Emphysema

“ The most common sequel of asthma is emphysema. The bronchial tubes being more or less completely closed, either by contraction of their muscular fibres or by plugs of thick, viscid mucus, the air pent up in the parts beyond the obstruction is subjected to the negative pressure produced by the exaggerated inspiratory act, becomes rarefied, and, in obedience to the diminished resistance induced by the partial vacuum in the thorax, causes distension of the air-cells. ”

“ Emphysema of the margins of the lung is a frequent concomitant of collapse. The cause is plain. The portion of lung, the subject of collapse, emptied of its air, does not occupy a tithe of the space it would normally fill. The rest of the lung tissue expands unduly to fill out the vacated portion of chest and the cells become overdistended and ruptured. The emphysematous lung is known by its lighter color, by its irregular bulging surface, by the subsidence of these elevations when pricked with a needle, and by a more marked crepitation when pressed. ”

“ Emphysema, from εν and φυσαω, to inflate; the diffusion of air into a part of or throughout the cellular tissue of the body. It has been said to take place after a wound of the chest, but without an injury of the lung, from the air passing through the wound into the cavity during inspiration; and by accumulation and subsequent compression under the act of expiration, giving rise to all the symptoms of the disease; a complaint more theoretical than real. ”

“ This improvement in respiration causes more complete tissue-metamorphosis, and thus aids nutrition and all the functions.
Still greater benefit is to be derived from the exhalation into rarefied air—a measure which acts upon mechanical principles, and has been found to give relief not only to the symptoms of emphysema, but to the organic disease itself; for the retention and stasis of the residual air, which is far larger in amount in emphysema than it is in health, serve at once to keep up the dilatation of the cells and to increase the dyspnoea ”

“ The main element in the treatment of emphysema consists in attention to the general condition of the health, and in the avoidance of all causes likely to aggravate the disease or induce its complications. Compressed air baths and expiration into rarefied air may be useful. During attacks of urgent dyspnoea and lividity, with engorgement of veins, the patient should be repeatedly bled until relief is obtained. ”

“ The emphysema occasions an increase in the shortness of breath from which the person had previously suffered, and later, in consequence of the greater difficulty with which the blood circulates through the emphysematous lungs, the right side of the heart becomes dilated, and from that we have the development of a general dropsy of the subcutaneous tissues, and less and less perfect aeration of the blood. ”

“ In some cases of bronchitis, where numbers of the smaller bronchial tubes become obstructed, the air in the pulmonary vesicles remains imprisoned, the force of expiration being insufficient to expel it; while, on the other hand, the stronger force of inspiration being adequate to overcome the resistance, the air-cells tend to become more and more distended, and permanent alterations in their structure, including emphysema, are the result. ”

“ Immediately ensued suffocation, nausea, vomiting, together with the expectoration of blood and mucus. There was emphysema of the face, neck, and chest. The fish could be easily felt impacted in the tissues, but, after swallowing much water and vinegar, together with other efforts at extraction, the fins were loosened—about twenty-four hours after the accident. By this time the emphysema had extended to the scrotum. There was much expectoration of muco-purulent fluid, and on the third day complete aphonia, but the symptoms gradually disappeared, and recovery was complete in eight days. ”

“ It appears from a series of experiments that have been made in France on animals, and from observations relative to the human subject, that no very great force of insufflation is necessary to rupture the delicate air-cells, and cause a fatal emphysema of the pulmonary structure. ”

“ The right cavities of the heart were filled with fluid blood. The sinuses of the dura mater contained less blood than usual, and the brain was pale. The medical man reporting the case considered that the emphysema was the cause of death, by interfering with expiration, and thus detaining the vapour; and it must be admitted that, if the vapour were not sufficiently diluted with air, the emphysema might increase the danger. I have, however, administered chloroform in several cases in which emphysema existed to an extreme degree, without any ill effects ”

“ Obstruction of a large bronchus would be followed by absence of health sounds and intense dyspnoea, but we should not have the other physical signs of pneumothorax. Extensive emphysema would produce some of the signs—exaggerated resonance on percussion and enlargement of the side. Emphysema, however, is bilateral, and the resonance over an emphysematous lung has not the same pronounced tympanitic quality as in pneumothorax. The enlargement in emphysema is more under the clavicle; the breathing not amphoric; the normal murmur, although enfeebled, is never completely annulled ”

“ Expiration is prolonged, because there is a loss of their normal elasticity, and an effort is made by voluntary action of the expiratory muscles to expel the stagnant residual air. This alteration in rhythm is eminently characteristic of emphysema when the disease is far advanced and occupies a considerable portion of the lungs. ”

“ A dangerous symptom which sometimes arises in the course of the chronic bronchitis accompanying emphysema is profuse bronchial catarrh, which may destroy life by producing apnoea, the surface becoming cold and the pulse feeble and vanishing as the patient seems to be drowning in his own secretion. ”

“ The suddenness with which the attack comes and goes, the severity of the symptoms compared with the insignificance of the local lesions, the absence of dyspnoea in the intervals between the attacks (in uncomplicated cases) , are all the reverse of what is observed in emphysema. In that disease the attacks develop more gradually; there is always more or less shortness of breath, and the evidences of changes in the structure of the lung are quite marked. ”

