py will succeed. Of course there is usually no cough to aid,
but the involuntary abdominal and thoracic compression helps. Should a
patient arrive in a serious state of water-hunger, as part of the
preparation the patient must be given water by hypodermoclysis and
enteroclysis, and if necessary the endoscopy, except in dyspneic
cases, must be delayed until the danger of water-starvation is past.

As pointed out by Ellen J. Patterson the size of the thymus gland
should be studied before an esophagoscopy is done on a child.

Every patient should be examined by indirect, mirror laryngoscopy as a
preliminary to peroral endoscopy for any purpose whatsoever. This
becomes doubly necessary in cases that are to be anesthetized.

[65] CHAPTER IV--ANESTHESIA FOR PERORAL ENDOSCOPY

A dyspneic patient should never be given a general anesthetic. Cocaine
should not be used on children under ten years of age because of its
extreme toxicity. To these two postulates always in mind, a third one,
applicable to both general and local anesthesia, is to be added--total
abolition of the cough-reflex should be for short periods only.
General anesthesia is never used in the Bronchoscopic Clinic for
endoscopic procedures. The choice for each operator must, however, be
a matter for individual decision, and will depend upon the personal
equation, and degree of skill of the operator, and his ability to
quiet the apprehensions of the patient. In other words, the operator
must decide what is best for his particular patient under the
conditions then existing.

_Children_ in the Bronchoscopic Clinic receive neither local nor
general anesthesia, nor sedative, for laryngoscopic operations or
esophagoscopy. Bronchoscopy in the older children when no dyspnea is
present has in recent years, at the suggestion of Prof. Hare, been
preceded by a full dose of morphin sulphate (i.e., 1/8 grain for a
child of six years) or a full physiologic dose of sodium bromide. The
apprehension is thus somewhat allayed and the excessive cough-reflex
quieted. The morphine should be given not less than an hour and a half
before bronchoscopy to allow time for the onset of the soporific and
antispasmodic effects which are the desiderata, not the analgesic
effects. Dosage is more dependent on temperament than on age or body
weight. Atropine is advantageously added to morphine in bronchoscopy
for foreign bodies, not only for the usual reasons but for its effect
as an antispa