The primary functions of the respiratory system

At its simplest level, the respiratory system, for all its complexity, really has just two primary
functions. First, it is an exchange system that swaps out carbon dioxide, the byproduct of
metabolism, for oxygen. In addition, it is instrumental in maintaining the acid/alkaline pH
balance in your body through the bicarbonate buffer system. This is a simple concept to
understand vis-à-vis the respiratory system once you realize that when carbon dioxide dissolves
in water, it can react with that water to produce carbonic acid, which acidifies the blood. This
means that eliminating carbon dioxide in the blood reduces acid levels both in the blood and in
the body tissue served by that blood.
Understanding what we're trying to do when breathing is more important than it might first seem.
With understanding comes the first awareness of what we can do to improve those functions.
Anatomy of the respiratory system
Surprisingly, the respiratory system and the gastrointestinal system are closely linked by
evolution. Or if you prefer the shorter term perspective, the respiratory system grows out of the
gastrointestinal system during the development of the fetus in the womb. This linkage can easily
be seen in the shared connections in the two systems. The mouth, tongue, nasal cavities, and
esophagus are involved in both respiration and eating. In fact, this linkage can at times be
problematic as it puts the lungs at risk of aspiration during swallowing and vomiting.
In essence, the respiratory system consists of a series of tubes for conduction of air, then
distribution of that air to the remotest corners of your lungs, and finally the exchange of gases at
the capillary level. Air is inhaled through the nose and mouth, then down through the "airways,"
passing from the larynx and trachea and then into a rapidly dividing series of about 23
generations of bronchi and bronchioles. The bronchi are comprised of a series of cartilaginous
rings that keep them relatively rigid. But by the time you reach the smallest of the conductive
tubes, the bronchioles, the cartilage is gone and the tubes are flexible -- subject to opening and
closing through muscle action.
In summary, the larynx, trachea, bronchi, and their smaller divisions perform pulmonary
ventilation, which is simply the movement of air. The bronchioles and alveoli, which are found
at the far end of the respiratory system, perform pulmonary respiration, which is the actual
exchange of gases.
There are nearly 50 distinct types of cells that have been identified in the lungs -- at least 12 can
be found in the airways. In addition, mucus is secreted onto the surfaces of the airways by glands
and by "goblet cells" abundantly present on bronchial surfaces. This mucous rests on a thin layer
of an electrolyte solution and covers much of the bronchial surfaces. In addition, a large number
of cells with hair like extensions called cilia can also be found along the entire length of the
airways (at least in a person who doesn't smoke). The purpose of the cilia is to capture any
particles or smoke that enters the air passages, mix them with the mucous that lines the
passageway, and then beat that mixture back up through the passageway until it is expelled from
the lungs. From there it is either coughed and expectorated out of the body or swallowed. As a
side note, approximately 500 ml of this mucous (one pint) is
swallowed every day. Any damage to this system, such as that
caused by smoking which destroys the cilia, leaves one prone
to develop respiratory infections and bronchial dilation, which
narrows the airways and restricts the ability to breathe.
Upper airway
The first part of the airway (nose and mouth) is devoted to air conditioning -- warming up cold
air, cooling hot air, moisturizing dry air, etc. before it enters the lungs. The nasal cavity (also
called the nasopharynx) is lined with mucous membranes, which contain many folds to provide a
large surface area. This facilitates temperature and moisture control. It's the reason you get a
runny nose in cold air as the nasal tissue releases large quantities of fluid in an attempt to
moisturize the cold dry air. In addition, the mucous produced by the membranes is thick and
sticky so as to catch dust and particulate matter so it does not enter the lungs.
The epiglottis is made of cartilage and serves to prevent food or liquids from entering the lungs.
When you swallow, the swallowing action causes the trachea to rise up. At the same time, the
action of the tongue presses the epiglottis down on top of the trachea -- thus closing off entry to
the lungs. (Note: this action can be seen by watching the Adams apple which sits above the
trachea and is part of the voice box as it rises up with the trachea each time you swallow.)
