bleeding after
operation is very rare except in bleeders. Hemorrhage within the
larynx can be stopped by the introduction of a roll of gauze from
above, tracheotomy having been previously performed. Morphin
subcutaneously administered, has a constricting action on the vessels
which renders it of value in controlling hemorrhage.

[97] CHAPTER IX--INTRODUCTION OF THE BRONCHOSCOPE

No one should do bronchoscopy until he is able to expose the glottis
by left-handed direct laryngoscopy in less than one minute. When he
has mastered this, one minute more should be sufficient to introduce
the bronchoscope into the trachea.

TECHNIC OF BRONCHOSCOPY

Local anesthesia is usually employed in the adult. The patient is
placed in the Boyce position shown in Fig. 51, with head and shoulders
projecting over the edge of the table and supported by an assistant.
The glottis is exposed by left-handed laryngoscopy. The
instrument-assistant now inserts the distal end of the bronchoscope
into the lumen of the laryngoscope, the handle being directed to the
right in a horizontal position. The operator now grasps the
bronchoscope, his eye is transferred from the laryngoscope to the
bronchoscope, and the bronchoscope is advanced and so directed that a
good view of the glottis is obtained. The slanted end of the
bronchoscope should then be directed to the left, so as clearly to
expose the left cord. In this position it will be found that the tip
of the slanted end is in the center of the glottic chink and will slip
readily into the trachea. No great force should be used, because if
the bronchoscope does not go through readily, either the tube is too
large a size or it is not correctly placed (Fig. 60). Normally,
however, there is some slight resistance, which in cases of subglottic
laryngitis may be considerable. The trained laryngologist will readily
determine by sense of touch the degree of pressure necessary to
overcome it. When the bronchoscope has been inserted to about the
second or third tracheal ring, the heavy laryngoscope is removed by
rotating the handle to the left, removing the slide, and withdrawing
the instrument. Care must be taken that the bronchoscope is not
withdrawn or coughed out during the removal of the laryngoscope; this
can be avoided by allowing the ocular end to rest against the
gown-covered chest of the operator. If preferred the operator may
train his instrumental assistant to take off the laryngoscope, while