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SYSTEM OF PRACTICAL MEDICINE, VOL 3 ***




Produced by Ron Swanson





A SYSTEM OF PRACTICAL MEDICINE.

BY AMERICAN AUTHORS.




EDITED BY WILLIAM PEPPER, M.D., LL.D.,

PROVOST AND PROFESSOR OF THE THEORY AND PRACTICE OF MEDICINE AND OF
CLINICAL MEDICINE IN THE UNIVERSITY OF PENNSYLVANIA.


ASSISTED BY LOUIS STARR, M.D.,

CLINICAL PROFESSOR OF DISEASES OF CHILDREN IN THE HOSPITAL OF THE
UNIVERSITY OF PENNSYLVANIA.




VOLUME III.

DISEASES OF THE RESPIRATORY, CIRCULATORY, AND HÆMATOPOIETIC SYSTEMS.




PHILADELPHIA:
LEA BROTHERS & CO.
1885.




Entered according to Act of Congress, in the year 1885, by

LEA BROTHERS & CO.,

in the Office of the Librarian of Congress at Washington. All rights
reserved.





WESTCOTT & THOMSON,
_Stereotypers and Electrotypers, Philada._

WILLIAM J. DORNAN,
_Printer, Philada._




CONTENTS OF VOLUME III.


DISEASES OF THE RESPIRATORY SYSTEM.
PAGE
LARYNGOSCOPY AND RHINOSCOPY. By CARL SEILER, M.D. . . . . . . . . 19

DISEASES OF THE NASAL PASSAGES. By HARRISON ALLEN, M.D. . . . . . 41

NEUROSES OF THE LARYNX. By HOSMER A. JOHNSON, M.D., LL.D. . . . . 59

ACUTE CATARRHAL LARYNGITIS (FALSE OR SPASMODIC CROUP).
By ABRAHAM JACOBI, M.D. . . . . . . . . . . . . . . . . . . . . 92

PSEUDO-MEMBRANOUS LARYNGITIS. By ABRAHAM JACOBI, M.D. . . . . . . 100

DISEASES OF THE LARYNX. By LOUIS ELSBERG, A.M., M.D. . . . . . . 109

DISEASES OF THE TRACHEA. By LOUIS ELSBERG, A.M., M.D. . . . . . . 133

TRACHEOTOMY. By GEORGE M. LEFFERTS, A.M., M.D. . . . . . . . . . 145

DISEASES OF THE BRONCHI. By N. S. DAVIS, M.D., LL.D. . . . . . . 164

BRONCHIAL ASTHMA. By W. H. GEDDINGS, M.D. . . . . . . . . . . . . 184

HAY ASTHMA. By W. H. GEDDINGS, M.D. . . . . . . . . . . . . . . . 210

DILATATION OF THE BRONCHIAL TUBES, CIRCUMSCRIBED AND DIFFUSED.
By SAMUEL C. CHEW, M.D. . . . . . . . . . . . . . . . . . . . . 227

EMPHYSEMA. By SAMUEL C. CHEW, M.D. . . . . . . . . . . . . . . . 232

COLLAPSE OF THE LUNG (ATELECTASIS). By SAMUEL C. CHEW, M.D. . . . 250

CONGESTION AND OEDEMA OF THE LUNGS (HYPOSTATIC PNEUMONIA).
By SAMUEL C. CHEW, M.D. . . . . . . . . . . . . . . . . . . . . 258

HÆMOPTYSIS. By WILLIAM CARSON, M.D. . . . . . . . . . . . . . . . 266

PULMONARY APOPLEXY. By WILLIAM CARSON, M.D. . . . . . . . . . . . 293

ABSCESS OF THE LUNG. By WILLIAM CARSON, M.D. . . . . . . . . . . 296

GANGRENE OF THE LUNG. By WILLIAM CARSON, M.D. . . . . . . . . . . 301

CROUPOUS PNEUMONIA. By ALFRED L. LOOMIS, M.D., LL.D. . . . . . . 307

CATARRHAL PNEUMONIA. By WILLIAM PEPPER, M.D., LL.D. . . . . . . . 353

PULMONARY EMBOLISM. By BEVERLEY ROBINSON, M.D. . . . . . . . . . 373

PULMONARY PHTHISIS (FIBROID PHTHISIS OR CHRONIC INTERSTITIAL
PNEUMONIA). By AUSTIN FLINT, M.D. . . . . . . . . . . . . . . . 391

