Dyspnea

“ The symptoms in the dogs were all alike, dyspnea, increasing as the inflammation increased, until the accessory muscles of respiration were called into play. The stethoscope showed that air had great difficulty in entering the bronchi and air vesicles, and showed also the tumultuous beating of the heart in pumping blood through the lung. It was impossible to take the temperatures. Post-mortem examinations showed the lungs dark, congested and solid in some places. ”

“ Later the typical asthmatic [Pg 349] symptoms appear in which there is a constriction of the bronchi due to spasms of the unstriped muscular fibers. There is hyperemia in the mucous membrane and a slight exudate. Usually the tonsils are enlarged and there are adenoid growths. There is more or less severe dyspnea, moderate cyanosis and, in severe cases, prostration. The peculiarity in respiration consists in a short inhalation with slow, labored exhalation. Dyspnea may be so severe that it is impossible for the child to breathe lying down. There is an almost constant dry teasing cough. ”

“ A normal person should hold his breath from thirty to forty seconds without much subsequent dyspnea, while a patient with myocardial weakness can hold his breath only from ten to twenty seconds, and then much temporary dyspnea will follow. ”

“ If there is more dyspnea than normally should occur in the individual patient after walking rapidly or climbing a hill or going upstairs, or if after a period of a little excitement one finds that he cannot breathe quite normally, or that something feels tight in his chest, the heart needs resting. ”

“ There is dyspnea, but the patient cannot aid respiration with the auxiliary muscles by holding the arms and shoulders tense or obtaining support from the aruls; in fact, the arms are almost strengthless. ”

“ This tends to cause dyspnea, and the heart tends to be disturbed from these causes, if much fat is not really in the pericardium. The symptoms are those of imperfect heart action; the patient is dyspneic on exertion or in leaning over, the heart acts rapidly on such exertion, the patient puffs, perspires easily, and becomes leg weary, sedentary in his habits, and more or less incapacitated for work. He may not be a large eater; if he is, and his eating habit is corrected, the prognosis is better than if he is putting on weight in spite of eating sparingly. ”

“ This incoördination is relatively rare in small children, except in diphtheria, when it appears as a contamination into the bronchi from the larynx and trachea. It may be acute or chronic and affects all ages from infancy to puberty. The characteristics are severe dyspnea and the coughing up of fibrinous casts from the large bronchi after which there is a marked improvement. As the exudate collects again the symptoms reappear. In the chronic form there is dyspnea and expectoration of fibrinous casts. ”

“ The distress in breathing arises from the air being diffused over the surface of the lung, which it gradually causes to collapse under the pressure exercised by the act of expiration; while, at the same time, the mediastinum yielding, the opposite lung suffers in a similar way, although to a less extent, until the aerification of the blood is so greatly obstructed as at last to interfere with life, unless relief be obtained by the equalization of the pressure made on the lung by the compressed air in the cavity of the pleura, with that exercised on the inside of the lung through the glottis. ”

“ If the patient is breathing from twenty-five to thirty-five times per minute, the respiration being confined to one lung as indicated by the lack of expansion in the other, and if he lies so as to take the strain off the lung that does not expand, it is almost sure that the patient has pneumonia. In case the lung is fixed rigidly by the muscles and the opposite lung forced to do all the work, then the patient has pleurisy. ”

“ Thus, although an increase of work is thrown on the upper part of the lungs, breathing cannot be naturally performed, and from this many serious diseases may arise. A tendency to consumption is hereby encouraged, and, even without this tendency, blood-spitting may be caused by the pressure. But, besides interfering with the action of the lungs, this pressure, in limiting the space occupied by the other organs, hinders their natural and healthy motions, the heart and stomach are deranged, the action of the liver hampered, the movements of the bowels restricted. ”

“ In pneumonia or inflammation of the lung-substance the process is different. A portion of one or other lung, sometimes of both, becomes overfilled with blood, or congested, and though the air-tubes themselves are not the special seat of the congestion, yet the air-cells are pressed on by the surrounding swollen substance, and the entrance of air into them is impeded. If the mischief goes further the substance becomes solid and impervious to air, and lastly it becomes softened, its structure destroyed, and infiltrated with matter ”

“ Embolism of one of the middle or larger branches of the pulmonary artery is also characterized by great embarrassment of respiration, but is not likely to be mistaken for asthma by any one at all familiar with the two affections. The cachectic appearance of the patient, the intense anxiety depicted on his countenance, the evidence of cardiac disease or of some affection of the vessels, the weakened cardiac impulse, the thready and at times irregular pulse, together with evidences of more or less pulmonary oedema, are sufficient to distinguish this form of dyspnoea from that of asthma. ”

“ Breathing is in man mostly abdominal, in woman mostly thoracic, but inflammation in the chest or abdomen will affect its character.
Dyspnœa, difficulty of breathing, arises when from any cause the amount of air entering the lungs does not correspond to the amount of blood sent by the heart for purification. The air may be unfit for its work, or disease in the lungs, or air passages may shut it out. Asphyxia results if the supply of air is in any way cut off. ”

“ Chronic Interstitial Pneumonia.—Synonyms.—Cirrhosis of the lungs; Fibroid Pneumonia.
Definition.—A chronic inflammation of the lungs, in which the normal air cells are replaced by fibrous or connective tissue, followed by induration and atrophy of the lung.
Pathology.—The disease is nearly always confined to one lung, though, in very rare cases, both lungs may be involved, while localized areas are the rule. The affected lung becomes atrophied and in extreme cases, may be no larger than the closed hand. As a result of the shrinkage of the lung tissue, the heart undergoes hypertrophy. ”

