light of the sun from a mirror held in the left hand.
Trousseau & Belloc* in 1837, refer to a laryngeal
speculum which was made for them by a Mons. Sellique,
an ingenious mechanic, who had himself been subject
to laryngeal phthisis. This instrument which consisted
of two tubes, through one of which light was thrown
on the glottis, whilst through the other the image of
the glottis was reflected from a mirror placed at its
gutteral extremity, was, however, difficult of application,
since not one in ten could bear its presence in the
throat. Soon it was declared void of practical utility
and abandoned. Although Bennatif is said to have
been enabled by it to obtain a view of the glottis,
which statement however is strongly doubted, as
Bennati,J then Physician-in-Chief to the Italian Opera
in Paris, does not allude to the fact in the least in
his writings on this subject.
Baumes of Lyons§ about 1838, laid before the
Medical Society of that city, a laryngeal speculum of
a somewhat complicated construction, but about the
* Traite pratique de la phthisie laryngee, de la laryngite chronique, et les maladies
<ie la voix, par Trousseau et Belloc, Paris : 1837, p. 179.
"|- Opus cit: Trousseau et Belloc. p. 180.
"l Etudes physiologiques et pathologiques sur les organes de la voix humaine,
Paris: 1833 and 1834.
J Compte rendu des travaux de la Societe de Medecine de Lyons : 1840, p. 62.
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4 THE PRINCIPLES AND PRACTICE OF
practical utility and the results of its application no
record has been published.
In 1840, Liston, in his Practical Surgery"^ mentions
the successful employment of this instrument in medi-
cal practice in the following words, page 417, ^^ Ulcerated
glottis : a view of the parts may be sometimes ob-
tained by means of a speculum ; such a glass as is used
by dentists, on a long stalk previously dipped in hot
water, introduced with its reflecting surface downwards,
and carried well into the fauces."
Beyond a doubt it is established, that the late Dr.
Warden, in the year 1 844, employed a powerful Argand
lamp before which he placed a prism of flint-glass, by
means of which contrivance he succeeded in seeing
disease of the glottis in two cases.f These are so accur-
ately described by him in all their details, that Warden
must be regarded as the first observer who had by arti-
ficial light examined an unhealthy larynx in the liv-
ing.
Dr. Avery, of London, is also reported to have
worked successfully, from 1844, till his death in 1854
cut short his investigations, in the construction of a
laryngoscope and other instruments for the examination
of internal organs, but he has published nothing on
the subject.^
Thus matters stood, when in the year 1855, the
Spaniard Manuel Garcia, a singing teacher in London,
* Practical Surgery, with 50 engravings on wood; by Robert Li8ton,{|£sq.
f London Medical Gazette. New series, 1844, vol. II., page 256. And British
and Foreign Medico-Chirurgical Review, January, 1863
% Introduction to the Art of Laryngoscopy, by Dr. Yearsley, 1862.
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LARYNGOSCOPY AND RHINOSCOPY. 5
published his observations on the formation of the
human voice, in an interesting paper, entitled " Phys-
iological Observations on the Human Voice,'' in the Pro-
ceedings of the Royal Society.*
Garcia was the first, then, to employ the laryngeal
mirror for physiological purposes ; the first who suc-
ceeded in obtaining a view of his own larynx, so as to
describe accurately the parts he saw in the mirror and
their respective motions. Having long studied the
anatomy and physiology of the larynx as the organ of
voice, a great desire to see the movements must have
been the natural consequence. How he at length ob-
tained the desired object he describes himself. Stand-
ing with his back to the sun, he held a looking-glass
in his left hand before his face ; the sun's rays were
thus reflected by the glass into his open mouth. Then
he introduced a dentist's mirror — previously warmed —
into the back of his mouth, and thus he saw the reflec-
tion of his larynx in the looking-glass. Auto-laryn-
goscopy was discovered ; it was an indisputable fact,
and to Garcia belongs the credit of having demonstrated
it. His method is to-day the simplest and best for
auto-laryngoscopic examination.
Strange to say, as Senn's, Babington's and Warden's
observations were sown without fruit ; as Liston's
teachings were forgotten, so Garcia's brilliant results
were received with distrust, nay, positively doubted and
rejected. Still, in spite of the continued opposition ot
those who, either from old age, pride, caste, or ignor-
* Observations on the Human Voice, Philosophical Magazine and Journal of
Science, vol. X. and Gazette Hebdom. de Med. et de Chir. i6 Nov., 1855.
