e spatular tip of the
laryngoscope is worked under the point. Instruments and foreign body
are then removed together. Often the pin point will catch in the
light-chamber where it is very safely lodged. If the pin be then
pulled upon it will straighten out and may be withdrawn through the
tube.

[FIG. 94.--Endogastric version. One of the author's methods of removal
of upward pointed esophageally lodged open safety-pins by passing them
into stomach, where they are turned and removed. The first
illustration (A) shows the rotation forceps before seizing pin by the
ring of the spring end. (Forceps jaws are shown opening in the wrong
diameter.) At B is shown the pin seized in the ring by the points of
the forceps. At C is shown the pin carried into the stomach and about
to be rotated by withdrawal. D, the withdrawal of the pin into the
esophagoscope which will thereby close it. If withdrawn by flat-jawed
forceps as at F, the esophageal wall would be fatally lacerated.]

_Double pointed tacks and staples_, when lodged point upward, must be
turned so that the points trail on removal. This may be done by
carrying them into the stomach and turning them, as described under
safety-pins.

_The extraction of foreign bodies of very large size_ from the
esophagus is greatly facilitated by the use of general anesthesia,
which relaxes the spasmodic contractions of the esophagus often
occurring when attempt is made to withdraw the foreign body. General
anesthesia, though entirely unnecessary for introduction of the
esophagoscope, in any case may be used if the body is large, sharp,
and rough, in order to prevent laceration through the muscular
contractions otherwise incident to withdrawal.* In exceptional cases
it may be necessary to comminute a large foreign body such as a tooth
plate. A large smooth foreign body may be difficult to seize with
forceps. In this case the mechanical spoon or the author's safety-pin
closer may be used.

* It must always be remembered that large foreign bodies are very
prone to cause dyspnea that renders general anesthesia exceedingly
dangerous especially in children.

[FIG. 95.--Lateral roentgenogram of a safety-pin in a child aged 11
months, demonstrating the esophageal location of the pin in this case
and the great value of the lateral roentgenogram in the localization
of foreign bodies. The pin was removed by the author's method of
endogastric version. (Plate made by George C. Johnston )]

_The e