the
bronchoscope. When the foreign body has been centered in the
bronchoscopic field and placed in a position favorable for grasping,
it is important that this position be maintained by anchoring the tube
to the upper teeth with the left, third, and fourth fingers hooked
over the patient's upper alveolus (Fig. 63)

_The Light Reflex on the Forceps_.--It is often difficult for the
beginner to judge to what depth an instrument has been inserted
through the tube. On slowly inserting a forceps through the tube, as
the blades come opposite the distal light they will appear brightly
illuminated; or should the blades lie close to the light bulb, a
shadow will be seen in the previously brilliantly lighted opposite
wall. It is then known that the forceps are at the tube mouth, and the
endoscopist has but to gauge the distance from this to the foreign
body. This assistance in gauging depth is one of the great advances in
foreign body bronchoscopy obtained by the development of distal
illumination.

_Hooks_ are useful in the solution of various mechanical problems, and
may be turned by the operator himself into various shapes by heating
small probe-pointed steel rods in a spirit lamp, the proximal end
being turned over at a right angle for a controlling handle. Hooks
with a greater curve than a right angle are prone to engage in small
orifices from which they are with difficulty removed. A right angle
curve of the distal end is usually sufficient, and a corkscrew spiral
is often advantageous, rendering removal easy by a reversal of the
twisting motion (Bib. 11, p. 311).

_The Use of Forceps in Endoscopic Foreign Body Extraction_.--Two
different strengths of forceps are supplied, as will be seen in the
list in Chapter 1. The regular forceps have a powerful grasp and are
used on dense foreign bodies which require considerable pressure on
the object to prevent the forceps from slipping off. For more delicate
manipulation, and particularly for friable foreign bodies, the lighter
forceps are used. Spring-opposed forceps render any delicacy of touch
impossible. Forceps are to be held in the right hand, the thumb in one
ring, and the third, or ring finger, in the other ring. These fingers
are used to open and close the forceps, while all traction is to be
made by the right index finger, which has its position on the forceps
handle near the stylet, as shown in Fig. 78. It is absolutely
essential for accurate work, that the forceps ja