EMPHYSEMA OF THE LUNG.
This is usually the outcome of attacks of bronchitis, asthma. whooping cough, &c., especially in subjects who have been horn with a deficiency of yellow elastic tissue in the walls of the pulmonary infundibula, and the problem of prevention is of more importance than is that of cure. Un fortunately, however, there is no means of recognising or detecting the congenital developmental error till dilatation of the air cells and of the interalveolar passages has already occurred under one or more bronchial attacks.
If the existing cause can be removed judicious treatment will in most instances reduce or confine it to its original sites in the lung. Hence the importance of climatic treatment,which by preventing attacks of bronchial catarrh may save the predisposed patient from a life of invalidism. An equable warm atmosphere as free from dust and winds as possible should be selected along the South ('oast of England for residence during the winter months. If experience proves that the patient's bronchial trouble is best suited by a dry atmosphere, Sicily, Egypt, or Algiers as a winter resort, or South Africa or South Australia may be selected as a permanent home.
The presence of adenoids and abnormal conditions of the nasal and naso pharyngeal regions should he seen to in young subjects, as asthmatic troubles may sometimes be averted by early operative interference. The hygienic surroundings of the patient, whether at home or abroad, should be carefully supervised; an open-air life with protection by suitable clothing against changes of temperature, the avoidance of late hours and crowded rooms, and a generous mixed diet with regular hours for meals, exercise and rest are essential. As regards exercise, whilst this need never be curtailed, all athletic performances which cause high thoracic pressure, as football, feats of endurance on the land and in water, as well as shorter spurts in running, must be forbidden. Obstinate constipation by acting in the same manner is injurious, and must he met by appropriate drugs.
Artisans who cannot change their climate must change their occupation; all those occupations which entail the breathing of a dusty atmosphere, or which cause pulmonary strain as in glass-blowing, must be abandoned. Playing on wind instruments is also most injurious to the weakened air cells.
All bronchial attacks must he discreetly treated ; coughing which might be left unchecked in robust subjects may do serious mischief when once the dilatation and degeneration of the air cells have become established. Under Bronchitis the various indications for the use of remedies have been discussed and need not be here repeated; suffice it to say that though the employment of narcotics or sedatives must be avoided in all cases of bronchial catarrh it will, amongst the emphysematous, be always wise to prevent unnecessary coughing. This rarely can be accomplished without danger by the use of narcotics, even Heroin being objectionable. The aim of the physician should always he to act upon the bronchial secretion so as to render it more fluid and therefore more easily expelled by ciliary action. The best routine drug for this purpose is Iodide of Potassium or
Sodium combined with Ammonia; when the patient is obviously coughing more frequently than is necessary for the mere expulsion of the secretion Heroin or Morphia in small amount may be added to the iodide mixture. This method is often as efficacious in the treatment of bronchitis with profuse ropy secretion as it is in dry catarrhs. In thin delicate subjects, especially those suffering from the chronic lobular pneumonia following whooping cough and measles, there is no routine combination equal to the Syrup of Iodide of Iron administered in conjunction with Cod-Liver Oil.
Severe wheezing and breathlessness in acute bronchial attacks occur ring in emphysematous patients may he relieved by Oxygen inhalations, and when the element of spasm is present Lobelia and othtr bronchial antispasmodics may be prescribed, but the practice of drenching such patients with nauseating doses of hippo, apomorphine and tartar emetic for long periods is most injurious owing to the condition of the dilated heart and to the tendency towards degeneration of the elastic tissue already present. Cardiac dilatation should be met by heart tonics and Strychnine.
No drug exercises any specific action upon the dilated air sacs; Arsenic is, however, extolled by many, and some authorities believe that Iodides independent of their expectorant properties have the power of at least retarding the degenerative process. The combination of these agents may therefore have a routine place in the treatment of the accompanying catarrh, and may be used as adjuvants to the following remedial measure.
The Compressed Air Chamber has given excellent results in fully estab lished emphysema. The patient is placed in a small chamber into which a free supply of pure air is introduced, which is gradually raised to an extra pressure of more than two-thirds of the outer atmosphere; the exposure should be at least of one hour's duration under the maximum pressure, which is then slowly reduced during about zo minutes to the normal tension before the patient emerges. During the stay under pressure the vesicular murmur may be observed to return, the hepatic and cardiac dulness to increase, and the circumferential measurement of the thorax to diminish. These effects may be heightened by causing the patient at the same time to expire into rarefied air, but the apparatus for this purpose is necessarily a complicated one, and the results of using the ordinary compressed air chamber are so satisfactory that the simpler method is considered sufficient. This treatment should be resorted to about 4 times a week, and the stay in the chamber may be prolonged till a couple of hours are spent in it each time.
For the atrophic or small lunged type of emphysema which is simply a part of the senile wasting sometimes observed in old subjects, nothing can be done save what little may be effected occasionally by improved hygienic and dietetic measures.