ere and probably fatal trauma will be produced. The pin may be
closed with the pin-closer as illustrated in Fig. 37, and then removed
with forceps. Arrowsmith's pin-closer is excellent. Another method
(Fig. 87) consists in bringing the point of the safety pin into the
bronchoscope, after disengaging the point with the side curved
forceps, by the author's "inward rotation" method. The forceps-jaws
(Fig. 21) devised recently by my assistant, Dr. Gabriel Tucker, are
ideal for this maneuver. As the point is now protected, the spring,
seen just off the tube mouth, is best grasped with the rotation
forceps, which afford the securest hold. The keeper and its shaft are
outside the bronchoscope, but its rounded portion is uppermost and
will glide over the tissues without trauma upon careful withdrawal of
the tube and safety pin. Care must be taken to rotate the pin so that
it lies in the sagittal plane of the glottis with the keeper placed
posteriorly, for the reason that the base of the glottic triangle is
posterior, and that the posterior wall of the larynx is membranous
above the cricoid cartilage, and will yield. A small safety-pin may be
removed by version, the point being turned into a branch bronchial
orifice. No one should think of attempting the extraction of a safety
pin lodged point upward without having practiced for at least a
hundred hours on the rubber tube manikin. This practice should be
carried out by anyone expecting to do endoscopy, because it affords
excellent education of the eye and the fingers in the endoscopic
manipulation of any kind of foreign body. Then, when a safety pin case
is encountered, the bronchoscopist will be prepared to cope with its
difficulties, and he will be able to determine which of the methods
will be best suited to his personal equation in the particular case.

[FIG. 86.--Schema illustrating the "upper-lobe-bronchus problem,"
combined with the "mushroom-anchor" problem and the author's method
for their solution. The patient being recumbent, the bronchoscopist
looking down the right main bronchus, M, sees the point of the tack
projecting from the right upper-lobe-bronchus, A. He seizes the point
with the side-curved forceps; then slides down the bronchoscope to the
position shown dotted at B. Next he pushes the bronchoscopic
tube-mouth downward and medianward, simultaneously moving the
patient's head to the right, thus swinging the bronchoscopic level on
its fulcrum, and dragging the