ical and dorsal spine. It is necessary,
therefore, to bring the cervical spine into a straight line with the
upper portion of the dorsal spine and this is accomplished by
elevation of the head--the "high" position (Figs. 66-71).

[PLATE III--ESOPHAGOSCOPIC VIEWS FROM OIL-COLOR DRAWINGS FROM LIFE, BY
THE AUTHOR:
1, Direct view of the larynx and laryngopharynx in the dorsally
recumbent patient, the epiglottis and hyoid bone being lifted with the
direct laryngoscope or the esophageal speculum. The spasmodically
adducted vocal cords are partially hidden by the over-hang of the
spasmodically prominent ventricular hands. Posterior to this the
aryepiglottic folds ending posteriorly in the arytenoid eminences are
seen in apposition. The esophagoscope should be passed to the right of
the median line into the right pyriform sinus, represented here by the
right arm of the dark crescent. 2, The right pyriform sinus in the
dorsally recumbent patient, the eminence at the upper left border,
corresponds to the edge of the cricoid cartilage. 3, The
cricopharyngeal constriction of the esophagus in the dorsally
recumbent patient, the cricoid cartilage being lifted forward with the
esophageal speculum. The lower (posterior) half of the lumen is closed
by the fold corresponding to the orbicular fibers of the
cricopharyngeus which advances spasmodically from the posterior wall.
(Compare Fig. 10.) This view is not obtained with an esophagoscope. 4,
Passing through the right pyriform sinus with the esophagoscope;
dorsally recumbent patient. The walls seem in tight apposition, and,
at the edges of the slit-like lumen, bulge toward the observer. The
direction of the axis of the slit varies, and in some instances it is
like a rosette, depending on the degree of spasm. 5, Cervical
esophagus. The lumen is not so patulent during inspiration as lower
down; and it closes completely during expiration. 6, Thoracic
esophagus; dorsally recumbent patient. The ridge crossing above the
lumen corresponds to the left bronchus. It is seldom so prominent as
in this patient, but can always be found if searched for. 7, The
normal esophagus at the hiatus. This is often mistaken for the cardia
by esophagoscopists. It is more truly a sphincter than the cardia
itself. In the author's opinion there is no truly sphincteric action
at the cardia. It is the failure of this hiatal sphincter to open as
in the normal deglutitory cycle that produces the syndrome called
"card