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Murray & Nadel’s
Textbook of
Respiratory Medicine
SEVENTH EDITION
Editor-in-Chief Lynn M. Schnapp, MD

V. Courtney Broaddus, MD George R. and Elaine Love Professor
Professor Emeritus of Medicine Chair, Department of Medicine
University of California San Francisco School of Medicine and Public Health
Division of Pulmonary and Critical Care Medicine University of Wisconsin-Madison
Zuckerberg San Francisco General Hospital Madison, Wisconsin
San Francisco, California Renee D. Stapleton, MD, PhD
Professor of Medicine
Division of Pulmonary and Critical Care Medicine
Editors University of Vermont Larner College of Medicine
Joel D. Ernst, MD Burlington, Vermont
Chief, Division of Experimental Medicine
University of California San Francisco School of Medicine Thoracic Imaging Editor
San Francisco, California Michael B. Gotway, MD
Talmadge E. King Jr, MD Professor of Radiology
Dean, UCSF School of Medicine Department of Diagnostic Imaging
Vice Chancellor for Medical Affairs Mayo Clinic
University of California San Francisco Scottsdale, Arizona;
San Francisco, California Clinical Associate Professor
Departments of Diagnostic Radiology and Biomedical
Stephen C. Lazarus, MD, FCCP, FERS Imaging, and Pulmonary and Critical Care Medicine
Professor of Medicine University of California San Francisco
Division of Pulmonary and Critical Care Medicine San Francisco, California;
Senior Investigator, Cardiovascular Research Institute Clinical Professor
University of California San Francisco University of Arizona College of Medicine
San Francisco, California Phoenix, Arizona;
Adjunct Professor
Kathleen F. Sarmiento, MD, MPH Department of Biomedical Informatics
Associate Professor of Medicine
Arizona State University
Division of Pulmonary, Critical Care, and Sleep Medicine
Tempe, Arizona
University of California San Francisco;
San Francisco VA Healthcare System
San Francisco, California
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MURRAY & NADEL’S TEXTBOOK OF RESPIRATORY MEDICINE, ED 7 ISBN: 978-0-323-65587-3

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Previous editions copyrighted © 2016, 2010, 2005 by Saunders, an imprint of Elsevier, Inc.
Cover images courtesy Michael B. Gotway, MD (images 1 and 4), and U.S. Centers for Disease Control and
Prevention/Alissa Eckert, MSMI; Dan Higgins, MAMS (image 2); https://phil.cdc.gov/Details.aspx?pid=23311.
Executive Content Strategist: Robin Carter

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Publishing Services Manager: Catherine Jackson
Senior Project Manager/Specialist: Carrie Stetz
Design Direction: Brian Salisbury
Printed in Canada
Last digit is the print number: 9 8 7 6 5 4 3 2 1

We dedicate this Textbook to Dr. John F. Murray. In 1988, Dr. Murray, together with Dr. Jay A. Nadel,
published the first edition of this Textbook. Motivated by his love of teaching, he aimed to create a
comprehensive, clear, authoritative, thoroughly annotated compendium of respiratory medicine, always
integrated with scientific principles. Over the subsequent years and six more editions, he inspired us to
continue his work and to maintain his high standards.
Of all his contributions to respiratory medicine, he was perhaps most proud of the Textbook.
John F. Murray, MD
(1927-2020)
Dedication
To my husband, Chuck, who has been the bedrock. For my parents, to whom I owe all I have, and to my
To the rest of our wonderful family, Chris and Clay, Mary loving wife and daughter, Mary Pat and Allison, for all
and Lydia, and the grandboys Charlie and Rory. the support and inspiration they provide.
Michael B. Gotway, MD
To my mentors, colleagues and fellow editors for their
inspiration and support of my career and of this project.
V. Courtney Broaddus, MD
To Vicki, Kristina, and Genevieve, who make everything To my wife, Mozelle D. King
worthwhile. To my children, Consuelo King and Malaika King Kattke
Joel Ernst, MD
To my grandchildren, Madison and Siena Kattke
To the memories of my mother and father, Almetta and
Talmadge King
Talmadge E. King Jr, MD
Dedication vii
To my wife, Gail, who makes everything possible, and In loving memory of my parents, who were
better; to my daughter, Hillary, and her husband, an unwavering source of support and encouragement
Andrew, who continue to ask about what I do, and for everything that I did. They may not have
encourage it; to my grandchildren Lola and Axel, who understood why I ran, but they were always at the finish
give me hope for the future and joy in the present; and line to cheer me on.
to the many colleagues, students, and trainees, who Lynn M. Schnapp, MD
made my first 49 years at UCSF so enjoyable.
Stephen C. Lazarus, MD, FCCP, FERS
To my parents, Barbara and Barry Brennan, who taught To my husband Jonathan; our children Walker,
by example the value of hard work, perseverance, Emmerson, and Orion; my parents Myrna and Ted;
and compassion. and my mentors, colleagues, patients, and trainees for a
Kathleen F. Sarmiento, MD, MPH lifetime of pushing me to learn, grow, and change.
Renee D. Stapleton, MD, PhD
Contributors
Lewis Adams, PhD Christopher I. Amos, PhD

Professor of Physiology Professor of Medicine
School of Allied Health Sciences Director, Institute for Clinical and Translational
Griffith University Research Medicine
Gold Coast, Queensland, Australia Associate Director of Quantitative Science
Chapter 36: Dyspnea Dan L. Duncan Comprehensive Cancer Center
Baylor College of Medicine
Rosemary Adamson, MB, BS Houston, Texas
Associate Professor of Medicine Chapter 74: Lung Cancer: Epidemiology
Division of Pulmonary, Critical Care, and Sleep Medicine
University of Washington School of Medicine Douglas A. Arenberg, MD, FACCP
Veterans Affairs Puget Sound Healthcare System Professor of Medicine
Seattle, Washington Division of Pulmonary and Critical Care Medicine
Chapter 23: Ultrasonography: Principles and Basic University of Michigan Medical School
Thoracic and Vascular Imaging Ann Arbor, Michigan
Chapter 79: Metastatic Malignant Tumors
Dan E. Adler, MD Chapter 80: Benign Lung Tumors
Professor of Pulmonary Medicine
Division of Pneumology A. Christine Argento, MD, FCCP
University Hospital of Geneva Assistant Professor of Medicine
Geneva, Switzerland Division of Pulmonary and Critical Care Medicine
Chapter 136: Noninvasive Support of Ventilation Northwestern University Feinberg School of Medicine
Chicago, Illinois;
Evangelia Akoumianaki, MD, PhD Division of Pulmonary and Critical Care Medicine
Consultant
Johns Hopkins University School of Medicine
Intensive Care Unit
Baltimore, Maryland
University Hospital of Heraklion
Heraklion, Crete, Greece Chapter 27: Diagnostic Bronchoscopy: Advanced
Chapter 136: Noninvasive Support of Ventilation Techniques (EBUS and Navigational)
Shaikh M. Atif, PhD

Tyler J. Albert, MD Instructor of Medicine
Assistant Professor of Medicine Division of Clinical Immunology
Department of Medicine University of Colorado Anschutz Medical Campus
Division of General Internal Medicine Aurora, Colorado
University of Washington School of Medicine
Chapter 16: Adaptive Immunity
Veterans Affairs Puget Sound Health Care System
Seattle, Washington
Najib T. Ayas, MD, MPH
Chapter 12: Acid-Base Balance Associate Professor of Medicine
University of British Columbia Faculty of Medicine
Kurt H. Albertine, PhD, FAAAS, FAAA Vancouver, British Columbia, Canada
Edward B. Clark Endowed Chair IV in Pediatrics Chapter 11: Respiratory System Mechanics and Energetics
Adjunct Professor of Medicine and Neurobiology and
Anatomy Jennifer M. Babik, MD, PhD
University of Utah School of Medicine Associate Clinical Professor of Medicine
Editor-in-Chief, The Anatomical Record Division of Infectious Diseases
Salt Lake City, Utah University of California San Francisco School of Medicine
Chapter 1: Anatomy San Francisco, California
Chapter 46a: COVID-19
Barbara D. Alexander, MD, MHS
Professor of Medicine and Pathology Jessica B. Badlam, MD
Division of Infectious Diseases Assistant Professor of Medicine
Duke University Medical Center Division of Pulmonary Disease and Critical Care Medicine
Durham, North Carolina University of Vermont Larner College of Medicine
Chapter 57: Fungal Infections: Opportunistic Burlington, Vermont
viii Chapter 39: Wheezing and Stridor
Contributors ix
John Randolph Balmes, MD Joshua O. Benditt, MD

Professor of Medicine Professor of Medicine
Division of Occupational and Environmental Medicine Division of Pulmonary and Critical Care Medicine
University of California San Francisco University of Washington School of Medicine
Division of Pulmonary and Critical Care Medicine Director, Respiratory Care Services
Zuckerberg San Francisco General Hospital University of Washington Medical Center
San Francisco, California; Seattle, Washington
Professor of Environmental Health Sciences Chapter 130: The Respiratory System and Neuromuscu-
University of California Berkeley School of Public Health lar Diseases
Berkeley, California
Chapter 102: Indoor and Outdoor Air Pollution Neal L. Benowitz, MD
Emeritus Professor of Medicine
Niaz Banaei, MD University of California San Francisco;
Professor Attending Physician
Departments of Pathology and Medicine (Infectious Departments of Medicine and Biopharmaceutical Sciences
Diseases) Program in Clinical Pharmacology
Stanford University School of Medicine Division of Cardiology
Stanford, California; Zuckerberg San Francisco General Hospital
Medical Director, Clinical Microbiology Laboratory San Francisco, California
Stanford University Medical Center Chapter 65: Smoking Hazards: Cigarettes, Vaping, Marijuana
Palo Alto, California
Chapter 19: Microbiologic Diagnosis of Lung Infection Nirav R. Bhakta, MD, PhD
Christopher F. Barnett, MD, MPH Division of Pulmonary, Critical Care, Allergy, and Sleep
Director, Pulmonary Hypertension Program Medicine
Director, Medical Cardiovascular Intensive Care Unit Director of Education and Associate Director, Adult Pulmo-
Department of Cardiology nary Function Laboratory
Medstar Washington Hospital Center University of California San Francisco
Washington, DC San Francisco, California
Chapter 24: Ultrasonography: Advanced Applications and Chapter 31: Pulmonary Function Testing: Physiologic
Procedures and Technical Principles
Chapter 85: Pulmonary Hypertension Due to Lung Chapter 32: Pulmonary Function Testing: Interpretation
Disease: Group 3 and Applications
Chapter 60: Asthma: Pathogenesis and Phenotypes
Sonja D. Bartolome, MD
Professor of Medicine Rahul Bhatnagar, MBChB, PhD
Division of Pulmonary and Critical Care Medicine Honorary Lecturer
University of Texas Southwestern Medical Center Academic Respiratory Unit
Dallas, Texas University of Bristol
Chapter 84: Pulmonary Arterial Hypertension: Bristol, United Kingdom
Group 1 Chapter 112: Pleural Fibrosis and Unexpandable Lung
Robert P. Baughman, MD Surya P. Bhatt, MD, MSPH

Professor of Medicine Associate Professor of Medicine
Department of Internal Medicine Division of Pulmonary, Allergy, and Critical Care Medicine
University of Cincinnati College of Medicine Medical Director, Pulmonary Function and Exercise
Cincinnati, Ohio Physiology Laboratory
Chapter 93: Sarcoidosis University of Alabama at Birmingham
Birmingham, Alabama
Michael F. Beers, MD Chapter 32: Pulmonary Function Testing: Interpretation
Robert L. Mayock and David A. Cooper Professor of and Applications
Medicine
Department of Medicine Anna C. Bibby, MBChB, BSC, MRCP
Division of Pulmonary and Critical Care Academic Respiratory Unit
Perelman School of Medicine at the University of Translational Health Sciences
Pennsylvania University of Bristol Medical School;
Philadelphia, Pennsylvania Respiratory Department
Chapter 3: Alveolar Compartment North Bristol NHS Trust
Bristol, United Kingdom
Chapter 109: Pleural Infections
x Contributors
Alexandra Binnie, MD, DPhil, FRCP(C) Steven L. Brody, MD

