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RESPIRATORY
PHYSIOLOGY
2ND EDITION

Michelle M. Cloutier, MD
Professor Emerita Pediatrics and Medicine
UCONN Health
Farmington, Connecticut
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899

RESPIRATORY PHYSIOLOGY, SECOND EDITION ISBN: 978-0-323-59578-0

Copyright © 2019 Elsevier Inc. All Rights Reserved.

Previous editions copyrighted 2007.

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechan-
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This book and the individual contributions contained in it are protected under copyright by the Publisher (other
than as may be noted herein).

Notices

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds or experiments described herein. Because of rapid advances in
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 To my husband, John B. Morris,
who grounds, supports, and challenges me
and to my three stepchildren who are amazing.
Thank you all.
P R E FA C E
I wrote this book to help teach medical students and other
students of medicine. I have been gratified by the many
positive responses from students about how they have used
this book to learn respiratory physiology, and also by how
many pulmonary fellows and new pulmonologists have
used this book to prepare for certification and recertifica-
tion—in particular, in pulmonary medicine. In this revised
edition, I have included many more clinical vignettes to
help students fill the gaps between respiratory physiology
vi
and its application to respiratory disease. The vignettes
were chosen to demonstrate how respiratory physiology is
used in medicine to guide diagnosis and treatment.
I hope students will find this book especially useful in
understanding difficult concepts. I encourage your feed-
back and comments.
Michelle M. Cloutier
 Overview of the Respiratory
System: Function and Structure
OBJECTIVES
1. Introduce the major functions of respiration.
2. Describe the components of the upper and lower
airways.
3. Outline and briefly describe the components of the
respiratory system including:
• The conducting airways
• The alveolar-capillary unit
The principal function of the respiratory system is to bring
oxygen from the external environment to the tissues in the
body and to remove from the body the carbon dioxide pro­
duced by cell metabolism. In addition, respiration func­
tions in acid-base balance (see Chapter 9), in host defense,
in metabolism, and in the handling of bioactive materials
(see Chapter 11).
The respiratory system is composed of th lungs· the
upper and lower airways, including the nose; he chest wall,
including the muscles of respiration (diar,hrag , inte cos­
tal muscles, and abdominal muscles) and thvrib cage; the
pulmonary circulation; and those parts of the central ner­
vous system that regulate respiration ( ig. 1.1).
BASIC STRUCTURE OFT E RESPIRATORY
SYSTEM
The airways are divided into upper and lower airways. The
upper airway consists of all structures from the nose to the
vocal cords, whereas the lower airway consists of the tra­
chea and the bronchial structures to the alveolus.
Air flows to the lower airways through either the mouth
or the nose. Nasal breathing is the preferred route for two
reasons: first, the nose filters particulate matter and plays
a major role in lung defense (see Chapter 11); second, the
nose humidifies inspired air as a result of the large surface
area created by the nasal septum and the nasal turbinates.
The nose also offers a higher resistance to airflow than the
mouth, however, and this resistance is increased in the
• The alveolar surface
• The pulmonary circulation
The cells of the airwar.
• The muscles of respiration
• The central nervous system and neural pathways
regulating respiration
4. Relate lung stru<l:ture to lung function.
presence o nasal congestion, large adenoids, or nasal pol­
yps. Increasing airflow as occurs during exercise results in
increasing resistance in the nose, with a switch from nasal to
mouth breathing during exercise around inspiratory flow
rates of35 L/min.
The tracheobronchial tree is an arrangement of branch­
ing tubes that begins at the larynx and ends in the alveoli.
The trachea begins at the larynx and in the tracheobron­
chial tree nomenclature has been designated Generation
0. The trachea divides at the carina, or "keel" (so named
because it looks like the keel of a boat), into the right and
left main-stem bronchi (Generation 1) that penetrate the
lung parenchyma (tissue of the lung). The right main-stem
bronchus is larger than the left, and the angle of the take­
off is less acute. This has implications for aspiration of for­
eign bodies, which most often enter the right rather than
the left main-stem bronchus. Main-stem bronchi branch
into lobar bronchi (three on the right and two on the left)
(Generation 2) that in turn branch into segmental bronchi
(Generation 3) and an extensive system of subsegmental
and smaller bronchi. As a rough rule, in the first six airway
generations, the number of airways in each generation is
double that in the previous generation and the number of
airways in each generation is equal to the number 2 raised to
the generation number. Airway branching beyond the sixth
generation is asymmetric in branching angle, size, number
of branches, and number of subsequent generations. As
a result, although in general there are between 15 and 20
generations of airways from the trachea to the level of the
1
 Turbinates
Frontal sinus

Sphenoid sinus
Nasal cavity

Nasal vestibule Pharyngeal tonsil

(adenoids)
Nasopharynx

Oropharynx

Epiglottis

Esophagus
Hyoid bone
Thyroid cartilage
Cricothyroid membrane
Cricoid cartilage

Posterior tracheal wall

(membranous portion)

Right main-stem
bronchus Apex
Trachea
Tracheal cartilage
Right 1 2 Left main-stem
upper lobe bronchus
2 1

3 3
Left
4 upper lobe
Carina

6 6
4
5
5
Right Left
middle lobe 8 lower lobe
7

8
10
Right 9 7
lower lobe 10

Lingula 9

Fig. 1.1 Schematic diagram of the respiratory system including the bronchopulmonary segments; anterior
view. Numbers refer to bronchopulmonary segments: 1, apical; 2, posterior; 3, anterior; 4, lateral (superior
on the left); 5, medial (inferior on the left); 6, superior; 7, medial basal; 8, anterior basal; 9, lateral basal;
10, ­posterior basal (see Fig. 1.13).
 CHAPTER 1 Overview of the Respiratory System: Function and Structure 3

Total cross
Generation Diameter, cm Length, cm Number sectional
area, cm2
Trachea 0 1.80 12.0 1 2.54
Conducting zone

Bronchi 1 1.22 4.8 2 2.33

2 0.83 1.9 4 2.13

3 0.56 0.8 8 2.00

Bronchioles 4 0.45 1.3 16 2.48

5 0.35 1.07 32 3.11

Terminal
bronchioles 16 0.06 0.17 6 × 104 180.0

17
Respiratory
bronchioles 18
respiratory zones
Transitional and

19 0.05 0.10 5 × 105 103

T3 20
Alveolar
ducts T2 21
T1 22

Alveolar T 23 0.04 0.05 8 × 106 104

sacs

Fig. 1.2 Airway generations and approximate dimensions in the human lung. In the adult, alveoli can be
found as early as the 10th airway generation and as late as the 23rd generation. (Redrawn from Weibel ER.
Morphometry of the Human Lung. Berlin: Springer Verlag; 1963. Data from Bouhuys A. The Physiology of
Breathing. New York: Grune & Stratton; 1977.)

terminal bronchioles, there can be as few as 10 or as many as
20 generations (Fig. 1.2). With each airway generation, the
airways become smaller and more numerous (Fig. 1.3) as
they penetrate deeper into the lung parenchyma.
Both the right and the left lung are encased by two
membranes—the visceral pleura and the parietal pleura.
The visceral pleural membrane completely envelops the
lung except at the hilum where the bronchus, pulmonary
vessels, and nerves enter the lung parenchyma. The parietal
pleural membrane lines the inner surface of the chest wall,
mediastinum, and diaphragm and becomes continuous
with the visceral pleura at the hilum. Under normal con-
ditions, the space between the two pleuras contains a small
amount of clear, serous fluid that is produced by filtration
from the parietal pleural capillaries and is resorbed by the
visceral pleural capillaries. This fluid facilitates the smooth
gliding of the lung as it expands in the chest and creates
a potential space that can be involved in disease. Air can
enter this potential space between the visceral and parietal
pleuras because of trauma, rupture of a weakened area at
the surface of the lung, or surgery producing a pneumo-
thorax. Fluid can also enter this space, creating a pleural
effusion. Because the pleuras of the right and left lung are
separate, a pneumothorax involves only the right or the left
hemithorax.
Structurally, the trachea is supported by C-shaped
(sometimes referred to as U-shaped) cartilage anteriorly
and laterally that prevents tracheal collapse and by smooth
muscle posteriorly, which can invaginate and markedly
decrease the cross-sectional area of the trachea. Like the tra-
chea, cartilage in large bronchi is also semicircular, but as
the bronchi enter the lung parenchyma, the cartilage rings
disappear and are replaced by plates of cartilage. As the air-
ways further divide, these plates of cartilage decrease in size
and eventually disappear around the 11th airway genera-
tion. Airways beyond the 11th generation are imbedded in
4 CHAPTER 1 Overview of the Respiratory System: Function and Structure

Fig. 1.3 Transition of terminal bronchiole. Scanning electron micrograph of airway branches peripheral to
terminal bronchiole in a silicon-rubber cast of cat lung. Note multiple, smaller branches from respiratory to
terminal bronchioles. A, alveolus; RB, respiratory bronchiole; TB, terminal bronchiole. Note absence of alveoli
in terminal bronchiole (From Berne RM, Levy ML, Koeppen BM, Stanton BA (eds.). Physiology, 7th ed. St.
Louis: Mosby; 2018.)