Talking while swallowing will defeat this mechanism, leading to aspiration (the accidental
sucking in of food particles or fluids into the lungs). Also, sometimes as people age, the
mechanism works less efficiently, thus causing people to aspirate more and go into painful
coughing fits in an attempt to force the food or liquid back out of the lungs. Major and minor
episodes of aspiration contribute to the terminal stages of many diseases, and aspiration appears
to play a role in a variety of chronic disorders, such as cough, bronchial asthma, bronchiectasis,
and pulmonary fibrosis.
Lower airway
Like the heart, surrounded by the pericardium, the lungs are likewise enclosed in a two piece
membrane called the pleura lining. This is a thin membrane which lines the inside of the chest
cavity and also covers the lungs. The two "pleural cavities" (one for each lung) are enclosed
compartments, with normally only a film of lubricating fluid between the layer lining the chest
(parietal pleura) and the layer covering the lungs (visceral pleura).
The "visceral" layer covering the lungs is continuous with the "parietal" layer that covers the
inner surface of the chest cavity -- like a balloon folded over on itself. The thin layer of fluid,
which separates these two layers amounts to less than 10 ml (about 1/3 of an oz) total in the
normal adult lungs. This fluid contains both mesothelial cells and a significant concentration of
mucopolysaccharides, which acts as a lubricant for the smooth movement of the pleural layers
against one another. The two layers continually tend to pull away from each other, because of the
stretched elastic condition of the lungs -- an important factor in the mechanics of breathing. If the
chest wall is penetrated by a wound, air is readily sucked into the pleural cavity, separating the
two pleural layers and collapsing the lung.
Air is conducted from the nose and mouth down into the lungs by
the trachea (a tube made primarily of cartilage that serves only
one purpose -- to conduct air). At the bottom of the trachea, the
passageway splits into two bronchial tubes called the mainstem
bronchi -- one heading into each lung. The mainstem bronchi then
divide progressively into smaller and smaller segmented bronchi
as they spread into the lungs. The bronchi are, like the trachea,
are primarily composed of inflexible cartilage. Again, they are
used for conduction of air only. At the lowest or smallest level,
however, the bronchi change. The cartilage is mostly gone, and
the composition is now mostly flexible muscle. These terminal
bronchi are called bronchioles. As we saw with the cardiovascular
system, the muscle tissue at this level allows the bronchioles to expand and contract -- thus
directing air flow to the different parts of the lung as needed. The whole system is known as the
tracheal-bronchi tree -- and it in fact looks like a tree if you turn it upside down, with the trachea
serving as the trunk of the tree.
Note: the muscle tissue at the level of the bronchioles can sometimes present a problem. In some
cases, this tissue is extremely sensitive and hyper responsive to allergens. In those cases, the
muscle can lock the bronchiole in a closed state. At that point air can still be forced past the
bronchiole into the alveolar sacs, but because of the constriction, it cannot leave -- which makes
breathing extremely difficult. This condition is known as asthma. (More on this later in the
series.) Incidentally, the wheezing that asthmatics experience is merely the sound of air trying to
rush through the constricted tubing.
After the division of the mainstem bronchi, each lung divides itself into three lobes -- although in
the left lung, the upper and middle lobes have merged together, making it look like there are only
two lobes. The lobes are then divided into smaller segments named after the bronchi that go into
them. From a surgical point of view, it is far easier to remove an entire lung, as opposed to just a
piece of lung since you only have to staple off the one large bronchi and one main blood vessel.
Lobes are also fairly easy to remove in that you are still dealing with just a handful of bronchi
and blood vessels. But if you try and remove a piece of a lobe, you must close off dozens of
bronchioles and blood vessels.
Exchange system
At the end of all the bronchioles are the alveoli, the
microscopic air sacs that serve as the exchange system
of the lungs. It is the alveoli that interact with the vast
network of tiny pulmonary arterioles, venules, and
capillaries -- exchanging oxygen for carbon dioxide
and refreshing the blood. The network of arterioles and
venules literally cover the alveolar sacs complete with
a spider web like network, providing access to every
square inch of lung tissue. The actual exchange of
gases takes place at the level of the pulmonary alveolar