SYPHILITIC DISEASE OF THE LUNG. By EDWARD T. BRUEN, M.D. . . . . 447

PNEUMONOKONIOSIS. By EDWARD T. BRUEN, M.D. . . . . . . . . . . . 454

CANCER OF THE LUNGS. By EDWARD T. BRUEN, M.D. . . . . . . . . . . 460

PULMONARY HYDATIDS. By EDWARD T. BRUEN, M.D. . . . . . . . . . . 466

ACUTE MILIARY TUBERCULOSIS. By JOHN S. LYNCH, M.D. . . . . . . . 472

DISEASES OF THE PLEURA. By FRANK DONALDSON, M.D. . . . . . . . . 483


DISEASES OF THE CIRCULATORY SYSTEM.

DISEASES OF THE SUBSTANCE OF THE HEART. By WILLIAM OSLER, M.D. . 601

ENDOCARDITIS AND CARDIAC VALVULAR DISEASES.
By ALFRED L. LOOMIS, M.D., LL.D. . . . . . . . . . . . . . . . 639

CYANOSIS AND CONGENITAL ANOMALIES OF THE HEART AND GREAT VESSELS.
By MORRIS LONGSTRETH, M.D. . . . . . . . . . . . . . . . . . . 687

CARDIAC THROMBOSIS. By BEVERLEY ROBINSON, M.D. . . . . . . . . . 718

NEUROSES OF THE HEART. By AUSTIN FLINT, M.D. . . . . . . . . . . 747

DISEASES OF THE PERICARDIUM. By J. M. DACOSTA, M.D., LL.D. . . . 769

THE OPERATIVE TREATMENT OF PERICARDIAL EFFUSIONS.
By JOHN B. ROBERTS, A.M., M.D. . . . . . . . . . . . . . . . . 794

DISEASES OF THE AORTA. By G. M. GARLAND, M.D. . . . . . . . . . . 800

DISEASES OF THE CORONARY, PULMONARY, SUPERIOR MESENTERIC,
INFERIOR MESENTERIC, AND HEPATIC ARTERIES, AND OF THE COELIAC
AXIS. By ELBRIDGE G. CUTLER, M.D. . . . . . . . . . . . . . . . 828

DISEASES OF THE VEINS. By ANDREW HEERMANCE SMITH, M.D. . . . . . 843

THE CAISSON DISEASE. By ANDREW HEERMANCE SMITH, M. D. . . . . . . 854

DISEASES OF THE MEDIASTINUM. By EDWARD T. BRUEN, M.D. . . . . . . 861


DISEASES OF THE BLOOD AND OF THE HÆMATOPOIETIC SYSTEM.

DISEASES OF THE BLOOD AND BLOOD-GLANDULAR SYSTEM.
By WILLIAM OSLER, M.D. . . . . . . . . . . . . . . . . . . . . 882

DISEASES OF THE SPLEEN. By I. EDMONDSON ATKINSON, M.D. . . . . . 951

DISEASES OF THE THYROID GLAND. By D. HAYES AGNEW, M.D., LL.D. . . 974

SIMPLE LYMPHANGITIS. By SAMUEL C. BUSEY, M.D. . . . . . . . . . . 983


INDEX. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 993




CONTRIBUTORS TO VOLUME III.


AGNEW, D. HAYES, M.D., LL.D.,
Professor of Principles and Practice of Surgery in the University of
Pennsylvania, Philadelphia.

ALLEN, HARRISON, M.D.,
Emeritus Professor of Physiology in the University of Pennsylvania,
Philadelphia.

ATKINSON, I. EDMONDSON, M.D.,
Professor of Pathology and Clinical Medicine and Clinical Professor
of Dermatology in the University of Maryland, Baltimore.

BRUEN, EDWARD T., M.D.,
Assistant Professor of Physical Diagnosis in the University of
Pennsylvania; Physician to Philadelphia (Blockley) Hospital; Lecturer
on Pathology in the Woman's Medical College, Philadelphia.

