TREATMENT.—The treatment of this condition is symptomatic, though meas ures indicated in chronic bronchitis are often beneficial. Strychnine is a valu able tonic, especially when the hygienic indications recommended in the treat ment of the hypertrophic form can also out.
Compensatory Emphysema. — As its name indicates, this form of emphysema is compensative; it affords an increase in the respiratory capacity in various parts of the lung to make up for that lost in other parts through local disease, especially tuberculosis, lobular pneu monia, pleurisy, and extensive pleural adhesions. Tuberculous areas and cavi ties or cicatricial masses occupying for merly diseased spots, especially when situated near the peripheral parts of the organ, are almost always surrounded by areas of distended air-vesicles. The op posite lung may also and often does as sume vicarious distension to compensate for the loss of respiratory area in an extensively-diseased lung. This occurs especially in cases of pulmonary fibrosis and tuberculosis.
Case of compensatory emphysema which occurred in tuberculosis in which one lung was doing the work of two. Vansant (Times and Register, May 17, 'DO).
Case observed in which the entire left lung was reduced to the condition of one single air-sac. Guttmann (Deut. med. Woch., Apr. 23, '91).
Whether the compensation is truly such—i.e., a provision of Nature to pro long life through vicarious continuation of a physiological process—or whether the vesicular dilatation merely occurs as the result of the increased pressure resulting from restriction of air-space elsewhere cannot be determined. Both features of the process seem, however, to be involved concurrently. At first the dilated alveolar walls remain histolog ically normal, but, when the case is ad vanced, atrophy becomes manifest and the lesions of true emphysema are to be found.
Interlobular Emphysema.—This form of emphysema is due to the escape of air into the interlobular connective tis sue, and thence in a large proportion of cases to adjoining structures. It is usually brought on by injuries of the lung-tissue, during which the latter is punctured or torn. It may also be caused by excessive effort, in which the diaphragm exerts pressure upon the lungs, as during the act of "bearing down" in parturition, defecation, violent coughing, etc. In all such cases there
is also, doubtless, a congenital weakness of the pulmonary tissues.
The air-cavities thus formed vary in size from that of a pea to that of an egg. At times, rupture occurs at the junction between the lung and the trachea, the air penetrating the subcutaneous areolar tissue of the neck and sometimes far beyond this region.
Half an hour after being run over by a wagon, a robust, 8-year-old boy was found to be suffering from emphysema, extending over the whole body except the palms and soles. Penis and scrotum were so puffed up as to resemble oblong rubber balls, and an attempt to hold the eyelids open with adhesive straps proved unavailing because of the tense state of the skin. The tissues under the scalp were also involved, crackling being dis tinctly perceived. The skin of the whole body was tense and pale. There were slight contusions on the elbow and chest. Respiration was labored. Palpation dis closed fractures of the sternum and sec ond right rib. Three hours later the emphysema had so increased as materi ally to interfere with respiration; skin stretched almost to the limit of its elasticity; increasing cyanosis. On in cising the chest the effect was instanta neous, as if a tense rubber ball had been pricked, and breathing immediately be came deeper and slower. Two rubber drainage-tubes were inserted and left in for five days. Next day a pneumonia jacket was applied, after which the treat ment was expectant and symptomatic, the only complication being a mild lo calized pleurisy and hmmoptysis. The pneumothorax had practically disap peared on the sixth day, by expulsion rather than by absorption. The air in the tissues was absorbed so slowly that it could still be detected therein eighteen days afterward. C. G. Violin (Brooklyn Med. Jour., Oct., '97).
Three cases of subcutaneous emphy sema complicating measles observed in one family. There was probably a con genital weakness of the pulmonary ves icles, and also a predisposition produced by whooping-cough. Galliard (Jour. des Prat., Nov 25, '97).