ged
metallic foreign body. If, however, an inflammatory condition of the
bronchi existed previous to the bronchoscopy, as for instance the
intense diffuse, purulent laryngotracheobronchitis associated with
the aspiration of nut kernels, or in the presence of pulmonary abscess
from long retained foreign bodies, a moderate temporary rise of
temperature may be expected. These cases almost always have had
irregular fever before bronchoscopy. Disturbance of the epithelium in
the presence of pus without abscess usually permits enough absorption
to elevate the temperature slightly for a few days.

_Surgical shock_ in its true form has never followed a carefully
performed and time-limited bronchoscopy. Severe fatigue resulting in
deep sleep may be seen in children after prolonged work.

_Local reaction_ is ordinarily noted by slight laryngeal congestion
causing some hoarseness and disappearing in a few days. If dyspnea
occur it is usually due to (1) Drowning of the patient in his own
secretions. (2) Subglottic edema. (3) Laryngeal edema.

_Drowning of the Patient in His Own Secretions_.--The accumulation of
secretions in the bronchi due to faulty bechic powers and seen most
frequently in children, is quickly relievable by bronchoscopic
sponge-pumping or aspiration through the tracheotomic wound, in cases
in which the tracheotomy may be deemed necessary. In other cases, the
aspirating bronchoscope with side drainage canal (Fig. 1, E) may be
used through the larynx. Frequent peroral passage of the bronchoscope
for this purpose is contraindicated only in case of children under 3
years of age, because of the likelihood of provoking subglottic edema.
In such cases instead of inserting a bronchoscope the aspirating tube
(Fig. 9) should be inserted through the direct laryngoscope, or a low
tracheotomy should be done.

_Supraglottic edema_ is rarely responsible for dyspnea except when
associated with advanced nephritis.

_Subglottic edema_ is a complication rarely seen except in children
under 3 years of age. They have a peculiar histologic structure in
this region, as is shown by Logan Turner. Even at the predisposing age
subglottic edema is a very unusual sequence to bronchoscopy if this
region was previously normal. The passage of a bronchoscope through an
already inflamed subglottic area is liable to be followed by a
temporary increase in the swelling. If the foreign body be associated
with but slight amount of secretion, the