reach a deeper
lodgement.]

The one exception to these general positions is found in procedures
for the removal of foreign bodies from the larynx. In such cases,
while the same relative position of the head to the plane of the table
is maintained, the whole table top is so inclined as to elevate the
feet and lower the head, known as Jackson's position. This
semi-inversion of the patient allows the foreign body to drop into the
pharynx if it should be dislodged, or slip from the forceps (Fig. 53).

[82] CHAPTER VII--DIRECT LARYNGOSCOPY

_Importance of Mirror Examination of the Larynx_.--The presence of
the direct laryngoscope incites spasmodic laryngeal reflexes, and the
traction exerted somewhat distorts the tissues, so that accurate
observations of variations in laryngeal mobility are difficult to
obtain. The function of the laryngeal muscles and structures,
therefore, can best be studied with the laryngeal mirror, except in
infants and small children who will not tolerate the procedure of
indirect laryngoscopy. A true idea of the depth of the larynx is not
obtained with the mirror, and a view of the ventricles is rarely had.
With the introduction of the direct laryngoscope it is found that the
larynx is funnel shaped, and that the adult cords are situated about 3
cm. below the aryepiglottic folds; the cords also assume their true
shelf-like character and take on a pinkish or yellowish tinge, rather
than the pearly white seen in the mirror. They are not to any extent
differentiated by color from the neighboring structures. Their
recognition depends almost wholly on form, position and movement.

Accurate observation is stimulated in all pathologic cases by making
colored crayon sketches, however crude, of the mirror image of the
larynx. The location of a growth may be thus graphically recorded, so
that at the time of operation a glance will serve to refresh the
memory as to its site. It is to be constantly kept in mind, however,
that in the mirror image the sides are reversed because of the facing
positions of the examiner and patient. Direct laryngoscopy is the only
method by which the larynx of children can be seen. The procedure need
require less than a minute of time, and an accurate diagnosis of the
condition present, whether papilloma, foreign body, diphtheria,
paralysis, etc., may be thus obtained. The posterior pharyngeal wall
should be examined in all dyspneic children for the possible existence
of re