Atlas and abstract of the diseases of the larynx / L. Grünwald ; edited by Charles P. Grayson.

  • Grünwald, L.
Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: Atlas and abstract of the diseases of the larynx / L. Grünwald ; edited by Charles P. Grayson. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    If the patient chokes before the mirror is in place, or even at the first touch, make him say a as in fate (not ah) very loud and long, and introduce the mirror during- phonation. It is absolutely impossible to see the image if the patient holds his breath convulsively : the larynx is drawn high up under the root of the tongue, the pillars of the fauces are stretched to the utmost, and the glottis is closed. .Many patients do this as soon as they open their mouths and put out their tongues. In such cases, before attempt- ing to introduce the mirror, have the patient take long, deep breaths with the mouth in the proper position to receive the mirror, until the respiration is no longer dis- turbed by the introduction of the instrument. Psychical irritability is sometimes diminished by olo&mg the eyes, but they must not be shut convulsively, lest it cause the oral cavity to become narrower. Remember that the tendency to choke is constantly aggravated by accumulation of saliva from excessive re- flex secretion; the patient should therefore be allowed to expectorate, without hawking, as that only aggravates re- flex sensibility. By this means and by suitable encour- agement one can also prev ent constant swallowing, which is so troublesome and dims the mirror every time. Never, not even for practice, have the patient say ah, but always a, as the epiglottis is only raised in high- pitched notes, and often a mere trial-examination affords a satisfactory view of the larynx. If, as happens in rare instances, the epiglottis even then fails to rise and expose the larynx, a slight pressure and forward pull with a long spatula (Frankel's, for instance) on the median fold of the glosso-epiglottidean ligament will bring about the desired result. Choking and vomiting are sometimes so excessive that they can only be overcome by painting the parts to be touched with cocain. A pledget of cotton the size of a pea does not hold enough of the 10 per cent, solution to make an application to the mucous membrane at all dan-