TABLE 1.1 Anatomic Features of Bronchi and Bronchioles

Cartilage Present Size Epithelium Blood Supply Alveoli Volume
Bronchi Yes >1 mm Pseudostratified Bronchial No ∼675 mL
columnar
Terminal bronchioles No <1 mm Cuboidal Bronchial No >150 mL

Respiratory bronchioles No <1 mm Cuboidal/alveolar Pulmonary Yes 2500 mL

the lung parenchyma, and the caliber of their lumen is reg-
ulated by the elastic recoil of the lung and lung volume. In
addition, the number of bronchioles increases beyond the
11th generation more rapidly than the diameter decreases.
As a result the cross-sectional area increases rapidly at this
point and is 30 times the cross-sectional area of the main-
stem bronchi. This results in a marked decrease in airway
resistance to approximately one-tenth of the resistance of
the entire respiratory system (see Chapter 3).
The airways can thus be divided into two types: cartilag-
inous airways, or bronchi; and noncartilaginous airways,
or bronchioles (Table 1.1). Bronchi contain cartilage and
are the conductors of air between the external environment
and the distal sites of gas exchange. They do not participate
in gas exchange. Bronchioles do not contain cartilage and
are subdivided into terminal bronchioles, which do not
participate in gas exchange; and respiratory bronchioles,
which contain alveoli and alveolar ducts and function as
sites of gas exchange.
The airways from the nose to and including the ter-
minal bronchioles are known as the conducting airways
because they bring (conduct) gas to the gas-exchanging
units but do not actually participate in gas exchange. The
conducting airways (primarily the nose) also function to
warm and humidify inspired air. Because the conducting
airways contain no alveoli and therefore take no part in gas
 CHAPTER 1 Overview of the Respiratory System: Function and Structure
A
* IN
* PK C
C C
EC
A *
Fig. 1.4 Scanning electron micrograph of an alveolar surface
demonstrating the alveolar septum. Capillaries (C) are seen in
cross section in the foreground with erythrocytes (EC) in their
lumen. At the circled asterisk, three septae come together. The
septae are held together by connective tissue fibers (uncircled
asterisks). A, alveolus; D, alveolar duct; PK, pores of Kohn. (Mi-
crograph courtesy of Weibel ER, Institute of Anatomy, Univer-
sity of Berne, Switzerland.)
exchange, they constitute the anatomic dead space (see
Chapter 5). In normal individuals, the first 16 generations
of airway branchings, with a volume of 150 mL, constitute
the anatomic dead space, whereas the next 7 generations
contain an increasing number of alveoli and constitute the
gas exchange unit.
Alveolar–Capillary Unit
The terminal bronchioles divide into respiratory bronchi-
oles, which contain alveolar ducts and alveoli and constitute
the last three to five generations of the respiratory system. Gas
exchange occurs in the alveoli through a dense meshlike net-
work of capillaries and alveoli called the alveolar–capillary
network (Fig. 1.4). The alveolar–capillary unit consists of the
respiratory bronchioles, the alveolar ducts, the alveoli, and
the pulmonary capillary bed. It is the basic physiologic unit
of the lung and is characterized by a large surface area and a
blood supply that originates from the pulmonary arteries. In
the adult, there are approximately 300 million alveoli, which
are 250 μm in size and are entirely surrounded by capillaries. In
addition, there are 280 billion capillaries in the lung or almost
1000 capillaries for each alveolus. The result is a large surface
area for gas exchange—approximately 50 to 100 m2, which
occurs in a space that is only 5 mm in length. It is one of the
most remarkable engineering feats in the body. The portion of
the lung supplied by respiratory bronchioles is called an aci-
nus. Each acinus contains in excess of 10,000 alveoli; gas move-
ment in the acinus is by diffusion rather than tidal ventilation.
5
RBC
Alv
FB
EP
IN
EN 4 32
BM
RBC
EN Alv
EP
1 µm
Fig. 1.5 Transmission electron micrograph of a pulmonary
capillary in cross section. Alveoli (Alv) are on either side of the
capillary that is shown with a red blood cell (RBC). The diffusion
pathway for oxygen and carbon dioxide (arrow) consists of the
areas numbered 2, 3, and 4, which are the alveolar–capillary
barrier, plasma, and erythrocyte, respectively. BM, basement
membrane; C, capillary; EN, capillary endothelial cell (note its
large nucleus); EP, alveolar epithelial cell; FB, fibroblast pro-
cess; IN, interstitial space. (Reproduced with permission from
Weibel ER. Morphometric estimation of pulmonary diffusion
capacity, I. Model & method. Respir Physiol. 1970;11:54–75.)
The barrier between the gas in the alveoli and the red
blood cells is only 1 to 2 μm in thickness and consists of
type I alveolar epithelial cells, capillary endothelial cells,
and their respective basement membranes (Fig. 1.5). O2
diffuses across this barrier into plasma and red blood cells,
whereas the reverse occurs for CO2 (see Chapter 8). Red
blood cells pass through the pulmonary network in less
than 1 second, which is sufficient time for CO2 and O2 gas
exchange to occur.
In some regions of the alveolar wall there is nothing
between the airway epithelial cells and the capillary endo-
thelial cells other than their fused basement membranes.
In other regions there is a space between the epithelial and
endothelial cells called the interstitial space or intersti-
tium (see Fig. 1.5). The interstitium is composed of col-
lagen, elastin, proteoglycans, a variety of macromolecules
involved with cell–cell and cell–matrix interactions, some
nerve endings, and some fibroblast-like cells. The alveolar
septum creates a fiber scaffold through which pulmonary
capillaries are threaded and is supported by the basement
membrane. There are also small numbers of lymphocytes
that have migrated out of the circulation in the interstitium
and capillary endothelial cells. The basement membrane
is capable of withstanding high transmural pressures and
sometimes is the only remaining separation between blood
and gas.
6 CHAPTER 1 Overview of the Respiratory System: Function and Structure
Fig. 1.6 Structure of the normal alveolus.
The type I cell, with its long thin cytoplasmic
processes, lines most of the alveolar surface,
whereas the cuboidal type II cell, which is
more numerous, occupies only about 7% of
the alveolar surface. Capillaries (C) with red
blood cells (RBC) are also shown. A, alveo-
lar surface; IS, interstitial space; L, lamellar
body, source of surfactant. (Modified from
Weinberger S, Cockrill, BA, Mandel J. Princi-
ples of Pulmonary Medicine, 5th ed. Philadel-
phia: W.B. Saunders; 2008.)
Alveolar Surface
The alveolar epithelium is a continuous layer of tissue
composed primarily of type I cells or squamous pneumo-
cytes. These cells have broad, thin extensions that cover
approximately 93% of the alveolar surface (Fig. 1.6). They
are highly differentiated cells that do not divide, which
makes them particularly susceptible to injury from inhaled
or aspirated toxins and from high concentrations of oxy-
gen (see Chapter 11). They are joined into a continuous
sheet by tight junctions that prevent large molecules such
as albumin from entering the alveoli, resulting in pulmo-
nary edema. The thin cytoplasm of the type I cell is ideal for
optimal gas diffusion.
Type II cells, or granular pneumocytes, are more numer-
ous than type I cells; however, because of their cuboidal shape,
they occupy only approximately 7% of the alveolar surface
and are located in the corners of the alveolus (see Fig. 1.6).
The hallmarks of the type II cell are their microvilli and their
osmiophilic lamellar inclusion bodies that contain surfactant,
a compound with a high lipid content that acts as a detergent
to reduce the surface tension of the alveoli (Fig. 1.7; also see
Chapter 2). The type II cell is the progenitor cell of the alveolar
epithelium. When there is injury to the type I cell, the type II
cell multiplies and eventually differentiates into a type I cell. In
a group of diseases that result in pulmonary fibrosis, the type I
cell is injured and the alveolar epithelium is now lined entirely
by type II cells, a condition that is not conducive to optimal
Type II cell
A
L
Type I cell
C
Type I cell
IS
C
RBC
Type II cell L
gas exchange. This repair system is an example of phylog-
eny recapitulating ontogeny, because the epithelium of the
alveolus is composed entirely of type II cells until late in
gestation.
The lumen of the alveolus is covered by a thin layer
of fluid composed of a water phase immediately adjacent
to the alveolar epithelial cell and covered by surfactant.
Within the alveolar epithelium there are also a small num-
ber of macrophages, a type of phagocytic cell that patrols
the alveolar surface and ingests (phagocytizes) bacteria and
inhaled particles (see Chapter 11).
Pulmonary Circulation
The lung has two separate blood supplies (see Chapter
6). The pulmonary circulation brings deoxygenated
blood from the right ventricle to the gas-exchanging
units (alveoli). Pulmonary perfusion (Q̇) refers to pul-
monary blood flow, which equals the heart rate multi-
plied by the right ventricular stroke volume. The lungs
receive the entire right ventricular cardiac output and
are the only organ in the body that functions in this
manner. The bronchial (or lesser) circulation arises
from the aorta and provides nourishment to the lung
parenchyma. The dual circulation to the lung is another
of the unique features of the lung.
The pulmonary capillary bed is the largest vascular bed
in the body, with a surface area of 70 to 80 m2. It is best
 A

