n body
is soon absorbed, and the negative pressure thus produced increases
the impaction. A ring of edematous mucosa quickly forms and covers the
presenting part of the object, leaving visible only a small surface in
the center of an acute edematous stenosis. A forceps with narrow,
stiff, expansive-spring jaws may press back a portion of the edema and
may allow a grasp on the sides of the foreign body; but usually the
attempt to apply forceps when there are no spaces between the
presenting part of the foreign body and the bronchial wall, will
result only in pushing the foreign body deeper.* A better method is to
use the lip of the bronchoscope to press back the swollen mucosa at
one point, so that a hook may be introduced below the foreign body,
which then can be worked up to a wider place where forceps may be
applied (Fig. 89). Sometimes the object may even be held firmly
against the tube mouth with the hook and thus extracted. For this the
unslanted tube-mouth is used.

* The author's new ball forceps are very successful with ball-bearing
balls and marbles.

[FIG. 89.--Schema illustrating the use of the lip of the bronchoscope
in disimpaction of foreign bodies. A and B show an annular edema above
the foreign body, F. At C the edematous mucosa is being repressed by
the lip of the tube mouth, permitting insinuation of the hook, H, past
one side of the foreign body, which is then withdrawn to a convenient
place for application of the forceps. This repression by the lip is
often used for purposes other than the insertion of hooks. The lip of
the esophagoscope can be used in the same way.]

_Extraction of Soft Friable Foreign Bodies from the Tracheobronchial
Tree_.--The difficulties here consist in the liability of crushing or
fragmenting the object, and scattering portions into minute bronchi,
as well as the problem of disimpaction from a ring of annular edema,
with little or no forceps space. There is usually in these cases an
abundance of purulent secretion which further hinders the work. The
great danger of pushing the foreign body downward so that the swollen
mucosa hides it completely from view, must always be kept in mind.
Extremely delicate forceps with rather broad blades are required for
this work. The fenestrated "peanut" forceps are best for large pieces
in the large bronchi. The operator should develop his tactile sense
with forceps by repeated practice in order to acquire the skill to
grasp peanut kernels