BUSEY, SAMUEL C., M.D.,
Attending Physician and Chairman of the Board of Hospital
Administration of the Children's Hospital, Washington, D.C.

CARSON, WILLIAM, M.D.,
Physician to and Clinical Lecturer at the Cincinnati Hospital,
Cincinnati.

CHEW, SAMUEL C., M.D.,
Professor of Materia Medica, Therapeutics, and Clinical Medicine in
the University of Maryland, Baltimore.

CUTLER, ELBRIDGE G., M.D.,
Clinical Instructor in Auscultation in the Harvard Medical School;
Physician to Out-Patients, Massachusetts General Hospital.

DACOSTA, J. M., M.D., LL.D.,
Professor of Theory and Practice of Medicine in the Jefferson Medical
College, Philadelphia.

DAVIS, N. S., M.D., LL.D.,
Professor of Principles and Practice of Medicine in the Chicago
Medical College, Chicago.

DONALDSON, FRANK, M.D.,
Clinical Professor of Diseases of the Throat and Chest in the
University of Maryland, Baltimore.

ELSBERG, LOUIS, A.M., M.D.,
Late Professor of Laryngology and Rhinology in the New York
Polyclinic and in Dartmouth Medical College; Physician to Charity
Hospital, Blackwell's Island (Throat Wards), New York.

FLINT, AUSTIN, M.D.,
Professor of the Principles and Practice of Medicine and Clinical
Medicine in the Bellevue Hospital Medical College, New York.

GARLAND, G. M., M.D.,
Formerly Professor of Thoracic Diseases in the University of Vermont,
and Assistant in Clinical Medicine in Harvard Medical School.

GEDDINGS, W. H., M.D.,
Aiken, South Carolina, and Bethlehem, N.H.

JACOBI, ABRAHAM, M.D.,
Clinical Professor of Diseases of Children in the College of
Physicians and Surgeons, New York, etc.

JOHNSON, HOSMER A., M.D., LL.D.,
Emeritus Professor of Practical Medicine in the Chicago Medical
College, Chicago.

LEFFERTS, GEORGE M., A.M., M.D.,
Professor of Laryngoscopy and Diseases of the Throat in the College
of Physicians and Surgeons, New York; Consulting Laryngoscopic
Surgeon to St. Luke's Hospital, etc.

LONGSTRETH, MORRIS, M.D.,
Physician to the Pennsylvania Hospital, Philadelphia.

LOOMIS, ALFRED L., M.D., LL.D.,
Professor of Pathology and Practice of Medicine in the University of
the City of New York.

LYNCH, JOHN S., M.D.,
Professor of Principles and Practice of Medicine in the College of
Physicians and Surgeons, Baltimore.

OSLER, WILLIAM, M.D.,
Professor of Clinical Medicine in the University of Pennsylvania;
formerly Professor of the Institutes of Medicine in McGill
University, Montreal.

PEPPER, WILLIAM, M.D., LL.D.,
Professor of the Theory and Practice of Medicine and of Clinical
Medicine in the University of Pennsylvania, Philadelphia.

ROBERTS, JOHN B., A.M., M.D.,
Professor of Applied Anatomy and Operative Surgery in the
Philadelphia Polyclinic and College for Graduates in Medicine.

ROBINSON, BEVERLEY, M.D.,
Clinical Professor of Medicine in the Bellevue Hospital Medical
College, New York.

SEILER, CARL, M.D.,
Instructor in Laryngoscopy in the University of Pennsylvania;
Professor of Acoustics and Vocal Physiology at the National School of
Oratory, Philadelphia.

SMITH, ANDREW HEERMANCE, M.D.,
Professor of Therapeutics and Clinical Medicine in the New York
Post-Graduate Medical School; Physician to the Presbyterian Hospital,
New York.




ILLUSTRATIONS.

