Louis H. Clerf

PROGRESS IN OTOLARYNGOLOGY: A Summary of the Bibliographic Material Available in the Field of Otolaryngology: PERORAL ENDOSCOPY: A REVIEW OF THE LITERATURE

It has become apparent during the last few years that the recognition of the importance of bronchoscopy for diagnosis and treatment in disease has resulted in an enormous increase in the proportion of this class of cases as compared with those in which a foreign body is involved, notwithstanding the fact that the actual number of the latter type of cases in which bronchoscopy was used has increased enormously also. After commenting on this fact, Chevalier Jackson,1 in one of the most important articles of the year, presented an interesting analysis of the reasons for the phenomenal success of bronchoscopy in disease. First among these he placed the restoration of the defensive power of the lungs. He stated that bronchoscopic researches have demonstrated that the deeper bronchi are practically sterile, and that the bacteria are increasingly numerous as the larynx is approached. As bacteria-laden atmospheric air necessarily reaches the alveoli, the observations justify the inference that the defensive powers of the lung destroy the bacteria. Two obvious elements in this defensive power are the cough reflex and the ciliary action. The tissues and juices everywhere in the body have defensive powers against bacterial invasion; but the defensive power that bronchoscopic studies have demonstrated is one against bacterial invasion by air-borne infection. Invasions by the hematogenous route do not meet with the same degree of defense. It is by assisting in this defense, by the bronchoscopic attack on the invading host from the rear, that the marvelous results of bronchoscopic aspiration in early suppurative pulmonary disease seem to be obtained. In dealing with the subject of bronchoscopic aspiration, Chevalier Jackson stated, It is probable that the drainage of superficial foci of suppuration was done with a flint in the hands of the caveman. It is reasonably certain that this was done by the ancient Peruvian. Hippocrates preached and practiced drainage of pus, and since his time drainage has been fundamental in surgery. Bronchoscopic aspiration is the same in principle; the new thing about it is the discovery that with the bronchoscope, suppurative foci can be drained through the mouth harm