Bronchoscopy and Esophagoscopy | Page 5

fail during the endoscopy. The wires connecting the battery and
endoscopic instrument are covered with rubber, so that they may be
cleansed and superficially sterilized with alcohol. They may be totally
immersed in alcohol for any length of time without injury.
* When this is done care is necessary to avoid attempting to use
simultaneously the two cords from one pair of posts.
[FIG 8.--The author's endoscopic battery, heavily built for reliability.
It contains 6 dry cells, series-connected in 3 groups of 2 cells each.
Each group has its own rheostat and pair of binding posts.]
Aspirating Tubes.--Independent aspirating tubes involve delay in their
use as compared to aspirating canals in the wall of the endoscopic tube;
but there are special cases in which an independent tube is invaluable.
Three forms are used by the author. The "velvet eye" cannot traumatize
the mucosa (Fig. 9). To hold a foreign body by suction, a squarely cut
off end is necessary. For use through the tracheotomic wound without a
bronchoscope a malleable tube (Fig. 10) is better.
[FIG. 9.--The author's protected-aperture endoscopic aspirating tube for
aspiration of pharyngeal secretions during direct laryngoscopy and
endotracheobronchial secretions at bronchoscopy, also for draining
retropharyngeal abscesses. The laryngoscopes are obtainable with
drainage canals, but for most purposes the independent aspirating tube
shown above is more satisfactory. The tubes are made in 20 30, 40, and
60 cm. lengths. An aperture on both sides prevents drawing in the

mucosa. It can be used for insufflation of ether if desired. An aspirating
tube of the same design, but having a squarely cut off end, is
sometimes useful for removing secretions lying close to a foreign body;
for removing papillomata; and even for withdrawing foreign bodies of
a soft surface consistency. It is not often that the foreign bodies can be
thus withdrawn through the glottis, but closely fitting foreign bodies
can at least be withdrawn to a higher level at which ample forceps
spaces will permit application of forceps. Such aspirating tubes,
however, are not so safe to use as the protected, double aperture tubes.]
[FIG. 10.--The author's malleable tracheotomic aspirating tube for
removal of secretions, exudates, crusts, etc., from the tracheobronchial
tree through the tracheotomic wound without a bronchoscope. The tube
is made of copper so that it can be bent to any curve, and the copper
wire stylet prevents kinking. The stylet is removed before using the
tube for aspiration.]
[28] Aspirators.--The various electric aspirators so universally used in
throat operations should be utilized to withdraw secretions in the tubes
fitted with drainage canals. They, however, have the disadvantages of
not being easily transported, and of occasionally being out of order.
The hand aspirator shown in Fig. 11 is, therefore, a necessary part of
the instrumental equipment. It never fails to work, is portable, and
affords both positive and negative pressures. The positive pressure is
sometimes useful in clearing the drainage canal of any particles of food,
tissue, clots, or secretion which may obstruct it; and it also serves to fill
the stomach or esophagus with air when the ballooning procedure is
used. The mechanical aspirator (Fig. 12) is highly efficient and is the
one used in the Bronchoscopic Clinic. The positive pressure will
quickly clear obstructed drainage canals, and may be used while the
esophagoscope is in situ, by simply detaching the minus pressure tube
and attaching the plus pressure. In the lungs, however, high plus
pressures are so dangerous that the pressure valve must be lowered.
[Fig. 11--Portable aspirator for endoscopy with additional tube
connected with the plus pressure side for use in case of occlusion of the
drainage canal. This aspirator has the advantage of great power with

portability. Where portability is not required the electrically operated
aspirator is better.]
[FIG. 12.--Robinson mechanical aspirator adapted for bronchoscopic
and esophagoscopic aspiration by the author. The positive pressure is
used for clearing obstructed drainage canals and tubes.]
[FIG. 13.--Apparatus for insufflation of ether or chloroform during
bronchoscopy, for those who may desire to use general anesthesia. The
mechanical methods of intratracheal insufflation anesthesia
subsequently developed by Meltzer and Auer, Elsberg, Geo. P. Muller
and others have rightly superseded this apparatus for all general
surgical purposes.]
Sponge-pumping.--While the usually thin, watery esophageal and
gastric secretions, if free from food, are readily aspirated through a
drainage canal, the secretions of the bronchi are often thick and
mucilaginous and aspirated with difficulty. Further-more, bronchial
secretions as a rule are not collected in pools, but are distributed over
the walls of the larger bronchi and continuously well up from smaller
bronchi during cough. The aspirating bronchoscopes should be used
whenever their very slight additional area of cross-section is
unobjectionable. In most cases, however, the most advantageous way to
remove bronchial secretion has been found to be by introducing a gauze
swab