Broncho

“ Cough, hoarseness, dyspnea, and cyanosis are often present. Diagnosis is by roentgenray, auscultation, palpation, and bronchoscopy. Listen long for "audible slap," best heard at open mouth during cough. The "asthmatoid wheeze" is heard with the ear or stethoscope bell (McCrae) at the patient's open mouth. History of initial choking, gagging, and wheezing is important if elicited, but is valueless negatively.
Bronchial Foreign Body.—Initial symptoms are coughing, choking, asthmatoid wheeze, etc. ”

“ If the lungs, or the larynx seem so contracted that it appears impossible to blow breath into him by the mouth, recourse must be had to bronchotomy, that is, opening the wind-pipe betwixt the third and fourth cartilage; to which a man should put his mouth and inflate the lungs; the throat should be tickled with a feather, a little pepper blown up the nostrils and the body here and there scratched with pins, or small wounds made in the legs and arms, and plentifully rubbed with salt. If there is salt enough to do it, the patient ought to be covered all over. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ Peanut kernels and watermelon seeds and, rarely, other foreign bodies in the bronchi produce obstructive emphysema of the invaded side. Fluoroscopy shows the diaphragm flattened, depressed and of less excursion on the invaded side; at the end of expiration, the heart and the mediastinal wall move over toward the uninvaded side and the invaded lung becomes less dense than the uninvaded lung, from the trapping of the air by the expiratory, valve-like effect of obliteration of the "forceps spaces" that during inspiration afford air ingress between the foreign body and the swollen bronchial wall. ”

“ It is the last gleam springing from the dying flame; but soon the eyes become fixed and insensible to the action of light, the nose grows pointed and cold, the mouth, wide open, seems to call for the air that fails it, the cavity within it is parched, and the lips, as if withered, cling to the curves of the teeth. The last movements of respiration are spasmodic, and a wheezing, and sometimes a marked gurgling sound, may be heard at some distance, caused by obstruction of the bronchial tubes with a quantity of mucus. The breath is cold, the temperature of the skin lowered. ”

“ The unexpanded lungs are brownish-red, firm in consistence and distinctly lobulated. Air-containing lung floats in water and crepitates, and gives off bubbles when cut beneath the water. Attempts at artificial respiration may draw some air into the lungs. Gas-bubbles may be produced by decomposition. In white pneumonia the lung is pale, grayish-white and airless. The larynx, trachea and bronchi are to be examined for presence of mucus, [Pg 185] amniotic fluid, meconium, foreign substances, etc. ”

“ Pneumothorax is the only pathologic condition associated with signs similar to those of expiratory, valve-like bronchial obstruction by a foreign body.
3. Partial bronchial obstruction by an object such as a nail allows air to pass to and fro with some degree of retardation, and impairs the drainage of the subjacent lung. Limitation of expansion will be found on the invaded side. The area below the foreign body will give an impaired percussion note. Breath-sounds are diminished in the area of dullness, and vocal resonance and fremitus are impaired. Rales are of great diagnostic import ”

“ Consequently, any one who draws into his lungs this breath or conglomerated vapour, must necessarily absorb into his system the properties of that body from which it emanated, and from which it derived its being. For we know by experience that the air which enters the lungs dry, goes forth carrying with it moisture, [Pg 142] as may be seen by breathing on a glass, or in cold weather. Also, when we inhale the breath of any one who is ill, we are conscious of receiving infection. ”

“ Inhaling cold air after sitting in a close atmosphere, will induce an attack of bronchial inflammation, or thickening of the air-tubes, in persons of all classes and conditions. Persons who are liable to frequent attacks of bronchitis, are apt to imagine that their lungs are affected, since it prevents a free use of the voice in singing or speaking audibly. I will repeat that this complaint generally terminates with a loss of tone in the lung substance, caused by the failure of the tubes to supply them with oxygen or air ”

“ 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. ”

“ That broken wind is a frequent concomitant or sequel of chronic bronchitis is undeniable, and theoretically nothing is more likely to cause dilatation and rupture of the air cells and consequent impairment of the innervation and contractility of the lung than violent fits of coughing, while the bronchial tubes have thickened and friable walls, or are partially plugged by tenacious mucus. ”

“ With the access of the hot stage the characteristic symptoms of lung disease are manifested, at first resembling those of congested lungs, but less severe than those given under that head. There is a distinct increase of the body temperature; the visible mucous membranes are suffused with a blush; the expired air feels hot upon the hand; the breathing, 30 to 40 per minute, is short and accompanied by much lifting of the flanks— (labored) ; the cough is deep as if coming from the depth of the chest, but not so hard nor so painful as in bronchitis ”

“ 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. ”