Invited Assistant Professor Dorothy R. and Hubert C. Moog Professor of Pulmonary
University of Algarve Medicine
Faro, Portugal; Washington University School of Medicine in St. Louis
Critical Care Physician St. Louis, Missouri
William Osler Health System Chapter 4: Airway Biology
Toronto, Canada
Chapter 134: Acute Respiratory Distress Syndrome Kevin K. Brown, MD
Professor and Chair
Paul D. Blanc, MD, MSPH Department of Medicine
Professor of Medicine National Jewish Health
Endowed Chair in Occupational and Environmental Denver, Colorado;
Medicine Professor of Medicine
University of California San Francisco Division of Pulmonary Sciences and Critical Care Medicine
Chief, Division of Occupational and Environmental University of Colorado School of Medicine
Medicine Aurora, Colorado
UCSF Medical Center Chapter 87: Pulmonary Vasculitis
Chapter 103: Acute Responses to Toxic Exposures Paul G. Brunetta, MD
Adjunct Associate Professor of Medicine
Zea Borok, MB, ChB Division of Pulmonary and Critical Care Medicine
Professor of Medicine and Biochemistry and Molecular University of California San Francisco;
Medicine Fontana Tobacco Treatment Center
Division of Pulmonary, Critical Care, and Sleep Medicine Mt. Zion Medical Center
Keck School of Medicine San Francisco, California
University of Southern California Chapter 66: Smoking Cessation
Los Angeles, California
Chapter 3: Alveolar Compartment Jacques Cadranel, MD, PhD
Professor of Respiratory Medicine
T. Douglas Bradley, MD, FRCPC Service de Pneumologie
Professor of Medicine Hôpital Tenon, Assistance Publique Hôpitaux de Paris
Director, Division of Respirology Paris, France
Centre for Sleep Medicine and Circadian Biology Chapter 78: Rare Primary Lung Tumors
University of Toronto Faculty of Medicine;
Director, Sleep Medicine Laboratory Shamus R. Carr, MD
University Health Network Associate Research Physician
Toronto Rehabilitation Institute Thoracic Surgery Branch
Toronto General Hospital Center for Cancer Research
Toronto, Ontario, Canada National Cancer Institute
Chapter 121: Central Sleep Apnea Bethesda, Maryland
Chapter 30: Thoracic Surgery
V. Courtney Broaddus, MD
Professor Emeritus of Medicine Tara F. Carr, MD
University of California San Francisco Associate Professor of Medicine
Division of Pulmonary and Critical Care Medicine College of Medicine, Tucson
Zuckerberg San Francisco General Hospital Asthma and Airway Disease Research Center
San Francisco, California University of Arizona Health Sciences
Chapter 14: Pleural Physiology and Pathophysiology Tucson, Arizona
Chapter 44: Hypoxemia Chapter 62: Asthma: Diagnosis and Management
Chapter 108: Pleural Effusion
Adithya Cattamanchi, MD, MAS
Laurent J. Brochard, MD Professor of Medicine and Epidemiology
Interdepartmental Division Director for Critical Care Division of Pulmonary and Critical Care Medicine
University of Toronto Faculty of Medicine University of California San Francisco Center for
Full Professor and Clinician Scientist Tuberculosis
Department of Medicine University of California San Francisco School of Medicine
Division of Critical Care San Francisco, California
Saint Michael’s Hospital Chapter 53: Tuberculosis: Clinical Manifestations and
Keenan Research Center for Biomedical Science Diagnosis
Toronto, Ontario, Canada
Chapter 136: Noninvasive Support of Ventilation
Contributors xi
Lara Chalabreysse, MD Michael H. Cho, MD, MPH

Département de Pathologie Associate Professor of Medicine
Groupement Hospitalier Est Hospices Civils de Lyon Channing Division of Network Medicine and Division of
Lyon, France Pulmonary and Critical Care Medicine
Chapter 78: Rare Primary Lung Tumors Brigham and Women’s Hospital
Harvard Medical School
Edward D. Chan, MD Boston, Massachusetts
Professor of Medicine Chapter 9: Genetics of Lung Disease
University of Colorado Anschutz Medical Campus Chapter 63: COPD: Pathogenesis and Natural History
Staff Physician
Department of Medicine David C. Christiani, MD
Rocky Mountain Regional Veterans Affairs Medical Center Professor of Medicine
Aurora, Colorado; Harvard Medical School
Staff Physician Elkan Blout Professor of Environmental Genetics
Department of Academic Affairs Department of Environmental Health
National Jewish Health Harvard School of Public Health;
Denver, Colorado Physician
Chapter 69: Bronchiectasis Division of Pulmonary and Critical Care
Massachusetts General Hospital
Ken K.P. Chan, MBChB, MRCP (UK), FHKCP, FHKAM Boston, Massachusetts
Clinical Assistant Professor (Honorary) Chapter 74: Lung Cancer: Epidemiology
Department of Medicine & Therapeutics
Chinese University of Hong Kong; Kian Fan Chung, MD, DSc, FRCP
Associate Consultant Professor of Respiratory Medicine
Department of Medicine & Therapeutics Head of Experimental Studies
Prince of Wales Hospital National Heart & Lung Institute
Hong Kong Imperial College London;
Chapter 111: Chylothorax Consultant Physician
Royal Brompton and Harefield NHS Trust
Jean Chastre, MD London, United Kingdom
Professor Chapter 37: Cough
Service de Réanimation Médicale
Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière Amelia O. Clive, MBBS, PhD
Paris, France Consultant in Thoracic Medicine
Chapter 49: Ventilator-Associated Pneumonia North Bristol Lung Centre
Southmead Hospital
Guang-Shing Cheng, MD Bristol, United Kingdom
Associate Professor, Clinical Research Division Chapter 112: Pleural Fibrosis and Unexpandable Lung
Fred Hutchinson Cancer Research Center;
Associate Professor of Medicine Robert A. Cohen, MD
Division of Pulmonary, Critical Care, and Sleep Medicine Professor of Medicine
University of Washington School of Medicine Northwestern University Feinberg School of Medicine
Seattle, Washington Clinical Professor of Environmental and Occupational
Chapter 115: Mediastinal Tumors and Cysts Health Sciences
Chapter 125: Pulmonary Complications of Stem Cell and University of Illinois at Chicago School of Public Health
Solid Organ Transplantation Chicago, Illinois
Chapter 101: Pneumoconioses
Kelly M. Chin, MD, MSCS
Associate Professor of Medicine Thomas V. Colby, MD
Division of Pulmonary and Critical Care Medicine Professor Emeritus
Director, Pulmonary Hypertension Program Department of Laboratory Medicine and Pathology
University of Texas Southwestern Medical Center Mayo Clinic Alix College of Medicine
Dallas, Texas Scottsdale, Arizona
Chapter 84: Pulmonary Arterial Hypertension: Group 1 Chapter 89: Idiopathic Pulmonary Fibrosis
xii Contributors
Carlyne D. Cool, MD Charles L. Daley, MD

Clinical Professor of Pathology Professor and Chief
University of Colorado School of Medicine Division of Mycobacterial and Respiratory Infections
Aurora, Colorado; National Jewish Health
Adjunct Professor Denver, Colorado;
National Jewish Health Professor of Medicine
Denver, Colorado Division of Pulmonary and Critical Care Medicine and
Chapter 87: Pulmonary Vasculitis Infectious Diseases
University of Colorado School of Medicine
Ricardo Luiz Cordioli, MD, PhD Aurora, Colorado;
Medical Staff Professor of Medicine
Division of Intensive Care Division of Pulmonary and Critical Care Medicine
Albert Einstein Hospital Icahn School of Medicine at Mt Sinai
Oswaldo Cruz Hospital New York, New York
São Paulo, Brazil; Chapter 55: Nontuberculous Mycobacterial Infections
Intensive Care Unit
University Hospital of Geneva Bruce L. Davidson, MD, MPH
Geneva, Switzerland Former Clinical Professor of Medicine
Chapter 136: Noninvasive Support of Ventilation Division of Pulmonary and Critical Care Medicine
University of Washington School of Medicine
Tamera J. Corte, MBBS, PhD, FRACP Seattle, Washington
Associate Professor of Medicine Chapter 82: Pulmonary Thromboembolism: Prophylaxis
University of Sydney Medical School and Treatment
Consultant Respiratory Physician
Director of Interstitial Lung Disease Service Helen E. Davies, MD, FRCP
Royal Prince Alfred Hospital Consultant Respiratory Physician
Sydney, Australia Department of Respiratory Medicine
Chapter 92: Connective Tissue Diseases University Hospital of Wales
Cardiff, United Kingdom
Vincent Cottin, MD, PhD Chapter 114: Pleural Malignancy
Professor of Respiratory Medicine
Claude Bernard University J. Lucian Davis, MD
University of Lyon; Associate Professor of Epidemiology
Head, Coordinating Reference Center for Rare Pulmonary Department of Epidemiology of Microbial Diseases
Diseases, Hospices Civils de Lyon Yale School of Public Health;
Louis Pradel Hospital Associate Professor of Medicine
Lyon, France Pulmonary, Critical Care, and Sleep Medicine Section
Chapter 96: Eosinophilic Lung Diseases Yale School of Medicine
New Haven, Connecticut
Kristina Crothers, MD Chapter 18: History and Physical Examination
University of Washington School of Medicine Teresa De Marco, MD
Chief, Section of Pulmonary, Critical Care, and Sleep Professor of Medicine
Medicine RH and Jane G. Logan Endowed Chair in Cardiology
Veterans Affairs Puget Sound Health Care System Chief, Advanced Heart Failure and Pulmonary
Seattle, Washington Hypertension
Chapter 123: Pulmonary Complications of HIV Infection Medical Director, Heart Transplantation
University of California San Francisco
Jeffrey L. Curtis, MD San Francisco, California
Professor of Internal Medicine Chapter 85: Pulmonary Hypertension Due to Lung
University of Michigan Medical School Disease: Group 3
Staff Physician, Medicine Service
VA Ann Arbor Healthcare System Stanley C. Deresinski, MD
Ann Arbor, Michigan Clinical Professor of Medicine
Chapter 63: COPD: Pathogenesis and Natural History Division of Infectious Diseases and Geographic Medicine
Stanford University School of Medicine
Stanford, California
Chapter 19: Microbiologic Diagnosis of Lung Infection
Contributors xiii
Christophe M. Deroose, MD, PhD C. Gregory Elliott, MD

Associate Professor of Nuclear Medicine and Molecular Professor of Internal Medicine
Imaging University of Utah School of Medicine
Katholieke Universiteit Leuven; Salt Lake City, Utah;
Deputy Head of Clinic Chairman, Department of Medicine
Nuclear Medicine Intermountain Medical Center
University Hospitals Leuven Murray, Utah
Leuven, Belgium Chapter 82: Pulmonary Thromboembolism: Prophylaxis
Chapter 25: Positron Emission Tomography and Treatment
Anne E. Dixon, MA, BM, BCh Joel D. Ernst, MD

Professor of Medicine Professor of Medicine
Chief, Division of Pulmonary Disease and Critical Care Chief, Division of Experimental Medicine
Medicine University of California San Francisco School of Medicine
Director, Vermont Lung Center San Francisco, California
University of Vermont Larner College of Medicine Chapter 52: Tuberculosis: Pathogenesis and Immunity
Burlington, Vermont
Chapter 61: Asthma and Obesity Christopher M. Evans, PhD
David H. Dockrell, MD, FRCPI, FRCP(Glas), FACP Division of Pulmonary Sciences and Critical Care
Professor of Infection Medicine University of Colorado School of Medicine
University of Edinburgh Aurora, Colorado
Edinburgh, United Kingdom Chapter 4: Airway Biology
Chapter 46: Community-Acquired Pneumonia
John V. Fahy, MD, MSc
Christophe Dooms, MD, PhD Professor of Medicine
Assistant Professor of Pneumology Division of Pulmonary, Critical Care, Allergy, and Sleep
Katholieke Universiteit Leuven; Medicine
Deputy Head of Clinic Cardiovascular Research Institute
Pneumonology University of California San Francisco
University Hospitals Leuven San Francisco, California
Leuven, Belgium Chapter 60: Asthma: Pathogenesis and Phenotypes
Chapter 25: Positron Emission Tomography
Elaine Fajardo, MD
Gregory P. Downey, MD Assistant Professor of Medicine
Executive Vice President, Academic Affairs Pulmonary, Critical Care, and Sleep Medicine Section
Department of Medicine Yale School of Medicine
National Jewish Health; New Haven, Connecticut
Professor Chapter 18: History and Physical Examination
Departments of Medicine and Immunology and
Microbiology Eddy Fan, MD, PhD
Associate Dean Associate Professor of Medicine
University of Colorado Denver School of Medicine Interdepartmental Division of Critical Care Medicine
Denver, Colorado University of Toronto Faculty of Medicine
Chapter 8: Regeneration and Repair Toronto, Ontario, Canada
Chapter 135: Mechanical Ventilation
Hilary DuBrock, MD, MMSc
Assistant Professor of Medicine Marie E. Faughnan, MD, MSc
Mayo Clinic Professor of Medicine
Rochester, Minnesota Division of Respirology
Chapter 126: Pulmonary Complications of Abdominal University of Toronto Faculty of Medicine
Diseases Toronto, Ontario, Canada
Chapter 88: Pulmonary Vascular Anomalies
Souheil El-Chemaly, MD, MPH
Assistant Professor of Medicine
Harvard Medical School
Brigham and Women’s Hospital
Boston, Massachusetts
Chapter 7: Lymphatic Biology
xiv Contributors
David Feller-Kopman, MD, FCCP Stephen K. Frankel, MD, FCCM, FCCP

