Diagnosis.—In the acute form of emphysema there are no symptoms sufficiently distinctive to indicate with certainty the presence of the lesion. This, however, is of little consequence, for no special treatment is required. In the large majority of cases the dilated air-cells return to their natural size when the cause or causes which have induced the distention are no longer in operation.
In chronic emphysema the chest distended in the upper regions and hyper-resonant on percussion, the diminished area of cardiac dulness, the pulsation at the epigastrium, the displacement of the liver and spleen (if present), and the wheezing breath-sounds are sufficiently characteristic of the lesion.
Prognosis.—In chronic emphysema the prognosis is not favourable ; for although the disease in itself is little hurtful to life; the accompanying tendency to catarrh is a serious danger to the patient. If the child be found to suffer from repeated attacks of bronchitis, and in the intervals to be wheezy and scant of breath, we can never feel satisfied with his condition or at ease with regard to his future prospects.
In cases of interlobular emphysema, where this has led to infiltration of air into the subcutaneous tissue of the neck and chest, the prognosis depends chiefly upon the disease, in the course of which the complication has arisen. The presence of subcutaneous emphysema is probably of little consequence, for the infiltrated air usually becomes absorbed very quickly.
Treatment.—In cases where acute emphysema is suspected no special treatment is required. So, also, in interlobular emphysema, where this has made itself evident by the passage of air into the subcutaneous tissue, no special measures are needed to hasten the absorption of the infiltrated gases. They may safely be left to disperse at leisure.
In chronic emphysema any existing bronchitis should receive immediate attention, and the treatment must be conducted upon the principles described elsewhere (see Bronchitis). In the attacks of acute dyspnoea
emetics are very useful ; and ipecacuanha wine or the turpeth mineral, each of which produces free secretion of mucus, are to be preferred for this purpose. A teaspoonful of the former, or three or four grains of the latter in syrup, may be given every fifteen minutes until an effect is pro duced. If the attacks continue, the feet should be soaked in a hot mustard foot-bath, mustard poultices should be applied to the chest and back, and a draught containing ether and the tincture of lobelia may be given every hour. Children bear lobelia well. Ten drops of the ethereal tinct ure may be given to a child of two years old every hour or half hour without any danger. In very severe cases the fumes of Himrod's powder may be inhaled. When the bronchitis has subsided iron should be given. A good form for its administration is the tartarate of iron with iodide of potassium. The combination makes a perfectly clear mixture with dis tilled water. It may be sweetened with glycerine.
The food of the child should be nutritious and digestible. The diet should be regulated upon the principles already laid down for the treat ment of scrofula. In fact, emphysematous subjects, who, as has been said, are very often of the strumous habit, require in all points such general treatment as is recommended elsewhere for children suffering from the scrofulous cachexia. The most important point in the treatment of pul monary emphysema lies in the adoption of means for the prevention of catarrh. With this object we should urge upon the child's parents the necessity of removing the patient to an equable climate where he can live an out-door life without danger of chill. It is only by keeping the lungs free from catarrh that we can hope to promote a return of the air-cells to their normal condition.