sufficiently firmly to hold them during
withdrawal, yet not so firmly as to crush them. Nipping off an edge by
not inserting the forceps far enough is also to be avoided. Small
fragments under 2 mm. in diameter may be expelled with the secretions
and fragments may be found on the sponges and in the secretions
aspirated or removed by sponge pumping. It is, however, never
justifiable deliberately to break a friable foreign body with the hope
that the fragments will be expelled, for these may be aspirated into
small bronchi, and cause multiple abscesses. A hook may be found
useful in dealing with round, friable, foreign bodies; and in some
cases the mechanical spoon or safety-pin closer may be used to
advantage. The foreign body is then brought close to, but not crushed
against the tube mouth.

[174] _Removal of animal objects from the tracheobronchial tree_ is
readily accomplished with the side-curved forceps. Leeches are not
uncommon intruders in European countries. Small insects are usually
coughed out. Worms and larvae may be found. Cocaine or salt solution
will cause a leech to loosen its hold.

_Foreign bodies in the upper-lobe bronchi_ are fortunately not common.
If the object is not too far out to the periphery it may be grasped by
the upper-lobe-bronchus forceps (Fig. 90), guided by the collaboration
of the fluoroscopist. These forceps are made so as to reach high into
the ascending branches of the upper-lobe bronchus. Full-curved
coil-spring hooks will reach high, but must be used with the utmost
caution, and the method of their disengagement must be practiced
beforehand.

_Penetrating Projectiles_.--Foreign bodies that have penetrated the
chest wall and lodged in the lung may be removed by oral bronchoscopy
if the intruder is not larger than the lumen of the corresponding main
bronchus (see Bibliography, 43)

[FIG. 90.--Schematic illustration of the author's upper-lobe-bronchus
forceps in position grasping a pin in an anteriorly ascending branch
of the upper-lobe bronchus. T, Trachea; UL, upper-lobe bronchus; LB,
left bronchus; SB, stem bronchus. These forceps are made to extend
around 180 degrees.]

RULES FOR ENDOSCOPIC FOREIGN BODY EXTRACTION

1. Never endoscope a foreign body case unprepared, with the idea of
taking a preliminary look.
2. Approach carefully the suspected location of a foreign body, so
as not to override any portion of it.
[175] 3. Avoid grasping a foreign body hastily as soon