Professor of Medicine, Anesthesiology, and Otolaryngology– Executive Vice President, Clinical Affairs
Head and Neck Surgery Professor of Medicine
Director, Bronchoscopy and Interventional Pulmonology National Jewish Health
Department of Pulmonary and Critical Care Medicine Denver, Colorado;
Johns Hopkins Medical Institutions Professor of Medicine
Baltimore, Maryland Division of Pulmonary Sciences and Critical Care Medicine
Chapter 27: Diagnostic Bronchoscopy: Advanced University of Colorado School of Medicine
Techniques (EBUS and Navigational) Aurora, Colorado
Chapter 28: Therapeutic Bronchoscopy: Interventional Chapter 87: Pulmonary Vasculitis
Techniques
Joseph Friedberg, MD
Brett E. Fenster, MD Charles Reid Edwards Professor of Surgery
Cardiologist Head, Division of Thoracic Surgery
Kaiser Permanente Director, Pleural Mesothelioma Program
Denver, Colorado University of Maryland School of Medicine
Chapter 38: Chest Pain Baltimore, Maryland
Chapter 30: Thoracic Surgery
Timothy M. Fernandes, MD, MPH Chapter 113: Hemothorax
Associate Clinical Professor of Medicine
Division of Pulmonary, Critical Care, and Sleep Medicine Monica Fung, MD
University of California San Diego School of Medicine Assistant Professor of Medicine
San Diego, California Division of Infectious Diseases
Chapter 86: Pulmonary Hypertension Due to Chronic University of California San Francisco School of Medicine
Thromboembolic Disease: Group 4 San Francisco, California
Chapter 46a: COVID-19
Evans R. Fernández Pérez, MD, MS
Associate Professor of Medicine Yuansheng Gao, PhD
Division of Pulmonary, Critical Care, and Sleep Medicine Professor of Physiology and Pathophysiology
National Jewish Health Peking University Health Science Center
Denver, Colorado Beijing, China
Chapter 91: Hypersensitivity Pneumonitis Chapter 6: Vascular Biology
William A. Fischer II, MD Erik Garpestad, MD

Assistant Professor of Medicine Associate Professor of Medicine
Institute of Global Health and Infectious Diseases Division of Pulmonary, Critical Care, and Sleep Medicine
Division of Pulmonary and Critical Care Medicine Director, Medical ICU
The University of North Carolina School of Medicine Tufts Medical Center
Chapel Hill, North Carolina Boston, Massachusetts
Chapter 59: Outbreaks, Pandemics, and Bioterrorism Chapter 132: Acute Ventilatory Failure
Andrew P. Fontenot, MD Eric J. Gartman, MD

Henry N. Claman Professor of Medicine Associate Professor of Medicine
Division of Clinical Immunology Division of Pulmonary, Critical Care, and Sleep Medicine
University of Colorado Anschutz Medical Campus Alpert Medical School of Brown University;
Aurora, Colorado Staff Physician
Chapter 16: Adaptive Immunity Division of Pulmonary, Critical Care, and Sleep Medicine
Providence VA Medical Center
Providence, Rhode Island
James Frank, MD, MA
Chapter 131: The Respiratory System and Chest Wall
Professor of Clinical Medicine
Division of Pulmonary, Critical Care, Allergy, and Sleep Diseases
Medicine
University of California San Francisco School of Medicine G.F. Gebhart, PhD
San Francisco, California Professor of Anesthesiology, Medicine, Neurobiology, and
Chapter 23: Ultrasonography: Principles and Basic Pharmacology
Thoracic and Vascular Imaging Director, Center for Pain Research
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania
Chapter 38: Chest Pain
Contributors xv
Gautam George, MD Robb W. Glenny, MD

Assistant Professor of Medicine Professor of Medicine and of Physiology and Biophysics
Division of Pulmonary, Allergy, and Critical Care Medicine Division of Pulmonary and Critical Care Medicine
Jane and Leonard Korman Respiratory Institute University of Washington School of Medicine
Sidney Kimmel Medical College Seattle, Washington
Thomas Jefferson University Chapter 33: Exercise Testing
Philadelphia, Pennsylvania
Chapter 5: Lung Mesenchyme Ewan C. Goligher, MD, PhD
Yaron B. Gesthalter, MD Interdepartmental Division of Critical Care Medicine
Assistant Professor of Medicine University of Toronto Faculty of Medicine;
Division of Pulmonary and Critical Care Scientist
Section of Interventional Pulmonology Toronto General Hospital Research Institute;
University of California San Francisco School of Medicine Attending Physician
San Francisco, California Department of Medicine, Division of Respirology
Chapter 40: Hemoptysis University Health Network
Toronto, Ontario, Canada
Mark T. Gladwin, MD Chapter 135: Mechanical Ventilation
Jack D. Myers Professor and Chair
Department of Medicine Antonio Gomez, MD
University of Pittsburgh School of Medicine Associate Professor of Medicine
Director, Pittsburgh Heart, Lung, Blood, and Vascular University of California San Francisco
Medicine Institute Medical Director, Critical Care Services
University of Pittsburgh Medical Center Zuckerberg San Francisco General Hospital
Pittsburgh, Pennsylvania San Francisco, California
Chapter 127: Pulmonary Complications of Hematologic Chapter 44: Hypoxemia
Diseases
Anne V. Gonzalez, MD, MSc
Leonard H.T. Go, MD Associate Professor of Medicine
McGill University Faculty of Medicine
Research Assistant Professor of Environmental and
Montreal, Quebec, Canada
Occupational Health Sciences
University of Illinois at Chicago School of Public Health; Chapter 76: Lung Cancer: Diagnosis and Staging
Department of Medicine
Stroger Hospital of Cook County; Stephen B. Gordon, MD, MA, FRCP, DTM&H
Department of Medicine Director, Malawi Liverpool Wellcome Programme
Northwestern University Feinberg School of Medicine University of Malawi College of Medicine
Chicago, Illinois Blantyre, Malawi;
Professor of Clinical Sciences
Chapter 101: Pneumoconioses
Liverpool School of Tropical Medicine
Liverpool, United Kingdom
Nisha H. Gidwani, MD Chapter 46: Community-Acquired Pneumonia
Associate Professor of Clinical Medicine
Division of Pulmonary, Critical Care, Allergy, and Sleep
Dominique Gossot, MD
Medicine Institut du Thorax Curie Montsouris
University of California San Francisco Institut Mutualiste Montsouris
San Francisco, California Paris, France
Chapter 50: Lung Abscess Chapter 78: Rare Primary Lung Tumors
Nicolas Girard, MD, PhD Jeffrey E. Gotts, MD, PhD
Professor of Respiratory Medicine Assistant Professor of Medicine
Institut du Thorax Curie Montsouris Division of Pulmonary and Critical Care Medicine
Institut Curie University of California San Francisco
Paris, France San Francisco, California
Chapter 78: Rare Primary Lung Tumors Chapter 65: Smoking Hazards: Cigarettes, Vaping, Marijuana
xvi Contributors
Michael B. Gotway, MD Nishant Gupta, MD, MS

Professor of Radiology Associate Professor of Internal Medicine
Department of Diagnostic Imaging Division of Pulmonary, Critical Care, and Sleep Medicine
Mayo Clinic University of Cincinnati College of Medicine
Scottsdale, Arizona; Cincinnati, Ohio
Clinical Associate Professor Chapter 97: Lymphangioleiomyomatosis
Departments of Diagnostic Radiology and Biomedical
Imaging, and Pulmonary and Critical Care Medicine Rob Hallifax, DPhil, BMCh, MSc, MRCP
University of California San Francisco Academic Clinical Lecturer
San Francisco, California; Respiratory Trials Unit
Clinical Professor Oxford Centre for Respiratory Medicine
University of Arizona College of Medicine Churchill Hospital NHS Trust
Phoenix, Arizona; Oxford, United Kingdom
Adjunct Professor Chapter 110: Pneumothorax
Department of Biomedical Informatics
Arizona State University
Tempe, Arizona Meilan K. Han, MD, MS
Chapter 20: Thoracic Radiology: Noninvasive Diagnostic Division of Pulmonary and Critical Care Medicine
Imaging University of Michigan School of Medicine
Ann Arbor, Michigan
Michael Gould, MD, MS Chapter 64: COPD: Diagnosis and Management
Director for Health Services Research
Department of Research and Evaluation Nadia N. Hansel, MD, MPH
Kaiser Permanente Southern California Professor of Medicine
Pasadena, California Division of Pulmonary and Critical Care Medicine
Chapter 41: Pulmonary Nodule Johns Hopkins University School of Medicine
Baltimore, Maryland
Bridget A. Graney, MD Chapter 63: COPD: Pathogenesis and Natural History
Instructor in Medicine
Division of Pulmonary Sciences and Critical Care Umur Hatipoğlu, MD, MBA
University of Colorado School of Medicine Associate Professor of Medicine
Aurora, Colorado Cleveland Clinic Lerner College of Medicine of Case
Chapter 90: Nonspecific Interstitital Pneumonitis and Western Reserve University
Other Idiopathic Interstitital Pneumonias Director, COPD Center
Respiratory Institute, Cleveland Clinic Foundation
Giacomo Grasselli, MD Cleveland, Ohio
Associate Professor Chapter 106: Air Travel
Department of Pathophysiology and Transplantation
University of Milan William R. Henderson, MD, PhD
Dipartimento di Anestesia-Rianimazione e Emergenza Clinical Professor of Critical Care Medicine
Urgenza University of British Columbia Faculty of Medicine
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Staff Intensivist
Milan, Italy Division of Critical Care Medicine
Chapter 138: Extracorporeal Support of Gas Exchange Vancouver General Hospital
Vancouver, British Columbia, Canada
John R. Greenland, MD, PhD Chapter 11: Respiratory System Mechanics and Energetics
University of California San Francisco School of Medicine; Susanne Herold, MD, PhD
Staff Physician Professor of Medicine
Medical Service Universities of Giessen and Marburg Lung Center
San Francisco Veterans Administration Health Care Giessen, Germany
System Chapter 8: Regeneration and Repair
Chapter 72: Bronchiolitis Margaret S. Herridge, MSc, MD, MPH, FRCP(C)
University of Toronto Faculty of Medicine;
David E. Griffith, MD Attending Physician
Professor of Medicine Division of Respirology and Critical Care
Division of Mycobacterial and Respiratory Infections University Health Network
National Jewish Health Toronto, Canada
Denver, Colorado
Chapter 134: Acute Respiratory Distress Syndrome
Chapter 55: Nontuberculous Mycobacterial Infections
Contributors xvii
Robert Hiensch, MD David J. Horne, MD, MPH

