Bronchus

“ 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. ”

“ Increased difficulty of breathing is the result, and where a large portion of lung is affected by the plugging up of a large bronchus, a fatal result may rapidly follow, the danger being specially great in the case of children. ”

“ The mechanism of production is, probably, the passage of air by a foreign body which narrows the lumen of a large bronchus. As the foreign body works downward the wheeze lessens. The wheeze is often so loud as to be heard at some distance from the patient. It is of greatest value in the diagnosis of non-roentgenopaque foreign body but its absence in no way negates foreign body. Its presence or absence should be recorded in every case.
Prolonged bronchial obstruction by foreign body is followed by bronchiectasis and lung abscess usually in a lower lobe. ”

“ This symptomless interval is followed sooner or later by ever increasing cough and expectoration of sputum, finally by bronchiectasis and pulmonary abscess, chronic sepsis, and invalidism.
Pathology.—If the foreign body completely obstructs a main bronchus, preventing both aeration and drainage, such rapid destruction of lung tissue follows that extensive pathologic changes may result in a few months, or even in a few weeks, in the case of irritating foreign bodies such as peanut kernels and soft rubber. Very minute, inorganic foreign bodies may become encysted as in anthracosis. ”

“ 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. ”

“ If the posterior mediastinal space be involved, the respiratory murmur may represent some type of bronchial breathing, or if the lumen of the trachea or one of the bronchi be decidedly lessened, the respiratory murmur may be whistling, feeble, or suppressed over the affected side. Over the other bronchus the respiratory murmur may be more high-pitched than in health, and slightly exaggerated. The rhythm is often jerky and paroxysmal; the paroxysms are more or less constant, but are liable at times to increase. ”

“ Later, granulation tissue and the formation of stricture further hide the object. The patient's health deteriorates with the onset of pulmonary pathology, and renders him a less favorable subject for bronchoscopy. Organic foreign bodies, which produce early and intense inflammatory reaction and are liable to swell, call for prompt bronchoscopy. When a bronchus is completely obstructed by the bulk of the foreign body itself immediate removal is urgently demanded to prevent serious lung changes, resulting from atelectasis and want of drainage. ”

“ 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. ”

“ 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 ”

“ Fever, toxemia, cyanosis, dyspnea and paroxysmal cough are promptly shown. 4. The child is unable to cough up the thick mucilaginous pus through the swollen larynx and may "drown in its own secretions" unless the offender be removed. 5. "Drowned lung," that is to say natural passages idled with pus and secretions, rapidly forms. 6. Pulmonary abscess develops sooner than in case of mineral foreign bodies. 7. The older the child the less severe the reaction.
SYMPTOMS OF PROLONGED FOREIGN BODY SOJOURN IN THE BRONCHUS 1. The time of inhalation of a foreign body may be unknown or forgotten. ”

“ Because the other one is firm and does not shield it. But if it's perforated facing the lung flesh, the flesh shields it and it's kosher.
7 A lung whose contents can be poured like a pitcher [i.e., whose tissue dissolved to the point of liquefaction, Sukkah 36a] but its outer membrane is intact with no holes - if the bronchia stay in place and are not dissolved, it's kosher. But if even one bronchus is rotted it's treif. How do we determine? We pierce [the lung] and pour it into a container that's lead glazed [Taz: the Tur explains that it's white] . ”

“ 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. ”

“ Bronchitis is not nearly such a dangerous disease as inflammation of the lungs.
The symptoms.—The child for the first few days labors under symptoms of a heavy cold; he has not his usual spirits. In two or three days, instead of the cold leaving him, it becomes more confirmed; he is now really poorly, fretful, and feverish; his breathing becomes rather hurried and oppressed; his cough is hard and dry and loud; he wheezes, and if you put your ear to his naked back, between his shoulder-blades, you will hear the wheezing more distinctly. If at the breast, he does not suck with his usual avidity ”

“ 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. ”

“ 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 ”

