CHRONIC ALVEOLAR EMPHYSEMA 47 



contracting with vigor in an effort to compensate for the 

 lost elasticity of the lung and to expel the air. A marked 

 groove appears along the costal arches ("heave line"). 

 The inspiratory act is shorter than the expiratory. The 

 ribs are, seen to roll forward beneath the skin, the intercostal 

 spaces deepen and the ventral portion of the thorax and the 

 anterior aperture of the chest sink inwardly. In advanced 

 cases the ribs are kept rolled forward, the thorax appearing 

 barrel-shaped. If bronchitis is present, there is cough which 

 is usually short, weak, and dull. The cough is often attended 

 by the discharge of flatus through the anus ("breaking 

 wind"). Tfye heart sounds are at times feebler than normal. 

 The diastolic sound may be accentuated. Percussion gives 

 a sound which is too full and drum-like (hyperresonance) . 

 The heart's dulness may be obliterated. Posteriorly, the 

 area of the field of percussion is enlarged, the posteroventral 

 limits extending through the 18th, 17th and 14th ribs at the 

 heights on the thorax of the external angle of the ilium, 

 tuberosities of the ischium and shoulder- joint respectively. 

 (With normal lungs the figures would read 17, 15, and 11.) 

 Auscultation: If the bronchitis is present, dry or moist 

 rales are heard, otherwise the vesicular murmur is weakened. 

 When the brbnchi are involved there is a bilateral, white 

 nasal discharge. The general condition suffers in old cases. 

 The patient loses flesh, becomes anemic with a tendency 

 for edema to form under the chest and belly and in the 

 limbs. 



Course.— The course is prolonged, the condition lasting 

 for months and years. Once affected the patient never 

 fully recovers. The symptoms improve as the attending 

 bronchitis improves, the patient's work lightened and the 

 quantity of roughage fed, especially tame hay, reduced. 

 On the other hand exposure, hard work and the feeding 

 of bulky, dusty food (hay), and allowing the thirsty patient 

 to drink at one time all the water it will, greatly increases 

 the dyspnea and cough. 



Diagnosis. — Only advanced cases can be diagnosed. The 

 characteristic dyspnea, which increases on exercise, the 

 dilated nostrils, the anal protrusion, cough, and absence 



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