B C
Fig. 1.7 Surfactant release by type II epithelial cells. Alv, alveolus. A, Type II epithelial cell from a human lung
showing characteristic lamellar inclusion bodies (white arrows) within the cell and microvilli (black arrows)
projecting into the alveolus. Bar = 0.5 μm. B, Early exocytosis of lamellar body into the alveolar space in a
human lung. Bar = 0.5 μm. C, Secreted lamellar body and newly formed tubular myelin in alveolar liquid in a
fetal rat lung. Membrane continuities between outer lamellae and adjacent tubular myelin provide evidence
of intraalveolar tubular myelin formation. Bar = 0.1 μm. (Courtesy Dr. Mary C. Williams.)
8 CHAPTER 1 Overview of the Respiratory System: Function and Structure

viewed as a sheet of blood interrupted by small vertical
supporting posts (Fig. 1.8). When the capillaries are filled
with blood, about 75% of the surface area of the alveoli
overlies the red blood cells. The capillaries allow red blood
cells to flow through in single file only; this greatly facili-
tates gas exchange between the alveoli and the red blood
cells. Once gas exchange is complete, the oxygenated blood
returns to the left side of the heart through pulmonary
venules and veins and is ready for pumping to the systemic
circulation. In contrast to the systemic circulation, the pul-
monary circulation is a highly distensible, low-pressure
system capable of accommodating large volumes of blood
at low pressure. This is another unique feature of the lung.
Pulmonary arteries that contain deoxygenated blood
follow the bronchi in connective tissue sheaths, whereas
pulmonary veins cross segments on their way to the left
atrium (Fig. 1.9). Bronchial arteries also follow the bronchi
and divide with them. In contrast, one-third of the blood

Fig. 1.8 Pulmonary capillary surface of the lung. View of alveolar

wall (in a frog) demonstrating the dense network of capillaries. A
small artery (left) and vein (right) can also be seen. The individual
capillary segments are so short that the blood forms an almost
continuous sheet. (From Maloney JE, Castle BL. Pressure-diam-
eter relations of capillaries and small blood vessels in frog lung.
500 µ
Respir Physiol. 1969;7:150–162.)

Pulmonary
artery Vasomotor nerves
Bronchus
Bronchial Lymphatics
artery

Bronchomotor nerve

Pulmonary
vein
Lymphatics TB

RB
Vasomotor A
nerves
A A
Fig. 1.9 The anatomic relation between the
pulmonary artery, the bronchial artery, the A AD
airways, and the lymphatics. A, alveoli; AD, al- AD AD A
AD
veolar ducts; RB, respiratory bronchioles; TB,
terminal bronchioles. (From Berne RM, Levy
ML, Koeppen BM, Stanton BA (eds.). Physiol-
ogy, 7th ed. St. Louis: Mosby; 2018.)
 CHAPTER 1 Overview of the Respiratory System: Function and Structure 9

from the bronchial veins (deoxygenated blood) drains
into the right atrium, and the remainder drains into pul-
monary veins that drain into the left atrium. Thus a small
amount of deoxygenated blood that has nourished the
lung parenchyma mixes with oxygenated blood in the left
atrium. Pulmonary capillaries, on the other hand, are not
confined to a single alveolus but pass from one to another
as well as to adjacent alveolar septae before emptying into
a venule. This improves the efficiency of gas exchange and
minimizes the effect of alveolar disease on gas exchange.
Submucosal tracheobronchial glands are present wher-
ever there is cartilage in the tracheobronchial tree. These
glands empty to the surface epithelium through a ciliated duct
and are lined by mucous and serous cells. Submucosal tra-
cheobronchial glands increase in number and size in chronic
bronchitis, a chronic lung disease primarily occurring in
smokers, and extend down to the bronchioles in disease.
The ciliated epithelium, goblet cell, Clara cell, and tra-
cheobronchial glands are important in host defense and are
discussed in Chapter 11.

Cells of the Airways The Muscles of Respiration

The respiratory tract (with the exception of the pharynx,
the anterior one-third of the nose, and the area distal to the
terminal bronchioles) is lined by a pseudostratified, ciliated,
columnar epithelium interspersed with mucus-secreting
goblet cells and other secretory cells (Fig. 1.10; also see
Chapter 11). In the distal airways, the columnar epithelium
gives way to a more cuboidal epithelium. The airway epithe-
lial cells are responsible for maintaining a thin, aqueous layer
of fluid adjacent to the cells (periciliary fluid) in which the
cilia can function. The depth of this periciliary fluid is main-
tained by the movement of ions across the epithelium.
Interspersed among the epithelial cells are surface
secretory cells, which are also known as goblet cells.
In general, there is one goblet cell per five to six ciliated
cells. Goblet cells decrease in number between the 5th and
12th lung generation and in normal individuals disap-
pear beyond the 12th tracheobronchial generation. Both
goblet cell number and secretions increase in many dis-
eases including asthma and cystic fibrosis. Secretions also
increase by rapid exocytosis in response to chemical irri-
tation, inflammatory cytokines, and neuronal stimulation.
In the bronchioles, goblet cells are replaced by Clara cells,
another type of secretory cell.
Basal cells are located underneath the columnar epithelium
and are responsible for the pseudostratified appearance of
the epithelial surface. They are absent in the bronchioles and
beyond. Although their function is not clear, they appear to be
the stem cells for the airway epithelium and the goblet cells.
The chest wall encases the lung, and normally the two struc-
tures move together. The lungs do not self-inflate. The force
for lung inflation is supplied by the muscles of respiration,
which are skeletal muscles. Like all skeletal muscles, their force
of contraction increases when they are stretched and decreases
when they are shortened. Thus the force of contraction of the
respiratory muscles increases with increasing lung volume.
Dividing the thoracic cavity from the abdominal cavity is
the diaphragm, the major muscle of respiration (Fig. 1.11).
The diaphragm is a thin, musculotendinous, dome-
shaped sheet of muscle that is inserted into the lower ribs
and separates the thoracic from the abdominal cavity. It is
supplied by the phrenic nerve that arises from the second
cervical vertebra. When it contracts, the abdominal con-
tents are forced downward and forward and the vertical
dimension of the chest cavity is increased. In addition, the
rib margins are lifted and moved out, causing an increase
in the transverse diameter of the thorax. In adults, the
diaphragm is capable of generating airway pressures
of 150 to 200 cm H2O during a maximal inspiratory
effort. During quiet breathing (known as tidal volume
breathing), the diaphragm moves approximately 1 cm,
but during large-volume breathing, the diaphragm can
move as much as 10 cm. If the diaphragm is paralyzed, it
moves higher up in the thoracic cavity during inspiration
because of the fall in intrathoracic pressure. This paradox-
ical movement of the diaphragm can be demonstrated
using the radiographic technique called fluoroscopy.

