atient. Boyce
position. The larynx is to be exposed as in direct laryngoscopy, the
right pyriform sinus identified, the tip of the speculum inserted
therein, and gently insinuated to the cricopharyngeal constriction.
Too great extension of the head is to be avoided--even slight flexion
at the occipito-atloid joint may be found useful at times. Moderate
anterior or upward traction pulls the cricoid away from the posterior
pharyngeal wall and the lumen of the esophagus opens above a
crescentic fold (the cricopharyngeus). The speculum readily slides
over this fold and enters the cervical esophagus. In searching for
foreign bodies in the esophagus the speculum has the disadvantage of
limited length, so that should the foreign body move downward it could
not be followed.

_Complications Following Esophagoscopy_.--These are to be avoided in
large measure by the exercise of gentleness, care, and skill that are
acquired by practice. If the instructions herein given are followed,
esophagoscopy is absolutely without mortality apart from the
conditions for which it is done.

Injury to the crico-arytenoid joint may simulate recurrent paralysis.
Posticus paralysis may occur from recurrent or vagal pressure by a
misdirected esophagoscope. These conditions usually recover but may
persist. Perforation of the esophageal wall may cause death from
septic mediastinitis. The pleura may be entered,--pyopneumothorax will
result and demand immediate thoracotomy and gastrostomy. Aneurysm of
the aorta may be ruptured. Patients with tuberculosis, decompensating
cardiovascular lesions, or other advanced organic disease, may have
serious complications precipitated by esophagoscopy.

_Retrograde Esophagoscopy_.--The first step is to get rid of the
gastric secretions. There is always fluid in the stomach, and this
keeps pouring out of the tube in a steady stream. Fold after fold is
emptied of fluid. Once the stomach is empty, the search begins for the
cardial opening. The best landmark is a mark with a dermal pencil on
the skin at a point corresponding to the level of the hiatus
esophageus. When it is desired to do a retrograde esophagoscopy and
the gastrostomy is done for this special purpose, it is wise to have
it very high. Once the cardia is located and the esophagus entered,
the remainder of the work is very easy. Bouginage can be carried out
from below the same as from above and may be of advantage in some
cases. Strictural lumina are much