Assistant Professor of Medicine Associate Professor of Medicine
Division of Pulmonary, Critical Care, and Sleep Medicine Division of Pulmonary, Critical Care, and Sleep Medicine
Icahn School of Medicine at Mount Sinai Adjunct Associate Professor of Global Health
New York, New York Harborview Medical Center
Chapter 119: Sleep-Disordered Breathing: A General University of Washington
Approach Seattle, Washington
Chapter 54: Tuberculosis: Treatment of Drug-Susceptible
Janet Hilbert, MD and Drug-Resistant
Assistant Professor of Clinical Medicine
Division of Pulmonary, Critical Care, and Sleep Medicine Richard L. Horner, PhD, FCAHS
Yale School of Medicine Professor of Medicine and Physiology
New Haven, Connecticut Faculty of Medicine, University of Toronto;
Chapter 130: The Respiratory System and Neuromuscu- Canada Research Chair in Sleep and Respiratory
lar Diseases Neurobiology
Fellow, Canadian Academy of Health Sciences
Nicholas S. Hill, MD, FPVRI Toronto, Ontario, Canada
Professor of Medicine Chapter 117: Control of Breathing and Upper Airways
Chief, Division of Pulmonary, Critical Care, and Sleep During Sleep
Medicine
Tufts University Medical Center Connie C.W. Hsia, MD
Boston, Massachusetts Professor of Internal Medicine
Chapter 132: Acute Ventilatory Failure Division of Pulmonary and Critical Care Medicine
University of Texas Southwestern Medical Center
Antonia Ho, MBChB, PhD Dallas, Texas
Clinical Senior Lecturer Chapter 128: Pulmonary Complications of Endocrine
MRC-University of Glasgow Centre for Virus Research Diseases
Institute of Infection, Immunity & Inflammation
Glasgow, United Kingdom Laurence Huang, MD
Chapter 46: Community-Acquired Pneumonia Professor of Medicine
University of California San Francisco School of Medicine
Stephanie M. Holm, MD, MPH Chief, HIV/AIDS Chest Clinic
Assistant Clinical Professor of Medicine Zuckerberg San Francisco General Hospital
Division of Occupational and Environmental Medicine San Francisco, California
University of California San Francisco; Chapter 123: Pulmonary Complications of HIV Infection
Co-Director
Western States Pediatric Environmental Health Specialty Lindsey L. Huddleston, MD
Units (WSPEHSU) Assistant Clinical Professor of Anesthesia
San Francisco, California; University of California San Francisco School of Medicine
Doctoral Student in Public Health San Francisco, California
Division of Epidemiology Chapter 24: Ultrasonography: Advanced Applications and
University of California Berkeley School of Public Health Procedures
Berkeley, California
Chapter 102: Indoor and Outdoor Air Pollution
Robert C. Hyzy, MD
Wynton Hoover, MD Division of Pulmonary & Critical Care Medicine
Professor of Pediatrics University of Michigan Medical School
Division of Pulmonary and Sleep Medicine Director, Critical Care Medicine Unit
University of Alabama at Birmingham University of Michigan Hospital
Birmingham, Alabama Ann Arbor, Michigan
Chapter 68: Cystic Fibrosis: Diagnosis and Management Chapter 137: Noninvasive Support of Oxygenation
Philip C. Hopewell, MD Yoshikazu Inoue, MD, PhD

Professor of Medicine Executive Director, Clinical Research Center
Director, Curry International TB Center National Hospital Organization Kinki-Chuo Chest Medical
University of California San Francisco Center
San Francisco, California Sakai, Osaka, Japan
Chapter 51: Tuberculosis Epidemiology and Prevention Chapter 97: Lymphangioleiomyomatosis
xviii Contributors
Claudia V. Jakubzick, PhD Marta Kaminska, MD, MSc

Associate Professor of Microbiology and Immunology Associate Professor of Medicine
Dartmouth College Division of Respiratory Medicine
Hanover, New Hampshire McGill University Faculty of Medicine
Chapter 15: Innate Immunity Sleep Laboratory
McGill University Health Centre
Shijing Jia, MD Montreal, Quebec, Canada
Assistant Professor of Medicine Chapter 120: Obstructive Sleep Apnea
Division of Pulmonary & Critical Care Medicine
University of Michigan Medical School David A. Kaminsky, MD
Ann Arbor, Michigan Professor of Medicine
Chapter 137: Noninvasive Support of Oxygenation Division of Pulmonary and Critical Care Medicine
University of Vermont Larner College of Medicine;
Kerri A. Johannson, MD, MPH Attending Physician
Assistant Professor of Medicine Division of Pulmonary and Critical Care Medicine
University of Calgary Cumming School of Medicine University of Vermont Medical Center
Calgary, Alberta, Canada Burlington, Vermont
Chapter 91: Hypersensitivity Pneumonitis Chapter 31: Pulmonary Function Testing: Physiologic
and Technical Principles
Meshell Johnson, MD Chapter 39: Wheezing and Stridor
University of California San Francisco Midori Kato-Maeda, MD, MS
Chief, Division of Pulmonary, Critical Care, and Sleep Associate Professor of Medicine
Medicine University of California San Francisco
San Francisco VA Health Care System Zuckerberg San Francisco General Hospital
San Francisco, California San Francisco, California
Chapter 71: Large Airway Disorders Chapter 51: Tuberculosis Epidemiology and Prevention
Clinton E. Jokerst, MD David A. Kaufman, MD

Assistant Professor of Radiology Assistant Professor of Medicine
Department of Diagnostic Imaging NYU Grossman School of Medicine
Mayo Clinic New York, New York
Scottsdale, Arizona Chapter 46a: COVID-19
Chapter 20: Thoracic Radiology: Noninvasive
Diagnostic Imaging Kim M. Kerr, MD
Clinical Professor of Medicine
Kirk D. Jones, MD Division of Pulmonary, Critical Care, and Sleep Medicine
Professor of Pathology University of California San Diego School of Medicine
University of California San Francisco School of Medicine San Diego, California
San Francisco, California Chapter 86: Pulmonary Hypertension Due to Chronic
Chapter 22: Pathology: Neoplastic and Non-neoplastic Thromboembolic Disease: Group 4
Lung Disease
Chapter 72: Bronchiolitis Shaf Keshavjee, MD, MSc, FRCSC, FACS
Professor of Surgery
Marc A. Judson, MD Division of Thoracic Surgery
Chief, Division of Pulmonary and Critical Care Medicine University of Toronto Faculty of Medicine
Albany Medical Center Surgeon-in-Chief
Albany, New York Sprott Department of Surgery
Chapter 93: Sarcoidosis Director, Toronto Lung Transplant Program
Director, Latner Thoracic Research Laboratories
University Health Network
Andre C. Kalil, MD, MPH Toronto, Ontario, Canada
Professor of Internal Medicine
Chapter 140: Lung Transplantation
Division of Infectious Diseases
University of Nebraska Medical Center
Omaha, Nebraska Fayez Kheir, MD, MSCR
Chapter 48: Hospital-Acquired Pneumonia Assistant Professor of Medicine
Division of Pulmonary, Critical Care, and Environmental
Medicine
Tulane University School of Medicine
New Orleans, Louisiana
Chapter 40: Hemoptysis
Contributors xix
Kristen M. Kidson, MD Kristine Konopka, MD

Clinical Instructor Assistant Professor of Pathology
Department of Anesthesiology, Pharmacology, and University of Michigan Medical School
Therapeutics Ann Arbor, Michigan
University of British Columbia Faculty of Medicine Chapter 80: Benign Lung Tumors
Vancouver, British Columbia, Canada
Chapter 11: Respiratory System Mechanics and Energetics Laura L. Koth, MD
Kami Kim, MD Division of Pulmonary and Critical Care Medicine
Andor Szentivanyl Professor of Medicine University of California San Francisco
Director, Division of Infectious Disease & International San Francisco, California
Medicine Chapter 93: Sarcoidosis
University of South Florida Morsani College of Medicine
Global Health Infectious Disease Research Program Robert M. Kotloff, MD
University of South Florida College of Public Health Professor of Clinical Medicine
Tampa, Florida Pulmonary, Allergy, and Critical Care Division
Chapter 58: Parasitic Infections The Perelman School of Medicine at the University of
Pennsylvania
Suil Kim, MD, PhD Philadelphia, Pennsylvania
Assistant Professor Chapter 140: Lung Transplantation
Departments of Medicine, Physiology, and Pharmacology
Oregon Health & Science University Monica Kraft, MD
Director, Pulmonary Function Laboratory Robert and Irene Flinn Professor and Chair
VA Portland Health Care System Department of Medicine
Portland, Oregon College of Medicine, Tucson;
Chapter 71: Large Airway Disorders Deputy Director, Asthma and Airway Disease Research Center
University of Arizona Health Sciences
R. John Kimoff, MD, FRCP(C) Tucson, Arizona
Professor of Medicine Chapter 62: Asthma: Diagnosis and Management
Division of Respiratory Medicine
McGill University Faculty of Medicine Vidya Krishnan, MD, MHS
Director, Sleep Laboratory Associate Professor of Medicine
McGill University Health Centre Case Western Reserve University School of Medicine
Montreal, Quebec, Canada Associate Director, Center for Sleep Medicine
Chapter 120: Obstructive Sleep Apnea Division of Pulmonary, Critical Care, and Sleep Medicine
The MetroHealth System
Talmadge E. King Jr, MD Cleveland, Ohio
Dean, UCSF School of Medicine Chapter 118: Consequences of Sleep Disruption
Vice Chancellor for Medical Affairs
University of California San Francisco Lisa Kroon, PharmD
San Francisco, California Professor and Chair
Chapter 89: Idiopathic Pulmonary Fibrosis Department of Clinical Pharmacy
Chapter 90: Nonspecific Interstitial Pneumonitis and University of California San Francisco School of Pharmacy
Other Idiopathic Interstitial Pneumonias San Francisco, California
Chapter 66: Smoking Cessation
Georgios Kitsios, MD, PhD
Assistant Professor of Medicine Wolfgang M. Kuebler, MD, FERS, FAPS
Division of Pulmonary, Allergy, and Critical Care Professor of Physiology
Medicine Institute of Physiology
University of Pittsburgh School of Medicine Charite–Universitatsmedizin Berlin
Pittsburgh, Pennsylvania Berlin, Germany
Chapter 17: Microbiome Chapter 6: Vascular Biology
Jeffrey S. Klein, MD Elif Küpeli, MD, FCCP

A. Bradley Soule and John P. Tampas Green and Gold Professor of Medicine
Professor of Radiology Pulmonary Department
University of Vermont College of Medicine Baskent Üniversitesi Hastanesi Göğüs Hastalıkları AD
Burlington, Vermont Ankara, Turkey
Chapter 21: Thoracic Radiology: Invasive Diagnostic Chapter 26: Diagnostic Bronchoscopy: Basic
Imaging and Image-Guided Interventions Techniques
xx Contributors
Ware G. Kuschner, MD Warren L. Lee, MD, PhD, FRCP(C)

Chief, Pulmonary Section Associate Professor of Medicine
VA Palo Alto Health Care System; University of Toronto Faculty of Medicine;
Professor of Medicine Attending Physician
Stanford University School of Medicine Medical-Surgical Intensive Care Unit
Palo Alto, California Canada Research Chair, Mechanisms of Endothelial
Chapter 103: Acute Responses to Toxic Exposures Permeability
Staff Scientist, Keenan Research Center
Bart N. Lambrecht, MD, PhD St. Michael’s Hospital, Unity Health Network
Department Director Toronto, Canada
Center for Inflammation Research (IRC) Chapter 134: Acute Respiratory Distress Syndrome
Vlaams Instituut voor Biotechnologie
Zwijnaarde, Belgium; Won Y. Lee, MD
Professor of Pulmonary Medicine Associate Professor of Internal Medicine
Ghent University Division of Pulmonary and Critical Care Medicine
Ghent, Belgium University of Texas Southwestern Medical Center
Chapter 60: Asthma: Pathogenesis and Phenotypes Dallas, Texas
Chapter 128: Pulmonary Complications of Endocrine
Matthew R. Lammi, MD, MSCR Diseases
Division of Pulmonary/Critical Care and Allergy/ Y.C. Gary Lee, MBChB, PhD, FRACP, FCCP
Immunology Professor of Respiratory Medicine
Louisiana State University Health Sciences Center Centre for Respiratory Health
New Orleans, Louisiana University of Western Australia;
Chapter 83: Pulmonary Hypertension: General Approach Consultant, Department of Respiratory Medicine
Director of Pleural Services
Stephen E. Lapinsky, MBBCh, MSc, FRCPC Sir Charles Gairdner Hospital
Professor of Medicine Perth, Australia
University of Toronto Faculty of Medicine Chapter 111: Chylothorax
Director, Intensive Care Unit Chapter 114: Pleural Malignancy
Mount Sinai Hospital
Toronto, Ontario, Canada Teofilo L. Lee-Chiong Jr, MD
Chapter 129: The Lungs in Obstetric and Gynecologic Professor of Medicine
Diseases University of Colorado School of Medicine
National Jewish Health
Stephen C. Lazarus, MD, FCCP, FERS Denver, Colorado
Professor of Medicine Chapter 38: Chest Pain
Senior Investigator, Cardiovascular Research Institute Jonathan M. Lehman, MD, PhD
University of California San Francisco Instructor in Medicine
San Francisco, California Division of Hematology and Oncology
Chapter 64: COPD: Diagnosis and Management Vanderbilt University Medical Center
Nashville, Tennessee
Jarone Lee, MD, MPH, FCCM Chapter 73: Lung Cancer: Molecular Biology and Targets
Associate Professor of Surgery and Emergency Medicine
Harvard Medical School Catherine Lemière, MD, MSc
Medical Director, Blake 12 ICU Professor of Medicine
Trauma, Emergency Surgery, Surgical Critical Care University of Montréal Faculty of Medicine
Department of Emergency Medicine Chest Physician
Massachusetts General Hospital Department of Medicine
Boston, Massachusetts Sacré-Coeur de Montréal Hospital
Chapter 104: Trauma and Blast Injuries Montréal, Canada
Chapter 100: Asthma in the Workplace
Joyce S. Lee, MD
Associate Professor of Medicine Robert J. Lentz, MD
Division of Pulmonary Sciences and Critical Care Assistant Professor of Medicine and Thoracic Surgery
University of Colorado School of Medicine Vanderbilt University Medical Center
Aurora, Colorado Nashville, Tennessee
Chapter 89: Idiopathic Pulmonary Fibrosis Chapter 116: Mediastinitis and Fibrosing Mediastinitis
Chapter 90: Nonspecific Interstitial Pneumonitis and
Other Idiopathic Interstitial Pneumonias
Contributors xxi
Richard W. Light, MD Nicole Lurie, MD, MSPH