capillaries -- the tiniest part of the system.
The alveoli
Alveoli begin to appear in the walls of the 17th generation of bronchioles. By the 20th generation
of bronchioles, the entire wall of the airway is composed of alveoli. But the actual alveolar sacs,
the bottom line of the lung so to speak, make their appearance at the 23rd generation of alveoli.
There are approximately 300 million alveoli within the lungs, providing a surface area about the
size of a tennis court. The barrier separating the pulmonary capillaries from the air in the alveolar
sacs is composed of a layer of endothelial cells, a small interstitial space, and a layer of
pulmonary epithelial cells known as pneumocytes. The exchange of oxygen for carbon dioxide in
blood cells takes place across this barrier.
The tissue separating the endothelial cells and the epithelium of the lungs contains elastic,
collagen fibers that give structural integrity and elasticity to the pulmonary tissues. When the
chest cavity is opened, it is the elasticity of the lungs that acts to expel all of the air remaining in
the lungs, which then collapse. This becomes significant when we talk about emphysema. One of
the effects of emphysema is that it destroys those elastic fibers, which severely impacts the
ability of the lungs to adequately contract, significantly impacting the ability of the patient to
breathe. At the other end of the spectrum, however, an overgrowth of fibrous elastic tissues in
the lungs happens in patients with pulmonary fibrosis and is responsible for the difficulty that
they experience during inhalation -- both in terms of the ability of the lungs to expand and
contract and the ability of carbon dioxide and oxygen to freely pass between the pulmonary
capillaries and the alveoli.
Another issue to consider is that for this system of gas exchange to work, the alveolar sacs must
be composed of many, many separate alveoli so that the sac itself looks something like a bunch
of grapes. The reason the multitude of alveoli is necessary is that they provide a vast surface area
to accommodate the multitude of pulmonary capillaries required to "feed" the system and
exchange sufficient gases. (As we mentioned a couple of paragraphs ago, in a pair of healthy
lungs, the surface area is equivalent to that of a tennis court.) In some diseases, such as
emphysema, the walls of the individual alveoli break down leaving you with one sack as opposed
to "the bunch of grapes." The net effect is a dramatically reduced surface area of the lungs,
thereby limiting the ability of the lungs to exchange gases -- thus the resulting shortness of
breath. But more on this later.
It is important to note that the lungs (and for the most part we're talking about the alveoli) are not
actually hollow, but rather, sponge like. If you cut a section of the lung, it does not look like a
balloon, but like a sponge. And in fact, if you squeeze the tissue, tiny little bubbles come out --
just like squeezing a sponge.
It should also be noted that the alveoli are extremely susceptible to complications if any foreign
particles or fluids enter them since they have no good mechanism for their removal. Pneumonia
is often the end result. In fact, the defense mechanisms to prevent this are actually in the trachea
and large bronchi, which, as we discussed earlier, are lined with cells that have a vast area of hair
like projections called cilia that beat upwards in an attempt to move the particulate matter
(including cigarette smoke, air pollution, or coal dust) out into the throat, where it can be cleared
by coughing or clearing the throat. It's probably worth mentioning that one of the first effects of
smoking cigarettes or inhaling heavily polluted air is that you destroy these cilia -- and thus the
ability of your lungs to protect themselves from further smoking or exposure to particulate
matter. Once started, it's a vicious circle.
Diaphragm and chest wall
The last part of the respiratory system we'll talk
about is the diaphragm, which is a large, sheet-
like muscle. It separates the thoracic cavity,
which holds the lungs and heart, and the
abdominal cavity, which holds the stomach,
intestines, kidneys, and liver. Like the cavities
it separates, it too is comprised of two distinct
portions. The costal portion is attached to the
ribs and is responsible for ventilation. The ribs
meanwhile, which define the chest wall, are
connected by two layers of intercostal muscles.
The outer layers run diagonally downward and
forward from the upper to lower ribs and act to lift the chest cavity. The internal intercostals run
diagonally in the opposite direction and assist in exhalation. The scalene muscles run from the
first five vertebrae to the first two ribs and lift the chest cage during inhalation.
The diaphragm is crucial for breathing and respiration. During inhalation, the diaphragm