C C

BB
GC GC

BC BC
CT

Fig. 1.10 Scanning electron micrograph of airway, showing the ciliated, pseudostratified, columnar epithelium of a bronchus. Each cilium
is connected to a basal body (BB), which collectively appears at the base of the cilia (C) as a dark band. Goblet cells (GC) and basal cells
(BC), the potential precursors of the ciliated cells, are shown. CT, connective tissue. (From Berne RM, Levy ML, Koeppen BM, Stanton
BA (eds.). Physiology, 5th ed. St. Louis: Mosby; 2004.)
10 CHAPTER 1 Overview of the Respiratory System: Function and Structure
Diaphragm
Fig. 1.11 The diaphragm. View from the inside of the thorax
illustrates the position of the diaphragm in the thorax. (From
Grippi MS, Elias JA, Fishman JA, et al. Fishman’s Pulmonary
Diseases and Disorders, 5th ed. New York: McGraw-Hill; 2015.)
The other significant muscles of inspiration are the exter-
nal intercostal muscles that pull the ribs upward and forward
during inspiration, causing an increase in both the side-to-
side and front-to-back diameters of the thorax (Fig. 1.12).
Innervation of these muscles originates from intercostal
nerves that originate from the spinal cord at the same level.
Paralysis of these muscles has no significant effect on respira-
tion because of the dominance of the diaphragm as the major
muscle of respiration. Accessory muscles of inspiration (sca-
lene muscles, which elevate the sternocleidomastoid; the alae
nasi, which cause nasal flaring; and small muscles in the neck
and head) are quiet during quiet breathing but contract vigor-
ously during exercise and with significant airway obstruction.
The upper airway must remain patent during inspira-
tion; therefore the pharyngeal wall muscles, the genioglos-
sus, and the arytenoid muscles are also considered muscles
of inspiration.
Exhalation during quiet breathing is passive but
becomes active during exercise and hyperventilation. The
most important muscles of exhalation are those of the
abdominal wall (rectus abdominis, internal and exter-
nal oblique, and transversus abdominis) and the internal
intercostal muscles that oppose the activity of the external
intercostal muscles (i.e., pull the ribs downward and inward).
The Central Nervous System and Neural
Pathways
The central nervous system (CNS), and in particular
the brainstem, functions as the main control center for
respiration (see Chapter 10). Breathing is both voluntary
and automatic. Each breath begins in the brain, where
the signal to breathe is carried to the respiratory muscles
through the spinal cord and the nerves that innervate the
respiratory muscles. It is remarkable that despite widely
varying demands for O2 uptake and CO2 removal, the arte-
rial levels of O2 and CO2 are normally maintained within
tight limits. Regulation of respiration requires three com-
ponents (see Chapter 10):
1. Generation and maintenance of a respiratory rhythm
(respiratory control center)
2. Modulation of the respiratory rhythm by sensory feed-
back loops and reflexes that allow adaptation to various
situations and minimize energy costs
3. Recruitment of respiratory muscles that can contract
appropriately for effective gas exchange.
Unlike the heart, which begins beating at approximately
6 weeks’ gestation, rhythmic respirations do not begin
until birth.
ANATOMIC AND PHYSIOLOGIC CORRELATES
Lung structure is closely correlated with lung function
in health and disease. Because lung disease is described
in anatomic terms (e.g., right middle lobe pneumonia),
knowledge of lung anatomy is essential. The broncho-
pulmonary segment is the region of the lung supplied
by a segmental bronchus. It is the functional anatomic
unit of the lung, so named because disease usually
involves one segment at a time and because surgical
resection follows along segments. When using a stetho-
scope (auscultation), all of the bronchopulmonary seg-
ments can be examined with one exception, namely the
hilar segments of the lower lobes (Fig. 1.13). The hilum
is the area of the lung where the main-stem bronchi
and pulmonary arteries and veins enter and leave the
right and left lung. These segments have no topographic
relationship to the chest.
The various lobes of the lung (three on the right and
two on the left) are subdivided by fissures. The division
into the lobes, however, is incomplete, which allows for
collateral ventilation. Collateral ventilation is an acces-
sory pathway that connects airspaces supplied by other
airways. There are two types of accessory pathways in
the lung: (1) canals of Lambert, which connect respira-
tory bronchioles and terminal bronchioles to airspaces
supplied by other airways; and (2) pores of Kohn, which
are openings in the alveolar walls that connect adjacent
alveoli. These accessory pathways help prevent collapse
of terminal respiratory units (atelectasis) when their
supplying airway becomes obstructed and are particu-
larly important in individuals with lung diseases such as
emphysema.
CHAPTER 1 Overview of the Respiratory System: Function and Structure 11

MUSCLES OF RESPIRATION

Muscles Muscles
of inspiration of expiration

Accessory Quiet
breathing
Sterno-
cleidomastoid Expiration
(elevates results
sternum) from
passive
Scalenes recoil
Anterior of lungs
Middle and rib
Posterior
cage
(elevate
and fix
upper ribs)

Principal Active
breathing
External
Internal
intercostals intercostals,
(elevate ribs, except
thus interchondral
increasing part
width of
Abdominals
thoracic
(depress
cavity)
lower ribs,
Interchondral compress
part of abdominal
internal contents,
intercostals thus pushing
(also elevates up diaphragm)
ribs) Rectus
Diaphragm abdominis
(domes External
descend, oblique
thus
increasing Internal
vertical oblique
dimension Transversus
of thoracic abdominis
cavity;
also elevates
lower ribs)
Fig. 1.12 Muscles of respiration. Diagram of the anatomy of the major respiratory muscles. Left side, inspi-
ratory muscles; right side, expiratory muscles. (Kaminsky D. The Netter Collection of Medical Illustrations:
Respiratory System, vol. 3, 2nd ed. Philadelphia: Elsevier; 2011.)
12 CHAPTER 1 Overview of the Respiratory System: Function and Structure

Esophagus
Trachea Apical

1
Apical
1 Aortic Upper
SVC arch lobe
Upper
lobe
Anterior Anterior
3 3

Ho Lingula
r
i z on Superior
Oblique tal f issur e
fissure Lateral 4
Middle Oblique
4 Medial Heart
lobe Inferior fissure
Anterior 5 5 Anterior
basal
8 8 basal

Lower lobe Lower lobe

Right Left

ANTERIOR VIEW

Apical
1
Apical Posterior
Upper 1 Upper
lobe Posterior 2 lobe
2
Superior Superior
6 6

Lateral
Lower basal Anterior Lower
Posterior
lobe 9 8 basal lobe
Posterior basal
Fig. 1.13 Topography of the lung demon- Lateral
basal 10
strating the lobes, segments, and fissures. basal
10
Numbers refer to specific bronchopulmona- 9
ry segments that are also shown in Fig. 1.1.
SVC, superior vena cava. (From Berne RM, Left Right
Levy ML, Koeppen BM, Stanton BA (eds.).
Physiology, 7th ed. St. Louis: Mosby; 2018.) POSTERIOR VIEW

Physiologically, the lung demonstrates functional unity; a different structure and a different function. The signifi-
that is, every alveolar unit has the same structure and the cance of functional unity is that a large portion of the lung
same function as every other alveolar unit. This is in con- can be removed without significantly compromising over-
trast to the heart, in which the various chambers have both all lung function (i.e., gas exchange).
 CHAPTER 1 Overview of the Respiratory System: Function and Structure 13

CLINICAL BOX
Understanding lung topography is useful in both diagnosing and localizing disease. For example, a 2-year-old boy pres-
ents with a 2-day history of fever, cough, and recent onset of tachypnea (an increased respiratory rate). On examination,
there are intercostal muscle retractions and nasal flaring, and the child appears ill. On auscultation, breath sounds are
decreased over the right upper lobe anteriorly.

A chest x-ray reveals opacification (known as consolidation) over the right upper lobe anteriorly consistent with lobar
(specifically right upper lobe) pneumonia.

  S U M M A RY
1. The principal function of the respiratory system is gas
exchange. Other functions include acid–base balance,
host defense and metabolism, and the handling of bio-
active materials.
2. Gas exchange occurs in the alveolar–capillary unit, the
basic physiologic unit of the lung.
3. The bronchopulmonary segment is the segment of the
lung supplied by a segmental bronchus. It is the func-
tional anatomic unit of the lung.
4. The alveolar surface is lined by type I and type II cells.
The thin cytoplasm of the type I cell is ideal for opti-
mal gas diffusion, whereas the type II cell is important
for the production of surfactant, which decreases the
surface tension of the alveolus.
5. The lung has two separate circulations. The pulmo-
nary circulation brings deoxygenated blood from
the right ventricle to the gas-exchanging units. The
bronchial circulation arises from the aorta and nour-
ishes the lung parenchyma.
6. The circulation to the lung is unique in its dual circu-
lation and in its ability to accommodate large volumes
of blood at low pressure.
7. The anatomic dead space is composed of all of the air-
ways that do not participate in gas exchange—that is,
the airways to the level of the respiratory bronchioles.
8. The cells of the conducting airways include the pseu-
dostratified, ciliated, columnar epithelial cells, surface
secretory cells, Clara cells, and submucosal tracheo-
bronchial gland cells.
9. The diaphragm is the major muscle of respiration.
10. Breathing is both voluntary and automatic.
11. The lung demonstrates both anatomic and physiologic
unity—that is, each unit is structurally identical and
functions just like every other unit.
14 CHAPTER 1 Overview of the Respiratory System: Function and Structure