Professor of Medicine Strategic Advisor to the CEO
Division of Allergy, Pulmonary, and Critical Care Medicine Coalition for Epidemic Preparedness Innovations (CEPI)
Vanderbilt University School of Medicine Oslo, Norway
Nashville, Tennessee Chapter 59: Outbreaks, Pandemics, and Bioterrorism
Chapter 108: Pleural Effusion
Charles-Edouard Luyt, MD, PhD
Andrew H. Limper, MD Professor
Associate Dean for Practice Transformation Medical Intensive Care Unit
Annenberg Professor of Pulmonary Research Pitié-Salpêtrière Hospital
Department of Internal Medicine Paris, France
Director, Thoracic Diseases Research Unit Chapter 49: Ventilator-Associated Pneumonia
Mayo Clinic College of Medicine
Rochester, Minnesota Stuart M. Lyon, MBBS, FRANZCR, EBIR
Chapter 99: Drug-Induced Pulmonary Disease Associate Professor of Radiology
Monash University
Michael S. Lipnick, MD Melbourne, Australia;
Associate Professor of Anesthesia and Perioperative Care Associate Professor of Radiology
University of California San Francisco School of Medicine Monash Health
Dive Medical Officer Ormond, Australia
California Academy of Sciences Chapter 111: Chylothorax
Chapter 107: Diving Medicine Roberto F. Machado, MD
Dr. Calvin H. English Professor of Medicine
Stanley Yung-Chuan Liu, MD, DDS, FACS Chief, Division of Pulmonary, Critical Care, Sleep, and
Assistant Professor of Otolaryngology Occupational Medicine
Assistant Professor of Plastic and Reconstructive Surgery, Indiana University School of Medicine
by Courtesy Indianapolis, Indiana
Co-director, Sleep Surgery Fellowship Chapter 127: Pulmonary Complications of Hematologic
Department of Otolaryngology Diseases
Stanford University School of Medicine;
Chief, Maxillofacial Surgery Lisa A. Maier, MD, MSPH, FCCP
Stanford Health Care Professor of Medicine
Stanford, California Chief, Division of Environmental and Occupational Health
Chapter 122: Sleep-Disordered Breathing: Treatment National Jewish Health
University of Colorado, Colorado School of Public Health
James E. Loyd, MD Denver, Colorado
Professor of Medicine Chapter 35: Evaluation of Respiratory Impairment and
Rudy W. Jacobson Chair in Pulmonary Medicine Disability
Division of Allergy, Pulmonary, and Critical Care Medicine
Vanderbilt University Medical Center
Atul Malhotra, MD
Nashville, Tennessee Peter C. Farrell Presidential Chair in Respiratory Medicine
Chapter 116: Mediastinitis and Fibrosing Mediastinitis Research Chief of Pulmonary and Critical Care Medicine
Director of Sleep Medicine
Njira Lugogo, MD University of California San Diego School of Medicine
Associate Professor of Medicine San Diego, California
Division of Pulmonary, Critical Care Medicine Chapter 117: Control of Breathing and Upper Airways
University of Michigan Medical School During Sleep
Ann Arbor, Michigan
Chapter 62: Asthma: Diagnosis and Management Thomas R. Martin, MD
Emeritus Professor of Medicine
Andrew M. Luks, MD University of Washington School of Medicine
Professor of Medicine Seattle, Washington;
Division of Pulmonary, Critical Care, and Sleep Medicine Global Head, Respiratory Therapeutic Area
University of Washington School of Medicine Global Drug Development
Seattle, Washington Novartis Pharmaceuticals
Chapter 33: Exercise Testing East Hanover, New Jersey
Chapter 105: High Altitude Chapter 15: Innate Immunity
xxii Contributors
Nick A. Maskell, DM, FRCP Anna M. May, MD, MS

Academic Respiratory Unit Assistant Professor
Translational Health Sciences Staff, Sleep Medicine Division
University of Bristol Medical School; Staff, Pulmonary and Critical Care Division
Respiratory Department Staff, Research Division
North Bristol NHS Trust VA Northeast Ohio Healthcare System;
Bristol, United Kingdom Staff, Division of Pulmonary, Critical Care, and Sleep
Chapter 109: Pleural Infections Medicine
University Hospitals Cleveland Medical Center
Pierre P. Massion, MD Staff, School of Medicine
Professor of Medicine, Cancer Biology, Radiology, and Case Western Reserve University
Radiological Sciences Cleveland, Ohio
Division of Allergy, Pulmonary, and Critical Care Chapter 122: Sleep-Disordered Breathing: Treatment
Medicine
Vanderbilt University School of Medicine Annyce S. Mayer, MD, MSPH
Director, Cancer Early Detection and Prevention Initiative Associate Professor of Medicine
Co-leader, Cancer Health Outcomes and Control Research Division of Environmental and Occupational Health
Program National Jewish Health
Vanderbilt Ingream Cancer Center University of Colorado, Colorado School of Public Health
Nashville, Tennessee Denver, Colorado
Chapter 73: Lung Cancer: Molecular Biology and Chapter 35: Evaluation of Respiratory Impairment and
Targets Disability
Stephen C. Mathai, MD, MHS Peter J. Mazzone, MD, MPH, FCCP

Associate Professor of Medicine Clinical Assistant Professor of Medicine
Division of Pulmonary and Critical Care Medicine Case Western Reserve University School of Medicine;
Johns Hopkins University School of Medicine Director, Lung Cancer Program
Baltimore, Maryland Respiratory Institute
Chapter 83: Pulmonary Hypertension: General Cleveland Clinic
Approach Cleveland, Ohio
Chapter 75: Lung Cancer: Screening
Scott M. Matson, MD
Assistant Professor of Medicine Stuart B. Mazzone, PhD
Division of Pulmonary, Critical Care, and Sleep Medicine Professor of Neuroscience
University of Kansas School of Medicine Department of Anatomy and Neuroscience
Kansas City, Kansas University of Melbourne
Chapter 94: Diffuse Alveolar Hemorrhage Parkville, Victoria, Australia
Chapter 37: Cough
Michael A. Matthay, MD
Professor of Medicine and Anesthesia Cormac McCarthy, MD, PhD
Cardiovascular Research Institute Associate Professor of Medicine
University of California San Francisco University College Dublin
San Francisco, California Consultant Respiratory Physician
Chapter 133: Pulmonary Edema St. Vincent’s Hospital Group
Dublin, Ireland
Richard A. Matthay, MD Chapter 98: Pulmonary Alveolar Proteinosis Syndrome
Professor Emeritus and Senior Research Scientist in
Medicine F. Dennis McCool, MD
Yale School of Medicine Professor of Medicine
New Haven, Connecticut Division of Pulmonary and Critical Care Medicine
Chapter 38: Chest Pain Alpert Medical School of Brown University
Chapter 130: The Respiratory System and Neuromuscu-
lar Diseases
Chapter 131: The Respiratory System and Chest Wall
Diseases
Contributors xxiii
Francis X. McCormack, MD Nuala J. Meyer, MD, MS

Taylor Professor and Director Associate Professor of Medicine
Division of Pulmonary, Critical Care, and Sleep Medicine Division of Pulmonary, Allergy, and Critical Care Medicine
University of Cincinnati College of Medicine Perelman School of Medicine at the University of
Cincinnati, Ohio Pennsylvania
Chapter 97: Lymphangioleiomyomatosis Philadelphia, Pennsylvania
Chapter 133: Pulmonary Edema
Meredith C. McCormack, MD, MHS
Associate Professor of Medicine Isabel C. Mira-Avendano, MD
Division of Pulmonary and Critical Care Medicine Assistant Professor of Medicine
Johns Hopkins University School of Medicine Mayo Clinic Florida
Baltimore, Maryland Jacksonville, Florida
Chapter 10: Ventilation, Blood Flow, and Gas Exchange Chapter 95: Pulmonary Langerhans Cell Histiocytosis
and Other Rare Diffuse Infiltrative Lung Diseases
David McCulley, MD
Assistant Professor of Pediatrics Gita N. Mody, MD, MPH
University of Wisconsin School of Medicine Assistant Professor of Surgery
Madison, Wisconsin Division of Cardiothoracic Surgery
Chapter 2: Lung Growth and Development University of North Carolina School of Medicine
Chapel Hill, North Carolina
Bryan J. McVerry, MD Chapter 77: Lung Cancer: Treatment
Associate Professor of Medicine, Environmental and Occu-
pational Health, and Clinical and Translational Science Babak Mokhlesi, MD, MSc
Division of Pulmonary, Allergy, and Critical Care Medicine Professor of Medicine
University of Pittsburgh School of Medicine Section of Pulmonary and Critical Care
Pittsburgh, Pennsylvania Director, Sleep Disorders Center
Chapter 17: Microbiome Director, Sleep Medicine Fellowship Program
The University of Chicago Pritzker School of Medicine
Reena Mehra, MD, MS, FCCP, FAASM, FAHA Chicago, Illinois
Professor of Medicine Chapter 45: Hypercapnia
Cleveland Clinic Lerner College of Medicine of Case
Western Reserve University Alison Morris, MD, MS
Director, Sleep Disorders Research, Neurologic Institute Professor of Medicine
Staff, Respiratory Institute Division Chief, Pulmonary, Allergy, and Critical Care
Staff, Heart and Vascular Institute Medicine
Staff, Department of Molecular Cardiology, Lerner Director, Center for Medicine and the Microbiome
Research Institute University of Pittsburgh School of Medicine
Cleveland Clinic Pittsburgh, Pennsylvania
Cleveland, Ohio Chapter 17: Microbiome
Chapter 122: Sleep-Disordered Breathing: Treatment
Amy E. Morris, MD
Atul C. Mehta, MBBS, FACP, FCCP Associate Professor of Medicine
Buoncore Family Endowed Chair in Lung Transplantation Division of Pulmonary, Critical Care, and Sleep Medicine
Professor of Medicine University of Washington School of Medicine
Lerner College of Medicine Seattle, Washington
Staff Physician Chapter 23: Ultrasonography: Principles and Basic
Respiratory Institute Thoracic and Vascular Imaging
Cleveland Clinic
Cleveland, Ohio Timothy A. Morris, MD
Chapter 26: Diagnostic Bronchoscopy: Basic Techniques Professor of Medicine
Mark L. Metersky, MD University of California San Diego School of Medicine
Professor of Medicine Clinical Service Chief
Division of Pulmonary, Critical Care, and Sleep Medicine University of California San Diego Medical Center
University of Connecticut School of Medicine San Diego, California
Farmington, Connecticut Chapter 81: Pulmonary Thromboembolism: Presentation
Chapter 48: Hospital-Acquired Pneumonia and Diagnosis
xxiv Contributors
Rory E. Morty, PhD Stephen L. Nishimura, MD

Department of Translational Pulmonology Professor of Pathology
University Hospital Heidelberg University of California San Francisco School of Medicine
Heidelberg, Germany San Francisco, California
Chapter 1: Anatomy Chapter 22: Pathology: Neoplastic and Non-neoplastic
Lung Disease
Lakshmi Mudambi, MBBS
Assistant Professor of Medicine Joshua D. Nosanchuk, MD
Oregon Health & Science University Senior Associate Dean
Director, Interventional Pulmonology Professor of Medicine and Microbiology & Immunology
VA Portland Health Care System Albert Einstein College of Medicine
Portland, Oregon New York, New York
Chapter 71: Large Airway Disorders Chapter 56: Endemic Fungal Infections
John S. Munger, MD Thomas G. O’Riordan, MD, MPH