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6 THE PRINCIPLES AND PRACTICE OF
ance, oppose all progress in experimental or practical
science, the seed that had been sown by Garcia came to
be the germ of many important results and discoveries.
Dr. Ludwig Tiirck, Professor at the University of
Vienna, and one of the Physicians-in-Chief to the gen-
eral hospital, ignorant at the time, as he distinctly
states, of the experiments and writings of Garcia,* had,
after a long series of most varied experiments, made
during the summer of 1857 on dead subjects and on
patients under his care, in the general hospital, suc-
ceeded in giving the laryngoscope so convenient a shape
as suited it best for the purpose of examination both
of the larynx and adjoining parts in a great number of
individuals.f
When demonstrating to Professor Ludwig in the
summer of 1857 the interior of the larynx on a patient
in his ward, Tiirck was for the first time made aware
of Garcia's researches-^ Garcia's investigations, how-
ever, were purely physiological ; Tiirck, on the other
hand, was seeking for larger results, viz, means for cor-
rect diagnosis from which would spring a more rational
♦ Tiirck, Clinic of the diseases of the Larynx and Trachea, Vienna, 1866, page 2 :
I desire here explicitly to state, notwithstanding the assertion to the contrary in many of
the works published in Europe on this subject, from my knowledge of the facts in
the case, and from my acquaintance with Professor Tiirck as a man of veracity, that he
was actively engaged in laryngoscopic researches before he had ever heard of Garcia's
experiments, or before he ever had read Garcia's articles on the subject published in
the Transactions of the Royal Society. — [Author.]
f Report of the Imp. R. Society of Physicians of Vienna; Meeting of April, 1858.
In the year of 1857, Prof. Tiirck treated, in seven wards of his division of the
hospital, 1,873 patients, among which there were only 275 casesof the nervous system.
The greater number of the remainder suffered from diseases of the throat and chest. —
Ibid. Clinical Researches i Londotiy 1862.
X Op. cit. page 2.
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LARYNGOSCOPY AND RHINOSCOPY. 7
and successful treatment of the various affections of the
throat. Tiirck used direct sunlight for his demon-
strations, in the absence of which, during apart of the
winter, from the hospital wards, his experiments were
discontinued.
Towards the end of that same year (1857) Dr.
Czermak, Professor of Physiology at Krakau, but at
that time sojourning in Vienna, who had heard of the
flattering results of Professor Turck's investigations,
borrowed the latter's mirrors for the express purpose of
repeating Garcia's physiological experiments and for
further investigations.*
Whilst Czermak repeated and verified Garcia's ex-
periments with Tiirck's mirrors, he, Turck, did not
remain idle, but improved upon his mirror until he
brought it to its present simple perfection — a mirror
now universally in use. During the clear days of the
latter part of winter, he resumed also his examinations
on patients in the wards, and the result answered his
most sanguine expectations.
Again, on the i6th day of March, 1858, Czermak
accompanied by University Docent and Secundar Phy-
sician, Dr. Gruber, visited Professor Turck,and sought
and obtained permission to use theborrowed mirror in the
syphilitic wards of the hospital. It was not many daysf
before it became evident Czermak was deeply im-
prescd with, and perceived the practical value of the
instrument, which became so potent in his hands, and
for which he made most strenuous efforts to secure its
f op. cit. page 203. f Wiener Med. Wochb.
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8 THE PRINCIPLES AND PRACTICE OF
recognition by the whole civilized world. Setting to
work with great zeal and energy with the mirrors of
Professor Tiirck, he first sought to render us inde-
pendent of sun-light by employing artificial light,
using for that purpose the large reflector of the ophthal-
moscope, thus rendering the laryngoscope available at
all times for practical purposes. In his first article on
this subject* Czermak called attention to the fact, that
by means of the laryngeal mirror the eye becomes the
sure guide of the hand. Further, he asserted the pos-
sibility of inspecting (in a manner similar to the larynx)
the posterior surface of the soft palate, the posterior
openings of the nasal fossae and the superior parts of
the pharynx, by simply turning the little mirror upwards
and by raising the velum up as far as practicable.
This was the advent of the kindred art of Rhinoscopy.
The foregoing pages sufficiently establish the fact,
that for the discovery of the art of laryngoscopy and its
kindred rhinoscopy, as well as for the progressive steps
of improvement and development which have led to
their adoption in the diagnosis and treatment of disease
we are chiefly indebted to Tiirck and Czermak.
