Bronc

“ The lungs are small and occupy only the dorsal portion of the thoracic cavity. There is only one right and one left lobe, each traversed through its whole length by a mesobronchium, whence arise about ten secondary bronchia ”

“ A man in Colorado had broncorrhœa and occasional lung hemorrhage. Although he could walk six or seven miles he could not breathe below the eighth rib. I said: “I did not know a man could live, and breathe no deeper. By all your hopes of life, you must learn to breathe. ”

“ The lungs have attained a high degree of efficiency. Each lung is an oval sac, and is transformed into a complicated system of tubes, at the end of which are the countless honeycomb-like respiratory cells, the whole lung being spongy. The main bronchus is continued straight down to the posterior end of the lung, and sends off during its course regular secondary bronchi, and these send off tertiary bronchi. The whole arrangement is very regular, the tubes coming off like rows of organ-pipes. Each lung hangs freely in the thoracic cavity. ”

“ Dr Brockmann makes three divisions of the morbid appearances, "The essential (wesentliche) , accidental (zufällige) , and secondary. The first shows an entirely black (pechschwärze) colour of the lungs through its whole substance, enclosing not only the air, blood, and lymph vessels, but also the connecting cellular tissue, the nervous substance, pleuræ pulmonalis, and bronchial glands." In such a state, it is usual for the lung to remain perfectly normal, and to exhibit the greatest varieties. ”

“ Branches of the stem bronchus in either lung are exposed, or their respective lumina presented, by manipulation of the lip of the bronchoscope, with movement of the head in the required direction. Posterior branches require the head quite high. A large one in the left stem just below the left upper-lobe bronchus is often invaded by foreign bodies. Anterior branches require lowering the head. The middle-lobe bronchus is the largest of all anterior branches. ”

“ Each lung is free in all directions, except at the root, which consists chiefly of the bronchi, arteries and veins connecting the lungs with the trachea and heart. The lungs are spongy and porous, and their tissues are very elastic. They are covered with a delicately constructed but strong sac, known as the pleural sac, one wall of which closely adheres to the lung, and the other to the inner wall of the chest, and which secretes a fluid which allows the inner surfaces of the walls to glide easily upon each other in the act of breathing. ”

“ Each bronchus, like the trachea, is lined with an epithelium of three or four layers of cells; but the epithelium is surrounded by a thin layer of much condensed mesoblast. The bronchi continue caudad, with slightly increasing caliber, through about fifty sections, when they suddenly enlarge to form the lungs. As seen in figure 6A the lungs are irregularly conical in outline and lie on either side of the posterior end of the oesophagus. ”

“ The lungs are two in number, right and left, and surround the heart, completely filling the thoracic cavity. The lungs are divided into superimposed lobes, three in the right and two in the left lung; they are composed essentially of infinitely small ramifications of the bronchi, resolving into tiny series of chambers, the pulmonary alveoli or air-cells. ”

“ Some of the air which enters the lung gets from the bronchial tubes into the blood-vessels by transudation, for there is no direct communication between them; and this air, penetrating the body, rapidly cools the blood throughout the vessels. ”

“ Prepared by this practice and the radiographic study, the bronchoscope is introduced into the patient. The location of the foreign body is approached slowly and carefully to avoid overriding or displacement. A study of the presentation is as necessary for the bronchoscopist as for the obstetrician. ”

“ The lungs receive the atmospheric air through the windpipe. At the root of the neck the windpipe, or trachea, divides into two branches, called bronchi, and each bronchus, upon entering its respective lung, divides into an infinity of small tubes ”

“ Air drawn into the lungs should be first warmed and moistened by passing through the nose, but when inspired through the mouth, produces so much irritation of the throat and air passages that constant "colds," chronic catarrh of the throat, laryngitis, and bronchitis ensue. ”

“ The lungs, the organs of respiration, are two pinkish gray structures of a light, spongy appearance, that fill the chest cavity, except the space taken up by the heart and large vessels. Between the lungs are situated the large bronchi, the œsophagus, the heart in its pericardium, and the great blood-vessels. The base of the lungs rests on the dome-like diaphragm, which separates the chest from the abdomen. This partly muscular and partly tendinous partition is a most important factor in breathing. ”

