The quantitative anatomy of the bronchi has been studied in sudden deaths in normal subjects, in deaths from status asthmaticus and chronic bronchitis, and in patients with emphysema. In the normal bronchi the observed range of values for the percentage volume of mucous glands was between 7 6 and 16 7. In the status asthmaticus group the mucous gland volume was greatly increased and in no case was there an overlap with the normal subjects. In a previous paper (Dunnill, 1960) the pathological anatomy of the bronchi in asthma was described with special reference to the mucosal changes. The outstanding feature at necropsy was the presence of numerous plugs of mucus in the airways. Histologically, shedding of the ciliated bronchial mucosa cells was prominent, and this was attributed to a transudation of oedema fluid from the submucosa. The loss of the ciliated epithelium, together with interference with the action of the remaining ciliated cells by the oedema fluid, were considered to be the essential factors in the failure of clearance of the bronchial secretions in asthma. The finding of smooth muscle hypertrophy emphasized by Huber and Koessler (1922) was also noted. The present paper is concerned with the quantitative differences in the bronchial wall between normal subjects and those with status asthmaticus, chronic bronchitis, and emphysema. MATERIALS AND METHODSThe bronchi were divided into four groups, and were from (1) normal individuals who had died suddenly, usually a traumatic death, with no previous history of chronic bronchitis; (2) patients who had died in status asthmaticus; (3) patients who had died with a history of chronic airways obstruction with expectoration and who, on pathological examination of their inflated lungs, were found not to have any destructive emphysema-chronic bronchiti^s; (4) patients who had died with chronic airways obstruction and were found at necropsy to have one of the varieties of destructive emphysema.The majority of the lungs were fixed by the formalin steam method of Weibel and Vidone (0961). but in the status asthmaticus lungs, due to the dense bronchial exudate, this was often not possible. and the lungs were fixed by perfusion of the vessels wvith 10% formol saline.Transverse histological sections, 5/1 thick, were taken at three different levels from each bronchus selected (vide infra). Points of bifurcation were avoided. The sections were stained by the Masson trichrome and periodic acid Schiff tethniques, as well as by haematoxylin and eosin. Sections. viewed with a Leitz Ortholux microscope fitted with a x4 objective and a projection mirror, were projected on to a piece of Bristol board with a point-counting grid drawn on it, the points being placed at the angles of equilateral triangles of side 0-6 cm. The details and rationale of the point-counting procedure have been described in previous papers (Dunnill, 1962;Anderson and Dunnill, 1964). Points falling on the bronchial wall were allocated to cartilage, muscle, mucous gland or 'connective tissue'. The latte...

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[WITH SPECIAL PLATE BETWEEN PAGES 466 AND 467] Brit. med. J., 1968, 2, 466-468 In a recent survey of Crohn's disease undertaken at the Radcliffe Infirmary three cases were encountered in which both carcinoma of the colon and Crohn's disease were present. As it is generally held that there is no association between these two diseases it seems important to report these cases and to discuss the possibility that a genuine association exists. Investigations.-Haemoglobin 7.2 g./100 ml. Blood filmmarked iron-deficiency changes. Stools-repeatedly positive for occult blood, negative for pathogens, no acid-fast bacilli on culture. Barium enema showed an irregular filling defect of the caecum, together with narrowing of a short segment of the pelvic colon.At operation in November 1949 the appearances were those of a malignant lesion of the caecum, to which the sigmoid colon and coils of terminal ileum were adherent. A right hemicolectomy, ileal resection, and sigmoid resection was carried out, with end-toend anastomosis of the left colon, and end-to-side ileotransverse colostomy.The caecum contained a large soft carcinoma which had partially infiltrated the caecal wall. There were adhesions between caecum and overlying loops of ileum. Histologically the tumour was a moderately differentiated papillary adenocarcinoma. Microscopically, some adhesions were inflammatory in nature and others were neoplastic. A mixed inflammatory infiltrate within the caecum extended well beyond the limits of the tumour, and within this infiltrate were granulomatous foci containing giant cells. There were marked submucosal fibrous thickening and fibrous infiltration of pericolic fat, and fissures were present. Within the ileum there was again pronounced subserosal and submucosal fibrous thickening, and the submucosa contained patchy mixed inflammatory infiltrate, including moderate numbers of giant cells. Enlarged mesenteric lymph nodes showed marked reactive hyperplasia but no evidence of malignancy. In summary the changes were typical of Crohn's disease involving the caecum and ileum.After the operation the patient developed a faecal fistula from the sigmoid resection site, but this eventually closed and she was discharged home three months after admission. She was readmitted four months later because the fistula had recurred. This was excised and the defect in the colon closed. She remained well for seven years.She was admitted again in 1957 and an intraperitoneal abscess adjacent to the ileocolic anastomosis was drained. Numerous adhesions were divided at the time. She had persistent diarrhoea after this operation and was readmitted a few months later with a fistula-in-ano, a fissure-in-ano, and an ischiorectal abscess. These were dealt with surgically and she was discharged considerably improved.She was next admitted in November 1958 with a small-intestinal obstruction. Laparotomy revealed a mass at the site of the ileocolic