pe.]

Pins are very prone to drop into the smaller bronchi and disappear
completely from the ordinary field of endoscopic exploration. At other
times, pins not dropping so deeply may show the point only during
expiration or cough, at which times the bronchi are shortened. In such
instances the invaded bronchial orifice should be clearly exposed as
near the axis of its lumen as possible; the forceps are now inserted,
opened, and the next emergence watched for, the point being grasped as
soon as seen.

_Extraction of Tacks, Nails and Large Headed Foreign Bodies from the
Tracheobronchial Tree_.--In cases of this sort the point presents the
same difficulty and requires solution in the same manner as mentioned
in the preceding paragraphs on the extraction of pins. The author's
inward-rotation method when executed with the Tucker forceps is ideal.
The large head, however, presents a special problem because of its
tendency to act as a mushroom anchor when buried in swollen mucosa or
in a fibrous stenosis (Fig. 83). The extraction problems of tacks are
illustrated in Figs. 84, 85, and 86. Nails, stick pins, and various
tacks are dealt with in the same manner by the author's "inward
rotation" method.

_Hollow metallic bodies_ presenting an opening toward the observer may
be removed with a grooved expansile forceps as shown in Figs 23 and
25, or its edge may be grasped by the regular side-grasping forceps.
The latter hold is apt to be very dangerous because of the trauma
inflicted by the catching of the free edge opposite the forceps; but
with care it is the best method. Should the closed end be uppermost,
however, it may be necessary to insert a hook beyond the object, and
to coax it upward to a point where it may be turned for grasping and
removal with forceps.

[FIG. 83.--"Mushroom anchor" problem of the upholstery tack. If the
tack has not been _in situ_ more than a few weeks the stenosis at the
level of the darts is simply edematous mucosa and the tack can be
pulled through with no more than slight mucosal trauma, _provided_
axis-traction only be used. If the tack has been in situ a year or
more the fibrous stricture may need dilatation with the divulsor.
Otherwise traction may rupture the bronchial wall. The stenotic tissue
in cases of a few months' sojourn maybe composed of granulations, in
which case axis-traction will safely withdraw it. The point of a tack
rarely projects freely into the lumen as here shown. More o