ACQUIRED atelectasis usually occurs as the result of a condition involving reduc tion of the lumen of the respiratory tract. Foreign bodies may thus cause atelectasis by preventing the ingress of air, while the residual air is gradually eliminated by contractions of the thoracic walls and diaphragm, or absorbed. False membrane, meconium, muco-purulent masses, blood, etc., have thus brought on this distressing condition. Processes that interfere with expansion of the chest by pressing on the lung—spinal curvature and other diseases of the bony frame-work, tumors, effusions into the pleural or pericardial cavities, aneurism, etc.—may also bring on atelectasis.
Case of pulmonary atelectasis of great extent, the normal resonance being re placed by flatness over the whole of the left lung and the respiratory murmur being weak, while the heart was dislo cated to the left by the distended right lung. At the autopsy the left bronchus was found contracted and the lung col lapsed and sclerotic. There was slight pigmentation of the left lung; this sug gested that the organ once functionated and that early in life the bronchus was constricted and the lung collapsed. It was thought to be probably of specific origin. Rohmer and Borchert (Deut.
Arch. f. klin. Med., Dec. 22, '97).
Pathology. — The atelectatic areas— though hepatized, "carnified," or firm— do not show histological change, barring, perhaps, slight dilatation of the vascular supply. The collapsed cavities, whatever be their size, can always be inflated with a blow-pipe, as shown by Legendre and Bailly. The affected parts sink in water and are resistant under section. When causative disorders are present, the post mortem evidences vary accordingly.
Collapse of the lobules sometimes oc curs as a complication of capillary bron chitis. Pertussis and wide-spread bron chopneumonia may also occur as causes.
Prognosis.—The prognosis varies ac cording to the extent of the area involved. When small areas are atelectatic, recov ery is usual, but extensive reduction of the respiratory capacity is seldom recov ered from. In premature births the
chances are greatly against the infant. The same is the case when atelectasis is the result of some pulmonary disorder.
COMPLJCATIONS.—Pulmonary tubercu losis, pleurisy, and broncho-pneumonia are frequently observed in these cases and greatly compromise the issue. When atelectasis is due to pressure,—i.e., occurs as the result of effusions into the pleura, aneurism, tumors, etc.,—the prognosis is very unfavorable. Emphysema some times presents itself in atelectatic infants, but as a compensating factor, its presence increasing the respiratory area.
important indication in this disorder is to increase as much as possible the vital activity of the patient. Gentle massage under warm bedclothes, the friction being always in the direction of the heart, tends greatly to increase the activity of the circulation. Laborde's method of rhythmical traction of the tongue is said to be valuable. Oxygen inhalations would seem to be indicated, though care should be taken to avoid overstimulation, lest pulmonary hyper demia follow. Pure air is essential in such cases. A little brandy, a few drops in sugar and water, given from time to time, is generally recommended. Tonics —strychnine, especially—are of value. Nutritious, though easily-digested, food, when the child is old enough, is of great importance as a curative factor to an tagonize the vital adynamia that lies back of the trouble.
Inversion of the child preferred to establish respiration, the child lying upon the back, head downward, upon the forearm of the operator, whose fingers are hooked into its shoulders. The arms of the child fall downward as the hands of the operator are depressed, and the chest is thus dilated. The press ure being then suddenly removed a res piration takes place. Such a movement also favors the removal of mucus from the air-passages. Reynolds (Archly f. Kinderh., B. 11, H. 1, '88).