Bronchoscopy and Esophagoscopy | Page 2

line of direct vision. Illumination is supplied by a small

tungsten-filamented, electric, "cold" lamp situated at the distal
extremity of the instrument in a special groove which protects it from
any possible injury during the introduction of instruments through the
tube. The bronchi and the esophagus will not allow dilatation beyond
their normal caliber; therefore, it is necessary to have tubes of the sizes
to fit these passages at various developmental ages. Rupture or even
over-distention of a bronchus or of the thoracic esophagus is almost
invariably fatal. The armamentarium of the endoscopist must be
complete, for it is rarely possible to substitute, or to improvise
makeshifts, while the bronchoscope is in situ. Furthermore, the
instruments must be of the proper model and well made; otherwise
difficulties and dangers will attend attempts to see them.
Laryngoscopes.--The regular type of laryngoscope shown in Fig. I (A,
B, C) is made in adult's, child's, and infant's sizes. The instruments
have a removable slide on the top of the tubular portion of the
speculum to allow the removal of the laryngoscope after the insertion
of the bronchoscope through it. The infant size is made in two forms,
one with, the other without a removable slide; with either form the
larynx of an infant can be exposed in but a few seconds and a definite
diagnosis made, without anesthesia, general or local; a thing possible
by no other method. For operative work on the larynx of adults, such as
the removal of benign growths, particularly when these are situated in
the anterior portion of the larynx, a special tubular laryngoscope having
a heart-shaped lumen and a beveled tip is used. With this instrument
the anterior commissure is readily exposed, and because of this it is
named the anterior commissure laryngoscope (Fig. 1, D). The tip of the
anterior commissure laryngoscope can be used to expose either
ventricle of the larynx by lifting the ventricular band, or it may be
passed through the adult glottis for work in the subglottic region. This
instrument may also be used as an esophageal speculum and as a
pleuroscope. A side-slide laryngoscope, used with or without the slide,
is occasionally useful.
Bronchoscopes.--The regular bronchoscope is a hollow brass tube
slanted at its distal end, and having a handle at its proximal or ocular
extremity. An auxiliary canal on its under surface contains the light

carrier, the electric bulb of which is situated in a recess in the beveled
distal end of the tube. Numerous perforations in the distal part of the
tube allow air to enter from other bronchi when the tube-mouth is
inserted into one whose aerating function may be impaired. The
accessory tube on the upper surface of the bronchoscope ends within
the lumen of the bronchoscope, and is used for the insufflation of
oxygen or anesthetics, (Fig. 2, A, B, C, D).
For certain work such as drainage of pulmonary abscesses, the lavage
treatment of bronchiectasis and for foreign-body or other cases with
abundant secretions, a drainage-bronchoscope is useful The drainage
canal may be on top, or on the under surface next to the light-carrier
canal. For ordinary work, however, secretion in the bronchus is best
removed by sponge-pumping (Q.V.) which at the same time cleans the
lamp. The drainage bronchoscope may be used in any case in which the
very slightly-greater area of cross section is no disadvantage; but in
children the added bulk is usually objectionable, and in cases of recent
foreign-body, secretions are not troublesome.
As before mentioned, the lower air passages will not tolerate dilatation;
therefore, it is necessary never to use tubes larger than the size of the
passages to be examined. Four sizes are sufficient for any possible case,
from a newborn infant to the largest adult. For infants under one year,
the proper tube is the 4 mm. by 30 cm.; the child's size, 5 mm. by 30
cm., is used for children aged from one to five years. For children six
years or over, the 7 mm. by 40 cm. bronchoscope (the adolescent size)
can be used unless the smaller bronchi are to be explored. The adult
bronchoscope measures 9 mm. by 40 cm.
The author occasionally uses special sizes, 5 mm. x 45 cm., 6 mm. x 35
cm., 8 mm. x 40 cm.
Esophagoscopes.-The esophagoscope, like the bronchoscope, is a
hollow brass tube with beveled distal end containing a small electric
light. It differs from the bronchoscope in that it has no perforations, and
has a drainage canal on its upper surface, or next to the light-carrier
canal which opens within the distal end of the tube. The exact size,
position, and shape of the drainage outlets is important on

bronchoscopes, and to an even greater degree on esophagoscopes. If the
proximal edge of the drainage outlet is too