  KE Y W O RD S A ND C O N C E P T S
Alveolar macrophage Interstitium/interstitial space
Alveolar–capillary unit Lower airway
Alveolus Parenchyma
Anatomic dead space Parietal pleura
Atelectasis Partial pressure
Bronchial circulation Periciliary fluid
Bronchiole Pleural effusion
Bronchopulmonary segment Pneumothorax
Bronchus Pores of Kohn
Canals of Lambert Respiratory control center
Chemoreceptor Surface secretory cells (goblet cells)
Clara cell Surfactant
Collateral ventilation Tracheobronchial glands
Diaphragm Turbinates
Emphysema Type I cell
Fissure Type II cell
Functional unity Upper airway
Glottis Visceral pleura
Hilum

  SE L F - ST U D Y P R OB L E MS
1. What anatomic features of the alveolar–capillary unit
make it appropriate to function as the gas-exchanging
unit?
2. How can you distinguish type I cells from type II
cells?
3. If the pulmonary artery that supplies the left lung was
occluded for a short period of time and the cardiac
output remained unchanged (that is, all of the blood
from the right ventricle now goes to the right lung),
what would be the effect on the pressure inside the
right pulmonary artery?
4. What are the components of the blood–gas barrier?
5. What are the anatomic features that make the lung
ideally suited for its principal function?

ADDITIONAL READINGS
Baile EM. The anatomy and physiology of the bronchial circula-
tion. J Aerosol Med. 1996;9:1–6.
Boggs DS, Kinasewitz GT. Review: pathophysiology of the pleu-
ral space. Am J Med. 1995;309:53–59.
Broaddus VC, Mason RJ, JD Ernst, et al., eds. Murray & Nadel’s
Textbook of Respiratory Medicine. 6th ed. Philadelphia: WB
Saunders; 2016.
Fehrenbach H. Alveolar epithelial type II cell: defender of the
alveolus revisited. Respir Res. 2001;2:33–46.
Gandevia SC, Allen GM, Butler J, et al. Human respiratory
muscles: sensations, reflexes and fatigability. Clin Exp Pharm
Physiol. 1998;25:757–763.
Grippi MA, Elias JA, Fishman JA, et al. Fishman’s Pulmonary
Diseases and Disorders. 5th ed. New York: McGraw Hill; 2015.
Hlastala MP, Berger AJ. Physiology of Respiration. 2nd ed. New
York: Oxford University Press; 2001.
Horsfield K, Cumming G. Morphology of the bronchial tree in
man. J Appl Physiol. 1968;24:373–383.
Leff AR. Schumacker PT. Respiratory Physiology: Basics and
Applications. Philadelphia: WB Saunders; 1993.
Lumb AB. Nunn’s Applied Respiratory Physiology. 8th ed.
Philadelphia: Elsevier; 2017.
Massaro D, Massaro GD. Invited review: pulmonary alveoli:
Formation, the “call for oxygen,” and other regulators. Am J
Physiol Lung Cell Mol Physiol. 2002;282:L345–L358.
Nettesheim P, Koo JS, Gray T. Regulation of differentiation
of the tracheobronchial epithelium. J Aerosol Med. 2000;13:
207–218.
Poole DC, Sexton WL, Farkas GA. Diaphragm structure and
function in health and disease. Med Sci Sports Exerc. 1997;
29:738–754.
Rogers DE. Airway goblet cells: Responsive and adaptable front-
line defenders. Eur Respir J. 1994;7:1690–1706.
Weibel ER. The Pathway for Oxygen: Structure and Function of
the Mammalian Respiratory System. Cambridge, MA: Harvard
University Press; 1984.
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 “I know it, I know it,” she answered, in a tone of such sweet
humility, as made Esmond repent that he should ever have
dared to reproach her. “I know how wicked my heart has been;
and I have suffered too, my dear. I confessed to Mr. Atterbury—I
must not tell any more. He—I said I would not write to you or go
to you—and it was better even that, having parted, we should
part. But I knew you would come back—I own that. That is no
one’s fault. And to-day, Henry, in the anthem, when they sang it,
‘When the Lord turned the captivity of Zion, we were like them
that dream,’ I thought yes, like them that dream—them that
dream. And then it went, ‘They that sow in tears shall reap in joy;
and he that goeth forth and weepeth, shall doubtless come again
with rejoicing, bringing his sheaves with him;’ I looked up from
the book and saw you. I was not surprised when I saw you. I
knew you would come, my dear, and saw the gold sunshine
round your head.”
She smiled an almost wild smile as she looked up at him.
The moon was up by this time, glittering keen in the frosty sky.
He could see for the first time now clearly, her sweet careworn
face.
“Do you know what day it is?” she continued. “It is the 29th
of December—it is your birthday! But last year we did not drink it
—no, no. My lord was cold, and my Harry was likely to die: and
my brain was in a fever; and we had no wine. But now—now you
are come again, bringing your sheaves with you, my dear.” She
burst into a wild flood of weeping as she spoke: she laughed and
sobbed on the young man’s heart, crying out wildly, “bringing
your sheaves with you—your sheaves with you!”

So they fare to the lit house, and to the tragedy which is the tragedy
of all womankind; of beauty fading while desire endures, the passion
to be loved persists; most tragic of all when a mother meets in a
daughter her careless conquering rival.

As they came up to the house at Walcote, the windows from

within were lighted up with friendly welcome; the supper-table
was spread in the oak parlour; it seemed as if forgiveness and
love were awaiting the returning prodigal. Two or three familiar
faces of domestics were on the look-out at the porch—the old
housekeeper was there, and young Lockwood from Castlewood,
in my lord’s livery of tawny and blue. His dear mistress pressed
his arm as they passed into the hall. Her eyes beamed out on
him with affection indescribable. “Welcome,” was all she said, as
she looked up, putting back her fair curls and black hood. A
sweet rosy smile blushed on her face; Harry thought he had
never seen her look so charming. Her face was lighted with a joy
that was brighter than beauty—she took a hand of her son, who
was in the hall waiting his mother—she did not quit Esmond’s
arm.
“Welcome, Harry!” my young lord echoed after her. “Here we
are all come to say so. Here’s old Pincot: hasn’t she grown
handsome?” and Pincot, who was older, and no handsomer than
usual, made a curtsey to the Captain, as she called Esmond,
and told my lord to “Have done, now.”
“And here’s Jack Lockwood. He’ll make a famous grenadier,
Jack; and so shall I; we’ll both ’list under you, Cousin. As soon
as I am seventeen, I go to the army—every gentleman goes to
the army. Look! who comes here—ho, ho!” he burst into a laugh.
“’Tis Mistress Trix, with a new ribbon; I knew she would put one
on as soon as she heard a captain was coming to supper.”
This laughing colloquy took place in the hall of Walcote
House, in the midst of which is a staircase that leads from an
open gallery, where are the doors of the sleeping chambers: and
from one of these, a wax candle in her hand, and illuminating
her, came Mistress Beatrix—the light falling indeed upon the
scarlet ribbon which she wore, and upon the most brilliant white
neck in the world.
Esmond had left a child and found a woman, grown beyond
the common height, and arrived at such a dazzling
completeness of beauty, that his eyes might well show surprise
and delight at beholding her. In hers there was a brightness so
lustrous and melting, that I have seen a whole assembly follow
her as if by an attraction irresistible: and that night the great
Duke was at the playhouse after Ramillies, every soul turned
and looked (she chanced to enter at the opposite side of the
theatre at the same moment) at her, and not at him. She was a
brown beauty: that is, her eyes, hair and eyebrows and eye-
lashes were dark: her hair curling with rich undulations, and
waving over her shoulders; but her complexion was as dazzling
white as snow in sunshine; except her cheeks, which were a
bright red, and her lips, which were of a still deeper crimson. Her
mouth and chin, they said, were too large and full, and so they
might be for a goddess in marble, but not for a woman whose
eyes were fire, whose look was love, whose voice was the
sweetest low song, whose shape was perfect symmetry, health,
decision, activity, whose foot as it planted itself on the ground
was firm but flexible, and whose motion, whether rapid or slow,
was always perfect grace—agile as a nymph, lofty as a queen—
now melting, now imperious, now sarcastic—there was no single
movement of hers but was beautiful. As he thinks of her, he who
writes feels young again, and remembers a paragon.
So she came holding her dress with one fair rounded arm,
and her taper before her, tripping down the stair to greet
Esmond.
“She hath put on her scarlet stockings and white shoes,”
says my lord, still laughing. “Oh, my fine mistress! is this the way
you set your cap at the Captain?” She approached, shining
smiles upon Esmond, who could look at nothing but her eyes.
She advanced holding forward her head, as if she would have
him kiss her as he used to do when she was a child.
“Stop,” she said, “I am grown too big! Welcome, Cousin
Harry,” and she made him an arch curtsey, sweeping down to
the ground almost, with the most gracious bend, looking up the
while with the brightest eyes and sweetest smile. Love seemed
to radiate from her. Harry eyed her with such a rapture as the
first lover is described as having by Milton.
 “N’est-ce pas?” says my lady, in a low, sweet voice, still
hanging on his arm.
Esmond turned round with a start and a blush, as he met his
mistress’s clear eyes. He had forgotten her, rapt in admiration of
the filia pulcrior.

