A British Medical Association Lecture on MASSIVE COLLAPSE OF THE LUNG (ACTIVE LOBAR COLLAPSE)
Authors: J. M. W. Morison
Journal: BMJ (1930)

THIs condlition lhas beeln described under various titles, suchl as acute massive collapse of the lungs, post-operative massive atelectasis, post-operative pulmonairy atelectasis, obstructive massive atelectasis, acute lobar collapse, apneu-1inatosis, and s-o oni.The title " massive collapse of the lung " was used by Pasteur in his last commilunication on this subject.It is clear,self-explanatory, avoids the use, as Gairdner puts it,of sesqouipedalia ver ba, and covers 'all deflations of a large ar ea of lunig, whatever the cause may be.The conditioni is found associated with pleurlal effusiolls, pnoeumothlorax, bronchial obstructionis by gr ow thi or foreign bodies, pneumonia, pulmonlary tuber-culosis, and other inflammatory conditions of the lungs, with certain nerve lesions, and as a complication following surgical operations and injuries.In somne of these conditions tlle lung plays a passive part, but in tlle post-operative and traumatic cases the lung plays ani active part.This was recognized by Pasteur when he uise(d the subtitle " active lobar collapse," and my obser- vationis in this paper are limited, more or less, to that type.ACTIVF, LOBAR COLLAPSE.I define this type as an airless coniditioni of the lung, or part of the IIIIlg, of suidden onset, lobar in distribution, u-ith coincident accumllulationi of tenacious mucus in the, -corri espon(ling bronchi, aiid accompaianied by characteristic physical signs, the clhief of which is displacemenit of the heart towards the affected side.The condition may be so sliglht as to pass unnioticed unless specially sought for, o-it miiay be so extreme as to menace the life of the patient.It u-suially occurs within forty-eight hours of the operationl or injury, but cases have been re- corded after lon-ger intervals.11i a typical case the Onset is sudden1; the patient is seized with a shiarp pa1ii il th1e side, has difficulty in breathing, and becomes snore or-less Cyaniosed.Thier e is usuallY a moder ate rise of temperature, annd it generally precedes the onset; it is rarely above 1020 F. There is also an increase in the rate of the pulse and respiration.The tendency is to lie o tlie -affected side or, if PilloWed up ill bed, to cUrl up towards the affected side, which, on inspection, is seen to be ;immnobilized and retracted, with ,inarroWing of the ib interspaces.Further examination reveals a dullness corresponiding to the area of lung collapsed, and over tlhis area there is an absenice of breath soun1ds anid tactile vocal f1rem1itus.Thie lieart is displaced towards the affectedh side, and the apex beat nay have shifted two ou more inches; in cases "where thie left lower lobe is col- lapsed, it is also displaced u'p-wards.Cough is slight and sputum scanty, or they may be absenit.There is a compen- satory emphysema of the uniaffected lung.Later on, these physical signs present great variation; the chest wall is not completely iinmobilized; the breatlh soulnds become tubular, and tactile vocal fremitus is iln-creased.The cough.increases, and there is expectoration of tenacious mucus, wlhich, how- ever, is -never rusty.As time goes oni the expectoration becomes more copious and less tenacious.Daily variationi in the physical signs may occur, auscultatio'n over one area of lunig at different times giving quite differenit results.The x-ray examination, ain extension of the physical examination by inspection, and in thle followving, cases miiade in the wards by a portable appalratus, clelaly shows: