A Clinico-pathological Study of Emphysema in an American Hospital

In 1951 Monroe found that the clinical and the pathological diagnoses of emphysema agreed in less than 5% of patients.His study, performed at a leading American hospital, is a convenient reference point since it antedates the widespread use of diagnostic pulmonary function tests as well as the recent advances in the morbid anatomy and methodology used for the pathological diagnosis of emphysema.It might be anticipated that a much better correlation could be achieved to-day, and the first part of this paper will show that this is the case.This study also provided an opportunity to investigate the relationship between emphysema, as a disorder of anatomy, and various conditions such as chronic bronchitis, fibrocystic disease of the pancreas, and peptic ulcer.This was particularly interesting since the relationship of these conditions to emphysema had previously been derived from the diagnosis of emphysema by clinical means, by inadequate pathological data, or by simple tests of pulmonary function.To some extent this study reflects a difference in attitude toward chronic lung disease between workers in the United States and in the United Kingdom, and this may be of particular interest to the British reader.