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The Genesis and Functional Implications of Collateral Circulation *

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THE GENESIS AND FUNCTIONAL IMPLICATIONS OF COLLATERAL CIRCULATION OF THE LUNGS* AVERILL A. LIEBOW, MILTON R. HALES, WILLIAM HARRISON, WILLIAM BLOOMER, AND GUSTAF E. LINDSKOG Foreword Those with the good fortune to be directly under the spell of M. C. W. will not soon forget how frequently and ringingly he uses the word "opportunity." He has become a master at providing opportunity, in his own Department and School, and now in a larger sphere. A few years ago, with the help of the Office of Naval Research, he provided the idea and the means for a collaborative study of pulmonary disease. In encouraging the collaboration of surgeons and pathologists he was striking another blow at departmental barriers that he had always regarded as an impediment to investigation. This progress report covers one phase of the joint effort. Herein, we shall heed the admonition "Respice; Adspice; Prospice." Let us be forgiven if, in the last, we may gaze into the realm of conjecture, rather than upon work accomplished. But, that we not offend him whom we seek to honor, speculation shall be kept separate from fact. In his Harvey Lecture of 1936, de Burgh Daly' stated: "Concerning tlle significance of the bronchial-arterial system in health and disease, we are still largely in the dark, but that this may be a fruitful field for investigation is unquestionable." Recent observations in several laboratories have to a degree, confirmed his prophecy; still, much darkness remains to be dispelled. It was known to Galen that the lungs had a double blood supply, but Luschka's'2 concept of the vasa publica and vasa privata had to await Har- vey's elucidation of the course of the circulation. To William Snow Miller""'l' is owed much of our knowledge of the vasculature of the lung. A single pulmonary artery slavishly follows and is joined by fascia to each branch of the bronchial tree, but yields it no branches until the first alveoli appear in the walls of the respiratory bronchioles; the pulmonary veins, on the contrary, are

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