I have said some hard things, Gentlemen, upon Thackeray and

have indicated some dislike of him here and there, or, at least, some
impatience. But to the man who could at once so poignantly and so
reticently bring those two scenes into contrast—with all its meaning
—all meaning—modulated to so perfect a balance of heart and
intelligence wedded in human speech—well, to that man I conclude
by bowing the head, acknowledging a real master: a great
melancholy man with his genius running in streaks, often in thin
streaks about him but always, when uttered, uttered in liquid lovely
prose.
 THE VICTORIAN BACKGROUND

I
I INTEND, in this and two following lectures, Gentlemen, taking my
illustrations in the main from Victorian times, to examine with you
how one and the same social question, urgent in our politics,
presented itself to several writers of imaginative genius, all of whom
found something intolerable in England and sought in their several
ways to amend it.
At the beginning of this enquiry let me disclaim any parti pris
about the duty of an imaginative writer towards the politics of his
age. Aristophanes has a political sense, Virgil a strong one even
when imitating Theocritus; Theocritus none: yet both are delightful:
Lucretius has no care for politics, Horace has any amount, and both
are delightful again: the evils of his time which oppress the author of
Piers Plowman, affect Chaucer not at all: Dante is intensely political,
Petrarch, far less sublime as a poet, disdains the business; Villon is
for life as it flies, Ronsard for verse and art (and the devil take the
rest); Spenser, with a sore enough political experience, casts it off
almost as absolutely as does Ariosto. Shakespeare has a strong
patriotic sense and a manly political sense: but he treats politics—let
us take King John and Coriolanus for examples—artistically, for their
dramatic value. He knows about
The oppressor’s wrong, the proud man’s contumely
and that they can be unendurable: but he does not use them for
propaganda (odious word!) whatever the minute of utterance. Milton
put all his religion into verse, his politics into prose; save for a
passage or two in Lycidas and Paradise Lost he excluded politics
from his high poetry. On the other hand Dryden had a high poetic
sense of politics, and it pervades the bulk of his original poetry, while
the opening of his famous Essay of Dramatic Poesy strikes an
introductory note as sure as Virgil’s, through whom a deep
undercurrent of politics runs from the first page of the Eclogues to
the last of the Æneid. Our poets of the eighteenth century were
social and political in the main: since if you once take Man for your
theme, you, or some one following you, must be drawn on irresistibly
to compare the position you assign him in the scheme of things with
his actual position in the body politic, to consider the “Rights of Man,”
“man’s inhumanity to man” and so forth. An Essay on Man (with the
philosophy Pope borrowed for it) leads on to The Deserted Village:

Ill fares the land, to hast’ning ills a prey,

Where wealth accumulates and men decay

—to Crabbe’s Poor House, Hall of Justice, Prison; to Blake’s lyrical

laments over small chimney-sweeps, blackamoors, foundlings and
all that are young and desolate and oppressed, and the vow to
sweep away “these dark Satanic mills” (of which I shall have more to
say by and by) “and build Jerusalem in England’s green and
pleasant land.” Turn now to Keats and you are returned upon mere
poetry, in the Latin sense of mere. Keats has no politics, no
philosophy of statecraft, little social feeling: he is a young apostle of
poetry for poetry’s sake.

Beauty is truth, truth beauty,—that is all

Ye know on earth, and all ye need to know.

But of course, to put it solidly, that is a vague observation—to

anyone whom life has taught to face facts and define his terms,
actually an uneducated conclusion, albeit most pardonable in one so
young and ardent. Let us, for a better, go on to the last and grandest
word of his last, unfinished, poem:
 “High Prophetess,” said I, “purge off
Benign, if so it please thee, my mind’s film.”
“None can usurp this height,” returned the Shade,
“But those to whom the miseries of this world
Are misery, and will not let them rest.”

Such a spirit, preëminently, was Shelley; of whom, when the last

word of disparagement has been said, or the undeniable truth, put
into a phrase by Mr. Max Beerbohm, “a crystal crank,” the equally
undeniable fact remains that Shelley suffered tortures over the woes
of his fellow-creatures, while Byron (for a contrast) cares scarcely at
all for the general woe surrounding him, everything for his own
affliction in a world which had paid him tribute far above the earnings
of common men, and yet not only (as Shelley does) casts the blame
on tyrants and governments, but the cure for his egoistical troubles
on political machinery, revolutions. I go on, taking names and
illustrations almost at random. Contrast any Radical utterance of
Tennyson’s—his Lady Clara Vere de Vere, for example—with poor
Thomas Hood’s Song of the Shirt. Why, it fades away: Hood’s
passionate charity simply withers up the other’s personal self-
assertive inverted snobbery. If you have stuff in you, contrast the
note of

With fingers weary and worn,

With eyelids heavy and red,
A woman sat, in unwomanly rags,
Plying her needle and thread

with the whine of Lady Clara Vere de Vere—

The grand old gardener and his wife

Laugh at the claims of long descent
—which is just

When Adam delved, and Eve span,

Who was then the gentleman?

—on the pianola. Observe, pray, that I am not comparing the poetic
gift, in which (as in other gifts of the gods) Tennyson very greatly
outweighted Hood. I am merely setting some poets against others
and contrasting the degrees in which they exhibit social or political
sensitiveness. We should all allow, probably, that Robert Browning
was a greater poet and a stronger thinker than his wife: but probably
deny to him the acute indignation against human misery, social
wrong, political injustice, evinced by the authoress of The Cry of the
Children or Casa Guidi Windows. Of the two friends, Matthew Arnold
and Arthur Hugh Clough, we should as probably admit Arnold to be
the better poet as Clough to be the less occupied with his own soul,
the more in vain attempt to save other men. So again among the
Pre-Raphaelites Swinburne raves magnificently for the blood of
tyrants: but when it came to lifting the oppressed, to throwing himself
into the job, what a puff-ball was he beside William Morris who had
announced himself as no more than “the idle singer of an empty
day”!

One fishes in the night of deep sea pools:

For him the nets hang long and low,
Cork buoyed and strong: the silver gleaming schools
Come with the ebb and flow
Of universal tides, and all the channels glow.

Or holding with his hand the weighted line

He sounds the languors of the neaps,
Or feels what current of the springing brine
The cord divergent sweeps,
The throb of what great heart bestirs the middle deeps.
 Thou also weavest meshes, fine and thin,
And leaguer’st all the forest ways:
But of that sea, and the great heart therein
Thou knowest nought: whole days
Thou toil’st, and hast thy end—good store of pies and jays.

II
So far we have spoken of poets—fairly selected, I trust—and
have found that there are poets and poets; and some are Olympian
in attitude, looking down deep below the surface from a great height
as a gannet spies his fish; but high aloof, concerned rather with
universal themes than with the woman of Canaan clamorous in the
street crying for her daughter, “Truth, Lord: yet the dogs eat of the
crumbs which fall from their masters’ table.”
Now if we turn to our novelists, from Defoe to Scott, we find that
the novel from its first virtual beginning in our country and for a
century or more, has for social diseases in the body politic little
concern and practically no sense at all. Defoe has strong political
sense, but keeps it for his tracts and pamphlets: in Robinson Crusoe
(and specially in the third volume, The Serious Reflections of
Robinson Crusoe), in Moll Flanders, in Roxana, he is always a
moralist, but a religious moralist. If—to twist a line of Hamlet—there’s
something rotten in the state of Denmark, it does not come within the
scope of the novelist whose office is to combine amusement with
general edification. So—leaving out the edification—it is in Tristram
Shandy, so in The Vicar of Wakefield. Richardson is all for the
human heart as he reads it, and female virtue. Fielding with his
genial manly morality—Fielding, magistrate of a London Police
Court, and a humane one—discloses little sense in his novels of any
vera causa in our system supplying the unfortunates for whom, in
daily life, he tempers justice with mercy. You will not, I think, cite
Jonathan Wild against me. Noble fellow, as he drops down the
Thames—stricken to death, and knowing it—on that hopeless
voyage to Lisbon, his thoughts are hopeful for England and the glory
of her merchant shipping: and (says he) it must be our own fault if it
doth not continue glorious:

for continue so it will, as long as the flourishing state of our trade

shall support it, and this support it can never want, till our
legislators, shall cease to give sufficient attention to the
protection of our trade, and our magistrates want sufficient
power, ability, and honesty to execute the laws: a circumstance
not to be apprehended, as it cannot happen till our senates and
our benches shall be filled with the blindest ignorance, or with
the blackest corruption.