“ Superficial Examination of Thorax.—Observe the position, color, and degree of distention of the lungs. It should be remembered that healthy lungs, as soon as the chest is opened, owing to their inherent elasticity, will collapse, and when this normal collapse is not seen it is generally due to a loss of elasticity as occurs in emphysema, to inflammatory diseases binding the lung to the chest wall, or to the alveoli being filled with solid or fluid substances or pent-up air. Most complete distention is seen when death is due to drowning or suffocation. ”

“ He calls attention to an analogous condition which obtains in capillary bronchitis, when, owing to swelling of the mucous membrane and to the accumulation of secretion in the tubes, the alveolæ are cut off. Here, too, the expiratory pressure is often sufficiently powerful to overcome the obstruction, but if under these circumstances it is too feeble, collapse of the lung ensues. When, on the other hand, the inspiration is strong enough to overcome this obstacle, air enters the alveolæ, and, being imprisoned there, causes inflation of the air-cells as in asthma. ”

“ If its relation to pneumonicula be the same in its cure, that I have supposed it to be in its cause, then I am persuaded, that the same excess in blood-letting is indicated in it, above what is necessary in phrenitis, that has been practised in pneumonicula, above what is necessary in the cure of an acute inflammation of the lungs. The continuance, and, in some instances, the increase of the appetite in the internal dropsy of the brain, would seem to favour this opinion no less in this disease, than in the inflammatory state of pulmonary consumption. ”

“ If the congestion is due to weakened action of the heart, with remora of the venous circulation, and is passive in character, the symptoms may be less acutely developed and less urgent than they are in the active form; indeed, in some cases in which very considerable portions of the lung are involved there may be no excessive dyspnoea while the patient is quiet, in consequence of the organism having become gradually accustomed to the imperfect respiration. ”

“ The pulse is quick, the tongue is coated; there is thirst and loss of appetite, and the temperature is raised. In a day or two the breathing becomes more difficult, owing to fluid being infused into the pleural cavity and pressing upon the lungs; this fluid after a time usually becomes absorbed, when the breathing grows easier. Sometimes this fluid does not become absorbed, when a slight operation has to be performed for its removal.
Treatment.—Place the patient in bed without delay, in a room the atmosphere of which is kept moist by allowing steam from a bronchitis kettle to pass into it ”

“ For the chief danger of chronic asthma is the probability of serious pathological complications. The direct result of dyspnœa is the impoverishment of the blood by an impeded process of aeration, and the concomitants of the disease are therefore analogous to those of pulmonary phthisis and protracted in-door life—hypertrophy of the heart, emphysema, or swelling of the lungs, inflammation of the bronchi, dropsical swellings of the extremities. ”

“ In pneumonia the difficulty of breathing consists in its painfulness; in asthma, in the persistent torpor of the respiratory organs. The patient feels as if the expansion apparatus of his chest were utterly paralyzed, the inhaled breath seems to come to the gate of the lungs and no farther ”

“ The lung follows the heart. The whole mediastinum finds itself altered in its position and in its contents. The depressed diaphragm rises promptly to its old position in the pleural cavity. The liver, spleen, and the rib-wall undergo striking modifications. We do not expect the lung to dilate to its full extent, as after aspirations in simple pleurisies. The lung, indeed, is already impaired in its movement. We admit air in order to secure treatment to these surfaces. When air is admitted into the normal chest, the lung is retracted to about one-half its size. ”

“ They are dependent upon the fact that the pneumonic process has a very striking tendency to undergo organization, a process which involves not only the exudate in the alveoli, but also that within the bronchioles. The organizing process may be present in both these portions of the lung or may be confined to the bronchiole alone, and lead to a progressive interference with the ingress and egress of alveolar air, so that atelectasis and emphysema become permanent, and in turn lead to narrowing of the vascular bed, ultimately producing right-sided cardiac decompensation. ”

“ It should always be remembered that the lung undergoes very various and opposite changes as the result of pressure on the bronchi, interrupting the entrance and egress of air from the lobules, and the physical signs of emphysema, infarction, congestion, or consolidation may exist in one or the other side. The ordinary methods of physical examination indicate the existence of pleural effusions, but large growths extending from the mediastinum or originating in the lung may so closely simulate such effusions that a positive diagnosis can be arrived at only by paracentesis. ”

“ When it is brought about in greater degree, either by over-action of the heart or sudden recession of blood from other parts, the earliest and most prominent symptoms are a sense of oppression in the chest and quickened, laborious respiration, which may rapidly increase until the dyspnoea becomes most urgent and distressing. ”

“ The Lungs.—The lungs are completely distended, almost entirely overlapping the heart, and pressing close to the ribs. They are spongy to the feel, and when cut into, a considerable quantity of bloody froth escapes. The froth found in the lungs is the result of the powerful attempts to breathe, and cannot be produced by artificial means. It adheres not to the sides of the bronchial tubes, as does the exudation of bronchitis or pneumonia. The distension of the lungs is due partly to an actual hyperæmia, and partly to inhaled fluid. ”

“ Labored breathing, which is at once hurried, deep, and without intermission, is seen in severe laryngitis, croup, capillary bronchitis, and pneumonia, in all cases alike from the difficulty experienced in introducing into the lungs the requisite amount of air. It is especially marked in double pneumonia, pleuro-pneumonia, complicated with effusion in the chest, and in old standing broken wind with dilatation of the right heart. ”

“ Inhaling cold air after sitting in a close atmosphere, will induce an attack of bronchial inflammation, or thickening of the air-tubes, in persons of all classes and conditions. Persons who are liable to frequent attacks of bronchitis, are apt to imagine that their lungs are affected, since it prevents a free use of the voice in singing or speaking audibly. I will repeat that this complaint generally terminates with a loss of tone in the lung substance, caused by the failure of the tubes to supply them with oxygen or air ”