plus pressure. In
the lungs, however, high plus pressures are so dangerous that the
pressure valve must be lowered.

[Fig. 11--Portable aspirator for endoscopy with additional tube
connected with the plus pressure side for use in case of occlusion of
the drainage canal. This aspirator has the advantage of great power
with portability. Where portability is not required the electrically
operated aspirator is better.]

[FIG. 12.--Robinson mechanical aspirator adapted for bronchoscopic and
esophagoscopic aspiration by the author. The positive pressure is used
for clearing obstructed drainage canals and tubes.]

[FIG. 13.--Apparatus for insufflation of ether or chloroform during
bronchoscopy, for those who may desire to use general anesthesia. The
mechanical methods of intratracheal insufflation anesthesia
subsequently developed by Meltzer and Auer, Elsberg, Geo. P. Muller
and others have rightly superseded this apparatus for all general
surgical purposes.]

_Sponge-pumping_.--While the usually thin, watery esophageal and
gastric secretions, if free from food, are readily aspirated through a
drainage canal, the secretions of the bronchi are often thick and
mucilaginous and aspirated with difficulty. Further-more, bronchial
secretions as a rule are not collected in pools, but are distributed
over the walls of the larger bronchi and continuously well up from
smaller bronchi during cough. The aspirating bronchoscopes should be
used whenever their very slight additional area of cross-section is
unobjectionable. In most cases, however, the most advantageous way to
remove bronchial secretion has been found to be by introducing a gauze
swab on a long sponge carrier (Fig. 14), so that the sponge extends
beyond the distal end of the bronchoscope, causing cough. Then
withdrawal of the sponge carrier will remove all of the secretion in
the tube just as the plunger in a pump will lift all of the water
above it. By this maneuver the walls of the bronchus are wiped free
from secretions, and the lamp itself is cleansed.

[FIG. 14.--Sponge carrier with long collar for carrying the small
sponges shown in Fig. 15. The collar screws down as in the Coolidge
cotton carrier. About a dozen of these are needed and they should all
be small enough to go through the 4 mm. (diameter) bronchoscope and
long enough to reach through the 53 cm. (length) esophagoscope, so
that one set will do for all tubes. The schema shows method of
sponging. The ca