_Secretions_ in the esophagus are readily aspirated through the drainage canal by a negative pressure pump. Food particles are best removed by "sponge pumping," or with forceps. Should the drainage canal become obstructed positive pressure from the pump will clear the canal. _Difficulties of Esophagoscopy_.--The beginner may find the esophagoscope seemingly rigidly fixed, so that it can be neither introduced nor withdrawn. This usually results from a wedging of the tube in the dental angle, and is overcome by a wider opening of the jaws, or perhaps by easing up of the bite block, but most often by correcting the position of the patient's head. If the beginner cannot start the tube into the pyriform sinus in an adult, it is a good plan to expose the arytenoid eminence with the laryngoscope and then to insert the 7 mm. esophagoscope into the right pyriform sinus by direct vision. Passing the cricopharyngeal and hiatal spasmodically contracted narrowings will prove the most trying part of esophagoscopy; but with the head properly held, and the tube properly placed and directed, patient waiting for relaxation of the spasm with gentle continuous pressure will usually expose the lumen ahead. In his first few esophagoscopies the novice had best use general anesthesia to avoid these difficulties and to accustom himself to the esophageal image. In the first favorable subject--an emaciated individual with no teeth--esophagoscopy without anesthesia should be tried. In cases of kyphosis it is a mistake to try to straighten the spine. The head should be held correspondingly higher at the beginning, and should be very slowly and cautiously lowered. Once inserted, the esophagoscope should not be removed until the completion of the procedure, unless respiratory arrest demands it. Occasionally in stenotic conditions the light may become covered by the upwelling of a flood of fluid, and it will be thought the light has gone out. As soon as the fluid has been aspirated the light will be found burning as brightly as before. If a lamp should fail it is unnecessary to remove the tube, as the light carrier and light can be withdrawn and quickly adjusted. A complete instrument equipment with proper selection of instruments for the particular case are necessary for smooth working. _Ballooning Esophagoscopy_.--By inserting the window plug shown in Fig. 6 the esophagus may be inflated and studied in the distended state. The folds are thus smoothed out and constrictions rendered more marked. Ether anesthesia is advocated by Mosher. The danger of respiratory arrest from pressure, should the patient be dyspneic, is always present unless the anesthetic be given by the intratracheal method. If necessary to use forceps the window cap is removed. If the perforated rubber diaphragm cap be substituted the esophagus can be reballooned, but work is no longer ocularly guided. The fluoroscope may be used but is so misleading as to render perforation and false passage likely.