sired. The elevation is the important thing.
C. The neck being maintained in position B, the desired amount of
extension of the head is obtained by a movement limited to the
occipito-atloid articulation by the assistant's hand placed as shown
by the dart (B).
D. Faulty position. Unless prevented, almost all patients will heave
up the chest and arch the lumbar spine so as to defeat the object and
to render endoscopy difficult by bringing the chest up to the
high-held head, thus assuming the same relation of the head to the
chest as exists in the Rose position (a faulty one for endoscopy) as
will be understood by assuming that the dotted line, E, represents the
table. If the pelvis be not held down to the table the patient may
even assume the opisthotonous position by supporting his weight on his
heels on the table and his head on the assistant's hand.]

In obtaining the position of high head with occipito-atloid extension,
the easiest and most certain method, as pointed out to me by my
assistant, Gabriel Tucker, is first to raise the head, strongly
flexed, as shown in Fig. 52; then while maintaining it
there, make the occipito-atloid extension. This has proven better
than to elevate and extend in a combined simultaneous movement.

If the patient would relax to limpness exposure of the larynx would be
easily obtained, simply by lifting the head with the lip of the
laryngoscope passed below the tip of the epiglottis (as in Fig. 55)
and no holding of the head would be necessary. But only rarely is a
patient found who can do this. This degree of relaxation is of course,
present in profound general ether anesthesia, which is not to be
thought of for direct laryngoscopy, except when it is used for the
purpose of insertion of intratracheal insufflation anesthetic tubes.
For this, of course, the patient is already to be deeply anesthetized.
The muscular tension exerted by some patients in assuming and holding
a faulty position is almost as much of a hindrance to peroral
endoscopy as is the position itself. The tendency of the patient to
heave up his chest and assume a false position simulating the
opisthotonous position (Fig. 52) must be overcome by persuasion. This
position has all the disadvantages of the Rose position for endoscopy.

[FIG. 53.--The author's position for the removal of foreign bodies
from the larynx or from any of the upper air or food passages. If
dislodged, the intruder will not be aided by gravity to