ure will usually expose the lumen ahead. In his
first few esophagoscopies the novice had best use general anesthesia
to avoid these difficulties and to accustom himself to the esophageal
image. In the first favorable subject--an emaciated individual with no
teeth--esophagoscopy without anesthesia should be tried.

In cases of kyphosis it is a mistake to try to straighten the spine.
The head should be held correspondingly higher at the beginning, and
should be very slowly and cautiously lowered.

Once inserted, the esophagoscope should not be removed until the
completion of the procedure, unless respiratory arrest demands it.
Occasionally in stenotic conditions the light may become covered by
the upwelling of a flood of fluid, and it will be thought the light
has gone out. As soon as the fluid has been aspirated the light will
be found burning as brightly as before. If a lamp should fail it is
unnecessary to remove the tube, as the light carrier and light can be
withdrawn and quickly adjusted. A complete instrument equipment with
proper selection of instruments for the particular case are necessary
for smooth working.

_Ballooning Esophagoscopy_.--By inserting the window plug shown in
Fig. 6 the esophagus may be inflated and studied in the distended
state. The folds are thus smoothed out and constrictions rendered more
marked. Ether anesthesia is advocated by Mosher. The danger of
respiratory arrest from pressure, should the patient be dyspneic, is
always present unless the anesthetic be given by the intratracheal
method. If necessary to use forceps the window cap is removed. If the
perforated rubber diaphragm cap be substituted the esophagus can be
reballooned, but work is no longer ocularly guided. The fluoroscope
may be used but is so misleading as to render perforation and false
passage likely.

_Specular Esophagoscopy_.--Inspection of the hypopharynx and upper
esophagus is readily made with the esophageal speculum shown in Fig.
4. High lesions and foreign bodies lodged behind the larynx are thus
discovered with ease, and such a condition as a retropharyngeal
abscess which has burrowed downward is much less apt to be overlooked
than with the esophagoscope. High strictures of the esophagus may be
exposed and treated by direct visual bouginage until the lumen is
sufficiently dilated to allow the passage of the esophagoscope for
bouginage of the deeper strictures.

_Technic of Specular Esophagoscopy_.--Recumbent p