Bronchoscopy and Esophagoscopy | Page 6

on a long sponge carrier (Fig. 14), so that the sponge extends
beyond the distal end of the bronchoscope, causing cough. Then
withdrawal of the sponge carrier will remove all of the secretion in the
tube just as the plunger in a pump will lift all of the water above it. By
this maneuver the walls of the bronchus are wiped free from secretions,
and the lamp itself is cleansed.
[FIG. 14.--Sponge carrier with long collar for carrying the small
sponges shown in Fig. 15. The collar screws down as in the Coolidge
cotton carrier. About a dozen of these are needed and they should all be
small enough to go through the 4 mm. (diameter) bronchoscope and
long enough to reach through the 53 cm. (length) esophagoscope, so
that one set will do for all tubes. The schema shows method of
sponging. The carrier C, armed with the sponge, S, when rotated as

shown by the dart, D, wipes the field, P, at the same time wiping the
lamp, L. The lamp does not need ever to be withdrawn for cleaning
during bronchoscopy. It is protected in a recess so that it does not catch
in the sponges.]
[FIG 15.--Exact size to which the bandage-gauze is cut to make
endoscopic sponges. Each rectangle is the size for the tubal diameter
given. The dimensions of the respective rectangles are not given
because it is easier for the nurse or any one to cut a cardboard pattern of
each size directly from this drawing. The gauze rectangles are folded
up endwise as shown at A, then once in the middle as at B, then strung
one dozen on a safety pin. In America gauze bandages run about 16
threads to the centimeter. Different material might require a slightly
different size and the pattern could be made to suit.]
[32] The gauze sponges are made by the instrument nurse as directed in
Fig. 15, and are strung on safety pins, wrapped in paper, the size
indicated by a figure on the wrapper, and then sterilized in an autoclave.
The sterile packages are opened only as needed. These "bronchoscopic
sponges" are also made by Johnston and Johnston, of New Brunswick,
N. J. and are sold in the shops.
Mouth-gag.--Wide gagging prevents proper exposure of the larynx by
forcing the mandible down on the hyoid bone. The mouth should be
gently opened and a bite block (Fig. 16) inserted between the teeth on
the left side of the patient's mouth, to prevent closing of the jaws on the
delicate bronchoscope or esophagoscope.
[FIG. 16.--Bite block to be inserted between the teeth to prevent closure
of the jaws on the endoscopic tube. This is the McKee-McCready
modification of the Boyce thimble with the omission of the etherizing
tube, which is no longer needed. The block has been improved by Dr.
W. F. Moore of the Bronchoscopic Clinic.]
Forceps.--Delicacy of touch and manipulation are an absolute necessity
if the endoscopist is to avoid mortality; therefore, heavily built and
spring-opposed forceps are dangerous as well as useless. For
foreign-body work in the larynx, and for the removal of benign

laryngeal growths, the alligator forceps with roughened jaws shown in
Fig. 17 serve every purpose.
[FIG. 17.--Laryngeal grasping forceps designed by Mosher. For my
own use I have taken off the ratchet-locking device for all general work,
to be reapplied on the rare occasions when it is required.]
Bronchoscopic and esophagoscopic grasping forceps are of the tubular
type, that is, a stylet carrying the jaws works in a slender tube so that
traction on the stylet draws the V of the open jaws into the lumen of the
tube, thus causing the blades to approximate. They are very delicate
and light, yet have great grasping power and will sustain any degree of
traction that it is safe to exert. They permit of the delicacy of touch of a
violin bow. The two types of jaws most frequently used, are those with
the forward-grasping blades shown in Fig. 18, and those having
side-grasping blades shown in Fig. 19. The side-curved forceps are
perhaps the most generally useful of all the endoscopic forceps; the side
projection of the jaws makes them readily visible during their closure
on an object; their broader grasp is also an advantage., The projection
of the blades in the side-curved grasping forceps should always be
directed toward the left. If it is desired that they open in another
direction this should be accomplished by turning the handle and not by
adjusting the blade itself. If this rule be followed it will always be
possible to tell by the position of the handle exactly where the blades
are situated; whereas, if the jaws themselves are turned, confusion is
sure to result. The forward-grasping forceps are always so adjusted that