Associate Professor of Medicine and Cell Biology Vice President US Medical Affairs
New York University Grossman School of Medicine Respiratory Therapeutic Area Head
New York, New York GlaxoSmithKline
Chapter 46a: COVID-19 Philadelphia, Pennsylvania
Chapter 13: Aerosols and Drug Delivery
Mohammed Munavvar, MD, DNB, FRCP(Lon),
FRCP(Edin) Victor Enrique Ortega, MD, PhD
Consultant Chest Physician Associate Professor of Medicine
Department of Respiratory Medicine Center for Precision Medicine
Lancashire Teaching Hospitals Wake Forest School of Medicine
Preston, United Kingdom Winston-Salem, North Carolina
Chapter 29: Thoracoscopy Chapter 60: Asthma: Pathogenesis and Phenotypes
Payam Nahid, MD, MPH Justin R. Ortiz, MD, MS, FCCP

Center for Vaccine Development and Global Health
Department of Medicine
University of California San Francisco Center for
University of Maryland School of Medicine
Tuberculosis
Baltimore, Maryland
University of California San Francisco School of Medicine
Zuckerberg San Francisco General Hospital Chapter 47: Influenza
Chapter 54: Tuberculosis: Treatment of Drug-Susceptible Sushmita Pamidi, MD, MSc
and Drug-Resistant
Division of Respiratory Medicine
McGill University Faculty of Medicine
Catherine Nelson-Piercy, MBBS, MA, FRCP, FRCOG Sleep Laboratory
Professor of Obstetric Medicine McGill University Health Centre
Women’s Health Academic Centre Montreal, Quebec, Canada
King’s Health Partners Chapter 120: Obstructive Sleep Apnea
Consultant Obstetric Physician
Women’s Health Service
Guy’s & St Thomas’ Foundation Trust
Nicholas J. Pastis, MD, FCCP
Consultant Obstetric Physician
Division of Pulmonary and Critical Care
Queen Charlotte’s and Chelsea Hospital
Medical University of South Carolina
Imperial College Healthcare Trust
Section Chief, Pulmonary and Critical Care
London, United Kingdom
Ralph H. Johnson Veterans Administration Medical Center
Chapter 129: The Lungs in Obstetric and Gynecologic Charleston, South Carolina
Diseases Chapter 76: Lung Cancer: Diagnosis and Staging
Linda Nici, MD
The Warren Alpert Medical School of Brown University
Chief, Pulmonary and Critical Care Medicine
Providence Veterans Affairs Medical Center
Chapter 139: Pulmonary Rehabilitation
Contributors xxv
Sanjay R. Patel, MD, MS Benjamin A. Pinsky, MD, PhD

Professor of Medicine, Epidemiology, and Clinical and Associate Professor
Translational Science Departments of Pathology and Medicine (Infectious
Division of Pulmonary Allergy and Critical Care Medicine Diseases)
University of Pittsburgh School of Medicine Stanford University School of Medicine
Pittsburgh, Pennsylvania Medical Director, Clinical Virology Laboratory
Chapter 118: Consequences of Sleep Disruption Stanford Health Care and Stanford Children’s Health
Stanford, California
Nicolò Patroniti, MD Chapter 19: Microbiologic Diagnosis of Lung Infection
Professor
Anesthesia and Intensive Care Steven D. Pletcher, MD
Ospedale Policlinico San Martino Professor and Director, Residency Training Program
IRCCS Department of Otolaryngology–Head and Neck Surgery
Department of Surgical Sciences and Integrated University of California San Francisco
Diagnostics (DISC) San Francisco, California
University of Genoa Chapter 70: Upper Airway Disorders
Genoa, Italy
Chapter 138: Extracorporeal Support of Gas Exchange Vikramaditya Prabhudesai, MBBS, MS, FRCR
Steven A. Pergam, MD, MPH University of Toronto Faculty of Medicine;
Associate Professor Interventional Radiologist
Vaccine and Infectious Disease Division Department of Medical Imaging
Fred Hutchinson Cancer Research Center; St. Michael’s Hospital
Associate Professor of Medicine Toronto, Ontario, Canada
University of Washington School of Medicine; Chapter 88: Pulmonary Vascular Anomalies
Director, Infection Prevention
Seattle Cancer Care Alliance Loretta G. Que, MD
Seattle, Washington Professor of Medicine
Chapter 125: Pulmonary Complications of Stem Cell and Division of Pulmonary, Allergy, and Critical Care Medicine
Solid Organ Transplantation Duke University Health System
Durham, North Carolina
Antonio Pesenti, MD Chapter 62: Asthma: Diagnosis and Management
Professor of Anesthesia and Critical Care
Department of Pathophysiology and Transplantation Bryon D. Quick, MD
University of Milan Chair, Department of Pulmonary and Sleep Medicine
Director, Dipartimento di Anestesia–Rianimazione e Emer- Kaiser Permanente Oakland Medical Center
genza Urgenza Oakland, California
Fondazione IRCCS Ca’ Granda–Ospedale Maggiore Policlinico Chapter 126: Pulmonary Complications of Abdominal
Milan, Italy Diseases
Chapter 138: Extracorporeal Support of Gas Exchange
Najib M. Rahman, BM, BCh, MA(Oxon), MSc, FRCP,
Michael C. Peters, MD, MAS DPhil
Assistant Professor of Medicine Professor of Respiratory Medicine
Division of Pulmonary and Critical Care Medicine Head, Oxford Pleural Unit
University of California San Francisco Director of Oxford Respiratory Trials Unit (ORTU)
San Francisco, California Nuffield Department of Medicine
Chapter 61: Asthma and Obesity University of Oxford
Oxford, United Kingdom
Kurt Pfeifer, MD, FACP, SFHM Chapter 29: Thoracoscopy
Professor of Medicine Chapter 110: Pneumothorax
Division of General Internal Medicine
Medical College of Wisconsin
Milwaukee, Wisconsin
J. Usha Raj, MD, MHA
Anjuli S. Nayak Professor of Pediatrics
Chapter 34: Preoperative Evaluation University of Illinois College of Medicine at Chicago
Chicago, Illinois
Jennifer A. Philips, MD, PhD Chapter 6: Vascular Biology
Co-director, Division of Infectious Diseases
Washington University in St. Louis
St. Louis, Missouri
Chapter 52: Tuberculosis: Pathogenesis and Immunity
xxvi Contributors
Maria I. Ramirez, PhD Carolyn L. Rochester, MD

