Bronchoscopy and Esophagoscopy | Page 4

gastroptosis. Drainage canals are placed at the top or at the side of
the tube, next to the light-carrier canal.
A, Adult's size, 10 mm. X 53 cm.; B, child's size, 7 mm. X 45 cm.; C
and D, full lumen, with both light canal and drainage canal outside the
wall of the tube, to be used for passing very large bougies. This
instrument is made in adult, child, and adolescent (8 mm. by 45 cm.)
sizes. Gastroscopes and esophagoscopes of the sizes given above (A)
and (B), can be used also as gastroscopes. A small form of C, 5 mm. X
30 cm. is used in infants, and also as a retrograde esophagoscope in
patients of any age. E, window plug for ballooning gastroscope, F.]
[FIG. 4.--Author's short esophagoscopes and esophageal specula A,
Esophageal speculum and hypopharyngoscope, adult's size; B,
esophageal speculum and hypopharyngoscope, child's size; C, heavy
handled short esophagoscope; D, heavy handled short esophagoscope
with drainage.]
[FIG. 5.--Cross section of full-lumen esophagoscope for the use of
largest bourgies. The canals for the light carrier and for drainage are so
constructed that they do not encroach upon the lumen of the tube.]
[25] The special sized esophagoscopes most often useful are the 8 mm.
X 30 cm., the 8 mm. X 45 cm., and the 5 mm. X 45 cm. These are
made with the drainage canal in various positions.
For operations on the upper end of the esophagus, and particularly for
foreign body work, the esophageal speculum shown at A and B, in Fig.
4, is of the greatest service. With it, the anterior wall of the
post-cricoidal pharynx is lifted forward, and the upper esophageal
orifice exposed. It can then be inserted deeper, and the upper third of
the esophagus can be explored. Two sizes are made, the adult's and the
child's size. These instruments serve, very efficiently as pleuroscopes.
They are made with and without drainage canals, the latter being the
more useful form.

[FIG. 6.--Window-plug with glass cap interchangeable with a cap
having a rubber diaphragm with a perforation so that forceps may be
used without allowing air to escape. Valves on the canals (E, F, Fig. 3)
are preferable.]
Gastroscopes.--The gastroscope is of the same construction as the
esophagoscope, with the exception that it is made longer, in order to
reach all parts of the stomach. In ordinary cases, the regular
esophagoscopes for adults and children respectively will afford a good
view of the stomach, but there are cases which require longer tubes,
and for these a gastroscope 10 mm. X 70 cm. is made, and also one 10
mm. X 80 cm., though the latter has never been needed but once.
[26] Pleuroscopes.--As mentioned above the anterior commissure
laryngoscope and the esophageal specula make very efficient
pleuroscopes; but three different forms of pleuroscopes have been
devised by the author for pleuroscopy. The retrograde esophagoscope
serves very well for work through small fistulae.
Measuring Rule (Fig. 7).--It is customary to locate esophageal lesions
by denoting their distance from the incisor teeth. This is readily done
by measuring the distance from the proximal end of the esophagoscope
to the upper incisor teeth, or in their absence, to the upper alveolar
process, and subtracting this measurement from the known length of
the tube. Thus, if an esophagoscope 45 cm. long be introduced and we
find that the distance from the incisor teeth to the ocular end of the
esophagoscope as measured by the rule is 20 cm., we subtract this 20
cm. from the total length of the esophagoscope (45 cm.) and then know
that the distal end of the tube is 25 cm. from the incisor teeth.
Graduation marks on the tube have been used, but are objectionable.
[FIG. 7.--Measuring rule for gauging in centimeters the depth of any
location by subtraction of the length of the uninserted portion of the
esophagoscope or bronchoscope. This is preferable to graduations
marked on the tubes, though the tubes can be marked with a scale if
desired.]
Batteries.--The simplest, best, and safest source of current is a double

dry battery arranged in three groups of two cells each, connected in
series (Fig. 8). Each set should have two binding posts and a rheostat.
The binding posts should have double holes for two additional cords, to
be kept in reserve for use in case a cord becomes defective.* The
commercial current reduced through a rheostat should never be used,
because there is always the possibility of "grounding" the circuit
through the patient; a highly dangerous accident when we consider that
the tube makes a long moist contact in tissues close to the course of
both the vagi and the heart. The endoscopist should never depend upon
a pocket battery as a source of illumination, for it is almost certain to