Respiratory Symptoms, Bronchitis, and Ventilatory Capacity in Men

FIBROSIS OF THE LUNGS MwBwrnouxafter cessation of treatment the mean figures are 8 before, 12.9 during, and 6.5 after treatment.These figures fit well with the clinical impression that, while an exceptional case treated early in the disease may show a more favourable response, all that can be expected of corticosteroid treatment is that it may suppress the progress of the disease process and certain of its symptoms, and that the favourable effects, if any, do not usually continue after cessation of treatment.Successful treatment of these cases will probably have to await more complete knowledge of their aetiology.At present, in our study we are in the preliminary stage of collecting information and building up an accurate description of every aspect of them.To go back to a point mentioned earlier, I think that at the moment it may be obscuring important issues to call the whole of this group the Hamman-Rich disease or Hamman-Rich syndrome.If those words mean anything, they would imply that the chronic cases represented a chronic reaction to the same noxious process, whatever it may be, to which the original cases described by Hamman and Rich were an acute reaction.This may or may not be found eventually to be true; but in our present state of ignorance the use of a form of words which assumes tacitly that it is true implies the uncritical acceptance of so many unproved hypotheses that it only confuses our thought, and this should certainly be avoided.For this reason I prefer to refer to this fascinating group of cases in the chronic stage by the purely descriptive name, chronic diffuse interstitial fibrosis of the lung of undetermined aeiiology.Summary Twenty-six cases of chronic diffuse interstitial fibrosis of the lungs have been observed during a period of nine years.Their clinical, radiological, and physiological features are described, and an account of the morbid histology, based upon studies in 13 of them, is given.The prognosis is discussed, and the effects of corticosteroid treatment in 12 cases are described.In this lecture, which was intended to recount my own experience, I have not attempted a formal review of the extensive literature.Good reviews have been published by Grant, Hillis, and Davidson (1956) and by Rubin and Lubliner (1957).I have previously published a brief account of 12 of my cases (Scadding, 1956).