Associate Professor of Medicine Professor of Medicine
Division of Pulmonary, Allergy, and Critical Care Medicine Section of Pulmonary, Critical Care, and Sleep Medicine
Center for Translational Medicine Yale University School of Medicine
Jane and Leonard Korman Respiratory Institute Director, Yale COPD Program
Sidney Kimmel Medical College at Thomas Jefferson Director, Pulmonary Rehabilitation
University VA Connecticut Healthcare System
Philadelphia, Pennsylvania New Haven, Connecticut
Chapter 1: Anatomy Chapter 139: Pulmonary Rehabilitation
Chapter 5: Lung Mesenchyme
Jesse Roman, MD
Rishindra M. Reddy, MD Professor of Medicine
Associate Professor of Surgery Division of Pulmonary, Allergy, and Critical Care Medicine
Section of Thoracic Surgery Center for Translational Medicine
University of Michigan Medical School Jane and Leonard Korman Respiratory Institute
Ann Arbor, Michigan Sidney Kimmel Medical College at Thomas Jefferson
Chapter 79: Metastatic Malignant Tumors University
Philadelphia, Pennsylvania
Elizabeth F. Redente, PhD Chapter 5: Lung Mesenchyme
Associate Professor of Pediatrics
Division of Cell Biology Alexandra Rose, MD
National Jewish Health Assistant Clinical Professor of Medicine
Denver, Colorado Division of Pulmonary and Critical Care Medicine
Chapter 15: Innate Immunity University of California San Diego School of Medicine
San Diego, California
Hasina Outtz Reed, MD, PhD Chapter 81: Pulmonary Thromboembolism: Presentation
Assistant Professor of Medicine and Diagnosis
Weill Cornell Medicine Clark A. Rosen, MD
New York, New York Lewis Francis Morrison, MD, Endowed Chair in
Chapter 7: Lymphatic Biology Laryngology
Professor, Department of Otolaryngology–Head and Neck
R. Lee Reinhardt, PhD Surgery
Associate Professor of Biomedical Research Chief, Division of Laryngology
National Jewish Health Co-Director, UCSF Voice and Swallowing Center
Department of Immunology and Microbiology University of California San Francisco
University of Colorado Anschutz Medical Campus San Francisco, California
Aurora, Colorado Chapter 70: Upper Airway Disorders
Chapter 16: Adaptive Immunity
John M. Routes, MD
David W.H. Riches, PhD Professor of Pediatrics, Medicine, and Microbiology and
Professor of Medicine and Immunology Immunology
Division of Pulmonary Sciences and Critical Care Medicine Medical College of Wisconsin
University of Colorado Anschutz Medical Campus Milwaukee, Wisconsin
Aurora, Colorado; Chapter 124: Pulmonary Complications of Primary
Professor and Division Head Immunodeficiencies
Program in Cell Biology
National Jewish Health Steven M. Rowe, MD, MSPH
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Chapter 15: Innate Immunity University of Alabama at Birmingham School of Medicine
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Aunt Martha bit her lips, and two bright pink spots showed on her
cheeks. “This is scandalous!” she exclaimed.
“It’s downright wicked!” said old Mrs. Lancaster.
The minister went on with the service, raising his voice to make
himself heard; but Don, and doubtless many others, had little thought
for what was being said inside the church.
At the end of the service many of the people hurried past the soldiers
on their way home; but others stood and watched with indignant
glances.
That event was only one of many other irritations that followed and
inflamed the hearts of the townsfolk.
“Aunt Martha, war has got to come,” said Don.
“Don’t speak of it, Donald,” she replied, and Don glanced once at his
aunt’s face and wished that he had held his tongue in the first place;
his aunt’s eyes were red and moist.
“All that cloth and powder is still in the cellar, isn’t it?” he asked a
while later.
“Yes, Donald; and your uncle intends to keep it there until he can find
a satisfactory way of getting it out, though what with all the trouble
that surrounds us, I do believe that he doesn’t often give it a thought
any more.”
“Seems too bad not to sell it,” said Don.
“Yes, I’ve said so myself, but he always nods and says, ‘Yes, that’s
right,’ and then his mind goes wandering off on—on other matters.”
David Hollis, and indeed all the members of the Committees of
Correspondence, had many matters to keep them busy. A close
watch was being kept on the troops in town. It was known that Gage
had sent two officers in disguise to make maps of the roads that led
to Boston; and rumor had it that he intended to send a strong force
to Concord to capture supplies that the patriots had stored there.
The month of March dragged past with war-like preparations on both
sides. Many of the townsfolk, realizing that open hostilities must
begin soon, had moved into the country. Samuel Adams and John
Hancock had gone to Lexington, where they were staying with the
Rev. Jonas Clark. David Hollis and Glen Drake had both made
several trips to the town with messages for them.
One day early in April, David Hollis took his wife aside out of hearing
of his nephew. “Martha,” he said in a low voice, “I want you to leave
the house for a while. There’s going to be trouble, and Boston will be
no safe place for you.”
Aunt Martha’s chin lifted a trifle. “And, pray, where should I go?” she
asked.
“To Cousin Deborah’s in Concord.”
“I shall not go!” Aunt Martha replied.
“But she has already prepared for you; I told her you’d come.”
“You had no right to say that.”
“But, Martha, listen to reason. I say there will be trouble—I know it!
And it’s coming soon. Need I speak plainer than that?”
“No, David, you need not. I understand. Yet I intend to remain right
here in our home.”
David Hollis threw out his hands and turned away. Then with another
gesture he said, “Martha Hollis, you are a foolish woman. I—I
command you to go; it is for your own good.”
Aunt Martha’s blue eyes flashed behind her spectacles. “And I refuse
to obey. My place is here, and here is where I stay.” Then with a
sudden flash of anger she exclaimed, “I’d like to see any Redcoats
drive me from my own home!”
David Hollis turned toward the fire and snapped his fingers several
times. “It’s too bad,” he said. “Stubbornness is not a virtue.”
“You have it!”
Uncle David made no reply.
“You tell Cousin Deborah that I’m sorry she has gone to any trouble
about me.”
“I don’t expect to go that way very soon.”
“Then Glen can see her.”
“Glen has gone—elsewhere.”
Aunt Martha was thoughtful. “Well,” she said at last, “as you say, it is
too bad, but, David, my mind is made up.”
“How would it be to send Donald? Seems to me it might be a good
vacation for him. He’s an able lad, and I know that he’d be glad to
make the trip. He could ride almost as far as Lexington with Harry
Henderson. Cousin Deborah would be glad to have him for
overnight.”
“Dear me!” said Aunt Martha. “I can’t allow it.”
But in the end she yielded, and that evening Don heard the news
with glee. “Your cousin is a nervous, exact kind of person,” his aunt
told him, “and I want you to tell her everything that I say.”
“But what is it?” asked Don.
“Tell her that I am very sorry she has gone to any trouble on my
account, but that I cannot with a clear conscience visit with her at
this time. Say also that when your uncle promised for me he had not
consulted me and therefore did not know all the facts.”
“She’ll want to know the facts,” said Don, grinning. “I’m kind of
curious myself, Aunt Martha.”
“Donald!”
But Don’s grin was irresistible, and his aunt smiled. “Never mind,”
she said. “And you’ll hurry home, won’t you?”
“I surely will, Aunt Martha.”
The next morning, the sixteenth of April, Don set out with Harry
Henderson, a raw-boned young fellow with red hair and a short
growth of red stubble on his face. The soldiers had just finished
standing parade on the Common when Don and Harry rattled by in
the cart; Harry’s light blue eyes narrowed as he watched them
moving in little groups to their barracks.
“Good morning to you, young sir,” said a cheerful voice.
Don, looking up, saw Harry Hawkins. “Good morning to you, sir,” he
replied.
Harry Henderson looked at his companion narrowly. “Friend of
yours?” he asked.
“Well, no, not exactly,” replied the boy.
“Friend of your uncle’s maybe?” Harry was grinning impudently now,
and Don’s cheeks were red.
“No; here’s how it is——” And Don gave a brief account of how he
had happened to meet the Redcoat.
“Well,” said Harry dryly, “I should think he might say good morning to
you.”
They passed the Common and finally turned into Orange Street and,
after some delay, drove past the fortifications on the Neck. “Clear of
’em b’gosh!” said Harry, cracking his whip. “We’ll reach Lexin’ton by
mid-afternoon if old Dan here doesn’t bust a leg.”
But Harry had not reckoned on horseshoes. Shortly before they
reached Medford, old Dan lost a shoe, and the circumstance caused
a delay of two hours. Then later Dan shied at a barking dog and
snapped one of the shafts. As a result Harry and Don did not reach
Lexington until almost ten o’clock.
“You’ve got to stay right here with me,” said Harry, “It’s too late for
you to reach Concord. I know your cousin, and she wouldn’t be at all
pleased to have you wake her at midnight—not she!” He laughed.
So Don remained at Lexington overnight and the next morning set
out on foot for Concord. He reached his cousin’s house just before
noon.
Cousin Deborah was a tall strong-looking woman with black hair,
black eyes and a nose that was overly large. She had once been a
school teacher and, as David Hollis used to say, had never lost the
look. “Where’s your Aunt Martha?” were her first words to Don.
“She decided she couldn’t come.”
“But Uncle David told me——”
Then followed the inevitable questions that a person like Cousin
Deborah would be sure to ask, and Don wriggled under each of
them. But after all, Cousin Deborah was good-hearted, and deep
within her she knew that she would have done the same as Don’s
aunt was doing, if she had been in similar circumstances—though
she would not acknowledge it now. “Your aunt always did have a
broad streak of will,” she said severely. “Now I want you to spend
several days with me, Donald.”
“Aunt Martha told me to hurry back.”
“That means you can stay to-night and to-morrow night,” Cousin
Deborah decided. “I’ll have dinner in a few moments, and then I want
you to tell me all the things that have happened in Boston.”
In spite of his cousin’s questions, which were many and varied, Don
managed to enjoy himself while he was at Concord. On the second
day he met a boy of his own age, and the two fished all morning from
the North Bridge. In the afternoon they went on a long tramp into the
woods along the stream.
At night Don was tired out and was glad when his cousin finally
snuffed the candles and led the way up-stairs. He was asleep shortly
after his head struck the pillow.
That night proved to be one of the most eventful in the history of the
Colonies.
CHAPTER V
THE REGULARS COME OUT
While Don was asleep, breathing the damp, fragrant air that blew
over the rolling hills and fields round Concord, his friend, Paul
Revere, was being rowed cautiously from the vicinity of Hudson’s
Point toward Charlestown. It was then near half-past ten o’clock.
Revere, muffled in a long cloak, sat in the stern of the small boat and
glanced now at his two companions—Thomas Richardson and
Joshua Bentley—and now at the British man-of-war, Somerset, only
a few rods off. The tide was at young flood, and the moon was rising.
The night seemed all black and silver—black shadows ahead where
the town of Charlestown lay, black shadows behind that shrouded
the wharfs and shipyards of the North End, and silver shimmering
splashes on the uneasy water and on the sleek spars of the
Somerset.
The sound of talking came from the direction of the man-of-war and
was followed by a burst of laughter that reverberated musically in the
cool night air. Revere blew on his hands to warm them. The little
boat drew nearer, nearer to Charlestown; now he could see the
vague outlines of wharfs and houses. Several times he glanced over
his shoulder in the direction of a solitary yellow light that gleamed in
the black-and-silver night high among the shadows on the Boston
side,—a light that burned steadily in the belfry of the Old North
Meeting-House behind Corps Hill as a signal that the British were on
their way by land to attack the Colonists.
“Here we are,” said one of the rowers, shipping his muffled oar and
partly turning in his seat.
A few minutes later the boat swung against a wharf, and the two
men at the oars held it steady while Revere stepped out. A brief
word or two and he was on his way up the dock. In the town he soon
met a group of patriots, one of whom, Richard Devens, got a horse
for him. Revere lost no time in mounting and setting off to warn the
countryside of the coming of the Redcoats.
He had not gone far beyond Charlestown Neck, however, when he
almost rode into two British officers who were waiting in the shadows
beneath a tree. One of them rode out into the middle of the path; the
other charged full at the American. Like a flash Revere turned his
horse and galloped back toward the Neck and then pushed for the
Medford road. The Redcoat, unfamiliar with the ground, had ridden
into a clay pit, and before he could get his horse free Revere was
safely out of his reach.
At Medford he roused the captain of the Minute-Men; and from there
to Lexington he stopped at almost every house along the road and
summoned the inmates from their beds. It was close to midnight
when he reached Lexington. Riding to the house of the Rev. Jonas
Clark, where Hancock and Adams were staying, he found eight men
on guard in command of a sergeant.
“Don’t make so much noise!” cried the fellow as Revere clattered up
to the gate.
“Noise!” repeated Revere in a hoarse voice. “You’ll have noise
enough here before long—the regulars are coming out!”
At that moment a window opened, and Hancock thrust his head out.
“Come in, Revere!” he said. “We’re not afraid of you!”
Revere dismounted and hurried inside. In a few words he told his
story, that the British were on their way either to capture Hancock
and Adams or to destroy the military stores at Concord. While he
was talking, William Dawes, who also had set out to warn the
people, clattered up to the door.
After he and Revere had had something to eat and to drink they
started for Concord and were joined by a Dr. Prescott, whom Don
had seen once or twice in company with his uncle. With Revere in
the lead the party rode on at a rapid pace.
About half-way to Concord, while Prescott and Dawes were rousing
the people in a house near the road, Revere spied two horsemen
ahead. Turning in his saddle, he shouted to his companions, and at
that moment two more horsemen appeared.
Prescott came riding forward in answer to the shout, and he and
Revere tried to get past the men, all of whom were British officers.
But the four of them were armed, and they forced the Americans into
a pasture. Prescott at once urged his horse into a gallop, jumped a
stone wall and, riding in headlong flight, was soon safe on his way to
Concord. Revere urged his horse toward a near-by wood, but just
before he reached it six British officers rode out, and he was a
prisoner.
“Are you an express?” demanded one of them.
“Yes,” replied Revere and with a smile added: “Gentlemen, you have
missed your aim. I left Boston after your troops had landed at
Lechemere Point, and if I had not been certain that the people, to the
distance of fifty miles into the country, had been notified of your
movements I would have risked one shot before you should have
taken me.”
For a moment no one spoke; it was clear that the Redcoats were
taken aback. Then followed more questions, all of which Revere
answered truthfully and without hesitating. Finally they ordered their
prisoner to mount, and all rode slowly toward Lexington. They were
not far from the meeting-house when the crash of musketry shook
the night air.
For an instant the major who was in command of the party thought
they had been fired on. Then he remarked to the officer beside him,
“It’s the militia.”
The officer laughed shortly and glanced at their prisoner. Then the
party halted, and the British took Revere’s horse. The major asked
him how far it was to Cambridge and, on being told, left the prisoner
standing in the field and with the rest of the party rode toward the
meeting-house.
A few minutes later Revere crossed the old burying-ground and
entered the town. He soon found Hancock and Adams again and
told them what had happened, and they concluded to take refuge in
the town of Woburn. Revere went with them. He had done his duty.
Perhaps it was a vague feeling of impending danger, perhaps it was
the mere twitter of a bird outside his window—at any rate Don awoke
with a start. All was darkness in the room. A light, cool wind stirred
the branches of the great elm at the side of the house; he could hear
the twigs rubbing gently against the rough shingles. He had no idea
what time it was; it must be after midnight, he thought; but somehow
he was not sleepy. He raised his head a trifle. Down-stairs a door
slammed; that seemed strange. Now someone was talking. “I
wonder——” he said to himself and then sat bolt upright in bed.
The church bell had begun to ring at a furious rate. Clang, clang!
Clang—clang! Don thought he had never before heard a bell ring so
harshly or so unevenly. He jumped out of bed and began to dress.
Clang! Clang! What in the world could be the matter? He could hear
shouts now and the sound of hastening footsteps. In his excitement
he got the wrong arm into his shirt. Clang! Clang—clang! He found
his shoes at last and with trembling fingers got them on his feet. He
unlatched the door and started carefully down the winding stairs. It
seemed as if there were a hundred steps to those creaking old
stairs. Twice he almost missed his footing—and all the while the bell
continued to clash and ring and tremble.
In the sitting-room a single candle was burning. Don got a glimpse of
his cousin Deborah, hastily dressed and still wearing her nightcap;
she was standing at the door, and his Cousin Eben, with a musket in
