Intra-thoracic surgery : bronchotomy through the chest-wall for foreign bodies impacted in the bronchi / by De Forest Willard.

  • Willard, De Forest, 1846-1910.
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: Intra-thoracic surgery : bronchotomy through the chest-wall for foreign bodies impacted in the bronchi / by De Forest Willard. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    and pectoral muscles were stitched with continuous suture of catgut, securely closing the chest. The skin was also closed in the same manner. The line of suture of the muscles showed a constant tendency to bulge, and the air soon burst through it at each inspiration. The dog breathed with comparative ease, and was rally- ing, while the wound was partially closed. So soon, however, as complete closure was accomplished, the dyspnoea became more marked, the tissues being pushed out more and more at each inspira- tion. The pneumothorax steadily increased, pushing the heart to the left and with it the septum, thus interfering with the left lung. Death speedily ensued. The opening in the bronchus evidently permitted the air at each inspiration to escape through the incision into the pleural cavity, but from the cylindrical shape of the tube return was prevented by closure of the slit. The action was that of a force-pump driving more air into the pleural cavity, which is probably the explanation of the increasing pneumothorax. An examination of the parts after death showed that the incision had been cleanly made in the bronchus, and that no injury had been done to any vessel or nerve-structure in the line of the wound. There was no hemorrhage, and death was apparently from the cause men- tioned. This experiment was made to observe the effect of a wound left open in the bronchus without stitching. The increasing pneumo- thorax seemed to be caused by the valve action of the bronchial slit. It has been demonstrated that the air of the bronchi is septic, and that it only becomes aseptic by the time that it reaches the bronchioles and air-vessels. My experiments show that upon the left side the bronchus of dogs is enveloped by the pulmonary veins and arteries and bronchial vessels, and although the aorta and pneumogastric can be speedily recognized, yet the cardiac and pleural branches of the pneumogastric run so closely to the root of the lung that the dangers upon the living animal are simply enormous, and in a human patient I cannot imagine a more appalling array of difficulties than would meet the surgeon in such an attempt, with these enormous vessels on either side and the heart in close