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Congenital Atelectasis

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CONGENITAL ATELECTASIS.

This variety of pulmonary collapse was first described in the year 1832 by Dr. Edward Jong, who gave it the name which it still retains. Congen ital atelectasis rarely occurs except in feeble infants, such as have been born prematurely, or are the offspring of weakly mothers, or have entered life under conditions unfavourable to the. efficient establishment of the re spiratory functions. A tedious labour producing long compression of the cord ; too energetic uterine contractions causing a too early separation of the placenta from the womb ; a low temperature of the external air ; a high temperature with imperfect ventilation and deficiency of oxygen—the im perfect expansion has been attributed to all these causes. In addition, the presence of mucus or fluid in the air-tubes may act as a direct mechanical impediment to the entrance of air and prevent the inflation of a part of the pulmonary tissue.

Morbid Anatomy.—On inspection of a lung which is the seat of this lesion the unexpanded portion is at once recognised by its dark red or purplish colour, contrasting with the rosy tint of the inflated tissue. Be ing perfectly airless, it looks shrunken and depressed, does not crepitate when squeezed, and feels tough and dense like soft leather. If a portion be cut out and placed in water, it sinks instantly to the bottom of the vessel. On examination of the cut surface with a lens, the outline of the air-cells may be visible ; but if the child have survived for some weeks, the vesicular structure can often hardly be perceived. The parts of the lung which thus remain airless after birth are most commonly the least bulky portions, such as the thin lower borders of the lobes, especially the inferior lobes and the middle lobe of the right lung. Often, however, the collapse is not confined to these parts, but extends for some distance over the posterior surface, and penetrates pretty deeply into the organ.

If the child die early, the unexpanded lobules can be readily inflated after death by a blow-pipe passed into the bronchus ; but if life has been prolonged for a period of weeks, re-inflation is not so easy and may only be effected by the expenditure of considerable force.

In cases of congenital atelectasis other parts besides the lungs often remain in the foetal state. The foramen ovale is usually open, and perhaps

the ductus arteriosus may still remain unclosed.

a new-born infant, when expansion of the lungs is im perfect, the child is usually small and ill-nourished. His appearance and manner show great want of power, and his muscles feel soft and flabby. His complexion is dirty white or pale, with lividity about the eyelids and mouth. He lies quietly without movement, and seems very apathetic, seldom attempting to cry. If he do, he utters only a feeble whimper and never makes a loud sound. Often he merely draws up the corners of his mouth without making any sound at all. The fingers and toes are of a dark red or purple tint; and feel cool to the touch ; indeed, the internal temperature of the child is below the normal level, and often reaches only 97.5° in the rectum. The respiratory movements are not laboured ; on the contrary, they are shallow and short, and evidently expand the chest very imperfectly. As in all cases where the bases of the lungs fail to ex pand in a young child, the corresponding ribs sink in to a certain extent at each inspiration. Still, on account of the feebleness of the inspiratory movements the depression at the bases is less noticeable than it is in some other diseases. When put to the breast the child is unable to suck, and has to be fed with a syringe or a spoon. Sometimes he cannot swallow. The pulse is very feeble and the fontanelle is more or less deeply depressed. A warm bath seems to revive the child for the time, and even gives a little colour to the skin ; but after removal the infant sinks into his former de pression.

An examination of the chest furnishes little information. If the un expanded area is small, we may detect no sign to indicate the nature of the lesion. There may be a little want of resonance at the bases of the lungs posteriorly ; but on account of the small size of the thorax at this period of life, and the facility with which sounds are conveyed from one part to the other, the vesicular murmur may appear to be as loud at the bases as at any other part of the chest. It is only in cases where the col lapse is very extensive that any suppression or alteration of the respiratory sound can be detected.

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