contracts, thus enlarging the thoracic cavity (the external intercostal muscles also participate in
this enlargement). This reduces intra-thoracic pressure. In other words, by enlarging the chest
cavity, you create suction that draws air into the lungs. When the diaphragm relaxes, air is
exhaled by the elastic recoil of the lungs and the tissues lining the thoracic cavity in conjunction
with the abdominal muscles, which now push inward and help the diaphragm rise up and shrink
the size of the chest cavity forcing air out.
The second portion of the diaphragm consists of the crural fibers, which surround the esophagus.
These fibers also contract during inhalation but have a relatively minor effect on respiration.
Their primary function is that they relax when food is swallowed. The crural diaphragm also
relaxes when vomiting, in contrast to the costal diaphragm, which contracts with the abdominal
musculature to increase intra-abdominal pressure in an attempt to force the vomit upward --
oftentimes with great force. (Think of the movie, The Exorcist.) The crural diaphragm acts in
concert with the smooth muscle of the esophagus to prevent the reflux of food and gastric fluid
into the esophagus.
It should also be noted that the diaphragm is involved in helping to prevent acid reflux by
exerting pressure on the esophagus as it passes through the esophageal hiatus. Malfunctions here
are known as hiatal hernias.
Lung facts
Like virtually all the systems and organs in our body, the lungs are a marvel of engineering and
function. Awake or asleep, conscious or unconscious, our bodies breathe automatically without
thought on our part.
• The normal human lungs weigh about 2 lbs or 1 kg, of which 40% to 50% is blood.
• New babies at rest breathe between 40 and 50 times per minute. By age five it decreases
to around 25 times per minute.
• At rest, an adult breathes about 14 to 16 times per minute. After exercise it could increase
to over 60 times per minute. Note: these rates are fixed. After years of doing yoga
breathing exercises, my normal breathing rate is about six times per minute. It used to
drive doctors crazy on the rare occasions I would have a physical. There are some people
who believe that slowing down the rate of breathing slows down the rate of aging. I don't
know if that's true, but after 61 years, I'd have to say, "So far so good."
• On average, you breathe 23,000 times a day and about 600 million breaths during your
lifetime.
• Each time you breathe you inhale approximately one liter of air (or up to 3 liters of air
with a full inhalation). That works out to about 600,000 cubic meters (785,000 cubic
yards) of air during your lifetime.
• As a side note, because you breathe so many molecules of air during your lifetime, those
same molecules get shared by everyone else on the planet as they breathe. Or to look at it
another way, with every breath you take, you are breathing billions of molecules of air
that have previously passed through the lungs of Genghis Khan, Mary Magdalene, Albert
Einstein, or Mohammed -- take your pick from any name in history. It's an amazing
concept when you think about it.
Wrapping up on the anatomy of the respiratory system
Let's take a break here. With the next issue, we'll pick up with an exploration of the physiology
of the respiratory system -- how it actually works and how gases are actually exchanged. After
that, we'll move into an exploration of what can go wrong and what you can do about it.
Conditions we'll cover include:
• COPD
• Emphysema
• Asthma
• Allergies
• Bronchitis and flu
• Bird flu
• Pneumonia (can be triggered by aspiration -- as happens with dolphins and whales)
• Cystic fibrosis
• Pulmonary fibrosis
• Pulmonary embolism
When we discuss those conditions, we'll get specific as to how you can help deal with them, but
for now, let's wrap up with a look at three things you can do now to improve the health of your
respiratory system.
Exercise your lungs
In my newsletter on Exercise, I talked about the importance of resistance breathing. Proper
breathing is a topic worthy of its own newsletter, but for now, let's just focus on the advantages
of resistance breathing. The concept is simple: putting a device in your mouth that restricts (in a
controlled manner) your inhalations and exhalations, which forces your lungs to work harder.
This, in turn, strengthens the muscles that makes your lungs work and increases their capacity.
There are a number of such devices widely available on the internet and in health magazines.
They tend to run $20-40. The investment is well worth it since this type of exercise can
significantly improve the strength of your respiratory muscles and increase your lung capacity.
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Yahoo! Education > Reference > Gray's Anatomy of the Human Body