Smollett’s recipe for a novel is just a rattling picaresque story

enlivened by jocular horse-play. Respect Fanny Burney and idolise
Jane Austen as we will, they move their plots on a narrow and
sheltered stage: while the romantics, working up from Horace
Walpole to Scott, call in the past to redress the poverty of the present
and the emptiness of a general theory of the arts which, deservedly
sovereign in its day, has passed by imitation into convention, and
through convention, as always, into mere inanition.

III
Now if you will take, as a convenient starting-point for your
enquiry, the year 1832—the year that saw the passing of the Great
Reform Bill and the death of Scott: if you will start (I say) with that
year beyond which, when I first made acquaintance, with the English
School here, our curiosity was forbidden to trespass—you will find
that then, or about then, certain terrible diseases in our
Commonwealth were brewing up to a head. As everyone now
recognises, we must seek the operating cause of these in what we
now agree to call the “Industrial Revolution”; that is in the process as
yet unrestricted by law, encouraged by economic theory, moving at
once too fast for the national conscience to overtake or even to
realise it and with a step of doom as rigidly inexorable as the
machinery, its agent and its symbol, converting England into a
manufacturing country, planting the Manchester of those days and
many Manchesters over England’s green and pleasant land, and
leaving them untended to grow as they pleased polluting her
streams, blackening her fields, and covering—here lies the
indictment—with a pall of smoke, infinite human misery: all this
controlled and elaborated by cotton-lords and mine-owners who
prospered on that misery.
The plight of rural, agricultural, England is another story. Here in
Lancashire, Derbyshire, Yorkshire was a monstrous revolution
gathering strength (as I say) beyond men’s power even to realise it.
And if they realised it, there was Political Economy assuring them
that it had to be. And it continued (as you will remember) long after
poor Wragg strangled and left her illegitimate infant on the dismal
Mapperly hills and the egregious Mr. Roebuck asked, if, the world
over or in past history, there was anything like it. “Nothing. I pray that
our unrivalled happiness may last.”
We all recognise it now, and the wicked folly of it—or at least I
hope we do. My purpose to-day, Gentlemen, is not to excite vain
emotions over a past which neither you nor I can remedy at all, but
simply to show that—as, after all, we are a kindly nation—the
spectacle of industrial England about and after 1832 became
intolerable to our grandfathers: how it operated upon two
extraordinarily different minds: and (if I can) how irresistible is the
wind of literature, through what mouthpiece soever it breathes with
conviction.

IV
But before examining how two of the most dissimilar minds
conceivable—one a man’s, the other a woman’s—reacted upon it, I
must indicate the enormity of the challenge.
France had passed through her Revolution and her Terror, with
graphic details of which our public speakers and writers had taken
pains to make our country familiar enough: and England had won out
of the struggle, having taken the side she chose, all oblivious (as we
are, maybe, to-day) that victory in arms is at best but the beginning
of true victory, and that she herself was in the throes of a revolution
not a whit the less murderous than that of France, and only less
clamant because its victims, instead of aristocrats and politicians and
eminent saviours of their country following one another by scores in
tumbrils to die scenically in the Place de la République, the Place of
the Guillotine, were serfs of the cotton-mill and the mine, wives,
small children, starved unscenically, withered up in foetid cellars or
done to death beside the machines of such a hell-upon-earth as
Manchester had grown to be out of towns in which an artificer,
however humble, had once been permitted to rejoice in that which
alone, beyond his hearth and family, heartens a man—the well-
executed work of hand and brain. The capitalists of that time simply
overwhelmed these towns, expanding, converting them into barracks
for workers. Who these workers were, let an advertisement in a
Macclesfield paper of 1825 attest—

To the Overseers of the Poor and to families desirous of

settling in Macclesfield. Wanted between 4,000 and 5,000
persons between the ages of 7 and 21 years.

Yes, let us pass the hideous towns with but one quotation, from
Nassau Senior—

As I passed through the dwellings of the mill-hands in Irish

Town, Ancoats and Little Ireland, I was only amazed that it was
possible to maintain a reasonable state of health in such homes.
The towns, for in extent and number of inhabitants they are
towns, have been erected with the utmost disregard of
everything except the immediate advantage of the speculative
builder.... In one place we found a whole street following the
 course of a ditch, because in this way deeper cellars could be
secured without the cost of digging, cellars not for storing wares
or rubbish, but for dwellings of human beings. Not one house in
the street escaped the cholera.

“Such,” wrote Chadwick, that careful observer, “is the absence of

civic economy in some of our towns that their condition in respect of
cleanliness is almost as bad as that of an encamped horde or an
undisciplined soldiery.”
But from the poor men and women—who had sold themselves
into these slums and industrial slavery—let us turn to their hapless
children, who, after all, had never asked to be born. Your Malthus in
that age, and your Mr. Harold Cox in this, are positive (God forgive
them!) that a number of these brats never ought to be born. (I don’t
know the price of millstones, but they ought to be cheap and handy,
and properly labelled.) I shall lay stress on these children,
Gentlemen, because—as children do so often—they brought back
the gospel—or something of it. For these weaklings, as they were
the foundation of the manufacturer’s wealth, by their illimitable woe
enabling him to cut his wages, in the end brought about his
exposure. To us—for always to us in our day the past wears a haze
softening it into sentiment—Elizabeth Barrett Browning’s Cry of the
Children is nothing, or suspected as sentimental, to be classed
alongside with anything (say) by Mrs. Hemans or L. E. L. Listen to a
couple of stanzas or three—

“For oh,” say the children, “we are weary,

And we cannot run or leap;
If we cared for any meadows, it were merely
To drop down in them and sleep.
Our knees tremble sorely in the stooping,
We fall upon our faces, trying to go;
And underneath our heavy eyelids drooping
The reddest flower would look pale as snow.
For, all day, we drag our burden tiring
Through the coal-dark, underground;
Or, all day, we drive the wheels of iron
In the factories, round and round.

For all day the wheels are droning, turning;

Their wind comes in our faces,
Till our hearts turn, our head with pulses burning,
And the walls turn in their places:
Turns the sky in the high window, blank and reeling,
Turns the long light that drops adown the wall,
Turn the black flies that crawl along the ceiling:
All are turning, all the day, and we with all.
And all day the iron wheels are droning,
And sometimes we could pray,
‘O ye wheels’ (breaking out in a mad moaning),
‘Stop! be silent for to-day!’”

And well may the children weep before you!

They are weary ere they run;
They have never seen the sunshine, nor the glory
Which is brighter than the sun.
They know the grief of man, without its wisdom;
They sink in man’s despair, without its calm;
As slaves, without the liberty in Christdom,
As martyrs, by the pang without the palm....

Let them weep! let them weep!

 They look up with their pale and sunken faces,
And their look is dread to see,
For they mind you of their angels in high places,
With eyes turned on Deity.
“How long,” they say, “how long, O cruel nation,
Will you stand, to move the world, on a child’s heart,—
Stifle down with a mail’d heel its palpitation,
And tread onward to your throne amid the mart?
Our blood splashes upward, O gold-heaper,
And your purple shows your path!”
But the child’s sob in the silence curses deeper
Than the strong man in his wrath.

