122 DISEASES OF THE PARENCHYMA OF THE LUNG. 



during life, that, in order the better to compress the thorax during expi- 

 ration, they contracted the triangularis sterni, and the upper part of the 

 transversus abdominis, and the expiratory gullies in the liver, first accu- 

 rately descnbed by Liebermeister, could be seen upon autopsy. When 

 rigid dilatation of the thorax is associated with structural change of the 

 lung, it constitutes a third factor in the dyspnoea of emphysematous 

 persons. 



The entire aspect of the patient betrays obstruction of the respira- 

 tion, oppression, dyspnoea, and want of air. They summon all their 

 force to open out their thorax ; the alae nasi play ; the lower part of 

 the neck becomes harder and broader from the energetic contraction of 

 the scalini with every inspiration. Frequently, and chiefly in the in- 

 stances in which the costal cartilages are ossified and their joints atro- 

 phied, the forms of the sterno-cleidomastoidei stand out like hard cords. 

 The muscular relaxation, the flabbiness, the apathy, which we perceive 

 in all patients of this class, are due to imperfect decarbonization and re- 

 tarded oxygenation of the blood. When to these constant hinderances 

 to respiration a fourth one is added, as when the bronchi are contracted 

 by an aggravated catarrh, the dyspnoea rises to an extreme pitch. 

 Patients pass entire nights in their arm-chairs, fearing to choke if they 

 should lie down. The complexion becomes ashy and muddy, the ex- 

 pression of the eye fatigued, the sensorium benumbed, the pulse and 

 heart-beat small and irregular, the extremities cool ; the manifestations 

 of surcharge of the blood with carbonic acid increase to those of acute 

 poisoning by this pernicious gas. Before the days of Laennec^ such 

 attacks, which recur with greater or less violence and frequence in all 

 emphysematous persons, used generally to be considered and described 

 as nervous asthma. 



The derangements of circulation which are produced by the ana- 

 tomical changes in the pulmonary parenchyma of emphysematous pa- 

 tients present a second series of symptoms. With the disappearance 

 of the mteralveolar septa and the loss of the numerous capillaries, the 

 number of efferent channels from the right side of the heart is dimin- 

 ished. It follows hence, in the first place, that in that portion of the 

 lung spared by the emphysema usually its lower part the pressure 

 of blood is increased, and it becomes the seat of intense hypersemia, 

 and that chronic catarrh takes place in its bronchi, and often chronic 

 oedema in its alveoli. Now, we might suppose, the number of capil- 

 laries which remain not being sufficient to receive the contents of the 

 right ventricle, that the right ventricle, its auricle, and the veins of the 

 aortic circulation would be overloaded with blood, and that cyanosis 

 and dropsy would accompany very extensive emphysema. No indica- 

 tion, however, of any of these symptoms is usuallv observed for a long 



