Bronco

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ A knowledge of the topographical lung anatomy, the bronchial tree, and of endoscopic pathology* should enable the examiner of the chest to locate very accurately a bronchial foreign body by physical signs alone, for all the significant signs occur distal to the foreign body lodgment. ”

“ The varices of the pulmonary vein not only retarded the blood in its passage to the left auricle of the heart; but, occupying a much larger space in the lungs than they naturally should, they left less room for the minute ramifications of the bronchia to extend themselves; and consequently a less quantity of air was taken in at every inspiration than was necessary for the ordinary purposes of life.
But the disorder of the lungs from the varices was made infinitely worse by the emphysema. ”

“ 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 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. ”

“ 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. ”

“ 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. ”

“ 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 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. ”

“ 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. ”

“ 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 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 lung, which is at first enlarged, becomes shrunken, dense in texture and solid, any unaffected portions being emphysematous; the bronchi are dilated, the pleura thickened, and the lung substance often deeply pigmented, especially in the case of miners, who are apt to suffer from this disease. The other lung is always greatly enlarged and distended from emphysema; the heart becomes hypertrophied, particularly the right ventricle ”

“ 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 ”

“ 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. ”

“ 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 lung follows the heart. The whole mediastinum finds itself altered in its position and in its contents. The depressed diaphragm rises promptly to its old position in the pleural cavity. The liver, spleen, and the rib-wall undergo striking modifications. We do not expect the lung to dilate to its full extent, as after aspirations in simple pleurisies. The lung, indeed, is already impaired in its movement. We admit air in order to secure treatment to these surfaces. When air is admitted into the normal chest, the lung is retracted to about one-half its size. ”

“ 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. ”

“ 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. ”

“ 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 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. ”

“ 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. ”

“ 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. ”

“ 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. ”