pose Arrowsmith's closer is
excellent. In other cases it may prove best to disengage the point of
the pin and to bring the pointed shaft into the esophagoscope with the
Tucker forceps and withdraw the pin, forceps, and esophagoscope, with
the keeper and its shaft sliding alongside the tube. The rounded end
of the keeper lying outside the tube allows it to slip along the
esophageal walls during withdrawal without inflicting trauma; however,
should resistance be felt, withdrawal must immediately cease and the
pin must be rotated into a different plane to release the keeper from
the fold in which it has probably caught. The sense of touch will aid
the sense of sight in the execution of this maneuver (Fig. 87). When
the pin reaches the cricopharyngeal level the esophagoscope, forceps,
and pin should be turned so that the keeper will be to the right, not
so much because of the cricopharyngeal muscle as to escape the
posteriorly protuberant cricoid cartilage. In certain cases in which
it is found that the pointed shaft of a small safety pin has
penetrated the esophageal wall, the pin has been successfully removed
by working the keeper into the tube mouth, grasping the keeper with
the rotation forceps or side-curved forceps, and pulling the whole pin
into the tube by straightening it. This, however, is a dangerous
method and applicable in but few cases. It is better to disengage the
point by downward and inward rotation with the Tucker forceps.

_Version of a Safety Pin_.--A safety pin of very small size may be
turned over in a direction that will cause the point to trail. An
advancing point will puncture. This is a dangerous procedure with a
large safety pin.

_Endogastric Version_.--A very useful and comparatively safe method is
illustrated in Figs. 94 and 95. In the execution of this maneuver the
pin is seized by the spring with a rotation forceps, and thus passed
along with the esophagoscope into the stomach where it is rotated so
that the spring is uppermost. It can then be drawn into the tube mouth
so as to protect the tissues during withdrawal of the pin, forceps,
and esophagoscope as one piece. Only very small safety-pins can be
withdrawn through the esophagoscope.

_Spatula-protected Method_.--Safety-pins in children, point upward,
when lodged high in the cervical esophagus may be readily removed with
the aid of the laryngoscope, or esophageal speculum. The keeper end is
grasped with the alligator forceps, while th