Birth of Laryngoscopy However, it was not a physician but Manuel Garcia (1805–1906), a voice teacher from London, who is generally credited with discovering laryngoscopy. In 1855, Garcia described how he could perform “autolaryngoscopy” using a dental mirror in combination with a second, larger mirror to direct sunlight into his mouth.13 This arrangement allowed him to see his larynx and trachea—a feat fortuitously made possible by Garcia’s absent gag reflex.
The “Autoscope” Others had been working toward a similar solution. In 1929, an English medical student named Benjamin Guy Babington created a device he dubbed the “glottiscope,” but the invention did not have the impact it deserved.14 Toward the end of the 19th century, Alfred Kirstein of Berlin, Germany, developed the self-named “autoscope” (Figure 3), consisting of a spatula, hood, and handle, which he was inspired to create after learning how an endoscope intended for esophagoscopy had inadvertently slipped into the trachea.15 To assist in viewing the airway, Kirstein also invented what he called a “forehead-lamp for reflected light,” a sort of premodern spelunking headlamp. In 1897, a 68-page translation of Kirstein’s Autoscopy of the Layrnx and the Trachea was published in the United States. The article included
Figure 3. Line engraving of Alfred Kirstein performing laryngoscopy with his laryngoscope. From: Hirsch NP, Smith GB, Hirsch PO. Alfred Kirstein: pioneer of direct laryngoscopy. Anaesthesia. 1986;41(1):42-45.
Selections From an 1888 Textbook on Intubation of the Larynx
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ew can appreciate the risks and dangers that were encountered in introducing this operation into private practice. Several times my life was threatened for “putting a plug in a child’s throat.” On one occasion I was obliged to beat a hasty retreat to avoid personal injury, and in another case the coroner was summoned to investigate and to hold me responsible for a child’s death. Through the support and encouragement of my brother practitioners, however, I was enabled to persevere until the operation became established as a legitimate procedure. Intubation has now become so thoroughly recognized as a practical and successful operation, that I believe it to be a duty the medical profession at large owe to the public, that at least one physician in every village, town, and city throughout this great country, should possess the necessary instruments, pluck, and skill to successfully perform this operation.
A Case Report May 5th, 1886. Courtesy Drs. Steele and Lawless. Termination, recovery. Age, fourteen months. Wore the tube three and a half days. Diphtheritic patches upon the tonsils, and the child almost dead from laryngeal obstruction. Intubation gave immediate relief. The baby did well for two days, when the tube was removed. As respiration was carried on with difficulty, the tube was again introduced. The child did poorly
for the next twenty-four hours, the respiration being rapid and somewhat embarrassed and moist sibilant rales were heard in both lungs. Little hope of recovery was entertained. The tube was removed, but the child was still unable to carry on respiration without it, and it was again introduced. Twelve hours later the patient was found in convulsions, and while not severe, were of frequent occurrence. The case now seemed entirely hopeless, but it was thought best to remove the tube, which was done while the child was in the stupor following a convulsion. The respiration, although rapid, numbering seventy per minute, was easily performed, and the tube was dispensed with. The bromides were given per rectum to control the convulsions, and carbonate of ammonia given in the milk as soon as the child was able to swallow. As the moist sibilant rales continued flax seed poultices well covered with oilsilk, were applied to the chest. Gradually the little one improved, and in a few days was on the safe road to recovery, and is at this writing as fine and healthy a child as is to be found in the city of Chicago. By F.E. Waxham, MD Professor of Otology, Rhinology and Laryngoscopy College of Physicians and Surgeons of Chicago Clinical Professor of Laryngology and Rhinology Chicago Ophthalmic College Published by Charles Truax Chicago, IL; 1888
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