uired to hold the patient's arms and still
another for the changing of the operator's glasses when they become
spattered. The endoscopic team of three maintain surgical asepsis in
the matter of hands and gowns, etc. The battery, on a small table of
its own, is placed at the left hand of the operator. Beyond it is the
table for the mechanical aspirator, if one is used. All extra
instruments are placed on a sterile table, within reach, but not in
the way, while those instruments for use in the particular operation
are placed on a small instrument table back of the endoscopist. Only
those instruments likely to be wanted should be placed on the working
table, so that there shall be no confusion in their selection by the
instrument nurse when called for. Each moment of time should be
utilized when the endoscopic procedure has been started, no time
should be lost in the hunting or separating of instruments. To have
the respective tables always in the same position relative to the
operator prevents confusion and avoids delay.

[FIG 43.--The author's retrograde esophagoscope.]

_Oxygen Tank and Tracheotomy Instruments_.--Respiratory arrest may
occur from shifting of a foreign body, pressure of the esophagoscope,
tumor, or diverticulum full of food. Rare as these contingencies are,
it is essential that means for resuscitation be at hand. No endoscopic
procedure should be undertaken without a set of tracheotomy
instruments on the sterile table within instant reach. In respiratory
arrest from the above mentioned causes, respiratory efforts are not
apt to return unless oxygen and amyl nitrite are blown into the
trachea either through a tracheotomy opening or better still by means
of a bronchoscope introduced through the larynx. The limpness of the
patient renders bronchoscopy so easy that the well-drilled
bronchoscopist should have no difficulty in inserting a bronchoscope
in 10 or 15 seconds, if proper preparedness has been observed. It is
perhaps relatively rarely that such accidents occur, yet if
preparations are made for such a contingency, a life may be saved
which would otherwise be inevitably lost. The oxygen tank covered with
a sterile muslin cover should stand to the left of the operating
table.

_Asepsis_.--Strict aseptic technic must be observed in all endoscopic
procedures. The operator, first assistant, and instrument nurse must
use the same precautions as to hand sterilization and sterile gowns as
would be exercis