. Medical diagnosis for the student and practitioner. thoroughly experienced and practised operator, and, in mostinstances, under profound anesthesia. This last procedure is doubtless tosome degree avoidable under the skilful technic of a past master of the art. The difficulties in gastroscopy also are manifestly greater than those ofesophagoscopy by reason of the obstacles to be overcome in bringing the partto be examined into view. The path from the teeth to the stomach must bemade direct and hence the normal curves must be straightened. Obviouslythe head must be thrown far back to raise the
. Medical diagnosis for the student and practitioner. thoroughly experienced and practised operator, and, in mostinstances, under profound anesthesia. This last procedure is doubtless tosome degree avoidable under the skilful technic of a past master of the art. The difficulties in gastroscopy also are manifestly greater than those ofesophagoscopy by reason of the obstacles to be overcome in bringing the partto be examined into view. The path from the teeth to the stomach must bemade direct and hence the normal curves must be straightened. Obviouslythe head must be thrown far back to raise the level of the upper jaw and over-come the curve normally present and considerable delicacy of technic isrequired to secure the entrance of the instrument into the cardia and beyondthat point as is actually accomplished by the expert. It occasionally happens that in individuals with a very prominent upperjaw and short thick neck the introduction of the tube may be well nigh impos-sible. The passage of the tube from the esophagus into the stomach may. Fig. 430.—Usual gastroscopic field. It is manifest that the accessible area will be greatlyincreased in ptotic stomachs. also be blocked by reason of great deformity of the spine, abnormalities ofthe gastric musculature itself, large aneurysms of the thoracic aorta, orexisting heart disease greatly distending the left auricle and producing com-pression upon, and stenosis of, the esophagus. Some of the modern forms of the gastroscope have largely overcome anydanger inherent in its use by dispensing with the uniformly rigid tube such aseasily led to perforation of the esophagus in clumsy or inexperienced handswhen the attempt was made to traverse that structure at its lower portionopposite its point of passage through the hiatus esophagus of the dia-phragm. The use of a flexible tip which in its passage conforms to thecurves of the esophagus offers an advantage, though adding somewhat to thecomplication of the instrument. Much diffi
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectdiagnos, bookyear1922
