LUNG, Gangrene of.
The treatment is identical almost with that of bronchiectasis detailed upon p. io3. Thus whilst every means is being employed to keep up the patient's strength and to improve the state of his nutrition, measures should be taken to diminish, as far as possible, the decomposition of the bronchial secretion and the fcetor or stench which surrounds him. This may be attempted by the administration of volatile antiseptics internally, and by the saturation of the surrounding atmosphere with similar agents. Creosote in doses of 2 to 5 mins., in an emulsion or in capsular form, is the best. Turpentine, Myrtol, Oil of Santal or of Eucalyptus or of Pepper mint, are also useful. Carbolic Acid cannot be given internally for any considerable period of time with safety in doses sufficiently large for this purpose. Sulpho-carbolatcs have been found to diminish the abominable odour from the perspiration. Berliner injects into the gluteal region 5 c.c. every 7 days of a 25 per cent. solution of Eucalyptol in Castor Oil.
The Creosote Chamber, if available, is the best of all methods for disin fecting directly the decomposing pulmonary tissue; in its absence the air of the room may be kept saturated with Oil of Turpentine. This may be accomplished by periodically pouring some of the oil upon the surface of very hot or boiling water, but the rapid evaporation or vaporisation of the turpentine soon ceases, as the temperature of the water falls. The writer's plan is to use metallic trays or pans half full of dry pine sawdust, upon which the oil is to be freely sprinkled from time to time. A uniform degree of evaporation may be thus obtained. A good method which he has also tried with satisfactory results is to make a muslin or gauze coverlet and fill it with freshly teased-out oakum. This may be kept upon the patient's bed, and the oakum can be easily renewed, or sprinkled over from time to time with Turpentine, Eucalyptus Oil, or other volatile antiseptic.
Chlorinated Lime, Creolin„ Sulphurous Acid, Commercial Terebene, Sanitas, or any of the innumerable cheap disinfectants may be used for the same purpose, and a spray apparatus may be employed to diffuse the disinfectant through the atmosphere.
The use of antiseptics by the ordinary earthenware inhalers is not to he relied upon. Where a very thorough disinfectant action is required, the volatile ingredient may be poured upon boiling water contained in a large wash-basin, as the patient holds his head over it, whilst a linen sheet is thrown loosely over him, so as to extemporise a tent, under which the concentrated vapour may he freely breathed at intervals of a few hours during the day. During the rest of the day and night he will be breathing the more diluted antiseptic atmosphere, unless when in bright warm sunshine he can be permitted to go into the open air.
Oxygen inhalation is often very serviceable, but to be of use it must be employed for long periods.
Atomisers containing Menthol, Eucalyptol, &c., in oily solution may
he employed, and sprays are of considerable use, and are less troublesome, though of less efficacy, than the steaming under a sheet; by, their use particles of a solution containing non-volatile ingredients may be projected in a state of minute subdivision, so that they may come into contact with putrefying secretions about the naso-pharynx, larynx, and larger air tubes. The following solutions may be used: r, per cent. solutions of Chlorinated Soda or Lime, or Sulphurous Acid, about i in 20 Bichloride of Mercury, i to 2 grs. in io oz.; Creosote or Carbolic Acid, r dr. in io oz.; Biniodide of Mercury, i to 2 grs. dissolved with Kr, in to oz. water; Creolin, i to 5 per cent. solutions in water.
Veo's perforated Zinc oro-nasal respirator may be worn for considerable portions of the day, the wool being kept moistened by diluted solu tions of Carbolic Arid, Iodine, Creosote, Tcrpinol, Terpine, Terebene, Eucalyptus, lodoform. Thvmol, Menthol, &e., as in the following: . Menthol 3ij.
Creosoli Puri ficaii Thyntol ass.
Spirit. Fini Rect. ad Misce.
Intralaryngeal injections of Menthol, as mentioned upon p. 493, may be tried. The injection of antiseptics through the chest wall into the gangrenous cavity has not been satisfactory.
The expectoration should be passed directly into a spittoon, containing sonic powerful disinfectant and deodoriser like Turpentine, Eucalyptus, Chlorinated Lime, or Permanganate of Potassium in strong solution. It is only by rigid attention to these details that the abominable factor can be so diminished as to permit the nurse and attendant to approach the patient closely.
When the physical signs, aided by the use of the X rays, bronchoscopy and the exploring needle, reveal a gangrenous abscess cavity, the operation of cutting down upon it, performing pneumonotomy with the galvano cautery or scalpel, evacuating its contents and establishing free drainage, as described in a preceding article, gives excellent results, and may be performed without resorting to the method of operating under differential pressure.
LUNG, (Edema of.
This is secondary to valvular disease of the heart, arteriosclerosis, or to Bright's disease, or merely as a local result of a general anasarca, and its treatment is detailed under the name of the primary affection. The chief indication in the majority of cases is to stimulate the heart Strychnine and Digitalis. As much as to mins. of the D.P. Liquor of Strychnine may be injected in a desperate case. In the acute form associated with dilatation of the right ventricle a large vein should be opened and 15 oz. blood removed, or wet cupping over the back of the chest if rapidly carried out may save life in apparently hopeless cases. Nothnagel advocated one large blister, and the hypodermic injection of Camphorated Oil. This may be administered in 15-min. doses ter die of a 20 per cent. solution in Olive Oil, but in all urgent cases a vein should be opened.