ly extreme stenosis
from cicatricial contraction. Perichondritis of the laryngeal or
tracheal cartilages may follow, and result in laryngeal stenosis
requiring tracheotomy. The damage produced by the foreign body is
often much less than that caused by blind and ill-advised attempts at
removal. If the foreign body becomes dislodged and moves downward, the
danger of intestinal perforation is encountered. The _prognosis_,
therefore, must be guarded so long as the intruder remains in the
body.

_Treatment_.--It is a mistake to try to force a foreign body into the
stomach with the stomach tube or bougie. Sounding the esophagus with
bougies to determine the level of the obstruction, or to palpate the
nature of the foreign body, is unnecessary and dangerous.
Esophagoscopy should not be done without a previous roentgenographic
and fluoroscopic examination of the chest and esophagus, except for
urgent reasons. The level of the stenosis, and usually the nature of
the foreign body, can thus be decided. Blind instrumentation is
dangerous, and in view of the safety and success of esophagoscopy,
reprehensible.

If for any reason removal should be delayed, bismuth sub-nitrate,
gramme 0.6, should be given dry on the tongue every four hours. It
will adhere to the denuded surfaces. The addition of calomel, gramme
0.003, for a few doses will increase the antiseptic action. Should
swallowing be painful, gramme 0.2 of orthoform or anesthesin will be
helpful. Emetics are inefficient and dangerous. Holding the patient up
by the heels is rarely, if ever, successful if the foreign body is in
the esophagus. In the reported cases the intruder was probably in the
pharynx.

_External esophagotomy_ for the removal of foreign bodies is
unjustifiable until esophagoscopy has failed in the hands of at least
two skillful esophagoscopists. It has been the observation in the
Bronchoscopic Clinic that every foreign body that has gone down
through the mouth into the esophagus can be brought back the same way,
unless it has already perforated the esophageal wall, in which event
it is no longer a case of foreign body in the esophagus. The mortality
of external esophagotomy for foreign bodies is from twenty to
forty-two per cent, while that of esophagoscopy is less than two per
cent, if the foreign body has not already set up a serious
complication before the esophagoscopy. Furthermore, external
esophagotomy can be successful only with objects lodged
in t