i 7 2 THE POPULAR SCIENCE MONTHLY. 



objective point. His operations are all made under the guidance of 

 the imao-e which he sees reflected in the laryngeal mirror, and are 

 comparatively bloodless and accompanied by little or no pain. 



A laryngoscopic examination is made as follows : In the second 

 cut we see the positions of the examiner and patient. The patient 

 opens his mouth as widely as possible, and at the same time protrudes 

 his tongue. The examiner, then, with a small napkin takes the pro- 

 truded tongue between his thumb and forefinger, thus gently steady- 

 ing it and preventing its slipping back into the mouth. The object 

 in thus protruding the tongue is to enlarge the cavity of the mouth as 

 much as possible. The laryngeal mirror is next warmed either over the 

 chimney of the illuminator or in some warm water, so as to prevent 

 its becoming obscured or dimmed by the breath. It is then quickly 

 and dexterously carried to the back of the mouth. A bungling man- 

 ner of doing this, by causing great irritation of sensitive parts of the 

 mouth, causes gagging and even vomiting, and, this once excited, 

 all further examination is either very difficult or impossible at this 

 sitting. It is not to be taken for granted, however, that examinations 

 can readily be made in all cases, nor even in the larger majority 

 of the patients. With many there is no trouble, but there are also 

 quite a number of patients whose throats are so irritable from disease 

 as to prevent the introduction of the laryngoscope. In other cases 

 the patient's tongue has an almost irresistible tendency to keep rising 

 up toward the roof of the mouth and thus obstruct the view. En- 

 largement of the tonsils according to the degree of their enlarge- 

 ment makes an examination either very difficult, or else, if so much 

 enlarged that they meet and almost close up the throat, makes it 

 impossible until the enlargement has been reduced. For the over- 

 coming of mere irritability of the throat or fauces when this per- 

 tains to a degree sufficient to be troublesome, vai'ious means have 

 been resorted to, to produce local anaesthesia of the fauces. A piece 

 of ice held in the mouth, the water being swallowed, is one plan. 

 Another is to drop twenty drops of chloroform on a handkerchief 

 and let the patient inhale it for a minute. With most cases of 

 irritable throat this is quite sufficient, and without at all rendering the 

 patient drowsy or uncomfortable. Bromide of potash has been used, 

 but has not given satisfaction practically. 



The examiner, having avoided touching the back of the tongue 

 and of the pharynx with the mirror, carries it, as already said, to the 

 back of the mouth to an oblique position below the soft palate and 

 with the uvula or " drop " of the palate at its back. The rays of light 

 from the illuminating apparatus, striking the laryngeal mirror, are 

 then reflected in a downward direction and light up the parts (the 

 larynx) below. These, being illuminated, are in return depicted 

 upon the laryngeal mirror above. The process may be compared to 

 that of the management of toilet-mirrors to enable us to see the back 



