ble pressure
on his neck and that he may feel as though he were about to choke. He
must be gently but positively made to understand (1) that while the
procedure is alarming, it is absolutely free from danger; (2) that you
know just how it feels; (3) that you will not allow his breath to be
shut off completely; (4) that he can help you and himself very much by
paying close attention to breathing deeply and regularly; (5) and that
he must not draw himself up rigidly as though "walking on ice," but
must be easy and relaxed.

_Direct Laryngoscopy. Adult Patient_.--Before starting, every detail
in regard to instrumental equipment and operating room assistants,
(including an assistant to hold the arms and legs of the patient) must
be complete. Preparation of the patient and the technic of local
anesthesia have been discussed in their respective chapters. The
dorsally recumbent patient is draped with (not pinned in) a sterile
sheet. The head, covered by sterile towels, is elevated, and slight
extension is made at the occipitoatloid joint by the left hand of the
first assistant. The bite block placed on the assistant's right thumb
is inserted into the left angle of the patient's open mouth (see Fig.
50).

The laryngoscope must always and invariably be held in the left hand,
and in such a manner that the greatest amount of traction is made at
the swell of the horizontal bar of the handle, rather than on the
vertical bar.

The right hand is then free for the manipulation of forceps, and the
insertion of the bronchoscope or other instrument. During
introduction, the fingers of the right hand retract the upper lip so
as to prevent its being pinched between the laryngoscope and the
teeth. The introduction of the direct laryngoscope and exposure of the
larynx is best described in two stages.
1. Exposure and identification of the epiglottis.
2. Elevation of the epiglottis and all the tissues attached to the
hyoid bone, so as to expose the larynx to direct view.

_First Stage_.--The spatular end of the laryngoscope is introduced in
the right side of the patient's mouth, along the right side of the
anterior two-thirds of the tongue. It was the German method to
introduce the laryngoscope over the dorsum of the tongue but in order
to elevate this sometimes powerful muscular organ considerable force
may be required, which exercise of force may be entirely avoided by
crowding the tongue over to the left. When the posterior third s