The gradual development of this subject is illustrated
by the numerous, interesting, scientific, and instructive
publications of these two gentlemen. Every learned
reader must, however, regret that ^ there should have
arisen a controversy, on the whole uninteresting and
unprofitable to the mass of the medical profession, as
to the claim of priority in the art of Laryngoscopy.
* op. cit.
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LARYNGOSCOPY AND RHINOSCOPY. 9
Where both have fought well and gained renown, when
success pours into the lap of both its reward, who shall
decide between the two ?
As an act of justice, however, and for the benefit of
those who have neither time nor inclination to read all
the published evidence, pro and con, of the case, the
controversy shall receive a passing notice.*
To prove priority we have to answer :
I St. Who conceived the idea and made use of the
laryngeal mirror first ?
2d. Who brought it to its present simple state of
perfection ?
3d. Who demonstrated first its usefulness in the
diagnosis and treatment of disease by actual experi-
ment ?
4th. Who demonstrated first the art of rhinoscopy ?
5th. Who labored most to compel for this art the
acknowledgment due it from the medical world ?
If we exempt, as we justly may, former and imperfect
attempts at laryngeal examination, and acknowledge
Garcia's claim to originality in the matter of auto-la-
ryngoscopy, being obviously quite distinct and indis-
putable; the contest is narrowed down to Czermak and
Tiirck. Tiirck deliberately states,f and this is the first
printed reference we have on this vexed question — that
being ignorant of the work of his predecessor, Garcia,
he happened accidentally upon the idea early in 1857
(if not before) to employ a small mirror in the examin-
* We draw our inferences from the works of the two persons most interested, viz,
Tiirck and Czermak.
f Op. cit. Page 2, line 1 6.
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lo THE PRINCIPLES AND PRACTICE OF
ation of diseases of the larynx. Professor Ludwig, in
the summer of 1857, first informed him of Garcia's ex-
periments. Great were the difficulties, but, in spite of
obstacles, in many cases he accomplished his object.
Winter interrupted his experiments for a time. Then
(winter 1857) Czermak borrowed Tiirck's mirrors, and
in March, 1858, obtained permission to make use of
the identical mirrors in the syphilitic wards of the hos-
pital.* Did Tiirck remain idle during the latter part of
that winter and the first months of 1858? No! he
continued to improve on his original mirror till it
reached a perfection then which nothing better has to
this day been produced in spite of various tinkerings
with the same — such as making the mirrors square, then
with round edges, oblong and oval, and lastly with a
convex border above and a concave one below. One
and all, so many attempts to make the most simple,
practical instrument complicated, they have failed.
March 27, 1858, Czermak published his first
paper,f in which he urgently recommended the laryn-
geal mirror to the medical profession for practical
experiments. Up to this date Tiirck had published as
yet nothing on the subject, but at a first meeting of the
Medical Society of Vienna, April 9, 1858, (the first
after Czermak's article appeared), Tiirck deliberately
and openly claimed priority in the matter, which Czer-
mak not only did not dispute, but published a second
* Op. cit. Page 3.
t Op. cit., page 3. Czermak Wiener Med. Wochenschrift, No. 13, March 27,
1853.
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LARYNGOSCOPY AND RHINOSCOPY. 1 1
article,* in which he, in the clearest manner possible,
acknowledged Tiirck's claim to priority. How he
could do otherwise we cannot conceive. What he
accomplished in this new field of discovery at first, he
brought about with Tiirck's instruments, which he bor-
rowed, and which were the result of Tiirck's ingenuity
and study. The one furnished the other with the thing
already discovered, necessary to accomplish another
thing dependent wholly upon the first for its accom-
plishment ; for we look upon the laryngeal mirror as the
laryngoscope. Without it, laryngoscopy falls to the
ground. Would the inventor of a machine, who
delivers or lends his invention to another friend for a
short time to repeat the same experiments for which the
original machine is intended, (should the latter succeed
in the use of it,) would the inventor of that machine
therefore, we ask, be rightfully regarded as the
inventor ? or would he be considered as having relin-
quished his claim to his friend who had borrowed the
machine ; although the latter may even have added
improvements, leaving, however, the original principle
of construction by which the utility of the original
machine may have been increased ?