FIGURE PAGE
1. LARYNGEAL MIRROR . . . . . . . . . . . . . . . . . . . . . . . 21

2. HEAD REFLECTOR . . . . . . . . . . . . . . . . . . . . . . . . 23

3. SEILER'S ELECTRIC ILLUMINATOR FOR THE LARYNGOSCOPE . . . . . . 24

4. POSITION OF HAND IN HOLDING THE LARYNGEAL MIRROR . . . . . . . 27

5. SECTION OF THE HEAD, SHOWING THE POSITION OF LARYNGEAL MIRROR
IN THE PHARYNX . . . . . . . . . . . . . . . . . . . . . . . 27

6. ELSBERG'S SPONGE-HOLDER AND EPIGLOTTIS FORCEPS . . . . . . . . 29

7. LARYNGEAL IMAGE DURING RESPIRATION . . . . . . . . . . . . . . 31

8. LARYNGEAL IMAGE DURING PHONATION . . . . . . . . . . . . . . . 31

9. LARYNGOSCOPIC DIAGRAM, SHOWING VOCAL CORDS WIDELY DRAWN APART,
AND THE POSITION OF THE VARIOUS PARTS DURING QUIET BREATHING 31

10. THE SAME, SHOWING APPROXIMATION OF VOCAL CORDS AND POSITION OF
THE VARIOUS PARTS DURING VOCALIZATION . . . . . . . . . . . 31

11. VERTICAL SECTION OF THE HEAD . . . . . . . . . . . . . . . . . 33

12. NASAL SPECULUM . . . . . . . . . . . . . . . . . . . . . . . . 36

13. BOSWORTH'S NASAL DILATOR . . . . . . . . . . . . . . . . . . . 36

14. SEPTOMETER FOR MEASURING THICKNESS OF NASAL SEPTUM . . . . . . 37

15. FOLDING TONGUE DEPRESSOR . . . . . . . . . . . . . . . . . . . 38

16. COHEN'S TONGUE DEPRESSOR . . . . . . . . . . . . . . . . . . . 38

17. JARVIS'S RHINOSCOPIC MIRROR AND TONGUE DEPRESSOR . . . . . . . 39

18. RHINOSCOPIC IMAGE . . . . . . . . . . . . . . . . . . . . . . 39

19. SHOWING ANTERO-POSTERIOR SECTION OF BONES OF THE FACE IN
POSITION . . . . . . . . . . . . . . . . . . . . . . . . . . 48

20. BELLOCQ'S CANULA . . . . . . . . . . . . . . . . . . . . . . . 52

21. ALLEN'S NASAL FORCEPS . . . . . . . . . . . . . . . . . . . . 54

22. THE GALVANO-CAUTERY SNARE . . . . . . . . . . . . . . . . . . 56

23. DOUBLE BATTERY AND FLEMING ELECTRODE FOR USE IN NASAL DISEASES 56

24. TWO ELECTRODES OF PECULIAR SHAPE, FOR USE IN NASAL DISEASES . 58

25. ACUTE TRACHEITIS: ANTERIOR WALL . . . . . . . . . . . . . . . 135

26. SAME CASE AS FIG. 25: POSTERIOR WALL . . . . . . . . . . . . . 135

27. TUBERCULOUS ULCERATION OF THE TRACHEA, AS SEEN DURING LIFE . . 137

28. SAME CASE AS FIG. 27: POST-MORTEM APPEARANCE . . . . . . . . . 137

29. SYPHILITIC ULCERATION OF TRACHEA, AS SEEN DURING LIFE . . . . 137

30. SAME CASE AS FIG. 29: POST-MORTEM APPEARANCE . . . . . . . . . 138

31. PAPILLOMA OF TRACHEA . . . . . . . . . . . . . . . . . . . . . 141

32. INVOLUTION OF TRACHEA, DUE TO ANEURISM . . . . . . . . . . . . 142

33. A TYPICAL CASE OF LOBAR PNEUMONIA IN THE ADULT: RECOVERY . . . 324

34. LOBAR PNEUMONIA, WITH CRISIS MARKED BY EVENING EXACERBATIONS
REACHING NEARLY THE HIGHEST PYREXIA OF THE SECOND STAGE . . 325

35. A TYPICAL CASE OF LOBAR PNEUMONIA IN A CHILD: RECOVERY . . . . 326

36. A CASE OF LOBAR PNEUMONIA IN A BOY TEN YEARS OLD, IN WHICH
TEMPERATURE WAS TAKEN EVERY FOUR HOURS . . . . . . . . . . . 327

