Emphysema of the lungs

Abstract

In this paper the disturbance of function in emphysema, and its mechanism as revealed by experiment at the bedside, are emphasized, and the bearing of these clinical observations on the natural history of the disease and its diagnosis is discussed. The primary lesion is loss of elasticity, the most common cause of which is the stress and strain of cough or respiratory obstruction on the structures concerned in respiration, the process being comparable to the loss of elasticity which occurs in blood vessels following hypertension. Almost all the symptoms and signs of emphysema, and also the over-distension of air sacs and formation of bullae, can be explained on the basis of loss of elasticity, and it is suggested that it is the wastage of ventilation on this “pathological dead space” which is responsible for the dyspnoea and the impairment of haemo-respiratory exchange which occur. The difficulties and fallacies in the diagnosis of emphysema are described, and it is suggested that the present state of confusion would be diminished if the diagnosis were reserved for those who have symptoms as weil as signs of this disease. © 1944, British Medical Journal Publishing Group. All rights reserved.