“ The relation between such lung diseases as bronchitis and pneumonia and the unwholesome condition of the air of our dwellings has not been sufficiently recognized by the medical profession and the public. One of the most common causes of an attack of bronchitis is a Budden exposure of the bronchial mucous membrane to extreme conditions of air. A man who breathes for some hours the hot and dry vitiated air of an unventilated room is prone to be thus affected on passing out into cold, damp night air. ”

“ 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. ”

“ The Lungs.—The lungs are completely distended, almost entirely overlapping the heart, and pressing close to the ribs. They are spongy to the feel, and when cut into, a considerable quantity of bloody froth escapes. The froth found in the lungs is the result of the powerful attempts to breathe, and cannot be produced by artificial means. It adheres not to the sides of the bronchial tubes, as does the exudation of bronchitis or pneumonia. The distension of the lungs is due partly to an actual hyperæmia, and partly to inhaled fluid. ”

“ For the first few years chronic bronchitis is usually found alone, and unaccompanied by disease of the body or lungs. The patient suffers more or less difficulty of breathing, which is affected by changes of the weather, and by variations in the weight of the atmosphere. He coughs frequently, and the expectoration is composed, for the most part, of white frothy and yellowish mucous fluid, occasionally containing blackish particles of carbon, the result of the combustion of the lamp, and also of minute coal-dust. ”

“ 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 ”

“ In the later stages of the illness areas of impaired note or of actual dullness may be found, particularly over the posterior aspects of the lungs, associated with bronchial breathing and crepitant râles. These may be due to the progression of the purulent bronchitis into hypostatic pneumonia, or into actual bronchopneumonia at the bases; or, on the other hand, they may be due to massive collapse of the lungs secondary to the bronchitis and obstruction of the bronchioles by pus. ”

“ When the delicate bronchioles are affected, there is always a more or less extensive involvement of the pulmonary parenchyma (124) , for the bronchioles have a more direct communication with the alveoli, and their walls present a less formidable barrier to the extension of the inflammation to the surrounding air sacs.
FIG. XI. AUTOPSY NO. 140. ILLUSTRATES A LATE CHANGE IN THE BRONCHIOLE; THE EXUDATE IS BEING ORGANIZED AND THE EPITHELIAL LINING IS PROLIFERATING AND HAS INVADED THE SURROUNDING LUNG TISSUE. COMPARE FIGURES XLVIII AND XLIX.
FIG. XII. AUTOPSY NO. 209. ”

“ Secretions, normal and pathologic, may shift from one location to another; the foreign body may change its position admitting more, less, or no air, or it may shift to a new location in the same lung or even in the other lung. A recently aspirated pin may produce no signs at all. The signs of diagnostic importance are chiefly those of partial or complete bronchial obstruction, though a non-obstructive foreign body, a pin for instance, may cause limited expansion (McCrae) or, rarely, a peculiar rale or a peculiar auscultatory sound. ”

“ Broncho-pneumonia is especially seen as a. complication of bronchitis, and while it more frequently attacks children than young adults, it is not uncommon in old people, especially secondary to bronchitis. It is frequent in children after acute infectious fevers, especially measles and diphtheria, and in cases of whooping-cough. It differs from the above-mentioned pneumonia in that it does not usually attack the whole of a lobe of a lung, but occurs in small disseminated patches more especially throughout the lower lobe of both lungs. ”

“ This lack of forced respiration is a frequent cause of acute bronchitis running into a chronic form.
In chronic bronchitis it is especially in the lower part of the lungs that stagnation of the secretions takes place, [Pg 169] and they can only be dislodged from the mucous membrane by forced abdominal expiration and the ascent of the diaphragm. This causes a cough which expels the mucus, and forcible abdominal expiration and cough are the only means of drainage of the lower and deep-seated parts of the lungs. ”

“ Bronchitis is an inflammation of the mucous membrane of the bronchial tubes. When a primary disease, it is generally the result of what is commonly known as "catching cold." It may be secondary to or complicated with many of the diseases of the respiratory system. It may also be caused by breathing irritating gases, or by the introduction of foreign bodies into the bronchial tubes, which sometimes results from injudicious and careless drenching when the larynx is temporarily relaxed. ”

“ 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. ”