37 and 56.

The endoscopic extraction of a foreign body is a mechanical problem
pure and simple, and must be studied from this viewpoint. Hasty,
ill-equipped, ill-planned, or violent endoscopy on the erroneous
principle that if not immediately removed the foreign body will be
fatal, is never justifiable. While the lodgement of an organic foreign
body (such as a nut kernel) in the bronchus calls for prompt removal
and might be included under the list of emergency operations, time is
always available for complete preparation, for thorough study of the
patient, and localization of the intruder. The patient is better off
with the foreign body in the lung than if in its removal a
mediastinitis, rupture into the pleura, or tearing of a thoracic blood
vessel has resulted. The motto of the endoscopist should be "I will do
no harm." If no harm be inflicted, any number of bronchoscopies can be
done at suitable intervals, and eventually success will be achieved,
whereas if mortality results, all opportunity ceases.

The first step in the solution of the mechanical problem is the study
of the roentgenograms made in at least three planes; (1)
anteroposterior, (2) lateral, and (3) the plane corresponding to the
greatest plane of the foreign body. The next step is to put a
duplicate of the foreign body into the rubber-tube manikin previously
referred to, and try to simulate the probable position shown by the
ray, so as to get an idea of the bronchoscopic appearance of the
probable presentation. Then the duplicate foreign body is turned into
as many different positions as possible, so as to educate the eye to
assist in the comprehension of the largest possible number of
presentations that may be encountered at the bronchoscopy on the
patient. For each of these presentations a method of disimpaction,
disengagement, disentanglement or version and seizure is worked out,
according to the kind of foreign body. Prepared by this practice and
the radiographic study, the bronchoscope is introduced into the
patient. The location of the foreign body is approached slowly and
carefully to avoid overriding or displacement. A _study of the
presentation_ is as necessary for the bronchoscopist as for the
obstetrician. It should be made with a view to determining the
following points:
1. The relation of the presenting part to the surrounding tissues.
2. The probable position of the unseen portion, as determined by the
appearance of the presenting