37. A TYPICAL CASE OF SENILE LOBAR PNEUMONIA . . . . . . . . . . . 327

38. CROUPOUS PNEUMONIA IN THE ADULT, TERMINATION OF, IN PURULENT
INFILTRATION . . . . . . . . . . . . . . . . . . . . . . . . 333

39. ACUTE LOBAR (CROUPOUS) PNEUMONIA IN A CHILD: RECOVERY . . . . 341

40. ACUTE LOBULAR (CATARRHAL) PNEUMONIA IN A CHILD: RECOVERY . . . 341

41. SPHYGMOGRAPHIC TRACING OF AORTIC OBSTRUCTION (AFTER FOSTER) . 656

42. SPHYGMOGRAPHIC TRACING OF AORTIC REGURGITATION . . . . . . . . 662

43. SPHYGMOGRAPHIC TRACING OF AORTIC OBSTRUCTION AND REGURGITATION 662

44. SPHYGMOGRAPHIC TRACING OF MITRAL OBSTRUCTION . . . . . . . . . 667

45. SPHYGMOGRAPHIC TRACING OF MITRAL AND AORTIC OBSTRUCTION AND
REGURGITATION . . . . . . . . . . . . . . . . . . . . . . . 669

46. SPHYGMOGRAPHIC TRACING OF MITRAL REGURGITATION . . . . . . . . 672

47. SPHYGMOGRAPHIC TRACING OF MITRAL AND AORTIC REGURGITATION . . 672

48. SPHYGMOGRAPHIC TRACING OF TRICUSPID REGURGITATION . . . . . . 679

49. ROBERTS'S PERICARDIAL ASPIRATING TROCAR . . . . . . . . . . . 797

50. SPHYGMOGRAPHIC TRACING OF NORMAL PULSE . . . . . . . . . . . . 809

51. SPHYGMOGRAPHIC TRACING OF RIGHT AND LEFT RADIAL PULSE IN
ANEURISM OF THE AORTA . . . . . . . . . . . . . . . . . . . 810

52. ARCH OF AORTA DURING EARLY FOETAL LIFE . . . . . . . . . . . . 826

53. SARCOMATOUS TUMOR OF ANTERIOR MEDIASTINUM . . . . . . . . . . 866

54. SECONDARY MYELOID SARCOMA OF MEDIASTINUM . . . . . . . . . . . 868

55. RESECTION OF STERNUM FOR REMOVAL OF ENCHONDROMA . . . . . . . 880




DISEASES OF THE RESPIRATORY SYSTEM.


LARYNGOSCOPY AND RHINOSCOPY. | CONGESTION AND OEDEMA OF THE LUNGS
| (HYPOSTATIC PNEUMONIA).
DISEASES OF THE NASAL PASSAGES. |
| HÆMOPTYSIS.
NEUROSES OF THE LARYNX. |
| PULMONARY APOPLEXY.
ACUTE CATARRHAL LARYNGITIS |
(FALSE OR SPASMODIC CROUP). | ABSCESS OF THE LUNG.
|
PSEUDO-MEMBRANOUS LARYNGITIS. | GANGRENE OF THE LUNG.
|
DISEASES OF THE LARYNX. | CROUPOUS PNEUMONIA.
|
DISEASES OF THE TRACHEA. | CATARRHAL PNEUMONIA.
|
TRACHEOTOMY. | PULMONARY EMBOLISM.
|
DISEASES OF THE BRONCHI. | PULMONARY PHTHISIS (FIBROID PHTHISIS
| OR CHRONIC INTERSTITIAL
BRONCHIAL ASTHMA. | PNEUMONIA).
|
HAY ASTHMA. | SYPHILITIC DISEASE OF THE LUNG.
|
DILATATION OF THE BRONCHIAL | PNEUMONOKONIOSIS.
TUBES, CIRCUMSCRIBED AND |
DIFFUSED. | CANCER OF THE LUNGS.
|
EMPHYSEMA. | PULMONARY HYDATIDS.
|
COLLAPSE OF THE LUNG | ACUTE MILIARY TUBERCULOSIS.
(ATELECTASIS). |
| DISEASES OF THE PLEURA.




