Elmer D. Barber, D. O.
The Lungs are the two principal organs of respiration,
placed one on each side of the chest, separated from each other by the
heart and other contents of the mediastinum. Each lung is divided
into two lobes, an upper and lower, by a long and deep fissure, which extends
from the upper part of the posterior border of the organ, about three inches
from its apex, downward and forward to the lower part of the anterior border.
This fissure penetrates nearly to the root. In the right lung the
upper lobe is partially subdivided by a second and shorter fissure, which
extends from the middle of the preceding, forward and slightly upward to
the anterior margin, making a small triangular portion, the middle lobe.
The right lung is larger and heavier than the left;
it is broader, owing to the inclination of the heart to the left side;
in consequence of the diaphragm rising higher on the right side to accommodate
the liver, it is also shorter by an inch. The weight of the lungs
is about forty-two ounces, the right lung being two ounces heavier than
the left; but much variation is met with, according to the amount of blood
or serous fluid they may contain. The lungs are heavier in the male
than in the female.
Each lung is conical in shape, and presents an Apex, Base, two Borders,
and two Surfaces for examination.
Apex. - The apex extends into the root of
the neck about an inch or an inch and a half above the level of the first
rib, and forms a tapering cone.
Base. - The base is concave, broad, and rests
upon the convex surface of the diaphragm. Its circumference is thin
and fits into the space between the lower ribs and the costal attachment
of the diaphragm, extending lower down externally and behind than in front.
Borders. - The anterior border is sharp and
thin, overlapping the front of the pericardium. The posterior border
is broad and rounded, and is received into the deep concavity on either
side of the spinal column. It is much longer than the anterior border
and projects between the ribs and the diaphragm.
Surfaces. - The surface is smooth, shining,
and marked out in numerous polyhedral spaces, which indicate the lobules
of the organ. The area of each of these spaces is crossed by numerous
lighter lines. The inner surface is concave; in front presenting
a depression corresponding to the convex surface of the pericardium; and
behind a deep fissure, which gives attachment to the root of the lung.
The thoracic or external surface is smooth and convex; corresponding to
the form of the cavity of the chest, being deeper behind than in front.
Root. - A little above the middle and inner
surface of each lung and nearer its posterior than its anterior border
is its root, by which the lung is connected to the heart and trachea.
The root is formed by the bronchial tube, pulmonary artery, pulmonary vein,
the bronchial arteries and veins, the pulmonary plexus of nerves, lymphatics,
bronchial glands, and areolar tissue, all of which are enclosed by a reflexion
of the pleura. The root of the right lung lies behind the superior
vena cava and the ascending portion of the aorta, and below the vena azygos
major. The root of the left lung passes beneath the arch of the aorta
in front of the descending aorta. The phrenic nerve and the anterior
pulmonary plexus lie in front of each, and the pneumogastric and posterior
pulmonary plexus behind.
Substance. - The substance of the lung is
of a light, porous, spongy texture; it floats in water and crepitates when
handled, owing to the presence of air in the tissue; it is very elastic,
hence the collapsed state of these organs when they are removed from the
cavity of the thorax.
Cells. - The air-cells are small, polyhedral
recesses, composed of a fibrillated connective tissue, and surrounded by
a few involuntary muscular and elastic fiber. They can be plainly
seen on the surface of the lung, and vary from 1-200 to 1-70 of an inch
Tubes. - The bronchus, upon entering the
substance of the lung, divides and subdivides throughout the entire organ;
sometimes three branches arise together, and occasionally small lateral
branches are given off from the sides of a larger. Each of the smaller
subdivisions of the bronchi enters a pulmonary lobule, and is termed a
lobular bronchial tube or bronchiole. Its walls now begin to present
irregular dilatations, air-cells, at first sparingly and on the one side
of the tube only, but as it proceeds onward, these dilatations become more
numerous and surround the tube on all sides, so that it loses its cylindrical
Blood-Vessels. - The pulmonary artery conveys
the venous blood to the lungs; it divides into branches, which accompany
the bronchial tubes, and terminate in a dense capillary network upon the
walls of the intercellular passages and air-cell. In the lung the
branches of the pulmonary artery are usually above and behind the bronchial
tube, the vein below and in front.
The pulmonary capillaries form plexuses, which lie
immediately beneath the mucous membranes in the walls and septa of the
air-cells and of the infundibula. In the septa between the air-cells
the capillary network forms a single layer. The capillaries form
a very minute network, the meshes of which are smaller than the air-cells
themselves; their walls are also exceedingly thin; the arteries of neighboring
lobules are distinct from each other and do not anastomose, whereas the
corresponding venous anastomoses are exceedingly fine.
