The prognosis in abscess of the lung depends largely on the nature of the per foration through which the pus finds its way into the bronchus, to be expecto rated. A large opening corresponds to free drainage and an acute course, while in cases in which the orifice is small the discharge takes place slowly, and the course accordingly becomes chronic and the outlook more unfavorable. Serous or purulent exudation into the pleura does not necessarily increase the gravity of the situation, but metastatic abscesses. especially in the brain, are always seri ous complications. Jacobson (Zeits. f. klin. .Med., vol. xl, Nos. 3 and 4, 1900).
Treatment.—In cases other than tuber culous ones, the abscess, when the diag nosis is certain, should be evacuated by aspiration or incision. It will not only tend to prevent rupture into the neigh boring cavities, but counteract the tend ency to mortal marasmus which an un treated abscess involves.
The results of operations for pulmo nary abscess are full of promise. Fabri cant reports 38 eases, with 29 recoveries and 9 deaths. Rklus reports, out of 23 operations which have been performed within the past ten years, 20 cures and 3 deaths. The old idea that adhesions between the lung and parietal pleura were a requisite for successful operation is passing into oblivion. Adhesions are unquestionably of great advantage. If adhesions are absent the operations can be carried out in two stages; at the first, suturing the two pleural layers: at the second, opening the abscess after a delay of a few days. Unfortunately, however, such delay is generally inad missible—it means death. The abscess must be opened at once. In certain cases the parietal pleura may be sutured to the lung, but generally the patient's condition is such that the operation must be rapidly completed, the pleural cavity being protected as well as pos sible by sponges and gauze. Editorial (Medical News, Feb. 13, '97).
Two cases of successful operation for abscess of the lung. In one case the clinical signs were those of an empyema, bnt at the operation it was found that the pleural cavity was free from pus, and an exploration of the lung-tissue discovered a circumscribed abscess. The operations were attended with a con siderable hcemorrhage; but this was easily controlled by packing. Riedel
(Munch. med. Woch.. July 12, '9S).
Case of pulmonary abscess in which the lung was stitched to the parietal pleura before the pus was evacuated. The abscess was opened by introducing a pair of haemostats and withdrawing them expanded. A rubber drainage-tube was then inserted and the patient made a goad recovery. C. A. Morton (Brit. Med. Jour., Feb. 17, 1900).
The measures recommended under FOETID BRONCHITIS (q. v.) are all indi cated here. Simultaneously and in addi tion to the measures employed to coun teract the causative disease, remedies and food calculated to increase the strength of the patient greatly enhance the chances of recovery.
Pulmonary Gangrene.
Gangrene—i.e., death and putrefac tion of a more or less extensive area of the lung-tissue—occurs occasionally as a complication of pulmonary or infectious diseases.
Symptoms.—These vary according to the characters of the causative affection and the region involved, but, as a rule, intense fcetor of the expectoration and of the breath is the first indication that a necrotic process has begun. This pe culiar fcetor may be said to be pathog nomonic; it contaminates the patient's surroundings, and renders his presence almost unbearable where other patients are gathered, and isolation becomes necessary. It is far more offensive than in pulmonary abscess or bronchiectasis.
When the sputum is allowed to ac cumulate in a glass dish it separates into three layers: a superficial layer, which is frothy, yellowish gray; a middle layer, almost transparent and resembling pure serum; and a lower, a foul, greenish mass, streaked with blood in proportion as the vascular elements are involved in the destructive process. The mass contains various bacteria, pieces of small bronchi, fat-globules, pus-cells, and fungi, etc., and sometimes portions of lung-tissue.
The general manifestations are mainly those of the marasmus of pymmia: great prostration, emaciation, weakness. Fever is, moreover, less marked and irregular and attended with chills and profuse sweating. Exhausting coughing spells tend to increase the patient's discomfort. Two forms are recognized: the diffuse and circumscribed.