{19}

LARYNGOSCOPY AND RHINOSCOPY.

BY CARL SEILER, M.D.


The laryngoscope is a combination of instruments designed for the
examination of the interior of the larynx and upper part of the
trachea, while the rhinoscope is a similar combination of instruments
designed to explore the posterior nasal cavity; and both are
comparatively recent inventions.

HISTORY OF THE LARYNGOSCOPE. - In medical literature before the middle
of the eighteenth century no mention is made of an instrument or
apparatus resembling the laryngoscope, but recent excavations at
Pompeii have brought to light small polished metal mirrors attached to
slender handles which are supposed to have been used to inspect the
cavities of the human body. The first authenticated attempt at
laryngoscopy and rhinoscopy was made by the distinguished French
accoucheur M. Levret in the year 1743, who invented, among other
surgical instruments, an apparatus by means of which polypoid growths
in the cavities of the nose, throat, ear, etc. could be seen, and a
ligature be passed around them for their removal.[1] This apparatus
consisted mainly of a polished metal mirror which "reflected the
luminous rays in the direction of the tumor," and on whose surface the
image of the growth was seen to be reflected. The great value of this
apparatus for the diagnosis and treatment of nasal and laryngeal
diseases was, however, not recognized, and it shared the fate of many
other valuable discoveries which were made before the world was ready
to receive them: it was forgotten.

[Footnote 1: _Mercure de France_, 1743, p. 2434.]

In 1807 a certain Dr. Bozzini, living in Frankfort-on-the-Main,
published a work describing an apparatus which he had invented for the
illumination and examination of the cavities of the human body.[2] This
apparatus consisted of a peculiarly-shaped lamp and of a number of
metal tubes, polished on their inner surface, of various shapes and
sizes adapted for the different cavities of the body. The one intended
for the examination of the larynx was bent near its end at a right
angle, and had a mirror placed at the bend, which served to throw the
light downward toward the opening of the larynx when the tube was
inserted into the mouth. When reflected light was to be used, the
interior of the tube or speculum was divided into two portions by a
longitudinal septum, and two mirrors were inserted at the bend - one for
the reflection of the light downward, and the other for receiving the
reflected image. This invention of Bozzini was treated, however, with
derision by the medical profession, probably on account of the
extravagant descriptions given of it in the papers, which were not
verified by its performances.

[Footnote 2: "Der Lichtleiter," Philipp Bozzini, _Med. und Chir. Dr._,
Weimar, 1807.]

In 1825, Cagniard de Latour, an investigator of the physiology of the
voice, made some unsuccessful attempts to examine the living larynx.[3]

[Footnote 3: _Physiologie de la Voix_, par Ed. Tournié, Paris, 1865.]

{20} Senn of Geneva in 1827 endeavored to examine the larynx of a
little girl suffering from an affection of the throat by means of a
small mirror which he had made and which he inserted into the pharynx,
but he failed to see the glottis, because, as he says, the mirror was
too small, and because he used neither direct nor reflected light to
illuminate the cavity below the mirror.[4]

[Footnote 4: _Journal de Progrès des Sciences, etc._, 1829.]

In the year 1829, Benjamin Guy Babington published[5] an account of
what he called the glottiscope, an apparatus which consisted mainly of
two mirrors. One of these was small and attached to a slender stem, and
was used to receive the image, while the other, an ordinary hand-glass,
was used to reflect the rays of the sun or ordinary daylight upon the
smaller mirror in the fauces. This combination was essentially the same
as is used at the present day in the laryngoscope, with the difference
that we now use artificial light in most instances, and a concave
mirror instead of a plane one for reflecting the light.

[Footnote 5: _Lond. Med. Gazette_, 1829, vol. iii.]

While Babington was still engaged in perfecting his instruments, a
mechanic named Selligue, who suffered from an affection of the throat,
in 1832 invented a speculum for his physician, Bennati of Paris, with
which the latter was able, as he asserted,[6] to see the vocal cords.
This instrument was similar to the one invented by Bozzini, and
consisted of a double speculum bent at right angles and carrying two
mirrors - one for illuminating the cavity, and the other for reflecting
the image. Selligue was rewarded for his efforts by a complete cure of
his affection.