“ The lungs were in the same condition of congestion and emphysema in strangulation, suffocation, and hanging. He failed to find the apoplexies described.
The lungs are sometimes anæmic. In healthy young subjects, especially children, the blood-vessels of the lungs often empty themselves after the heart stops. The lungs may, therefore, be bloodless, but emphysematous from the violent efforts to breathe. Page’s experiments on the lower animals showed the lungs of a pale reddish color and not much distended ”

“ But in rapidly-diffused and extensive lobar emphysema such an explanation cannot always be admitted, because sometimes the disease advances steadily, so as to involve the greater part of one or both lungs without the occurrence of any paroxysms of cough which could distend the air-cells by their violent expiratory efforts. ”

“ The lung, which is at first enlarged, becomes shrunken, dense in texture and solid, any unaffected portions being emphysematous; the bronchi are dilated, the pleura thickened, and the lung substance often deeply pigmented, especially in the case of miners, who are apt to suffer from this disease. The other lung is always greatly enlarged and distended from emphysema; the heart becomes hypertrophied, particularly the right ventricle ”

“ 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. ”

“ DIAGNOSIS.—The principal diseases from which acute inflammation of any part of the bronchial mucous membrane needs to be differentiated are pneumonia, pleurisy, laryngitis, tracheitis, and asthma, while it is still more important to keep a clear line of diagnosis between the chronic grades of bronchial inflammation and the earlier stages of pulmonary phthisis and of emphysema. ”

“ The effects of bronchial narrowing or occlusion produce serious mischief in the lungs proportioned to the degree of obstruction. By the retention of the bronchial secretions the air-supply to the vesicles is interfered with; emphysema with or without asthmatic symptoms or atelectasis may ensue. Further, the results of bronchial narrowing affect the circulation through the lungs, and in combination with atelectasis very intractable local bronchitis may be developed ”

“ In a certain number of these cases, there is some emphysema present, that is, overdistention of the lungs, such as is seen in high-chested people. Owing to the long anterio-posterior diameter of the chest and the fact that as a consequence it is nearly as thick through as it is wide, this form of chest is sometimes spoken of as barrel-chest. Patients who have it are particularly likely to suffer from asthma if they have any dread of heart trouble or if they are of a nervous constitution. ”

“ There is no fever, the appetite is maintained, and, what is an even more important point, animals in good condition preserve their flesh. Interlobular pulmonary emphysema and emphysema resulting from dilatation are inseparable accompaniments of chronic bronchitis, for which reason the flank respiratory movement is frequently very marked. ”

“ Diminution of the necessary oxygen may cause convulsions, apoplexy, and other brain symptoms. Acute emphysema of the portion of lung not obstructed may follow its forcible distention. The local effect of the foreign body is an irritation which causes spasm and cough. It may be carried upward by the expirations and downward again by each inspiration. Inflammation is likely to appear eventually and may involve the lung. If the obstruction is not complete there may follow periods of alternation of good and bad health, ending perhaps in recovery. ”

“ The respiratory murmur may be lessened in certain morbid conditions, such as emphysema and congestion of the lung, and may completely disappear in pneumonia or broncho-pneumonia, a fact which is even of greater significance. ”

“ Weber states such cases are not suitable.
"Chronic Bronchitis is also improved, though the cough at first is frequently increased for a time. When, as a result or complication of the bronchitis, there is much emphysema, considerable risk is run by coming to this elevation. However, when the emphysema is moderate in extent, and exertion is avoided for the first few weeks, the readier clearing of the bronchial tubes allows the sound portions of the lungs to be more perfectly used ”

“ Peanut kernels and watermelon seeds and, rarely, other foreign bodies in the bronchi produce obstructive emphysema of the invaded side. Fluoroscopy shows the diaphragm flattened, depressed and of less excursion on the invaded side; at the end of expiration, the heart and the mediastinal wall move over toward the uninvaded side and the invaded lung becomes less dense than the uninvaded lung, from the trapping of the air by the expiratory, valve-like effect of obliteration of the "forceps spaces" that during inspiration afford air ingress between the foreign body and the swollen bronchial wall. ”

“ Another complication is emphysema, either subpleural or pulmonary. It is not frequent, except in combination with fibrinous bronchitis. The increase of respiratory movements is quite sudden, percussion sound tympanitic, and auscultation negative. Pulmonary oedema is quite frequent; it is the result of the rarefaction of air in the bronchi, the consecutive dilatation of the blood-vessels, and the effusion of serum by intravascular pressure. Every severe case is accompanied with it; in every tracheotomy it is met with coming up into the incision. ”

“ The labored efforts of breathing in many cases make the upper and anterior part of the chest appear more prominent than natural, and even more resonant on percussion on account of temporary emphysema from over-distension of the air-cells in those parts, while in some parts of the lower and posterior portions there is less expansion and less resonance than natural from the occlusion of some of the bronchi and the partial obstruction of others leading to those parts of the lungs. ”

“ Thus, the vicarious dilatation of air-cells following acute bronchitis or whooping cough in children may leave no sign of its previous existence after recovery from these diseases. In general, the shorter the duration of the causal diseases, the more likely is the emphysema to disappear; for if it be maintained for a considerable time, the elasticity of the cells may be so damaged that they may never return to their natural size. ”

“ Chronic obstructive lung diseases afflict an estimated 17.2 million Americans, with more than three million being disabled to a greater or lesser degree by such disorders as chronic bronchitis, asthma, and emphysema and many other serious lung diseases of known and unknown causes. ”