The Lungs

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Anatomy The Lungs

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The lungs are the essential organs of respiration; they are two in number, placed one on either side within the thorax, a
separated from each other by the heart and other contents of the mediastinum (Fig. 970). The substance of the lung is o
light, porous, spongy texture; it floats in water, and crepitates when handled, owing to the presence of air in the alveoli;
also highly elastic; hence the retracted state of these organs when they are removed from the closed cavity of the thora
The surface is smooth, shining, and marked out into numerous polyhedral areas, indicating the lobules of the organ: ea
of these areas is crossed by numerous lighter lines.
 FIG. 970– Front view of heart and lungs. (See enlarged image)

At birth the lungs are pinkish white in color; in adult life the color is a dark slaty gray, mottled in patches; and as age
advances, this mottling assumes a black color. The coloring matter consists of granules of a carbonaceous substance
deposited in the areolar tissue near the surface of the organ. It increases in quantity as age advances, and is more
abundant in males than in females. As a rule, the posterior border of the lung is darker than the anterior.

The right lung usually weighs about 625 gm., the left 567 gm., but much variation is met with according to the amount
blood or serous fluid they may contain. The lungs are heavier in the male than in the female, their proportion to the bod
being, in the former, as 1 to 37, in the latter as 1 to 43.

Each lung is conical in shape, and presents for examination an apex, a base, three borders, and two surfaces.

The apex (apex pulmonis) is rounded, and extends into the root of the neck, reaching from 2.5 to 4 cm. above the leve
the sternal end of the first rib. A sulcus produced by the subclavian artery as it curves in front of the pleura runs upward
lateralward immediately below the apex.

The base (basis pulmonis) is broad, concave, and rests upon the convex surface of the diaphragm, which separates t
right lung from the right lobe of the liver, and the left lung from the left lobe of the liver, the stomach, and the spleen. Sin
the diaphragm extends higher on the right than on the left side, the concavity on the base of the right lung is deeper th
that on the left. Laterally and behind, the base is bounded by a thin, sharp margin which projects for some distance into
phrenicocostal sinus of the pleura, between the lower ribs and the costal attachment of the diaphragm. The base of th
lung descends during inspiration and ascends during expiration.
 FIG. 971– Pulmonary vessels, seen in a dorsal view of the heart and lungs. The lungs have been
pulled away from the median line, and a part of the right lung has been cut away to display th
air-ducts and bloodvessels. (Testut.) (See enlarged image)

Surfaces.—The costal surface (facies costalis; external or thoracic surface) is smooth, convex, of considerable exten
and corresponds to the form of the cavity of the chest, being deeper behind than in front. It is in contact with the costa
pleura, and presents, in specimens which have been hardened in situ, slight grooves corresponding with the overlying r

The mediastinal surface (facies mediastinalis; inner surface) is in contact with the mediastinal pleura. It presents a de
concavity, the cardiac impression, which accommodates the pericardium; this is larger and deeper on the left than on
right lung, on account of the heart projecting farther to the left than to the right side of the median plane. Above and beh
this concavity is a triangular depression named the hilum, where the structures which form the root of the lung enter a
leave the viscus. These structures are invested by pleura, which, below the hilus and behind the pericardial impressio
forms the pulmonary ligament. On the right lung (Fig. 972), immediately above the hilus, is an arched furrow which
accommodates the azygos vein; while running upward, and then arching lateralward some little distance below the apex
a wide groove for the superior vena cava and right innominate vein; behind this, and nearer the apex, is a furrow for th
innominate artery. Behind the hilus and the attachment of the pulmonary ligament is a vertical groove for the esophagu
this groove becomes less distinct below, owing to the inclination of the lower part of the esophagus to the left of the mid
line. In front and to the right of the lower part of the esophageal groove is a deep concavity for the extrapericardiac port
of the thoracic part of the inferior vena cava. On the left lung (Fig. 973), immediately above the hilus, is a well-marked
curved furrow produced by the aortic arch, and running upward from this toward the apex is a groove accommodating t
left subclavian artery; a slight impression in front of the latter and close to the margin of the lung lodges the left innomin
vein. Behind the hilus and pulmonary ligament is a vertical furrow produced by the descending aorta, and in front of th
near the base of the lung, the lower part of the esophagus causes a shallow impression.
 FIG. 972– Mediastinal surface of right lung. (See enlarged image)

Borders.—The inferior border (margo inferior) is thin and sharp where it separates the base from the costal surface a
extends into the phrenicocostal sinus; medially where it divides the base from the mediastinal surface it is blunt and
rounded.

