ted, for the foreign body does not often follow the
pus into the pleural cavity. It remains in the lung, held in a bed of
granulation tissue. Furthermore, to await the development is to
subject the patient to a prolonged and perhaps fatal sepsis, or a
fatal pulmonary hemorrhage from the erosion of a vessel by the
suppurative process. The recent developments in thoracic surgery have
greatly decreased the operative mortality of thoracotomy, so that this
operation is to be considered when bronchoscopy has failed.
Bronchoscopy can be considered as having failed, for the time being,
when two or more expert bronchoscopists on repeated search have been
unable to find the foreign body or to disentangle it; but the art of
bronchoscopy is developing so rapidly that the failures of a few years
ago would be easy successes today. Before considering thoracotomy
months of study of the mechanical problem are advisable. It is
probable that any foreign body of appreciable size that has gone down
the natural passages can be brought back the same way.

In the event of a foreign body reaching the pleura, either with or
without pus, it should be removed immediately by pleuroscopy or by
thoracotomy, without waiting for adhesive pleuritis.

The problem may be summarized thus:
1. Large foreign bodies in the trachea or large bronchi can always
be removed by bronchoscopy.
2. The development of bronchoscopy having subsequently solved the
problems presented by previous failures, it seems probable that by
patient developmental endeavor, any foreign body of appreciable size
that has gone down through the natural passages, can be
bronchoscopically removed the same way, provided fatal trauma is
avoided.

At the author's Bronchoscopic Clinics 98.7 per cent of foreign bodies
have been removed.

CHAPTER XVIII--FOREIGN BODIES IN THE ESOPHAGUS

_Etiology_.--The lodgement of foreign bodies in the esophagus is
influenced by:
1. The shape of the foreign body (disc-shaped, pointed, irregular).
2. Resiliency of the object (safety pins).
3. The size of the foreign body.
4. Narrowing of the esophagus, spasmodic or organic, normal, or
pathologic.
5. Paralysis of the normal esophageal propulsory mechanism.

The lodgement of a bolus of ordinary food in the esophagus is strongly
suggestive of a preexisting narrowing of the lumen of either a
spasmodic or organic nature; a large bolus of food, poorly masticated
and hurriedly swallowed, may,