[Footnote 6: _Recherches sur le Mécanisme de la Voix humane_.]

A number of others worked in the same direction, and endeavored to see
the interior of the larynx in the living subject by employing different
apparatus and methods of illumination. Thus, in 1838, Baumès of Lyons
described a mirror the size of a two-franc piece (1-1/8 inches in
diameter) as useful in examining the larynx and posterior nares.[7]
Then Liston in 1840 used a dentist's mirror,[8] and Warden of Edinburgh
employed a prism of flint glass attached to a long stem as a laryngeal
mirror.[9] In the latter part of the same year Avery of London employed
a speculum with a mirror in its end for examining the larynx, using as
an illuminator a concave reflector with a central opening, which was
supported by a frame to be worn on the head of the operator.[10]

[Footnote 7: _Compte Rendu des Travaux de la Société de Médecine de
Lyons_, 1836-38.]

[Footnote 8: _Practical Surgery_, 1840.]

[Footnote 9: _Lond. Med. Gazette_, vol. xxiv. p. 256.]

[Footnote 10: _Med. Circ._, June, 1862.]

Up to this time all efforts at laryngoscopy had been made with a view
to diagnose diseases of the larynx, with the exception of those made by
Latour. In the year 1854, however, Signor Manuel Garcia of London,
without any knowledge of previous efforts, conceived the idea of
studying the changes in the larynx during phonation in his own throat.
For this purpose he placed a small dentist's mirror against the uvula
and reflected the rays of the sun into his mouth and upon the small
mirror by means of a hand-glass held in the other hand. By arranging
his position in relation to the sun in such a manner that he could see
the reflected image of the small mirror in his throat in the
hand-glass, and in it the illuminated image of his larynx, after a few
ineffectual attempts his efforts at auto-laryngoscopy were crowned with
such success that he was enabled to study the movements of the vocal
cords during phonation, and accurately describe the registers of the
voice in a paper read before the Royal Society of London in 1855.[11]
Although Garcia was the first who practised laryngoscopy successfully,
his communication to the Royal Society attracted little attention, and
would have been forgotten if it had not been that, in 1857, Tuerk of
Vienna, having heard of Garcia's paper, began to use the laryngeal
mirror on the patients in the K. K. Algem. Krankenhaus for {21}
diagnostic purposes.[12] At first he was not very successful in his
attempts, and began to experiment with laryngeal mirrors of different
sizes and shapes. While thus engaged Czermak borrowed Tuerk's mirrors,
and modified them until he succeeded in the greater number of cases in
seeing the vocal cords,[13] using artificial light for illuminating the
larynx. Meanwhile, Tuerk continued his experiments, and also succeeded
in almost all cases of throat disease which came to his department of
the hospital in seeing the interior of the larynx and in treating the
lesions. Both Tuerk and Czermak improved their apparatus, and
especially the latter, who by substituting artificial light for
sunlight, and by inventing a number of different illuminating
apparatuses, has given us the laryngoscope in the form in which it is
used at the present day. It is but natural that Tuerk should have
claimed priority in the successful use of this instrument, and in
consequence of this claim a controversy was carried on for a number of
years in the medical press between him and Czermak, which at times
became quite spirited, but which left Czermak master of the field. In
the winter of 1858-59, Madam E. Seiler, having heard of Czermak's
experiments, had a laryngeal mirror constructed from his description,
practised laryngoscopy successfully on herself and others, among them
the writer, with a view to study the physiology of the voice. Her
efforts being crowned with success, she was able not only to verify
Garcia's observations in regard to the registers, but also discovered
the so-called head register of the female voice, as well as two small
cartilages in the vocal cords.[14]

[Footnote 11: _Proc. Royal Society of London_, vol. vii. No. 13, 1855.]

[Footnote 12: _Zeitschrift der Ges. der Aerzte zu Wien_, April, 1858.]

[Footnote 13: _Wien. Medicin. Wochenschrift_, March, 1858.]

[Footnote 14: _Altes und Neues_, Leipzig, 1861.]

HISTORY OF THE RHINOSCOPE. - Rhinoscopy, or the art of viewing the
naso-pharyngeal space by placing a small mirror behind the velum



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