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the iodised oil into the bronchial tree, but we have adopted a
method of injecting the solution directly into the nose with the
tongue held so that the mechanism of swallowing cannot take
place. Prior to this, the patient's sensitivity to iodine and cocaine
is tested. Given that this is satisfactory before the oil is introduced
into the bronchial tree, the nose and laryngo-pharynx are
anaesthetised. This simplified technique of introducing an
iodised oil into the bronchial tree by direct nasal injection under
local anaesthesia causes the patient the minimum of discomfort
and has enabled us to solve the diagnosis of some of the most
difficult of our chronic chest cases. In this way cases sent up
as being suggestive of pulmonary tuberculosis, have been proved
to be due, among other conditions, to lung cancer, bronchiectasis
and lung abscess.
Bronchoscopy.
This method of examining the interior of large and even
smaller bronchi by a bronchial speculum, i.e. a bronchoscope,
has proved to be invaluable in certain chronic chest cases. It
has been responsible for the diagnosis in many cases of (1) lung
cancer arising from the bronchus, (2) simple tumours, (3) obtaining
a positive sputum in certain difficult chest cases, where every
known method has failed to detect this, etc. In cases of foreign
bodies inhaled by children, it has been invaluable and sometimes
a life-saving device. We are greatly indebted to Mr. Ormerod
of the Bronchoscopic Clinic at Brompton Hospital for his help
and co-operation.
Cancer of the Lung.
I have in previous reports emphasised the increased number
of cases of cancer of the lung that are seen at the Chest Clinic.
The symptons and signs often closely resemble those of pulmonary
tuberculosis, and local practitioners, not unreasonably, refer them
as suggestive of pulmonary tuberculosis. The assistance derived
from X-ray films in varied planes, bronchograms and bronchoscopy
in these cases is invalauble. These procedures in the
numerous obscure cases seen at the Chest Clinic are the only
definite means of establishing an accurate diagnosis and enabling
us definitely to dismiss the question of pulmonary
tuberculosis.