Broncho-esophagology; a critical review.

It is difficult to review progress in one branch of medicine without taking into consideration the contributions that have been made in other fields and that applies to progress in bronchoesophagology. One must take into consideration the advances made in the diagnosis of bronchopulmonary diseases in other fields, notably by roentgenology, the influence of the antibiotics and the remarkable progress in the field of thoracic surgery which in turn owes much of its advances to antibiotics, to a greater knowledge of bronchopulmonary physiology, to broncho-esophagology and to advances in anesthesia. One of the outstanding contributions in the field of physiology was that by the Hildlngs1 who studied the volume of the bronchial tree at various levels and speculated concerning the physiological significance, particularly on the matter of cleansing Inspired air. While there was not observed a great increase in the volume of the tracheobronchial tree from the larynx to the bronchi measuring 1.5 mm. in diameter, they found a remarkable expansion In the volume of the tract in the bronchi less than 1.5 mm. in diameter. It was their opinion that this distal portion of the air passageway might be considered as a bronchiolar filter and that it probably was more effective in the matter of dust removal and humidification than the nose. Bronchospirography is attracting more attention particularly to determine the function of the separate lung. Norris2 and his associates have been carrying out studies in this field to ascertain the extent of participation of the separate lungs in the various phases of the total respiratory function in health as well as disease. The field of anesthesia as it pertains to broncho-esophagology has come in for a great deal of discussion. The whole problem still is unsettled. The development of certain synthetic anesthetics for topical application and instillation and the employment of sodium pentothal and curare have changed the entire picture as compared with anesthesia of 10 years ago. A majority I believe prefer local anesthesia supplemented by barbiturates or other sedatives.