years ago inflammation, laryngeal phthisis, or, popularly speaking, throat-consumption, and œdema, constituted the three recognized forms of throat-affection; but, in eight years from the first practical application of this instrument, the revolution was such that separate treatises described and treated of forty and more varieties of disease, such as acute laryngitis and the various acute affections; simple chronic laryngitis, chronic ulcerative laryngitis; of six or seven forms of inflammation of special parts of the larynx; of tubercular and syphilitic laryngitis, œdema, abscess, etc. Next we find descriptions of the diseases which attack the laryngeal cartilages or framework of the larynx, as perichondritis and chondritis. Then follow nervous forms of derangement, and then paralytic forms of difficulty. In the first we have conditions of nervous exaltation, such as spasmodic coughs, spasms, etc. Under the second head we have paralytic affections of the vocal cords and laryngeal muscles. These paralytic difficulties of the larynx may exist in the larynx without much or even any impairment of the general health. Then we have anæmia or impoverished blood-supply, and finally the varied forms of tumors and morbid growths, cancerous, syphilitic, etc. I might prolong this list yet further, and even dwell at length upon the many and ingenious instruments for operating within the larynx, but to do so would be to exceed the limits of my article.
The rhinoscopic mirror, or rhinoscope, is practically but a laryngeal mirror of a smaller size. The stem and handle are the same, and attached in the same manner, at about the same angle, but there is the difference of a much smaller size as compared to the laryngoscope, the mirror being usually about the size of a silver three-cent piece. Its use is to enable us to see the back or inner parts of the nose (posterior nares), and the upper part of the pharynx or vault of the back of the mouth. Its discovery, which occurred soon after that of the laryngoscope, is due to the patience and genius of Czermak, and was a direct result of the discovery of the laryngeal mirror. The parts which it enables us to see are hidden behind and above the palate, and the office of the rhinoscopic mirror is simply to so reflect the light as to illuminate these parts, and in turn enable their image to become visible in the mirror. In the first instance the little mirror is placed at the back of the opened mouth of the patient. At the same time a powerful and clear light from an illuminating apparatus is directed into the patient's mouth, and the rays striking upon the mirror are so reflected upward and forward as to illuminate the parts we seek to examine, and these are then, as just remarked, made visible in the mirror. And in this principle lies the entire secret of the art of making a laryngoscopic or rhinoscopic examination. It is simply a dexterous management of mirrors to secure proper reflection of light, and the consequent illumination and examination of hidden recesses.
