objective point. His operations are all made under the guidance of the image which he sees reflected in the laryngeal mirror, and are comparatively bloodless and accompanied by little or no pain.
A laryngoscopic examination is made as follows: In the second cut we see the positions of the examiner and patient. The patient opens his mouth as widely as possible, and at the same time protrudes his tongue. The examiner, then, with a small napkin takes the protruded tongue between his thumb and forefinger, thus gently steadying it and preventing its slipping back into the mouth. The object in thus protruding the tongue is to enlarge the cavity of the mouth as much as possible. The laryngeal mirror is next warmed either over the chimney of the illuminator or in some warm water, so as to prevent its becoming obscured or dimmed by the breath. It is then quickly and dexterously carried to the back of the mouth. A bungling manner of doing this, by causing great irritation of sensitive parts of the mouth, causes gagging and even vomiting, and, this once excited, all further examination is either very difficult or impossible at this sitting. It is not to be taken for granted, however, that examinations can readily be made in all cases, nor even in the larger majority of the patients. With many there is no trouble, but there are also quite a number of patients whose throats are so irritable from disease as to prevent the introduction of the laryngoscope. In other cases the patient's tongue has an almost irresistible tendency to keep rising up toward the roof of the mouth and thus obstruct the view. Enlargement of the tonsils according to the degree of their enlargement makes an examination either very difficult, or else, if so much enlarged that they meet and almost close up the throat, makes it impossible until the enlargement has been reduced. For the overcoming of mere irritability of the throat or fauces when this pertains to a degree sufficient to be troublesome, various means have been resorted to, to produce local anæsthesia of the fauces. A piece of ice held in the mouth, the water being swallowed, is one plan. Another is to drop twenty drops of chloroform on a handkerchief and let the patient inhale it for a minute. With most cases of irritable throat this is quite sufficient, and without at all rendering the patient drowsy or uncomfortable. Bromide of potash has been used, but has not given satisfaction practically.
The examiner, having avoided touching the back of the tongue and of the pharynx with the mirror, carries it, as already said, to the back of the mouth to an oblique position below the soft palate and with the uvula or "drop" of the palate at its back. The rays of light from the illuminating apparatus, striking the laryngeal mirror, are then reflected in a downward direction and light up the parts (the larynx) below. These, being illuminated, are in return depicted upon the laryngeal mirror above. The process may be compared to that of the management of toilet-mirrors to enable us to see the back
