EMPHYSEMA OF THE LUNG. 129 



or a tedious catarrh accompanied by violent cough, the presumption is 

 warranted that we here have to deal with a substantive emphysema. In 

 like manner, a permanent inspiratory state of the thorax argues for the 

 former, the barrel-shaped chest more for the latter form of emphysema. 



PROGNOSIS. The prognosis as to life is, upon the whole, favorable. 

 A fatal termination of the disease is rare, and then only occurs after 

 long duration. Indeed, it cannot be denied that emphysema sets up a 

 certain degree of protection, if not absolute immunity against tuber- 

 culosis, depending either upon the " venous crasis," or upon the blood- 

 lessness of the lung, especially at its apex. Emphysema complicated 

 >y pneumonia (a somewhat unusual occurrence) should excite our solici- 

 tude, lest the pneumonic exudation be not reabsorbed, but should desci- 

 cate, and afterward break down, together with the cell-wall, after under- 

 going cheesy metamorphosis. (See Croupous Pneumonia.) Prognosis 

 as to complete recovery is altogether unfavorable, as shown above. 



TREATMENT. The causal indication requires judicious treatment of 

 the bronchial catarrh, whooping-cough, etc., so as to set bounds, at least, 

 to the progress of the emphysema, though a cure be impossible. In raw 

 weather, and in winter, when the temperature is low, make emphysem- 

 atous persons keep constantly in their chamber. Observant patients are 

 sometimes able to tell precisely what degree of cold is hurtful to them, 

 and forbids their going out. To meet the indicatio morbi, the periodical 

 administration of emetics has been advised. The object was to com- 

 press the distended vesicles through the pressure exerted upon the lung 

 by active vomiting and retching, in the hope that frequent repetition 

 of the process might effect gradual decrease in their size. By others, 

 tonics are recommended, to brace the relaxed pulmonary tissue and make 

 the alveoli smaller. These, and many other proposed modes of medica- 

 tion equally naive, and quite as false in principle, do not deserve the 

 least confidence as radical " cures " of emphysema. The nutritive alter- 

 ations upon whjch the disease depends are irreparable, and we are totally 

 unable to fulfil the indications for the disease itself. 



The symptomatic indication, first of all, requires proper treatment 

 of the bronchial catarrh, which almost always accompanies emphysema, 

 and greatly adds to the distress of the patient. Habitual wearing of 

 flannel next the skin, stimulants to the chest, warm baths of water or 

 vapor, the alkaline muriatic mineral springs, especially the thermal 

 springs of Ems, and other similar treatment, are often signally benefi- 

 cial for a while, but their action is all due to their timely application 

 against that serious complication, the dry catarrh. The use of iodide 

 of potassium is especially efficacious in these cases. 



The next symptomatic indication is to moderate habitual shortness 

 of breath of the patient and the attacks of severe dyspnoea, for brevity's 

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