sudden dyspnea and
cyanosis occur? What has been the previous treatment and what attempts
at removal have been made? The nature of the foreign body is to be
determined, and if possible a duplicate thereof obtained.

_General physical examination_ should be complete including inspection
of the eyes, ears, nose, pharynx, and mirror inspection of the
naso-pharynx and larynx. Special attention is paid to the chest for
the localization of the object. In order to discover conditions
rendering endoscopy unusually hazardous, all parts of the body are to
be examined. Aneurysm of the aorta, excessive blood pressure, serious
cardiac and renal conditions, the presence of a hernia and the
existence of central nervous disease, as tabes dorsalis, should be at
least known before attempting any endoscopic procedure. Dysphagia
might result from the pressure of an unknown aneurysm, the symptoms
being attributed to a foreign body, and aortic aneurysm is a definite
contraindication to esophagoscopy unless there be foreign body present
also. There is no absolute contraindication to the endoscopic removal
of a foreign body, though many conditions may render it wise to
post-pone endoscopy. Laryngeal crises of tabes might, because of their
sudden onset, be thought due to foreign body.

PHYSICAL SIGNS IN ESOPHAGEAL FOREIGN BODY

There are no constant physical signs associated with uncomplicated
impaction of a foreign body in the esophagus. Should perforation of
the cervical esophagus occur, subcutaneous emphysema, and perhaps
cellulitis, may be found; while a perforation of the thoracic region
causing mediastinitis is manifested by toxemia, fever, and rapid
sinking. Perforation of the pleura, with the development of
pyopneumothorax, is manifested by the usual signs. It is to be
emphasized that blind bouginage has no place in the diagnosis of any
esophageal condition. The roentgenologist will give the information we
desire without danger to the patient, and with far greater accuracy.

FOREIGN BODIES IN THE LARYNX

Laryngeally lodged foreign bodies produce a wheezing respiration, the
quality of which is peculiar to the larynx and is readily localized to
this organ. If swelling or the size of the foreign body be sufficient
to produce dyspnea, inspiratory indrawing of the suprasternal notch,
supraclavicular fossae, costal interspaces and lower sternum will be
present. Cyanosis is only an accompaniment of suddenly produced
dyspnea; the facies