and for this the bronchial dilator shown in Fig. 25
was devised. The channel in each blade allows the closed dilator to be
pushed down over the presenting point of such bodies as tacks, after
which the blades are opened and the stricture stretched. A small and a
large size are made. For enlarging the bronchial narrowing associated
with pulmonary abscess and sometimes found above a bronchiectatic or
foreign body cavity, the expanding dilator shown in Fig. 26 is perhaps
less apt to cause injury than ordinary forceps used in the same way.
The stretching is here produced by the spring of the blades of the
forceps and not by manual force. The closed blades are to be inserted
through the strictured area, opened, and then slowly withdrawn. For
cicatricial stenoses of the trachea the metallic bougies, Fig. 40, are
useful. For the larynx, those shown in Fig. 41 are needed.
[FIG. 34.--A, Mosher's laryngeal curette; B, author's flat blade
cautery electrode; C, pointed cautery electrode; D, laryngeal knife.
The electrodes are insulated with hard-rubber vulcanized onto the
[FIG. 35.--Retrograde esophageal bougies in graduated sizes devised by
Dr. Gabriel Tucker and the author for dilatation of cicatricial
esophageal stenosis. They are drawn upward by an endless swallowed
string, and are therefore only to be used in gastrostomized cases.]
[FIG. 36.--Author's bronchoscopic and esophagoscopic mechanical spoon,
made in 40, 50 and 60 cm. lengths.]
[FIG. 37.--Schema illustrating the author's method of endoscopic
closure of open safety pins lodged point upward The closer is passed
down under ocular control until the ring, R, is below the pin. The
ring is then erected to the position shown dotted at M, by moving the
handle, H, downward to L and locking it there with the latch, Z. The
fork, A, is then inserted and, engaging the pin at the spring loop, K,
the pin is pushed into the ring, thus closing the pin. Slight rotation
of the pin with the forceps may be necessary to get the point into the
keeper. The upper instrument is sometimes useful as a mechanical spoon
for removing large, smooth foreign bodies from the esophagus.]
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