EMPHYSEMA AND BRONCHITIS.

Dominion, Volume 3, Issue 816, 13 May 1910, Page 5

EMPHYSEMA AND BRONCHITIS.

SECONDARY EFFECTS pN, HEART.

Emphysema is generally defined as a distension of .tissue with air or other gases; but emphysema of the lungs is a special disease, concerning whioh the following is gathered from-medical authorities: Emphysema of the lungs is nn excess of. air in the lungs, whether duo to a dilated condition of the air-sacs, or to tho presence of nir in tho interlobular tissue. Effect of Coughing, . .

With regard to tho determining causes of cmphy&eina, there are two theories, namely, the inspiratory theory and tho expiratory' theory. On the first view, the dilatation and rupture of the air-sacs are accounted for by the overdistension of the lungs in inspiration. On the second viou-, these changes ore considered to bo caused by .the strain to which the lung-tissuo is-siibjeoted in violent expiratory efforts, particularly the net of'coughing. (Tho King's frequent coughing hw> been mentioned in the cablegrams as affecting him greatly.) The pulmonary tissue loses .a portion of its elasticity, it yields to distension, and no longer reacts perfectly when the/distending power ceases, further distension follows; reaction diminishes still more until at length in some instances the lungs become greatly enlarged.". Expiration is difficult. ' ...

Further, as (he lungs are more or less riddled with perforations, their aerating surface diminshes, and this necessarily causes dyspnoea whenever, any increased demand is made on the respiratory {miction. Tho quantity of blood circulating through the lungs is also diminished. Some of tho physical signs are that the upper part of the chest and tho clavicles are prominent; the neck seems shortened; the sternum (bi east-bone) is arched. . Bronchitis is one of tho most frequent of tho diseases associated with emphysema of tho lungs. It is raro for the latter ailment to exist for any length of timo without the supervention of the former. Bronchitis presents some peculiarities when it affects an emphysematous lung. It is rather the result of congestion than of inflammation. Danger of Asphyxiation. Bronchitis in this case Often attacks the finer bronchial tubes; and, when severe, is attended with profuse secretion—a circumstance, which, coupled with tho fact that expectoration is less easily accomplished than when tho lungs are healthy, seriously complicates the affection, and increases the danger of death from asphyxia.' These severe bronehitic attacks nro very apt to be attended by the formation of fibrinous clots in the liee.rt and tho.lurgo. vessels arising therefrom. Bronchitis, in (i subacute or chronic form, is a very eou--tuut cause of winter cough in emphysematous patients. •Secondary . iiH'i'ctioiis of (he heart are constantly met with in advanced cusps of emphysema. There is a general hypertrophy of tin , heart, with dilatation of all the cavities, especially of the ventricles; valvular disease of the heart is also frequently found. The impediment which exists to the circulation of the Mood through the lungs necessarily gives rise to an overloaded state of the right side of the heart. Again. I lin position of Ihe heart is often iiltored; it i.- pu-hed downwards, and its impulse is often felt- strongly in the epigastrium. The pp.Mtiuii of tho ventricles is there-' fore chained, *nd tho direction of tho

axis of their cavities is altered with rc : forence to that of their great vessels. This must leatt , to Ihe embarrassment' of the circulation. Dyspnoea is increased by the stomach or bowels being overloaded.