Bronchoscopy and Esophagoscopy | Page 3

near the distal end of the
endoscopic tube, the mucosa will be drawn into the outlet, not only
obstructing it, but, most important, traumatizing the mucosa. If, for
instance, the esophagoscope were to be pushed upon with a fold thus
anchored in the distal end, the esophageal wall could easily be torn. To
admit the largest sizes of esophagoscopic bougies (Fig. 40), special
esophagoscopes (Fig. 5) are made with both light canal and drainage
canal outside the lumen of the tube, leaving the full area of luminal
cross-section unencroached upon. They can, of course, be used for all
purposes, but the slightly greater circumference is at times a
disadvantage. The esophageal and stomach secretions are much thinner
than bronchial secretions, and, if free from food, are readily aspirated
through a comparatively small canal. If the canal becomes obstructed
during esophagoscopy, the positive pressure tube of the aspirator is
used to blow out the obstruction. Two sizes of esophagoscopes are all
that are required--7 mm. X 45 cm. for children, and 10 mm. X 53 cm.
for adults (Fig. 3, A and B); but various other sizes and lengths are used
by the author for special purposes.* Large esophagoscopes cause
dangerous dyspnea in children. If, it is desired to balloon the esophagus
with air, the window plug shown in Fig. 6, is inserted into the proximal
end of the esophagoscope, and air insufflated by means of the hand
aspirator or with a hand bulb. The window can be replaced by a rubber
diaphragm with a perforation for forceps if desired. It will be noted that
none of the endoscopic tubes are fitted with mandrins. They are to be
introduced under the direct guidance of the eye only. Mandrins are
obtainable, but their use is objectionable for a number of reasons, chief
of which is the danger of overriding a foreign body or a lesion, or of
perforating a lesion, or even the normal esophageal wall. The slanted
end on the esophagoscope obviates the necessity of a mandrin for
introduction. The longer the slant, with consequent acuting of the angle,
the more the introduction is facilitated; but too acute an angle increases
the risk of perforating the esophageal wall, and necessitates the utmost
caution. In some foreign-body cases an acute angle giving a long slant
is useful, in others a short slant is better, and in a few cases the squarely
cut-off distal end is best. To have all of these different slants on hand
would require too many tubes. Therefore the author has settled upon a

moderate angle for the end of both esophagoscopes and bronchoscopes
that is easy to insert, and serves all purposes in the version and other
manipulations required by the various mechanical problems of
foreign-body extraction. He has, however, retained all the experimental
models, for occasional use in such cases as he falls heir to because of a
problem of extraordinary difficulty.
* A 9 mm. X 45 cm. esophagoscope will reach the stomach of almost
all adults and is somewhat easier to introduce than the 10 mm. X 53
cm., which may be omitted from the set if economy must be practiced.
[FIG. I.--Author's laryngoscopes. These are the standard sizes and
fulfill all requirements. Many other forms have been devised by the
author, but have been omitted from the list as unnecessary. The infant
diagnostic laryngoscope (C) is not for introducing bronchoscopes, and
is not absolutely necessary, as the larynx of any infant can be inspected
with the child's size laryngoscope (B).
A Adult's size; B, child's size; C, infant's diagnostic size; D, anterior
commissure laryngoscope; E, with drainage canal; 17, intubating
laryngoscope, large lumen. All the laryngoscopes are preferred without
drainage canals.]
[FIG. 2.--The author's bronchoscopes of the sizes regularly used.
Various other lengths and diameters are on hand for occasional use for
special purposes. With the exception of a 6 mm. X 35 cm. size for older
children, these special bronchoscopes are very rarely used and none of
them can be regarded as necessary. For special purposes, however,
special shapes of tube-mouth are useful, as, for instance, the oval end to
facilitate the getting of both points of a staple into the tube-mouth The
illustrated instruments are as follows:
A, Infant's size, 4 mm. X 30 cm.; B, child's size, 5 mm. X 30 cm.; C,
adolescent's size, 7 mm. X 40 cm.; D, adult's size, 9 mm. X 40 cm.; E,
aspirating bronchoscope made in all the foregoing sizes, and in a
special size, 5 mm. X 45 cm.]
[FIG. 3.--The author's esophagoscopes of the sizes he has standardized

for all ordinary requirements. He uses various other lengths and sizes
for special purposes, but none of them are really necessary. A
gastroscope, 10 mm. X 70 cm., is useful for adults, especially in cases
of