of a clear, clean passage in all the
"pipes," natural and artificial, is the reason why the mortality in
the Bronchoscopic Clinic has been less than half of one per cent,
while in ordinary routine surgical care in all hospitals collectively
it ranges from 10 to 20 per cent.

_Bronchial Aspiration_.--As mentioned above, bronchial aspiration is
often necessary. When the patient is unable to get up secretions, he
will, as demonstrated by the author many years ago, "drown in his own
secretions." In some cases bronchoscopic aspiration is required
(Peroral Endoscopy, p. 483). Occasionally, very thick secretions will
require removal with forceps. Pus may become very thick and gummy from
the administration of morphin. Opiates do not lessen pus formation,
but they do lessen the normal secretions that ordinarily increase the
quantity and fluidity of the pus. When to this is added the
dessicating effect of the air inhaled through the cannula, unmoistened
by the upper air-passages, the secretions may be so thick as to form
crusts and plugs that are equivalent to foreign bodies and require
removal with forceps. Diphtheritic membrane in the trachea may require
removal with bronchoscope and forceps. Thinner secretions may be
removed by sponge-pumping. In most cases, however, secretions can be
brought up through an aspirating tube, connected to a bronchoscopic
aspirating syringe (Fig. 11), an ordinary aspirating bottle, or
preferably, a mechanical aspirator such as that shown in Fig. 12. In
this, combined with bronchoscopic oxygen insuflation (q.v.), we have a
life-saving measure of the highest efficiency in cases of poisoning by
chlorine and other irritant and asphyxiating gases. An aspirating tube
for insertion into the deeper air passages should be of copper, so
that it can be bent to the proper curve to reach into the various
parts of the tracheobronchial tree, and it should have a removable
copper-wire core to prevent kinking, and collapse of the lumen. The
distal end should be thickened, and also perforated at the sides, to
prevent drawing-in of the mucosa and trauma thereto. A rubber tube may
be used, but is not so satisfactory. The one shown in Fig. 10 I had
made by Mr. Pilling, and it has proved very satisfactory.

_Decannulation_.--When the tracheal incision is placed below the first
ring, no difficulty in decannulation should result from the operation
per se. When by temporarily occluding the cannula with the finger it
is