the endoscopies are performed. The simple insertion of the
bronchoscope is devoid of harm if carefully done. The danger lies in
misdirected efforts at removal of the intruder and in repeating
bronchoscopies in children at too frequent intervals, or in prolonging
the procedure unduly. In children under one year endoscopy should be
limited to twenty minutes, and should not be repeated sooner than one
week after, unless urgently indicated. A child of 5 years will bear 40
to 60 minutes work, while the adult offers no unvarying time limit.
More can be ultimately accomplished, and less reaction will follow
short endoscopies repeated at proper intervals than in one long
procedure.

_Indications for bronchoscopy for suspected foreign body_ may be thus
summarized:
1. The appearance of a suspicious shadow in the radiograph, in the
line of a bronchus.
2. In any case in which lung symptoms followed a clear history of
the patient having choked on a foreign body.
3. In any case showing signs of obstruction in the trachea or of a
bronchus.
4. In suspected bronchiectasis.
5. Symptoms of pulmonary tuberculosis with sputum constantly
negative for tubercle bacilli. If the physical signs are at the base,
particularly the right base, the indication becomes very strong even
in the absence of any foreign body circumstance in the history.
6. In all cases of doubt, bronchoscopy should be done anyway.

There is no absolute _contraindication to bronchoscopy for foreign
bodies_. Extreme exhaustion or reaction from previous efforts at
removal may call for delay for recuperation, but pulmonary abscess and
even the rarer complications, bronchopneumonia and gangrene of the
lung, are improved by the early removal of the foreign body.

_Choice of Time to do Bronchoscopy for Foreign Body_.--The
difficulties of removal usually increase from the time of aspiration
of the object. It tends to work downward and outward, while the mucosa
becomes edematous, partly closing over the foreign body, and even
completely obliterating the lumen of smaller bronchi. Later,
granulation tissue and the formation of stricture further hide the
object. The patient's health deteriorates with the onset of pulmonary
pathology, and renders him a less favorable subject for bronchoscopy.
Organic foreign bodies, which produce early and intense inflammatory
reaction and are liable to swell, call for prompt bronchoscopy. When a
bronchus is completely obstructed by the