part taken in connection with the
knowledge obtained by the previous ray study, and by inspection of the
ray plate upside down on view in front of the bronchoscopist.
3. The version or other manipulation necessary to convert an
unfavorable into a favorable presentation for grasping and
disengagement.
4. The best instruments to use, and which to use first, as, hook,
pincloser, forceps, etc.
5. The presence and position of the "forceps spaces" of which there
must be two for all ordinary forceps, one for each jaw, or the
"insertion space" for any other instrument.

Until all of these points are determined it is a grave error to insert
any kind of instrument. If possible even swabbing of the foreign body
should be avoided by swabbing out the bronchus, when necessary, before
the region of the intruder is reached. When the operator has
determined the instrument to be used, and the method of using it, the
instrument is cautiously inserted, under guidance of the eye.

[160] _The lip of the bronchoscope_ is one of the most valuable aids
in the solution of foreign-body problems. With it partial or complete
version of an object can be accomplished so as to convert an
unfavorable presentation into one favorable for grasping with the
forceps; edematous mucosa may be displaced, angles straightened and
space made at the side of the foreign body for the forceps' jaw. It
forms a shield or protector that can be slipped under the point of a
sharp foreign body and can make counterpressure on the tissues while
the forceps are disembedding the point of the foreign body. With the
bronchoscopic lip and the forceps or other instrument inserted through
the tube, the bronchoscopist has bimanual, eye-guided control, which
if it has been sufficiently practiced to afford the facility in
coordinate use common to everyone with knife and fork, will accomplish
maneuvers that seem marvelous to anyone who has not developed facility
in this coordinate use of the bronchoscopic instruments.

_The relation of the tube mouth and foreign body_ is of vital
importance. Generally considered, the tube mouth should be as near the
foreign body as possible, and the object must be placed in the center
of the bronchoscopic field, so that the ends of the open jaws of the
forceps will pass sufficiently far over the object. But little lateral
control is had of the long instruments inserted through the tube;
sidewise motion is obtained by a shifting of the end of