So far, Tiirck's claim to priority is fully and incon-
trovertibly established by facts which ought to satisfy
the inquirer, whatever sophistry may have been
employed, or may hereafter be used, to explain these
facts away. Nor will — aside from the claim of priority
— the labors of Prof. Tiirck in this department permit
* Wiener Med. Wochenschrift, No. i6, Extra April 17, 1858.
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12 THE PRINCIPLES AND PRACTICE OF
him to remain in the background. His late great,
learned and superb work on the Diseases of the Larynx
and ^rachea^ places him in the very foremost position
in this department of science. It will ever be pointed
out as one of the best German classics in medical liter-
ature. It will be long before it will have a rival in its
own or kindred languages. To such genius it is a
pleasure and privilege to do homage and to render our
acknowledgments.
The Commissioners of the Institute Imperial of
France, (section of medicine and surgery), at the con-
course for the prize Montyon, March, 1861, unwilling
to enter into a discussion as to the relative merits of
priority of the two competitors, Tiirck and Czermak,
but being satisfied that the researches of both had
equally contributed to render laryngoscopy a useful art,
susceptible of good service in the diagnosis of the dis-
eases of the pharynx and larynx, granted to both of the
competitors an honorable mention, accompanied by a
prize of 1,200 francs each, placing Tiirck' s name first.
Thus having claimed justice for Professor Tiirck, we
shall not overlook Czermak's merits. He is entitled
to our praise ; it is hard earned. Discussing the rival
claims of discoverers, Sydney Smith is reported as
having said : " That man is not the first discoverer of
any art who first says the thing, but he who says it so
long and so loud and so clearly that he compels man-
kind to hear him — the man who is so deeply impressed
with the importance of his discovery that he will take
* Wien, 1866.
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LARYNGOSCOPY AND RHINOSCOPY. 13
no denial, but at the risk of fortune and fame, pushes
through all opposition, and is determined not to perish
for a want of a fair trial." On grounds like these,
Czermak has the strongest indisputable claims for our
recognition of his merits. He first rendered artificial
light available in our art. It was he who reduced the
art to a system ; he who, from the very first, insisted
and laid stress upon the importance of the laryngoscope
in the diagnosis and the treatment of laryngeal diseases,
and illustrated the correctness of his sayings by practi-
cal results in practice. To him, also, are we indebted
for the art of Rhinoscopy. Czermak, finally it was,
who labored much at home and in foreign lands, till he
became the great teacher of the arts of Laryngoscopy
and Rhinoscopy, as he had been one of their principal
improvers.
Semeleden Voltolini, Lewin, Stork, Ruete, Merlcel,
Traube, Middeldropf, in Germany, Mandl, Maura-
Bourouillon, Bataille, Cusco, and Fauvel, in France,
Mackenzie, Gibb, and Johnson, in England, received
their first impulses from him, having witnessed his
demonstrations.
The result of their many important investigations,
in this department, is recorded in our medical litera-
ture. Surely, the claim to priority may be dismissed,
without feeling, by one whose name is so indissolubly,
so praiseworthy, so honorably interwoven with this
subject.
This historical survey shows that the discovery and
development of the arts of Laryngoscopy and Rhino-
scopy, and all real and permanent progress made in the
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14 THE PRINCIPLES AND PRACTICE OF
same, dates only from the beginning of 1857. Ten
years have sufficed to develope this branch of science
to a perfection, so as to conquer for it the recognition
and support of the whole scientific world. As late as
I857, Mr. Porter, an English surgeon, wrote: " How
is a man of experience, when he meets with a case of
laryngeal disease, to know whether it is caused by an
oedematous condition of the submucous tissue — by a
chronic thickening of the mucous membrane itself—by
laryngeal ulceration — by destruction of the cartilages —
by the presence of abscess, or tumor, or by any other
of those numerous affections which dissection so
frequently shows us to be the occasion of death ?'*
And he suggests that : " Perhaps, by reason of the diffi-
culty of the subject, it will be long before we possess
the same accuracy of information with reference to the
affections of the windpipe that has been attained in
other diseases."*
What a change has been effected since Mr. Porter
wrote the above, and that change has been brought
about, as before said, in ten years ! The larynx has
ceased to be an organ hidden from sight; it is brought
within the range of our vision as much as the eye is,
and more so than the ear. Dr. Johnson's answer to
Mr. Porter's question, fittingly, may close this discus-
sion. " The man of experience has now only to look
into the larynx, and he will see what is the form of the
disease with which he has to deal."
