rd of the esophagus shows the anatomical basis for the "high
low" position for esophagoscopy]

[FIG. 48.--Correct position of the cervical spine for esophagoscopy
and
bronchoscopy. (_Illustration reproduced from author's article Jour.
Am. Med. Assoc., Sept. 25, 1909_)]

[FIG. 49.--Curved position of the cervical spine, with anterior
convexity, in the Rose position, rendering esophagoscopy and
bronchoscopy difficult or impossible. The devious course of the
pharynx, larynx and trachea are plainly visible. The extension is
incorrectly imparted to the whole cervical spine instead of only to
the occipito-atloid joint. This is the usual and very faulty
conception of the extended position. (_Illustration reproduced from
author's article, Jour. Am. Med. Assoc., Sept. 25, 1909._)]

[76] For _direct laryngoscopy_ the patient's head is raised above the
plane of the table by the first assistant, who stands to the right of
the patient, holding the bite block on his right thumb inserted in the
left corner of the patient's mouth, while his extended right hand lies
along the left side of the patient's cheek and head, and prevents
rotation. His left hand, placed under the patient's occiput, elevates
the head and maintains the desired degree of extension at the
occipito-atloid joint (Fig. 50).

[FIG 50.--Direct laryngoscopy, recumbent patient. The second assistant
is sitting holding the head in the Boyce position, his left forearm on
his left thigh his left foot on a stool whose top is 65 cm. lower than
the table-top. His left hand is on the patient's sterile-covered
scalp, the thumb on the forehead, the fingers under the occiput,
making forced extension. The right forearm passes under the neck of
the patient, so that the index finger of the right hand holds the
bite-block in the left corner of the patient's mouth. The fingers of
the operator's right hand pulls the upper lip out of all danger of
getting pinched between the teeth and the laryngoscope. This is a
precaution of the utmost importance and the trained habit of doing it
must be developed by the peroral endoscopist.]

_Position for Bronchoscopy and Esophagoscopy_.--The dorsally recumbent
patient is so placed that the head and shoulders extend beyond the
table, the edge of which supports the thorax at about the level of the
scapulae. During introduction, the head must be maintained in the same
relative position to the table as that described for direct
laryngoscopy, that is