The laryngoscope, and how to use it
The Laryngoscope in its simplest form is a thin circular mirror, about three-quarters of an inch in diameter, set in a metal frame, and fastened at an angle of 120° to a piece of wire from three to four inches long, which is put into a small wooden handle not much thicker than a pencil, and about the same length as the wire. By help of the laryngoscope we can either see our own larynx or that of another person. The easiest experiment is upon the larynx of some one else. In this case, the person to be operated upon sits facing the sun, the head slightly bent backwards, and the mouth wide open. If he has not sufficient control over his tongue to prevent it from arching up, he must gently hold its protruding tip with a pocket handkerchief between his thumb and forefinger. The mirror is now slightly warmed to prevent its becoming dimmed by the moisture of the breath, and then, holding it like a pen, the operator introduces it into the throat so that it touches the uvula. This must be done lightly yet firmly, care being taken not to bring the mirror into contact with the base of the tongue. The rays of the sun falling upon the mirror are reflected downwards into the voicebox, the image of which is clearly visible in the mirror. In making observations upon oneself, a second mirror in the shape of an ordinary hand looking-glass is necessary to reproduce the image in the small mirror. This is the way in which the renowned professor of singing, Senor Manuel Garcia, made those famous “Observations on the Human Voice,” communicated to the Royal Society by Dr. Sharpey, on May the 24th, 1855. Similar attempts had been made before; for instance, in 1827 by Babington, in 1838 by Baumès, in 1840 by Liston, and in 1844 by Warden and Avery. But they had all ended in failure, an occasional glimpse of some parts of the voicebox being the only result obtained. Garcia, however, brilliantly succeeded where all his predecessors had failed, and was the first not only to see the vocal ligaments, but to see them in the act of singing, and to see them so clearly as to be able to give an account of their minutest movements. The instrument has since been greatly improved, and the process of investigation has become a science. Medical men all over the world have laid hold of it, and suffering humanity is daily benefited by it. But Garcia is the man who produced the first results, and to him, therefore, is due the credit of being practically the inventor of the laryngoscope.
It is almost incredible, but it is true, that this splendid invention was received coldly and with distrust in this country, and had it not been for Dr. Johann N. Czermak, Professor of Physiology at the University of Pesth, the matter would, in all probability, have been forgotten. But this gentleman recognized the value of Garcia’s invention, and he at once went enthusiastically to work, and pushed on vigorously in the way which Garcia had opened for him. He constructed an apparatus which enabled him, by making use of artificial light, to work without interruption and without waiting for the sun to shine. He then made his first attempts on himself in order to become acquainted with the conditions which have to be fulfilled by the observer as well as by the person to be operated upon. In this way he soon became a master of the new process, which he immediately brought under the notice of the profession by giving lectures and demonstrations in the chief towns of Europe.
More than twenty years have passed since then, and the laryngoscope has, during that time, been made excellent use of, not only for the alleviation of suffering, and the cure of disease, but also for its original purpose—i.e., the exploration of the mechanism of the human voice.
My own connection with the matter has arisen through my desire to sift contradictory statements made by various observers. Having read many English, German, and French books on the subject, I was in position to pick up a hint here, and to get some good advice there, and the consequence was that I was able to pursue a course which made me familiar with the use of the laryngoscope in a very short time. As my experience may be useful to others, I will briefly relate how I proceeded.
I made my first attempts upon a skull, to which I attached a plaster-of-Paris model of the voicebox, the whole being fastened to an iron stand. The instrument I used was a concave reflector on a spectacle frame. The reflector had a hole in the centre, and was capable of being moved in various directions. The next thing was the little mirror described on page 73, and lastly, a gas lamp on the principle of the well-known “Queen’s” reading lamps, which can be raised or lowered at pleasure. I placed the skull to the left of the lamp, and looking with my right eye through the hole in the centre of the reflector, practised throwing the light swiftly and with certainty into the upper part of the throat. I then introduced the little spy mirror, and tried to see and to recognize the various parts of the voicebox, which, let it be remembered, present a somewhat different appearance in the looking-glass from what they do if seen without it. Then I got a friend to mark my artificial voicebox, unknown to me, in various ways, and endeavoured quickly to discover what he had done. In this way I soon acquired a considerable amount of skill in handling the instrument, and also became thoroughly familiar with the image of the voicebox in the mirror.M Having thus to a large extent mastered the mechanical part of my work, I proceeded to make observations upon myself. I placed to the left of the lamp an ordinary bedroom looking-glass, in which now appeared my own face instead of the skull which hitherto occupied this place. I opened my mouth, and by the help of the reflector directed the light into the image of it in the looking-glass. I then continued in every way as I had done with the skull, with this difference, however, that I had first, as pointed out before, to warm the little spy mirror in order to prevent its becoming dimmed in the throat.
An instrument has since been designed by the late Dr. G. D. Foulis, of Glasgow, which for simplicity, general excellence, and cheapness, far surpasses the above contrivance, and which I strongly recommend to intending students of laryngoscopy. It consists of a plain stand on which is placed a glass globe filled with water, the whole being surmounted by a small square mirror. The rays from a lamp or candle, placed behind the globe, are concentrated into the open mouth of the observer, who is seated in front of it, enabling him, by the use of an ordinary throat mirror, to inspect the movements of his own vocal ligaments.
This apparatus, as shown in the annexed drawing, including a throat mirror, and safely packed for transmission, may be had from Messrs. W. B. Hilliard & Sons, 65, Renfield Street, Glasgow, for the very small sum of 7s. 6d.
Let not the reader who tries laryngoscopic investigations be discouraged if, at first, violent retching is the result. It does not so much arise from sensitiveness of the parts touched, as from awkwardness in introducing the mirror. If he perseveres he will soon be rewarded by a view of the pearly white vocal ligaments, and a little repeated practice upon himself will enable him also to operate upon others without causing them discomfort.
I close this chapter by again reminding amateur laryngoscopists that in the vast majority of cases where the touch of the mirror causes retching and gagging, it is due less to the sensitiveness of the person operated upon than to the want of skill on the part of the operator. He should in that case renew his experiments upon himself, and continue them until he has fully mastered the use of the instrument, as it is not fair to make others suffer for his own clumsiness.