“ Have nothing less distinguished than a Bronchial Catarrh!
O when your head's a lump of lead and nought can do but sneeze:
Whene'er in turn you freeze and burn, and then you burn and freeze:—
It does not mean you're going to die, although you think you are—
These are the primal symptoms of a Bronchial Catarrh. ”

“ Superficial Examination of Thorax.—Observe the position, color, and degree of distention of the lungs. It should be remembered that healthy lungs, as soon as the chest is opened, owing to their inherent elasticity, will collapse, and when this normal collapse is not seen it is generally due to a loss of elasticity as occurs in emphysema, to inflammatory diseases binding the lung to the chest wall, or to the alveoli being filled with solid or fluid substances or pent-up air. Most complete distention is seen when death is due to drowning or suffocation. ”

“ The pulmonary tissues are endowed with great elasticity, in consequence of which the lungs collapse to about one-third of their bulk when the thorax is opened.
The root of each lung consists of bronchi, arteries, and veins, together with the nerves, lymphatic vessels, and glands, connected by areolar tissue, and inclosed in a sheath of the pleura.
Respiration consists of an expiration and an inspiration. The air passes in through the nose or [276] mouth, through the larynx, trachea, bronchi, into the lungs. ”

“ The natural perspiration is, in a great measure, retarded by the obstruction of the cutaneous pores; and the abundant humours, which should have passed off through the skin, lodge in the internal surface of the throat and lungs, where, by their quantity and acrimony, they create a constant tickling and wheezing, with a peculiar painful and distressing sensation; and the lungs, by endeavouring to dislodge the accumulated matter, become subject to a state of inflammation, with a harassing Cough, as the natural result. ”

“ The air we breathe is made so, that when it comes into the lungs, it combines with the noxious portions of the blood in the lungs, and then is returned again, when we breathe out the air. If, therefore, a person is shut up in a small, close room for a long time, the air of the room, after a while, is filled with this injurious matter which is sent out of the lungs. In this state it is unfit to breathe. Breathing it sometimes produces drowsiness, weakness, stupidity of feelings, and sometimes sickness at the stomach, or fainting. ”

“ 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. ”

“ The blood coming from the stomach too, is generally in larger quantity than that from the lungs.
In addition to these symptoms, the patient is often affected by an increased sensibility of the lungs, observable on any exposure to cold, change of dress, or going from a warm to a cool apartment. There is a sense of soreness in the lungs attended with a sensation of stricture about the chest. Pain is felt in the side or breast, and the patient lies with difficulty on the side affected. ”

“ The countenance becomes at an early period glazed and ghastly, and the extremities cold and clammy. The breathing is often laborious, owing to the movements of the chest increasing the pain in the stomach,—or because pulmonary inflammation is also at times present,—or because the admission of air into the lungs is impeded by the injury done to the epiglottis and entrance of the larynx. To these symptoms are added occasional fits of suffocation from shreds of thick mucus sticking in the throat, and sometimes croupy respiration, with sense of impending choking. ”

“ In some cases of bronchitis, where numbers of the smaller bronchial tubes become obstructed, the air in the pulmonary vesicles remains imprisoned, the force of expiration being insufficient to expel it; while, on the other hand, the stronger force of inspiration being adequate to overcome the resistance, the air-cells tend to become more and more distended, and permanent alterations in their structure, including emphysema, are the result. ”

“ The embarrassment in respiration often appears at the end of half a day, it becomes greater and greater, the bronchiæ are filled with a viscid fluid; and the animal usually dies on the third or fourth day. On examination of the body, no air is found in the heart or the vessels; but the lungs, instead of being pink-coloured, are greyish, tinged with brown, and loaded with frothy blood and mucus. ”

“ 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. ”

“ When once the extremities of the bronchia and the vesicular substance have given way, the mischiefs are easily foreseen. The air getting loose into the substance of the lungs cannot be parted with in exspiration; it consequently is retained there, and the space it occupies prevents as much of the external air being received into the lungs as its own quantity. As, from their incessant motion, injuries to the lungs are not easily removed, when once a rupture is made, every fit of couging or other violent exertion extravasates more air. ”

“ We bend forward, draw in the walls of the abdomen, and press the diaphragm upward, while the ribs are pulled downward,—all together diminishing the size of the chest, and forcing the air outward.
Ordinary, quiet breathing is performed mainly by the diaphragm,—one breath to every four beats of the heart, or eighteen per minute. (See p. 299.)
MODIFICATIONS OF THE BREATH.—Sighing is merely a prolonged inspiration followed by an audible expiration. Coughing is a violent expiration in which the air is driven through the mouth. Sneezing differs from coughing, the air being forced through the nose. ”