“ Blood spit up from the lungs is florid, because it has just been exposed to the influence of the air in its passage through the extremities of the pulmonary artery; it is frothy, from the admixture of air with it in the bronchia. The patients frequently vomit at the same time from the disagreeable titillation of blood about the fauces; and are thence liable to believe, that the blood is rejected from the stomach. ”

“ This air was extravasate, had burst through the extremities of the bronchia and vesicular substance, and had insinuated itself throughout the whole substance of the lungs, in which it was detained by the membrane investing them. In a word, the whole substance of the lungs was in a state truly emphysematous. In several parts this air had formed large bladders, which, though no pressure upon the surface of the lungs could force back, a sight incison into them permitted to escape, and caused the whole lobe to collapse. ”

“ At birth, also, the lungs are solid, so that the first air has to overcome adhesions between the collapsed walls of the bronchioles and air sacs, but after they are thus gradually unfolded, in that they are of extensible material and open to the air above, atmospheric pressure from within keeps them distended to the full extent of the chest, which is air tight. ”

“ Extraction of Soft Friable Foreign Bodies from the Tracheobronchial Tree.—The difficulties here consist in the liability of crushing or fragmenting the object, and scattering portions into minute bronchi, as well as the problem of disimpaction from a ring of annular edema, with little or no forceps space. There is usually in these cases an abundance of purulent secretion which further hinders the work. The great danger of pushing the foreign body downward so that the swollen mucosa hides it completely from view, must always be kept in mind. ”

“ Though the emphysematous lung is distended to a size equal to the healthy lung in deep inspiration, yet we know that emphysematous distention, being produced by extrabronchial air accumulation, is, in fact, obstructive to the respiratory act. ”

“ The histological groundwork of the whole lung tissue is a connective tissue of fine elastic fibers. In the lungs, on the canal that appears as the elongation of the bronchus, cartilage appears, according to Rathke, as bands lying one behind the other ”

“ In thickened pleura vocal fremitus is not entirely absent, and the breath-sounds can usually be heard, even if diminished. In case of partial obstruction of a bronchus, it is evident that air will still be present, hence the dulness may be only slight. The presence of air and secretion will probably result in the breath-sounds being somewhat harsh, and will cause a great variety of rales, principally coarse, and many of them bubbling. Difficulty may be caused by signs in the other lung or in a lobe other than the one affected by the foreign body. ”

“ The lungs are the essential organs of respiration or ventilators of the body. They are two in number, separated from each other by the heart, are placed in a semi-distended state in the air-tight thorax, which we have seen they, together with the heart and great blood-vessels, completely fill. The lungs ultimately consist of air-cells, surrounded by dense plexuses of capillaries and nerves. The air-cells communicate with the exterior through the bronchial tubes, trachea, larynx, throat, and nose. ”

“ The three diseases which more commonly affect the lungs, as the result of exposure, are pneumonia, or inflammation of the lungs, implicating principally the air-cells; bronchitis, an inflammation of the large bronchial tubes; and pleurisy, an inflammation of the investing membrane of the lungs, or pleura. Among the young, an affection of the trachea takes place, known as croup. ”

“ It commences in childhood, and becomes confirmed in adult life, often engendering consumption, chronic bronchitis, relaxed sore throat, or some other disease of the lungs or throat which is set down, usually, to a different cause altogether. In concluding this short article, we venture to ask our readers to judge for themselves. When they step out in the morning into the fresh, but cold, air, let them try the difference of feeling arising from the two modes of breathing — through the nostrils, and between the lips. ”

“ Bronchitis often supervenes upon sore throat, by the extension of the inflammation downward into the chest. Chilling of the surface by exposure to cold, drenching rains, is a frequent cause, by reason of the intimate sympathy existing between the skin and the mucous membrane. ”