his hand and a powder horn over his shoulder, was saying good-bye.
Don saw him kiss his wife. Then the door opened, the candle
flickered, and he was gone.
“Cousin Deborah, what’s wrong?” cried Don.
“The regulars are coming!” And then Cousin Deborah burst into
tears.
Don bit his lips; he had never thought of his cousin as being capable
of tears.
They did not last long. A few movements of her handkerchief and
Cousin Deborah seemed like herself again. “Donald,” she said, “they
have begun it, and the good Lord is always on the side of the right.
Now I want you to go back to bed and get your rest.”
“Are you going back to bed, Cousin Deborah?”
“No; there will be no sleep for me this night.”
“Then I shall remain up also,” replied Don.
Cousin Deborah made no protest but went to the stove and poked
the fire.
The bell had ceased ringing now. The town of Concord was wide
awake.
While Don and his cousin were eating a hastily prepared breakfast
the Minute-Men and the militia assembled on the parade ground
near the meeting-house. Meanwhile other patriots were hard at work
transporting the military stores to a place of safety.
Dawn was breaking, and the mist was rising from the river when Don
and his cousin finally got up from the table. “Now, Donald,” said
Cousin Deborah, “I’ve been thinking all along of your Aunt Martha
and blaming myself for my selfishness in having you stay here with
me for so long. I’d give most anything if you were back there with
her. And yet——” She paused frowning.
“Oh, I can get back all right,” said Don confidently.
“How?”
“Why, by keeping off the roads as much as possible. I know the
country pretty well.”
“You’re a bright lad, Donald,” said Cousin Deborah. “You’re a bright
lad; and I don’t know but what you’d better start. Your aunt needs
you more than I do. But oh, Donald, you’ll be cautious!”
“I don’t think I ought to leave you here alone.”
“Drat the boy!” exclaimed his cousin and then smiled. “Bless you,
Donald,” she added, “I’ll be safe enough. I shall go to Mrs. Barton’s
until things are quiet again. Now go and get yourself ready.”
Don needed only a few moments in which to get his things together.
Then he walked with his cousin as far as Mrs. Barton’s house, which
was situated some distance beyond the North Bridge, bade her
good-bye and started back. It was growing lighter every minute now,
and the birds were singing in all the trees. On the road he met a
Minute-Man who was hurrying in the opposite direction, and asked
him the news.
“Regulars fired on our boys at Lexin’ton,” replied the fellow as he
hurried past. Over his shoulder he shouted, “Killed six of ’em—war’s
begun!”
Don said not a word in reply, but stood stock still in the road. For
some reason a great lump had come into his throat, and he thought
of his Aunt Martha. He must get to her as quickly as possible.
As he came near the North Bridge he saw the Provincial troops—the
Minute-Men and the militia of the town and detachments of Minute-
Men from some of the outlying towns; and all the while fresh soldiers
were hurrying to swell the numbers. The British, he soon learned,
were on their way to Concord, and several companies of Provincials
had gone out to meet them.
Don left the town and struck off into the open country several
hundred yards from the Lexington road. After a few minutes of rapid
walking he saw the detachment of Americans coming back. He
quickened his pace and finally broke into a run.
He had gone something more than a mile and a half when he
suddenly stopped and threw himself on the ground. There on the
road, marching steadily in the direction of Concord, was a large force
of regulars. He could see the flash of metal and the bright red of their
coats. For a while he lay there, panting. Then at last, spying a great
rock with a hollow just behind it, he crept toward it and waited.
The long column advanced slowly. Now Don could hear the crunch
of their feet on the hard road. He lifted his head cautiously and
began to count; there must easily be a thousand Redcoats. The
crunching grew louder as the head of the column came almost
opposite to him. Now he could hear the rattle of equipment and the
occasional jangling of a sword.
He Lifted His Head Cautiously and Began to Count.
It was some time before the rear of the column had passed. He
waited until it was perhaps a quarter of a mile up the road and then
got to his feet. He ought not to have much trouble in reaching Boston
if he started at once. He was about to resume his journey when a
fresh thought came to him. Ought he to go without knowing what
was to happen to the town of Concord—and to his Cousin Deborah?
For at least five minutes he struggled with the question. “No, I
oughtn’t!” he declared at last and, turning suddenly, began to retrace
his steps.
It was close to seven o’clock when the regulars, in two columns,
marched into Concord and sent a party over the North Bridge into
the country. Don found a clump of spruces growing on a hillside and
climbed into the lower branches of one of them. From that position
he could see the scattered houses and the two bridges, though the
distance was too great for him to be able to distinguish features or
even the outlines of anybody in the town.
Part of the King’s force seemed to have disbanded, and later when
Don heard the ring of axes he suspected that they were destroying
the stores that had not been carried away. “Well,” he thought, “they
won’t be able to destroy much.”
But when he distinguished blue smoke curling upward from several
places near the centre of the town he almost lost his grip on the
branch to which he was clinging. One of them was the court-house!
Where was the militia? Where were the Minute-Men? He made out
the peaked roof of his cousin’s house and the great elm standing
beside it, and observed with some satisfaction that no Redcoats
were close to it. Then a while later he saw the thread of smoke
above the court-house grow thinner, and at last it disappeared
altogether.
Don held his position in the tree for more than an hour. He ground
his teeth as he saw a detachment of soldiers leave the town and cut
down the liberty pole on the side of the hill. Where were the Minute-
Men and the militia?
The main body of the regulars was well inside the town. At the South
Bridge there was a small party on guard, and at the North Bridge
was another party of about one hundred. Don was so much occupied
with watching the Redcoats that he had failed to observe a long
double column of Provincials coming down the hill beyond the North
Bridge; they were moving at a fast walk and carried their guns at the
trail.
At first glance he thought there were no more than a hundred of
them, but as he watched he was forced to conclude that there were
at least three hundred. He pulled himself farther out on the limb and
waited.
The detachment of regulars, who were on the far side of the bridge,
hastily retired across it and prepared for an attack. When the
Provincials were a few rods distant the Redcoats opened fire, then
waited and fired again, and Don saw two men fall. Then he saw a
succession of bright flashes and heard the crash of arms as the
Provincials returned the fire. Several of the enemy fell. Then there
was more firing, and in a few minutes the British left the bridge and
ran in great haste toward the main body, a detachment from which
was on the way to meet them. The Provincials pursued the regulars
over the bridge and then divided; one party climbed the hill to the
east, and the other returned to the high grounds.
Don found himself trembling all over; he felt sick and dizzy. With
much difficulty he reached the ground, where he lay for a few
minutes. On getting to his feet, he saw the Redcoats who had first
crossed the North Bridge returning. In the town there seemed to be
much confusion; the sun glanced on red coats and polished
trimmings as men hurried here and there.
Don would not trust himself to climb the tree again, but threw himself
on the ground at the foot of it. He would rest for a while and then set
out on his long journey back to Boston, fairly confident that his
cousin had not been harmed. He had not slept a wink since some
time between one and two o’clock in the morning; now it was after
ten o’clock. So when his head began to nod he did not try very hard
to fight off sleep.
CHAPTER VI
ACROSS THE FLATS
Don was wakened by the sound of firing. He sat up and rubbed his
eyes; then, looking at the sun, he guessed that twelve o’clock had
passed. He could see nothing of the Redcoats; nor could he see
smoke anywhere inside the town. From the east came the sound of
firing that had wakened him, and men with muskets were hurrying
across fields in that direction. For a moment he thought of returning
to his Cousin Deborah’s; then he decided to push for Boston as fast
as he could.
Half running, half walking, he made his way in a southeasterly
direction in order to avoid the main road. Once he wondered whether
the Redcoat Harry Hawkins was with this expedition of British troops,
but somehow the thought was painful, and he turned his mind to
other things.
For some time he had been climbing a rocky hillside; now, on
reaching the crest, he got his last glimpse of the skirmish. The British
were in the road just outside of Lexington, and, far off as Don was,
he could see plainly that they were having a hard time of it. He could
see the flash of sabres as if the officers were urging their men to
advance. One officer was prancing here and there on a spirited black
horse, as if he had lost control of the animal. Then Don saw part of
the King’s troops open fire and saw a dozen or more muskets flash
in reply along an old stone wall on the opposite side of the road.
Before he heard the reports of them he saw the black horse fall.
Another glance and he saw a company of Minute-Men crossing a
distant field at a rapid pace. The sight of a battle going on almost
under his nose, the sound of guns, the smell of powder, all seemed
to hold him spell-bound, and only the thought of his Aunt Martha
alone in the little house in Pudding Lane caused him to turn and
hurry on his way.
Soon he was out of hearing of the firing, but from time to time he saw
detachments of Minute-Men and militia marching to the east. Once
he stopped at a solitary farmhouse and asked for something to eat.
A woman who was alone except for a little girl of nine or ten years
gave him bread and cheese and then prepared a small bundle of the
food for him to take along.
Don told her what he had seen at Concord and at Lexington, and her
lips quivered; but she smiled at him. “Such a day!” she exclaimed.
“My husband and my three brothers have gone. It seems that all the
men from the village have gone. I have heard that the town of
Dedham is almost empty; even the company of gray-haired old
veterans of the French Wars has gone. Such a day! Be careful, my
boy, and return to your aunt as soon as possible.”
Don thanked her for her kindness as he was leaving the house, and
soon he was hurrying on his way toward Boston. From Glen Drake
he had learned many of the secrets of woodcraft and had little
trouble in making his way through the thickets in the vicinity of Fresh
Pond. But mishaps will sometimes overtake the best of woodsmen.
As Don was descending a slope on the western side of the pond he
stepped on a loose stone, which turned under his weight and sent
him crashing headlong to the bottom. He lay there with teeth set and
both hands clenched; a sharp pain was throbbing and pounding in
his right ankle. Little drops of perspiration stood out like beads on his
forehead.
For several minutes he lay there; then as the pain decreased in
violence he sat up. But later when he rose he found that he dared
not put any weight at all on his right foot. Here was a predicament!
There was not a house in sight; he was a long way from the nearest
road; and night was coming on.
He tried to climb the slope down which he had slid, but the effort only
sent sharp pains shooting up his leg. Even when he crawled for only
a dozen yards or so on his hands and knees the pain would force
him to stop; it seemed that he could not move without giving the
ankle a painful wrench. Several times he shouted for help, but he
had little hope that anybody would be in that vicinity to hear him. So
at last he dragged himself to a little cove that was overgrown with
birches and willows; there he loosened his shoe and rubbed his
swollen ankle.
“Well,” he said to himself, “I’ve got to stay here all night, and I
haven’t a thing except my knife and——” He interrupted himself with
an exclamation; his knife was not in his pocket. Then he
remembered that he had left it at his Cousin Deborah’s.
The missing knife made his situation even more desperate than he
had supposed it was. With a knife he might have fashioned a bow
such as he had once seen Glen Drake use for lighting a fire; as it
was, he should have to keep warm as best he could.
The first thing he did was to choose a convenient hollow that was
protected at the back by the hill and on the sides by birches and the
willows. Then, breaking off a quantity of branches, he fashioned a
rude but effective windbreak for the front. By the time he had finished
doing that work it was twilight, and a cool wind was blowing across
the pond.
Don opened the package of food that the good lady at the farmhouse
had given him. There were bread and cheese and three small ginger
cakes; and when he had eaten half the food and put the rest by till
morning he felt a good deal better. Pulling his coat up round his
neck, he snuggled down on the light branches with which he had
carpeted the floor of his bower and prepared to wait for morning.
All light had faded from the sky, and the wind was rising steadily.
Loose twigs all round him tapped incessantly against one another in
tune with the wind. Don shivered and forgot the dull pain in his ankle.
Out in the pond and down close to the shore on both sides of the
cove he could hear strange little splashes, and in the thickets behind
him a pair of owls were calling every now and then. If it had not been
for thoughts of Aunt Martha, Don might really have enjoyed his
experience. He did not doubt that he should be able to walk in the
morning, and he rather liked being out alone as Glen Drake had
been many, many times.
Once he dozed off and awoke some time later, feeling cold and
hungry. The twigs were tapping all about him; somewhere far to the
south a hound was baying mournfully; and in front of him the moon
had covered the pond with a silvery sheen.
Again Don dozed off, and then awoke with a violent start. Somebody
—or something—was moving about in the underbrush on the slope
above him. Then a stone rattled down and bounded into the water.
Startled at the loud splash it made, Don gave an involuntary
exclamation. An instant later he heard someone call his name.
“O Don!” the call was repeated.
Don sat up. “Who is it?” he shouted in reply.
“Yer safe and sound? Praise be for that!”
“Glen!” cried Don, pulling himself upward.
In a moment the old trapper was at the foot of the slope, and Don
was explaining the accident that had befallen him.
“Well, yer a plucky lad,” said Glen. “I tracked ye all the way from
Concord, and when I found you was headin’ fer Fresh Pond I began
to have my fears. Here, now, let me take ye on my back, and we’ll
talk as we go along.”
Don was a sturdy boy and unusually solid for his age, but Glen
Drake lifted him to his back as if he had been no more than a child;
Don could feel the muscles in the old trapper’s shoulders play up
and down as Glen climbed the slope easily and walked quite as well
as if it had been daylight.
“What happened to the Redcoats, Glen?” asked Don.
“They got licked,” Glen replied promptly. “They ran most all the way
from Lexin’ton, and some of ’em fell and lay still with their tongues a-
hanging out; they were that tired. They lost a lot of men, Don, and
serves ’em right. Our boys kept a-coming from all directions—and
most of ’em know how to shoot too! I tell you, if a second force of the
King’s men hadn’t come out, not one of the Redcoats that tried to
burn Concord would have got back alive. Now they’re sewed up tight
in Boston; we’ve got an army watchin’ the town, and it’s growing
every minute.”
“How’s Aunt Martha, and how am I ever going to get back to her?”
“Your Aunt Martha is all right—at least, she was the last I saw her. As
to how you’re a-goin’ to get back, I can’t say for certain. But I’ll get
you back somehow; you trust me for that.”
“Where’s Uncle David?”
“He’s at Cambridge with the army. I’m sort of with the army myself,
though I don’t guess I’ll ever do much drillin’.” Glen Drake chuckled.
“Morning’s a-coming, Don; morning’s a-coming, and we’re at war!”
Don thought of his Aunt Martha, alone in Pudding Lane.
All the while Glen had been tramping with long strides in the
direction of the main part of Cambridge. Only once did he pause,
and then it was to fill his pipe. At last he turned into a lane at the right
of the road and approached a small house that overlooked the river.
By that time dawn was well on the way.
Don observed two or three soldiers at the side of the house; they
were cooking bacon over a small fire. “Hi, there!” shouted one. “I see
you found your boy.”
“Yes, I found him,” replied Glen. “Where’s Dave Hollis?”
“He hasn’t come in yet.”
Glen carried Don into the house, spoke a few words to a woman who
was preparing the morning meal and then, at her bidding, climbed
the stairs.
By the time the rays of the sun were slanting down on the river Don
was asleep deep within the feathery softness of a huge four-posted
bed. The woman down-stairs had given him a delicious breakfast,
and after he had eaten it the old trapper had rubbed his injured ankle
with some potent, vile-smelling ointment that he said would cure
anything from rheumatism to nose-bleed.
Near the middle of the afternoon Don awoke and a little to his
astonishment saw his Uncle David sitting beside Glen at one side of

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Murray & Nadel's Textbook of

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