Modern surgery, general and operative . s the instrument without general anesthesia except in children,highly nervous people, or cases of very severe spasm. Apply cocain to theback of the tongue, pillars of the fauces, epiglottis, and pharynx. Place thepatient on the right side with the head thrown back. This is known as Starchsposition, and, as Gottstein shows, it relaxes the diaphragmatic crura. Anassistant supports the head and follows every movement of the surgeon. Thepatient is cautioned to breathe tranquilly, and is told if the pain or annoyancebecomes intolerable to raise his left arm,
Modern surgery, general and operative . s the instrument without general anesthesia except in children,highly nervous people, or cases of very severe spasm. Apply cocain to theback of the tongue, pillars of the fauces, epiglottis, and pharynx. Place thepatient on the right side with the head thrown back. This is known as Starchsposition, and, as Gottstein shows, it relaxes the diaphragmatic crura. Anassistant supports the head and follows every movement of the surgeon. Thepatient is cautioned to breathe tranquilly, and is told if the pain or annoyancebecomes intolerable to raise his left arm, when the surgeon will cease for a surgeon must, of course, keep his word on this point. Artificial teeth areremoved. The instrument is kept in the midline and is inserted as is a sound orbougie. As soon as it passes the cricoid narrowing the mandrel is withdrawn,and the instrument is passed slowly and gently along while the surgeon islooking through and ahead of it. For Chevalier Jacksons method of esoph-agoscopy see page Fig. 590.—Position of patient during esophagoscopy (after von Mikulicz). The cervical esophagus is closed and seems to unroll before the instru-ment. The thoracic esophagus is open, and while the esophagoscope entersinto the upper part of this region, if the gullet is normal, the surgeon can seeall the way down to the diaphragm. At the diaphragm the esophagus bendsforward and to the left and this point must not be mistaken for the cardia(Kohler, in Brit. Med. Jour., Oct. 19, 1912). The cardia may be found closed or may be seen to open and close w^threspiration. This instrument is of great value in the extraction of foreignbodies, in the diagnosis and treatment of many esophageal diseases, and in thediagnosis of certain peri-esophageal conditions. Every surgeon should beable to use the esophagoscope. (See Gottstein, in Keens Surgery, vols, iiiand vi; Waggett, in Brit. Med. Jour., Oct. 19, 1912; Kohler, in Brit. , Oct. 19, 1912; Reports
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