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This condition may result evidently from any cause which inter feres seriously with the exit of air from the air cells; for with every act of breathing, these air cells are distended with air during inspiration, and collapse or fall together during expiration. Hence any impedi ments in the exit of air interfere with this falling together of the cells, and may, if sufficiently long continued, result in permanent distension, or emphysema. A familiar example occurs in musicians who habitually perform upon brass wind instruments. For these individuals drive the air from the lungs with considerable force against the obstacle, and frequently suffer from emphysema in consequence.
Symptoms.-Emphysema may, doubtless, exist to a consider able extent without attracting the patient's attention to the fact that something is wrong in the lung ; but after a time it is indicated by labored breathing and shortness of breath, especially upon active exercise. The difficulty in breathing is quite characteristic, in that the expiration is long and labored. In fact, the natural proportion between drawing the air in and breathing it out - inspiration and expiration - is reversed. For in the natural condi tion of the lungs the act of inspiration is three or four times as long in duration as the following act of expiration; in cases of emphysema, however, the act of expiration becomes much longer than that of inspiration.
Emphysema occurs from a variety of causes, among them chronic bronchitis and asthma. Indeed, it is somewhat rare to find a case of spontaneous emphysema, or one which is not associated with some other disease of the lungs. Many of the symptoms which are usually considered to be caused by emphysema, are really due to the bronchitis or asthma, or both, which are so often associated with this disease. Thus, there is usually cough and expectoration, the cough being violent, and being characterized by prolonged convulsive efforts at expiration, so that it resembles somewhat whooping cough. The matter expectorated varies con siderably, just as it does in bronchitis.
This disease is obstinate and long continued ; though it causes directly no other ill effects than the annoyance due to the difficulty of breathing, yet it is apt to occasion derangement in the circula tion of the blood. For all the blood in the body must pass through the lungs in order to give off carbonic acid gas and take up oxygen; now, when the lungs are thus partially disabled, the blood does not pass so readily, and hence the work of the heart is much increased. The blood is not completely purified, and hence emerges from the lungs not red, as it should, but still somewhat blue. The result is, that the skin of the individual is apt to exhibit a bluish tinge; the veins of the face and neck are often dis tended, giving the countenance an expression of distress. All these symptoms are increased by exercise, whether in walking, working, or speaking. Most of these individuals suffer at times from paroxysms of labored breathing, which are usually caused by the accompanying asthma, and not by the emphysema itself.
This disease may be developed at anytime of life, and, indeed, seems to commence in many cases during infancy or childhood, though it rarely becomes troublesome, or, indeed, is noticed at all until middle life is attained. The disease appears to be hereditary. In well-marked cases of emphysema the form of the chest is so characteristic that the experienced physician recognizes the dis ease at a glance ; the upper part of the chest is barrel-shaped, not flattened from side to side, as is the natural condition ; during inspiration, too, the chest sinks in at the lower part and above the breast bone, while the ribs and breast bone together rise as if they constituted one piece.
Treatment.-The treatment of emphysema must consist usually in the effort to cure the bronchitis, with which it is com monly associated ; for when the latter difficulty is relieved, the patient exhibits but little annoyance from the emphysema, although the latter be continued undiminished. The measures already indi cated as useful in bronchitis may, therefore, be employed in the treatment of this affection also.
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