V
Now, I dare say some of you, even while I read this, were
dismissing it in your minds as early-Victorian humanitarianism, faded
philanthropy, outworn sentiment. Yes, but even a sentiment, if it
works simultaneously upon a generation of great and very dissimilar
writers, is a fact in the story of our literature—a phenomenon, at
least, which made itself an event—to be studied by you scientifically.
One of the first rules of good criticism, and the sheet-anchor of the
historical method, is to put yourself (as near as may be) in the other
fellow’s place: and if you take but a very little pains to do so, you will
soon discover that Mrs. Browning was not writing “for the fun of the
thing,” exuding, or causing to be exuded, any cheap tears. We are
accustomed to Manchester to-day: we take it for granted as a great
community with a most honourable Press to represent its opinions.
But we only take it for granted because it has become tolerable, and
it only became tolerable, then dignified—it only became a city—
because our Victorian writers shamed its manufacturers out of their
villainies. In the twenties, thirties, and “hungry forties” of the last
century Manchester was merely a portent, and a hideous portent, the
growth of which at once fascinated our economists and frightened
our rulers. Think of the fisherman in the Arabian Nights who,
unstopping the bottle brought ashore in his net, beheld a column of
smoke escape and soar and spread, and anon and aloft, overlooking
it, the awful visage of a Genie. Even so our economists watched an
enormous smoke ascend from Manchester and said, “Here is
undreamed-of national prosperity”; while our ministers stared up into
the evil face of a monster they had no precedent to control. You
understand, of course, that I use “Manchester” as a symbolic name,
covering a Lancashire population which grew in the first twenty years
of the century from 672,000 to 1,052,000. But let a very different
person from Mrs. Browning—let Benjamin Disraeli, then a young
man, describe the portent.

From early morn to the late twilight our Coningsby for

several days devoted himself to the comprehension of
Manchester. It was to him a new world, pregnant with new trains
of thought and feeling. In this unprecedented partnership
between capital and science—

Mark you, not between capital and labour, but between capital and
science, still by machinery arming capital to vaster strength—

In this unprecedented partnership between capital and science,

working on a spot which Nature had indicated as the fitting
theatre for their exploits, he beheld a great source of the wealth
of nations which had been reserved for these times, and he
perceived that this wealth was rapidly developing classes whose
power was imperfectly recognised in the constitutional scheme,
and whose duties to the social system seemed altogether
omitted

—“and whose duties to the social system seemed altogether

omitted.” There, in Disraeli’s words, you have it. Every prolonged war
raises a new governing class of prosperous profiteers who turn their
country’s necessity to glorious gain. So it was a hundred years ago
at the conclusion of the long Napoleonic struggle: so it is to-day. So it
goes on ever. A profiteering class of speculators and (as Cobbett
would say) “loan-mongers” emerges at the top of any great war. Ex-
soldiers tramp the roads for work, for bread. Decent folk, bred in the
incurable belief that England, whoever suffers, must pay her debts,
sell out and suffer, breaking up old homes, cutting neighbourly ties,
disappearing, taxed out of endurance, electing to suffer, for honour’s
sake. Succeeds a generation or two which, at school or University,
are baptised into the old honourable cult. The gravity of an
Englishman, because they are English after all, revives and takes
possession of young hearts, made generous by education, forgetful
of old woes. And so in time—give it a couple of generations—the
descendants of the sponge and the parvenu will have shed the hair
from the hoof, will leap to the summons of noblesse oblige, and in
their turn make haste to die by Ypres or the Somme, transmitting
somehow the mettle of England into a future denied to them.

VI
But you will say that, although this revolt in the better minds of
England, a hundred years ago, may be a fact, I have as yet quoted
but the evidence of a poetess and a novelist. Very well, then: I go to
Blue Books and the reports of several commissions, reminding you
that I lay most stress on the children because it happened through
their almost inconceivable sufferings that, such as it was, victory
came.
In 1831 Michael Sadler (a great man, in spite of Macaulay, and
the ancestor of a great one—if I may insert this word of long
admiration for the first senior man who spoke to me at my first
undergraduate dinner in Hall, more than forty years ago)—in 1831
this Michael Sadler, member for Newark, introduced a Ten Hours Bill,
and moved its second reading in a speech that roundly exposed,
along with other woes of the poor, the sacrifice of child life in the
mills. The Bill was allowed a second reading on condition that the
whole subject should be referred to a Select Committee, over which
Sadler presided.
Now let me quote a page from Mr. and Mrs. Hammond’s recently
published study of Lord Shaftesbury, then Lord Ashley, who, though
so many have laughed at him, devoted his life that they should laugh
if they chose, but willy-nilly on the right side of their mouths, and not
with a grin unacceptable to any Divinity presumed as having created
Man in His image—

The Report of Sadler’s Committee is a classical document; it

is one of the main sources of our knowledge of the conditions of
factory life at the time. Its pages bring before the reader in the
vivid form of dialogue the kind of life that was led by the victims
of the new system. Men and women who were old at twenty,
from all the industrial districts, from Manchester, from Glasgow,
from Huddersfield, from Dundee, from Bradford, from Leeds,
passed before their rulers with their tale of weariness, misery,
and diseased and twisted limbs. A worsted spinner of
Huddersfield, Joseph Hebergram, aged seventeen, described
his day’s work at the age of seven. His hours were from five in
the morning to eight at night, with one solitary break of thirty
minutes at noon. All other meals had to be taken in snatches,
without any interruption of work. “Did you not become very
drowsy and sleepy towards the end of the day and feel much
fatigued?” “Yes; that began about three o’clock; and grew worse
and worse, and it came to be very bad towards six and seven.”
“What means were taken to keep you at your work so long?”
“There were three overlookers; there was one a head
overlooker, and there was one man kept to grease the
machines, and there was one kept on purpose to strap.” His
brother, who worked in the same mill, died at sixteen from spinal
affection, due to his work, and he himself began to grow
deformed after six months of it. “How far do you live from the
mill?” “A good mile.” “Was it very painful for you to move?” “Yes,
in the morning I could scarcely walk, and my brother and sister
used, out of kindness, to take me under each arm, and run with
 me to the mill, and my legs dragged on the ground; in
consequence of the pain I could not walk.” Another witness, an
overseer in a flax spinning mill at Dundee, said that there were
nine workers in the room under his charge who had begun work
before they were nine years old, and that six of them were splay-
footed and the other three deformed in other ways. A tailor at
Stanningley, Samuel Coulson, who had three daughters in the
mill, described the life of his household when the mill was busy.
In the ordinary time the hours were from six in the morning to
half-past eight at night; in the brisk time, for six weeks in the
year, these girls, the youngest of them “going eight,” worked
from three in the morning to ten or half-past ten at night. “What
was the length of time they could be in bed during those long
hours?” “It was near eleven o’clock before we could get them
into bed after getting a little victuals, and then at morning my
mistress used to stop up all night, for fear that we could not get
them ready for the time; sometimes we have gone to bed and
one of us generally awoke.” “Were the children excessively
fatigued by this labour?” “Many times; we have cried often when
we have given them the little victualling we had to give them; we
had to shake them, and they have fallen asleep with the victuals
in their mouths many a time.”
Another witness, Gillett Sharpe, described how his boy, who
had been very active and a good runner, gradually lost the use
of his limbs at the mill. “I had three steps up into my house, and I
have seen that boy get hold of the sides of the door to assist his
getting up into the house; many a one advised me to take him
away; they said he would be ruined and made quite a cripple;
but I was a poor man, and could not afford to take him away,
having a large family, six children under my care.”

—and so on, and so on. Sadler forced the horrible tale upon
Parliament. Unhappily, being pitted against Macaulay at Leeds in the
General Election of 1832, he lost his seat, though Manchester sent
an appeal signed by 40,000 factory-workers: and he never returned
to the House of Commons. He died in 1835 at fifty-five, worn out by
his work on behalf of these poor children.

VII
His mantle descended to Lord Ashley: and Ashley, after bitter
defeats, won on the mine-children what had been lost in the cotton-
mills. For the mines took an even more hideous toll of childhood than
did the mills. Listen to this, extracted from the Report of the
Commission of 1840–1842, which shocked all England by its
disclosures—

In every district except North Staffordshire, where the

younger children were needed in the Potteries, the employment
of children of seven was common, in many pits children were
employed at six, in some at five, and in one case a child of three
was found to be employed. Even babies were sometimes taken
down into the pits to keep the rats from their fathers’ food. The
youngest children were employed as trappers; that is, they were
in charge of the doors in the galleries, on the opening and
closing of which the safety of the mine depended. For the
ventilation of the mine was contrived on a simple principle; there
were two shafts, one the downcast, the other the upcast. A fire
was lighted at the foot of the upcast to drive the air up the shaft,
and air was sucked down through the downcast to fill the
vacuum. This air was conducted by means of a series of doors
through all the workings of the mine on its passage to the
upcast, and these doors were in the charge of a little boy or girl,
who sat in a small hole, with a string in his or her hand, in
darkness and solitude for twelve hours or longer at a time.
“Although this employment,” reported the Commission, “scarcely
deserves the name of labour, yet as the children engaged in it
are commonly excluded from light, and are always without
companions, it would, were it not for the passing and re-passing