s to be inserted closed into the invaded
bronchus, the grasp on the object being confirmed by the
fluoroscopist. It is to be kept in mind that while the object itself
may be in the grasp of the forceps, the fluoroscope will not show
whether there may not be included in the forceps' grasp a bronchial
spur or other tissue, the tearing of which may be fatal. Therefore
traction must not be sufficient to lacerate tissue. If the foreign
body does not come readily it must be released, and a new grasp may
then be taken. All of the cautions in faulty seizure already
mentioned, apply with particular force to fluoroscopic bronchoscopy.
The fluoroscope is of aid in finding foreign bodies held in abscess
cavities. The fluoroscope should show both the lateral and
anteroposterior planes. To accomplish this quickly, two Coolidge tubes
and two screens are necessary. Fluoroscopic bronchoscopy, because of
its high mortality and low percentage of successes, should be tried
only after regular, ocularly guided, peroral bronchoscopy has failed,
and only by those who have had experience in ocularly guided
bronchoscopy.

[177] CHAPTER XVI--FOREIGN BODIES IN THE BRONCHI FOR PROLONGED PERIODS

The sojourn of an inorganic foreign body in the bronchus for a year or
more is followed by the development of bronchiectasis, pulmonary
abscess, and fibrous changes. The symptoms of tuberculosis may all be
presented, but tubercle bacilli have never been found associated with
any of the many cases that have come to the Bronchoscopic Clinic.* The
history of repeated attacks of malaise, fever, chills, and sweats
lasting for a few days and terminated by the expulsion of an amount of
foul pus, suggests the intermittent drainage of an abscess cavity, and
special study should be made to eliminate foreign body as the cause of
the condition, in all such cases, whether there is any history of a
foreign body accident or not. Bronchoscopy for diagnosis is to be done
unless the etiology can be definitely proven by other means. In all
cases of chronic chest disease foreign body should be eliminated as a
matter of routine.

* One exception has recently come to the Clinic. 12

_The time of aspiration of a foreign body_ may be unknown, having
possibly occurred in infancy, during narcosis, or the object may even
enter the lower air passages without the patient being aware of the
accident, as happened with a particularly intelligent business man who
unknowingly aspir