Since Spanish vocalist, Manuel Garcia’s inadvertent invention of the laryngoscope in 1854, laryngology has been a field of invention and ingenuity.
In only the 2nd ever Semon Lecture, Killian describes the process of discovery of obtaining a view of the ‘topography of the bucco-pharyngeal cavity’ in a cadaver, using an ingenious combination of Kirstein ()’ spatula and mechanics. So excited by this new view he was, that he set out to develop the tools and techniques to attain the same view in a living patient, that is, direct laryngoscopy. In recent times, the field of medical engineering has arisen to develop the tools needed for investigation and treatment, but a century ago, physicians and surgeons employed, out of necessity, the degree of mechanical skill and ingenuity required to manipulate the human body. Killian’s lecture describes, in detail, how he overcame challenges – employing scopolamine, and engineering tools to improve on each new issue as they came along.
In Mosher’s 1929 lecture, he describes the success of novel techniques he used to examine the physiology and anatomy of the lower oesophagus. He pioneered the use of the barium striped bag. Having been ‘suspicious’ of the results he was achieving using tubing, he began using inflatable bags in order to visualise parts of the oesophagus. Later, he discovered that through the use of barium lines on the bag and a fluoroscope, he could perform dilation by sight. Furthermore, in order to better visualise the bag, he needed to create a gas bubble, a feat he creatively accomplished by the administration of effervescent Seidlitz powder.
In 1950, Freckner described his and Bjorkman’s into the technique of ‘bronchial catherisation’, or bronchospirometry, using bronchoscopes from metal tubing. He saw the technique of bronchospirometry limited by instrumentation and apparatus. In his investigations of gold and copper miners exposed to arsenic fumes and sulphur dioxide gas, Freckner designed an entirely new method of recording in order to attain a more careful analysis of breathing phases. He admitted that it was as-yet imperfect, but he saw the value in designing better tools to achieve better results.
Whilst later lectures discuss the role that new technologies (CO2 lasers, ventilating bronchoscopes, etc.) play in improving diagnostic outcome and patient comfort, by the later-half of the 20th century, this inventive spirit seems to play less of a role than it earlier did.