* Quoted by Dr. Johnson in his Lectures on the Laryngoscope, 1864.
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LARYNGOSCOPY AND RHINOSCOPY. 15
CHAPTER II.
THE PRACTICE OF LARYNGOSCOPY.
Section I.
a. Essentials for Laryngoscopic Examination,
The essentials for the purpose of undertaking a laryn-
goscopic examination are : a source of light from which
the rays are thrown either directly, or as is usual in-
directly, into the throat by means of a mirror — a re-
flector — from whence these rays, by the use of the small
mirror (laryngeal mirror) placed in a position obli-
quely beneath the palate, are cast into the cavity of the
larynx to illuminate the latter in such a manner that its
image is reflected in the laryngeal mirror, and seen by
the observer.*
a. The Laryngeal Mirror — Laryngoscope — Kehlkopfra-
chenspiegel of Prof. Tiirck, is simply a small looking-
glass, " whose end is to hold, as 'twere, the mirror up
to nature."f
It is, as it were, the only armament we absolutely
need to examine the larynx by direct sunlight without
reflection. What a store of knowledge this little in-
strument has revealed to us ! How instructive its
* Victor von Brun's Laryngoscopischc Chirurgie. Tubingen, 1865.
•|- Quoted by Dr. Johnson.
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i6 THE PRINCIPLES AND PRACTICE OF
lessons ! What benefits it enables us to bestow upon
our suffering fellow beings ! This small mirror, either
manufactured of the best polished steel, or of glass, set
in a silver frame, is fixed into a stem of metal, and this
into a handle of sufficient length, so that the insertion
of the stem into the handle will rest upon the first
phalanx of the middle finger, and the extremity of the
handle is supported by the soft parts forming the angle
of union between the thumb and index finger. Mir-
rors intended for operative purposes must have longer
handles The stem ought to be inserted firmly into the
mirror at an angle of 120**— 125** as first pointed out by
Tiirck,* whose round mirror is now universally in use^
and superior to any other known. Mirrors vary alsa
in size, and such choice must be made as is best adapted
to the condition of the person to be examined. Gra-
dually a tolerably large one can be introduced, where at
first the smallest size was hardly tolerated. Finely
silvered glass mirrors are preferable to those made of
steel or other metal ; the latter soon loose their polish,
quickly cool, and become dimned by the breath of the
patient.
Figure i.
lEVMDi
Mirrors of different diameter.
* Op. Cit. Page 4.
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LARYNGOSCOPY AND RHINOSCOPY.
«7
Fig. 2.
Fig.
^. 1'he reflector is a round
concave mirror of varying
diameter, fastened to the
forehead or placed in front
of one eye of the operator,
if perforated, for the pur-
pose of reflecting the light
of the sun, or of a lamp,
into the throat. Czermak,
Semeleder, Von Bruns and
others have each adopted
and recommended diflTer-
ent ways of handling the
reflector during examina-
tion. Every operator has
his preference. Where,
for want of sun-light,
direct examinations are
rarely made, and these in
haste, the reflector placed
on the forehead — rather
than in the front of the
eye — will soon be appre-
ciated as both convenient
and advantageous. Ex-
Profile of Turck's Mirror, and half aminations made with the
profile of the same. reflector, in the first men-
The handle is not given in full length, tioned position, are more
readily executed, by beginners in the art especially,
and are as satisfactory in their results as when the mirror
is placed before either eye, which requires special
11
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t8 THE PRINCIPLES AND PRACTICE OP
training, without yielding superior results. In sta-
tionary apparatus, such as Czermak's, Van Bruns,
Tobold's, Lewin's, and others, the reflector is attached
to the illuminating apparatus itself. When used with
sunlight, the patient is placed with his back to the sun
and the operator sits opposite him. In case a lamp is
employed, it is to be placed to the right side of the
patient's head, so that the flame is about on a level and
a little behind his right ear. By good sunlight, with a
laryngeal mirror and a reflector a perfect examination of
the larynx can be made without further addenda.*
c. Lights which is either natural or artificial, is a
third essential in laryngoscopy. Sunlight can be sup-
plied for this purpose either without or with reflectors.
In the first position, without reflector, which is the most
simple, the patient faces the light whilst the operator
introduces the mirror into the mouth and places it
obliquely against the palate. In the second position,
already described with reflectors, the patient is placed
with his back to the sun and light guided into the
throat by means of the reflector.