absorption of air impacts it still further. Swelling of the bronchial
mucosa from irritation plus infection completes the occlusion of the
bronchus. Retention of secretions and bacterial decomposition thereof
produces first a "drowned lung" (natural passages full of pus); then
sloughing or ulceration in the tissues plus the pressure of the pus,
causes bronchiectasis; further destruction of the cartilaginous rings
results in true abscess formation below the foreign body. The
productive inflammation at the site of lodgement of the foreign body
results in cicatricial contraction and the formation of a stricture at
the top of the cavity, in which the foreign body is usually held. The
abscess may extend to the periphery and rupture into the pleural
cavity. It may drain intermittently into a bronchus. Certain
irritating foreign bodies, such as soft rubber, may produce gangrenous
bronchitis and multiple abscesses. For observations on pathology (see
Bibliography, 38).

_Prognosis_.--If the foreign body be not removed, the resulting
chronic sepsis or pulmonary hemorrhage will prove fatal. Removal of
the foreign body usually results in complete recovery without further
local treatment. Occasionally, secondary dilatation of a bronchial
stricture may be required. All cases will need, besides removal of the
foreign body, an antituberculous regimen, and offer a good prognosis
if this be followed.

_Treatment_.--Bronchoscopy should be done in all cases of chronic
pulmonary abscess and bronchiectasis even though radiographic study
reveals no shadow of foreign body. The patient by assuming a posture
with the head lowered is urged to expel spontaneously all the pus
possible, before the bronchoscopy. The aspirating bronchoscope (Fig.
2, E) is often useful in cases where large amounts of secretion may be
anticipated. Granulations may require removal with forceps and
sponging. Disturbed granulations result in bleeding which further
hampers the operation; therefore, they should not be touched until
ready to apply the forceps, unless it is impossible to study the
presentation without disturbing them. For this reason secretions
hiding a foreign body should be removed with the aspirating tube (Fig.
9) rather than by swabbing or sponge-pumping, when the bronchoscopic
tube-mouth is close to the foreign body. It is inadvisable, however,
to insert a forceps into a mass of granulations to grope blindly for a
foreign body, with no knowledge of the