The posterior border (margo posterior) is broad and rounded, and is received into the deep concavity on either side
the vertebral column. It is much longer than the anterior border, and projects, below, into the phrenicocostal sinus.

The anterior border (margo anterior) is thin and sharp, and overlaps the front of the pericardium. The anterior border
the right lung is almost vertical, and projects into the costomediastinal sinus; that of the left presents, below, an angula
notch, the cardiac notch, in which the pericardium is exposed. Opposite this notch the anterior margin of the left lung
situated some little distance lateral to the line of reflection of the corresponding part of the pleura.
 FIG. 973– Mediastinal surface of left lung. (See enlarged image)

Fissures and Lobes of the Lungs.—The left lung is divided into two lobes, an upper and a lower, by an interlobula
fissure, which extends from the costal to the mediastinal surface of the lung both above and below the hilus. As seen o
the surface, this fissure begins on the mediastinal surface of the lung at the upper and posterior part of the hilus, and ru
backward and upward to the posterior border, which it crosses at a point about 6 cm. below the apex. It then extends
downward and forward over the costal surface, and reaches the lower border a little behind its anterior extremity, and
further course can be followed upward and backward across the mediastinal surface as far as the lower part of the hilu
The superior lobe lies above and in front of this fissure, and includes the apex, the anterior border, and a considerab
part of the costal surface and the greater part of the mediastinal surface of the lung. The inferior lobe, the larger of th
two, is situated below and behind the fissure, and comprises almost the whole of the base, a large portion of the costa
surface, and the greater part of the posterior border.

The right lung is divided into three lobes, superior, middle, and inferior, by two interlobular fissures. One of these
separates the inferior from the middle and superior lobes, and corresponds closely with the fissure in the left lung. Its
direction is, however, more vertical, and it cuts the lower border about 7.5 cm. behind its anterior extremity. The othe
fissure separates the superior from the middle lobe. It begins in the previous fissure near the posterior border of the lun
and, running horizontally forward, cuts the anterior border on a level with the sternal end of the fourth costal cartilage; o
the mediastinal surface it may be traced backward to the hilus. The middle lobe, the smallest lobe of the right lung, i
wedge-shaped, and includes the lower part of the anterior border and the anterior part of the base of the lung.

The right lung, although shorter by 2.5 cm. than the left, in consequence of the diaphragm rising higher on the right sid
accommodate the liver, is broader, owing to the inclination of the heart to the left side; its total capacity is greater and
weighs more than the left lung.

The Root of the Lung (radix pulmonis).—A little above the middle of the mediastinal surface of each lung, and nearer
posterior than its anterior border, is its root, by which the lung is connected to the heart and the trachea. The root is form
by the bronchus, the pulmonary artery, the pulmonary veins, the bronchial arteries and veins, the pulmonary plexuses
nerves, lymphatic vessels, bronchial lymph glands, and areolar tissue, all of which are enclosed by a reflection of the
pleura. The root of the right lung lies behind the superior vena cava and part of the right atrium, and below the azygos v
That of the left lung passes beneath the aortic arch and in front of the descending aorta; the phrenic nerve, the
pericardiacophrenic artery and vein, and the anterior pulmonary plexus, lie in front of each, and the vagus and posterio
pulmonary plexus behind each; below each is the pulmonary ligament.