“ The purity of the blood is influenced by the condition of the lungs. When the bronchial tubes and air-cells have become partially impervious to air, from pressure upon the lungs, from fluids in the chest, from tumors, or from the consolidation of the cells and tubes from disease,—as inflammation, or the deposition of yellow, cheesy matter, called tubercles,—the blood will not be purified, even if the air is pure, the lungs voluminous, and the respiratory movements unrestricted, as the air cannot permeate the air-cells. ”

“ Injuries of the lung or bronchus are always serious, but contrary to the general idea, recovery after extensive wound of the lung is quite a common occurrence. Even the older writers report many instances of remarkable recoveries from lung-injuries, despite the primitive and dirty methods of treatment. A review of the literature previous to this century shows the names of Arcaeus, Brunner, Collomb, Fabricius Hildanus, Vogel, Rhodius, Petit, Guerin, Koler, Peters, Flebbe, and Stalpart, as authorities for instances of this nature. ”

“ Man breathes by means of lungs; but who can understand their wonderful mechanism, so perfect in all its parts? Though every organ is subservient to another, yet each has its own office to perform. The minute air-cells are for the aeration of the blood; the larger bronchial tubes ramify the lungs, and suffuse them with air; the trachea serves as a passage for the air to and from the lungs, while at its upper extremity is the larynx, which has been fitly called the organ of the human voice. ”

“ The breath comes and goes in gasps,—involving coughs, perhaps, if the bronchial tubes are clogged with phlegm, but at the same time the feeling of pulmonary impediments is gradually relieved. The experimenter finds that he can breathe freer and deeper than before. ”

“ The bronchial breath sound which we hear over the lung, compressed by fluid, near the vertebra continues sometimes a long time after the absorption of the fluid, because the lung, deprived of air, expands slowly. ”

“ Simple bronchitis is usually connected with climatic change or exposure, tends to affect a number at once, gives the blowing and mucous râles, without indications of extended lung consolidation or pleural effusion, and after death does not furnish lesions of all ages, recent and remote. ”

“ The respiratory murmur may be lessened in certain morbid conditions, such as emphysema and congestion of the lung, and may completely disappear in pneumonia or broncho-pneumonia, a fact which is even of greater significance. ”

“ If much inflammatory reaction has occurred in the first invaded bronchus, temporarily suspending the aerating function of the corresponding lung, reaspiration of a dislodged foreign body is liable to carry it into the opposite main bronchus, by reason of the greater inspiratory volume of air entering that side. This may produce sudden death by blocking the only aerating organ. ”

“ The foreign body may be in the larynx, trachea, bronchi, nasal chambers, nasopharynx, fauces, tonsil, pharynx, hypopharynx, esophagus, stomach, intestinal canal, or may have been passed by bowel, coughed out or spat out, with or without the knowledge of the patient. ”

“ The chief distinguishing symptoms are the abundance and nature of the discharge, the fetor of the breath, and the presence of the mucous râle in the chest. It is one of the conditions known by the horseman’s expression “thick wind.”
Treatment. Like its type (dilatation of the bronchia, bronchiectasis) in man this disease obstinately resists treatment. In our efforts to cure it the same general principles must be followed as in acute bronchitis, with this grand qualification that the general aim must be to stimulate and support. ”

“ Objects that have lodged in the esophagus, larynx, trachea, or bronchi should be endoscopically removed.
Foreign Bodies in the Insane.—Foreign bodies may be introduced voluntarily and in great numbers by the insane. Hysterical individuals may assert the presence of a foreign body, or may even volitionally swallow or aspirate objects. It is a mistake to do a bronchoscopy in order to cure by suggestion the delusion of foreign body presence. ”

“ Severity of bronchial symptoms much increased; respiration panting; colour of skin in general, but especially of face, livid; deglutition difficult; pulse 124, weak. Died following morning.
Thorax. Mucous membrane of bronchi inflamed; bronchial tubes filled with mucus, mixed with pus; mucous membrane of trachea vascular; [both lungs studded with miliary tubercles.] Head. Dura mater and arachnoid highly vascular; theca of spinal cord highly vascular; substance of brain vascular. Abdomen. [Spleen contained a small mass of cheesy tubercles near its surface;] ”