Epidemic Respiratory Disease: The pneumonias and other infections of the repiratory tract accompanying influenza and measlesOpie, Eugene L. (Eugene Lindsay)
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Epidemic Respiratory Disease: The pneumonias and other infections of the repiratory tract accompanying influenza and measles
It is furthermore probable that cyanosis, which is a conspicuous feature
of many instances of pneumonia following influenza, is referable, in
part at least, to obstruction of the bronchi by mucopurulent exudate.
The term pneumonia will refer to those inflammatory changes in the lung
which are found within the alveoli; it will include inflammatory changes
in the alveoli surrounding the respiratory bronchioles, in the alveolar
ducts and infundibula and in their tributary alveoli. Bronchitis will be
described by defining the changes which occur (a) in the small bronchi
with no cartilage or mucous glands, and (b) in the large bronchi
including the primary branches of the trachea.
For convenience of description those bronchi may be designated small,
which have no cartilaginous plates in their wall. Larger bronchi have
cartilage and mucous glands, the latter situated in considerable part
outside the cartilaginous plates. These bronchi, of which the largest
are the right and left bronchi formed by bifurcation of the trachea,
diminish with repeated branching to a caliber of about 1 mm. Small
bronchi are lined by columnar ciliated epithelium; their wall consists
of very vascular connective tissue containing a layer of smooth muscle
and their caliber varies approximately from 1 to 0.5 mm. It is
convenient to designate as respiratory bronchioles[80] the terminal
ramifications of the bronchi; they are lined by a single layer of
columnar ciliated cells passing over into cuboidal nonciliated
epithelium and are beset with small air sacs lined by flat cells or
epithelial plates similar to those of the alveoli elsewhere. Not
infrequently these alveoli occur along only one side of the bronchiole,
the remainder of the circumference being covered by a continuous layer
of cubical epithelium. The respiratory bronchiole by branching along its
course or at its end is continued into several alveolar ducts which
unlike the respiratory bronchioles have no cubical or columnar
epithelium but are closely beset by alveoli lined by flat epithelial
plates. The alveolar duct is recognized by the absence of cubical
epithelium and the presence of bundles of smooth muscle which occur in
the wall. The infundibula or alveolar sacs arise as branches from the
alveolar ducts and like them are beset with alveoli, but smooth muscle
does not occur in their walls. The base of the infundibulum is wider
than its orifice, which Miller states is surrounded by a sphincter-like
bundle of smooth muscle.
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