I KNOW a woman who says that if she wants to get her ...
The author wishes to caution the reader not to rely merely on...
The application of the lunar caustic in recent burns or scald...
Nose Bleed - Epistaxis
If it arises from fullness of the vessels of the head, with t...
This trouble is found in the double form; first, of limbs whic...
JOHANN JOSEPH GASSNER, who was regarded as a thaumaturge by h...
Chloroform Or Ether (swallowed)
Emetic; enema of hot coffee; keep awake. If necessary, artific...
Simple remedies such as we advocate are found of immense servi...
The Royal Touch
Malcolm. Well; more anon.--Comes the king forth, I pray ...
of children, where there is a discharge of yellow and watery ...
Croup Less Serious Form
The less serious croup proceeds from a nervous closing of the ...
If you would cure thoroughly, you must first make sure that th...
Hepatization Of Lungs
Take A D current, pretty strong force. Treat in front, over t...
Frequently a failure of some kind shows itself in the limbs of...
Diabetes A Kidney Disease
This disease occurs in two forms--diabetes insipidus and diab...
The Digestive System
How the Food Reaches the Stomach. Our body, then, has an open...
If the disease be general in the system, moving from place to...
The prognosis is very uncertain. This infirmity is often cure...
Cooling In Heating
Often it is difficult to get a sufficient cooling effect by me...
Breath And Blood
Often difficulty of breathing, especially in close air, mistak...
Practice On The Dog
Category: ACQUIRING SKILL
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
Having mastered the technic of introduction on
the cadaver and trained the eye and fingers by practice work on the
rubber tube, experience should be had in the living lower air and food
passages with their pulsatory, respiratory, bechic and deglutitory
movements, and ever-present secretions. It is not only inhuman but
impossible to obtain this experience on children. Fortunately the dog
offers a most ready subject and need in no way be harmed nor pained by
this invaluable and life-saving practice. A small dog the size of a
terrier (say 6 to 10 pounds in weight) should be chosen and
anesthetized by the hypodermic injection of morphin sulphate in dosage
of approximately one-sixth of a grain per pound of body weight, given
about 45 minutes before the time of practice. Dogs stand large doses
of morphin without apparent ill effect, so that repeated injection may
be given in smaller dosage until the desired degree of relaxation
results. The first effect is vomiting which gives an empty stomach for
esophagoscopy and gastroscopy. Vomiting is soon followed by relaxation
and stupor. The dog is normal and hungry in a few hours. Dosage must
be governed in the clog as in the human being by the susceptibility to
the drug and by the temperament of the animal. Other forms of
anesthesia have been tried in my teaching, and none has proven so safe
and satisfactory. Phonation may be prevented during esophagoscopy by
preventing approximation of the cords, through inserting a silk-woven
cathether in the trachea. The larynx and trachea may be painted with
cocain solution if it is found necessary for bronchoscopy. A very
comfortable and safe mouth gag is shown in Fig. 73. Great gentleness
should be exercised, and no force should be used, for none is required
in endoscopic work; and the endoscopist will lose much of the value of
his dog practice if he fails to regard the dog as a child. He should
remember he is not learning how to do endoscopy on the dog; but
learning on the dog how safely to do bronchoscopy on a human being.
The degree of resistance during introduction can be gauged and the
color of the mucosa studied, while that interesting phenomenon, the
dilatation and lengthening of the bronchi during inspiration and their
contraction and shortening during expiration, is readily observed and
always forms subject for thought in its possible connection with
pathological conditions. Foreign body problems are now to be solved
under these living conditions, and it is my feeling that no one should
attempt the removal of a foreign body from the bronchus of a child
until he has removed at least 100 foreign bodies from the dog without
harming the animal. Dogs have the faculty of easily ridding their
air-passages of foreign objects, so that one need not be alarmed if a
foreign body is lost during practice removal. It is to be remembered
that dogs swallow very large objects with apparent ease. The dog's
esophagus is relatively much larger than that of human beings.
Therefore a small dog (of six to eight pounds' weight) must be used
for esophagoscopic practice, if practice is to be had with objects of
the size usually encountered in human beings. The bronchi of a dog of
this weight will be about the size of those of a child.
[FIG. 73.--Author's mouth gag for use on the dog. The thumb-nut serves
to prevent an uncomfortable degree of expansion of the gag. A bandage
may be wound around the dog's jaws to prevent undue spread of the
Next: Endoscopy On The Human Being
Previous: Practice On The Rubber-tube Manikin