will therefore usually be anxious and pale, unless
the patient is seen immediately after the aspiration of the foreign
body. If labored breathing has been prolonged, and exhaustion
threatened, the heart's action will be irregular and weak. The foreign
body can be seen with the mirror, but a roentgenograph must
nevertheless be made, for the object may be of another nature than was
first thought. The roentgenograph will show its position, and from
this knowledge the plan of removal can be formulated. For example, a
straight pin may be so placed in the larynx that only a portion of its
shaft will be visible, the roentgenogram will tell where the head and
point are located, and which of these will be the more readily
disengaged. (See Chapter on Mechanical Problems.)

PHYSICAL SIGNS OF TRACHEAL FOREIGN BODY

If fixed in the trachea the only objective sign of foreign body may be
a wheezing respiration, the site of which may be localized with the
stethoscope, by the intensity of the sound. Movable foreign bodies may
produce a palpatory thrill, and the rumble and sudden stop can be
heard with the stethoscope and often with the naked ear. The lungs
will show equal aeration, but there may be marked dyspnea without the
indrawing of the fossae, if the object be of large size and located
below the manubrium.

To the peculiar sound of the sudden subglottic, expiratory or bechic
arrest of the foreign body the author has given the name "audible
slap;" when felt by the thumb on the trachea he calls it the
"palpatory thud." These signs can be produced by no condition other
than the arrest of some substance by the subglottic taper. Once heard
and felt they are unmistakable.

PHYSICAL SIGNS OF BRONCHIAL FOREIGN BODY

In most cases there will be limitation of expansion on the invaded
side, even though the foreign body is of such a shape as to cause no
bronchial obstruction. It has been noted frequently in conjunction
with the presence of such objects as a common straight pin in a small
branch bronchus. This peculiar phenomenon was first noted by Thomas
McCrae in one of the author's cases and has since been abundantly
corroborated by McCrae and others as one of the most constant physical
signs.

To understand the peculiar physical findings in these cases it is
necessary to remember that the bronchi are not tubes of constant
caliber; there occurs a dilatation during inspiration, and a
contraction of the lumen during expiration; furthe