THE LARYNGOSCOPE AND RHINOSCOPE. 169 



years ago inflammation, laryngeal phthisis, or, popularly speaking, 

 throat -consumption, and CEdema, constituted the three recognized 

 forms of throat-affection ; but, in eight years from the first practical 

 application of this instrument, the revolution was such that separate 

 treatises described and treated of forty and more varieties of disease, 

 such as acute laryngitis and the various acute affections ; simple 

 chronic laryngitis, chronic ulcerative laryngitis; of six or seven forms 

 -of inflammation of special parts of the larynx ; of tubercular and 

 syphilitic laryngitis, oedema, abscess, etc. Next we find descriptions 

 of the diseases which attack the laryngeal cartilages or framework 

 of the larynx, as perichondritis and chondritis. Then follow nervous 

 forms of derangement, and then paralytic forms of difficulty. In the 

 first we have conditions of nervous exaltation, such as spasmodic 

 coughs, spasms, etc. Under the second head we have paralytic affec- 

 tions of the vocal cords and laryngeal muscles. These paralytic 

 difficulties of the larynx may exist in the larynx without much or 

 even any impairment of the general health. Then we have anaemia 

 or impoverished blood-supply, and finally the varied forms of tumors 

 and morbid growths, cancerous, syphilitic, etc. I might prolong this 

 list yet further, and even dwell at length upon the many and ingen- 

 ious instruments for operating within the larynx, but to do so would 

 be to exceed the limits of my article. 



The rhinoscopic mirror, or rhinoscope, is practically but a laryn- 

 geal mirror of a smaller size. The stem and handle are the same, and 

 attached in the same manner, at about the same angle, but there is 

 the difference of a much smaller size as compared to the laryngo- 

 scope, the mirror being usually about the size of a silver three-cent 

 piece. Its use is to enable us to see the back or inner parts of the 

 nose (posterior nares), and the upper part of the pharynx or vault of 

 the back of the mouth. Its discovery, which occurred soon after that 

 of the laryngoscope, is due to the patience and genius of Czermak, 

 and was a direct result of the discovery of the laryngeal mirror. 

 The parts which it enables us to see are hidden behind and above 

 the palate, and the office of the rhinoscopic mirror is simply to so 

 reflect the light as to illuminate these parts, and in turn enable 

 their image to become visible in the mirror. In the first instance the 

 little mirror is placed at the back of the opened mouth of the patient. 

 At the same time a powerful and clear light from an illuminating 

 apparatus is directed into the patient's mouth, and the rays striking 

 upon the mirror are so reflected upward and forward as to illuminate 

 the parts we seek to examine, and these are then, as just remarked, 

 made visible in the mirror. And in this principle lies the entire secret 

 of the art of making a laryngoscopic or rhinoscopic examination. It 

 is simply a dexterous management of mirrors to secure proper reflec- 

 tion of light, and the consequent illumination and examination of hid- 

 den recesses. 