The radicles of the pulmonary veins commence in
the pulmonary capillaries and coalesce into larger branches, which accompany
the arteries and return the oxygenated blood to the left auricle of the
heart. The radicles come together in the septa between the infundibula,
entirely separate from the small arterial ramifications. Those which
are near the surface of the lungs have an undivided course for some distance,
and then either unite with some deeper lying vein, or form with their companions
a wide-meshed superficial plexus.
The bronchial arteries supply blood for the nutrition
of the lung, and are derived from the thoracic aorta, accompanying the
bronchial tubes, and are distributed to the bronchial glands and upon the
walls of the larger bronchial tubes and pulmonary vessels. Those
supplying the bronchial tubes form the capillary plexus in the muscular
coat, from which branches are given off to form a second plexus in the
mucous coat. This plexus in the lobular bronchioles is continued
with that of the pulmonary artery, and the blood which the bronchial artery
brings is thus carried back by the pulmonary vein. Others are distributed
in the interlobular areolar tissue, and terminate partly in the deep and
partly in the superficial bronchial vein. Some ramify upon the surface
of the lung, beneath the pleura, where they form a capillary network.
The bronchial vein is formed at the root of the
lung, receiving superficial and deep veins corresponding to the branches
of the bronchial artery. It does not, however, receive all the blood
supplied by the artery, as some of it passes into the pulmonary vein.
It terminates on the right side in the vena azygos major, and on the left
side in the superior intercostal or left upper azygos vein. Some
authorities state that in other parts of the lung than in the lobular bronchioles,
bronchial veins, even those coming from the larger bronchial tubes, join
more or less freely with pulmonary veins.
The intercostal arteries give small branches to the surface of the lungs
by way of the ligamentum latum pulmonis.
The lymphatics consist of a superficial and deep
set; they terminate at the root of the lung in the bronchial glands.
Nerves. - The nerve-supply of the lungs is
from the anterior and posterior pulmonary plexus, formed chiefly by branches
from the sympathetic and pneumogastric. The filaments from these
plexuses accompany the bronchial tubes upon which they are lost.
Small ganglia are found upon these nerves.
As many of our readers are unfamiliar with anatomy and physiology,
we have followed Gray quite closely and have entered rather deeply into the
anatomy of the organs of respiration, for several very important reasons.
The most important of which is to call attention to the immense and complicated
blood-supply of the lungs, and the consequent importance of a perfect and unobstructed
circulation. Another very important point that we discover by referring
to the anatomy is the fact that the lungs are controlled by nerves from the
anterior and posterior pulmonary plexus, formed chiefly by branches from the
sympathetic and pneumogastric nerves. These nerves are affected either
by a pressure or stimulation in the neck, or in the spine at about the fifth
In any lung trouble of a serious nature, a pressure at the
last named point causes the patient to cough; the spine is also usually very
tender in this region. Contracted muscles are not only obstructing the
circulation, causing congestion, but their pressure upon nerves which control
the lung causes paroxysms of coughing. Very serious cases of lung troubles
are often cured by simply manipulating and freeing the muscles of the spine
from the first to the tenth dorsal.
In the treatment of any and all diseases of the organs of
respiration, the osteopath has three objects in view, which he must accomplish
before he can hope to attain results:
(1) Expansion of the chest.
(2) Freeing the entire blood-supply to and through
the affected parts.
(3) Freeing and equalizing the nerve-wave.
It is absolutely impossible to lay down a line of treatment
that will be applicable in all the complications arising in different causes;
hence a great deal will depend on the operator constantly keeping these points
in mind, and applying the treatment which seems best adapted to suit the case.
The osteopath cares very little for names, simply dealing
with conditions as they arise, seeking by a skillful manipulation to remove
By using the arms as levers we can expand the chest.
By vibration and a skillful manipulation of the muscles
we can equalize the circulation.
By a pressure upon the vaso-motor center in the upper
cervical region we can control fever.
Acting upon the above principles, and applying the treatment
as given for acute, chronic, or capillary bronchitis, asthma, or consumption,
as the similarity of the case to either of the above diseases would indicate,
or by a combination of any of these treatments, as the judgment of the operator
would dictate, we can hope either to relieve or cure a very large per cent of
the diseases of the respiratory organs.