The chief structures composing the root of each lung are arranged in a similar manner from before backward on bot
sides, viz., the upper of the two pulmonary veins in front; the pulmonary artery in the middle; and the bronchus, togeth
with the bronchial vessels, behind. From above downward, on the two sides, their arrangement differs, thus:

On the right side their position is—eparterial bronchus, pulmonary artery, hyparterial bronchus, pulmonary veins, but
the left side their position is—pulmonary artery, bronchus, pulmonary veins. The lower of the two pulmonary veins, is
situated below the bronchus, at the apex or lowest part of the hilus (Figs. 972, 973).

Divisions of the Bronchi.—Just as the lungs differ from each other in the number of their lobes, so the bronchi differ
their mode of subdivision.

The right bronchus gives off, about 2.5 cm. from the bifurcation of the trachea, a branch for the superior lobe. This
branch arises above the level of the pulmonary artery, and is therefore named the eparterial bronchus. All the other
divisions of the main stem come off below the pulmonary artery, and consequently are termed hyparterial bronchi. Th
first of these is distributed to the middle lobe, and the main tube then passes downward and backward into the inferior lo
giving off in its course a series of large ventral and small dorsal branches. The ventral and dorsal branches arise
alternately, and are usually eight in number—four of each kind. The branch to the middle lobe is regarded as the first of
ventral series.

The left bronchus passes below the level of the pulmonary artery before it divides, and hence all its branches are
hyparterial; it may therefore be looked upon as equivalent to that portion of the right bronchus which lies on the distal s
of its eparterial branch. The first branch of the left bronchus arises about 5 cm. from the bifurcation of the trachea, and
distributed to the superior lobe. The main stem then enters the inferior lobe, where it divides into ventral and dorsal
branches similar to those in the right lung. The branch to the superior lobe of the left lung is regarded as the first of th
ventral series.

Structure.—The lungs are composed of an external serous coat, a subserous areolar tissue and the pulmonary substa
or parenchyma.

The serous coat is the pulmonary pleura (page 1090); it is thin, transparent, and invests the entire organ as far as th
root.

The subserous areolar tissue contains a large proportion of elastic fibers; it invests the entire surface of the lung, an
extends inward between the lobules.

The parenchyma is composed of secondary lobules which, although closely connected together by an interlobular are
tissue, are quite distinct from one another, and may be teased asunder without much difficulty in the fetus. The seconda
lobules vary in size; those on the surface are large, of pyramidal form, the base turned toward the surface; those in th
interior smaller, and of various forms. Each secondary lobule is composed of several primary lobules, the anatomical un
 of the lung. The primary lobule consists of an alveolar duct, the air spaces connected with it and their bloodvessels,
lymphatics and nerves.

The intrapulmonary bronchi divide and subdivide throughout the entire organ, the smallest subdivisions constituting
lobular bronchioles. The larger divisions consist of: (1) an outer coat of fibrous tissue in which are found at intervals
irregular plates of hyaline cartilage, most developed at the points of division; (2) internal to the fibrous coat, a layer o
circularly disposed smooth muscle fibers, the bronchial muscle; and (3) most internally, the mucous membrane, lined b
columnar ciliated epithelium resting on a basement membrane. The corium of the mucous membrane contains numero
elastic fibers running longitudinally, and a certain amount of lymphoid tissue; it also contains the ducts of mucous gland
the acini of which lie in the fibrous coat. The lobular bronchioles differ from the larger tubes in containing no cartilage a
in the fact that the ciliated epithelial cells are cubical in shape. The lobular bronchioles are about 0.2 mm. in diameter

FIG. 974– Part of a secondary lobule from the depth of a human lung, showing parts of several
primary lobules. 1, bronchiole; 2, respiratory bronchiole; 3, alveolar duct; 4, atria; 5, alveolar sa
6, alveolus or air cell: m, smooth muscle; a, branch pulmonary artery; v, branch pulmonary vei
s, septum between secondary lobules. Camera drawing of one 50 μ section. X 20 diameters.
(Miller.) (See enlarged image)

Each bronchiole divides into two or more respiratory bronchioles, with scattered alveoli, and each of these again divi
into several alveolar ducts, with a greater number of alveoli connected with them. Each alveolar duct is connected with
variable number of irregularly spherical spaces, which also possess alveoli, the atria. With each atrium a variable numb
(2–5) of alveolar sacs are connected which bear on all parts of their circumference alveoli or air sacs. (Miller.)

