Endoscopy On The Human Being

Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

Dog work offers but little practice

in laryngoscopy. Because of the slight angle at which the dog's head

joins his spine, the larynx is in a direct line with the open mouth;

hence little displacement of the anterior cervical tissues is

necessary. Moreover the interior of the larynx of the dog is quite

different from that of the human larynx. The technic of laryngoscopy

in the human subject is best perfected by a routine direct examination

of the larynx of anesthetized patients after such an operation as, for

instance, tonsillectomy, to see that the larynx and laryngopharynx are

free of clots. To perform a bronchoscopy or esophagoscopy under these

conditions would be reprehensible; but direct laryngoscopy for the

seeking and removal of clots serves a useful purpose as a preventative

of pulmonary abscess and similar complications.* Diagnosis of

laryngeal conditions in young children is possible only by direct

laryngoscopy and is neglected in almost all of the cases. No

anesthesia, general or local, is required. Much clinical material is

neglected. All cases of dyspnea or dysphagia should be studied

endoscopically if the cause of the condition cannot be definitely

found and treated by other means. Invaluable practice in esophagoscopy

is found in the treatment of strictures of the esophagus by weekly or

biweekly esophagoscopic bouginage.

* Dr. William Frederick Moore, of the Bronchoscopic Clinic, has

recently collected statistics of 202 cases of post-tonsillectomic

pulmonary abscess that point strongly to aspiration of infected clots

and other infective materials as the most frequent etiologic mechanism

(Moore, W. F., Pulmonary Abscess. Journ. Am. Med. Assn., April 29,

1922, Vol. 78, pp. 1279-1281).

In acquiring skill as an endoscopist the following paraphrased

aphorisms afford food for thought.