The alveoli are lined by a delicate layer of simple squamous epithelium, the cells of which are united at their edges b
cement substance. Between the squames are here and there smaller, polygonal, nucleated cells. Outside the epithelia
lining is a little delicate connective tissue containing numerous elastic fibers and a close net-work of blood capillaries, a
forming a common wall to adjacent alveoli (Fig. 975).
 FIG. 975– Schematic longitudinal section of a primary lobule of the lung (anatomical unit); r. b.,
respiratory bronchiole; al. d., alveolar duct; at., atria; a. s., alveolar sac; a, alveolus or air cell;
a.: pulmonary artery: p. v., pulmonary vein; l., lymphatic; l. n., lymph node. (Miller.) (See enlarg
image)

FIG. 976– Section of lung of pig embryo, 13 cm. long, showing the glandular character of the
developing alveoli (J. M. Flint.) X 70. a. Interstitial connective tissue. b. A bronchial tube. c. An
Alveolus. l. lymphatic clefts. q. Pleura. (See enlarged image)

The fetal lung resembles a gland in that the alveoli have a small lumen and are lined by cubical epithelium (Fig. 976
After the first respiration the alveoli become distended, and the epithelium takes on the characters described above.
 Vessels and Nerves.—The pulmonary artery conveys the venous blood to the lungs; it divides into branches which
accompany the bronchial tubes and end in a dense capillary net-work in the walls of the alveoli. In the lung the branche
the pulmonary artery are usually above and in front of a bronchial tube, the vein below.

The pulmonary capillaries form plexuses which lie immediately beneath the lining epithelium, in the walls and septa
the alveoli and of the infundibula. In the septa between the alveoli the capillary net-work forms a single layer. The
capillaries form a very minute net-work, the meshes of which are smaller than the vessels themselves; their walls are a
exceedingly thin. The arteries of neighboring lobules are independent of each other, but the veins freely anastomose

The pulmonary veins commence in the pulmonary capillaries, the radicles coalescing into larger branches which ru
through the substance of the lung, independently of the pulmonary arteries and bronchi. After freely communicating wi
other branches they form large vessels, which ultimately come into relation with the arteries and bronchial tubes, and
accompany them to the hilus of the organ. Finally they open into the left atrium of the heart, conveying oxygenated bloo
be distributed to all parts of the body by the aorta.

The bronchial arteries supply blood for the nutrition of the lung; they are derived from the thoracic aorta or from the
upper aortic intercostal arteries, and, accompanying the bronchial tubes, are distributed to the bronchial glands and up
the walls of the larger bronchial tubes and pulmonary vessels. Those supplying the bronchial tubes form a capillary plex
in the muscular coat, from which branches are given off to form a second plexus in the mucous coat; this plexus
communicates with small venous trunks that empty into the pulmonary veins. Others are distributed in the interlobula
areolar tissue, and end partly in the deep, partly in the superficial, bronchial veins. Lastly, some ramify upon the surface
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 branches
the bronchial artery. It does not, however, receive all the blood supplied by the artery, as some of it passes into the
pulmonary veins. It ends on the right side in the azygos vein, and on the left side in the highest intercostal or in the
accessory hemiazygos vein.

The lymphatics are described on page 718.

Nerves.—The lungs are supplied from the anterior and posterior pulmonary plexuses, formed chiefly by branches from
sympathetic and vagus. The filaments from these plexuses accompany the bronchial tubes, supplying efferent fibers to
bronchial muscle and afferent fibers to the bronchial mucous membrane and probably to the alveoli of the lung. Smal
ganglia are found upon these nerves.

The apneustic center of the lower pons appears to promote inspiration by stimulation of the I
neurons in the medulla oblongata providing a constant stimulus.
The apneustic centre of pons sends signals to the dorsal respiratory centre in the medulla to delay
the 'switch off' signal of the inspiratory ramp provided by the pneumotaxic centre of pons. It
controls the intensity of breathing. The apneustic centre is inhibited by pulmonary strech
receptors. However, it gives positive impulses to the inspiratory (I) neurons.