The duration of the disease, as well as the severity of the disturbances, arc subject to great fluctuations, and depend essentially upon whether the patient is able to take proper care of himself, or whether he is compelled to constantly expose himself to further harmful influences. But, even at best, the prospects of complete recovery are only slight ; and physician as as patient must regard it as a great success if the progress of the disease can he arrested. • All measures must be directed toward overcoming the condi tions which are known to aggravate the affection. The patient should refrain, as much as possible, from all kinds of bodily labour, as well as from dancing, singing. shouting, and the playing of wind-instruments. He should avoid over-burdening his stomach, and see to it that the bowels ate evacuated every day. If the patient's financial condition permit it, he should live in a mild climate during the inclement seasons ; this will also facilitate the improvement or cure of a bronchial catarrh which may be present.
In the treatment of emphysema it is necessary, in addition to the em ployment of remedies, which act less upon the disease process than upon the various resultant' disturbances, to consider all those measures which mechanically facilitate expiration and possibly improve also the expansi bility of the pulmonary tissue. For instance, a friend of the patient or the patient himself should place both hands Hat over the side of the chest and exert pressure during expiration. This measure must he repeated from live to ten minutes daily for several weeks. The so-called pneumatic treat ment has found wide application in the struggle against emphysema. Special forms of apparatus are widely employed. If a catarrh of the finer ramifications of the bronchi be present, inhalation of compressed air, such as is employed in pneumatic cabinets, is advisable.
Gangrene of the Lungs.—Putrefactive bacteria, which enter the lungs and remain there, cause portions of the pulmonary tissue to die and to de compose. These bacteria occasionally reach the lungs through the blood current, as, for instance, in puerperal fever and inflammation of bones. More often they arc introduced through the air-passages, or they spread from putrid areas into adjacent parts.
The most frequent causes of pulmonary gangrene are foreign bodies, especially food remnants, which may enter the lungs by getting into the windpipe instead of into the (esophagus, or by suction. This entrance may occur during vomiting, particularly in patients who arc unconscious or in sane, or who stiffer from paralysis of the muscles of swallowing. Gangrene of the lungs sometimes results from other severe affections of these organs, such as pneumonia, or suppurative catarrh of the bronchi: The disease is either chronic or subacute. Fever is almost invariably present. Most patients have cough, stitching pains in the sides, and short YIN'S of breath. But neither these signs nor an examination of the lungs are snfficient to determine with certainty the true nature of the affection. In most cases a positive diagnosis may arrived at by a microscopical and general study of the sputum. The sputum is characterised by its repulsively purr4ent and putrid odour, which rapidly permeates the air in the neighbour hood of the patient, rendering it almost impossible to approach him. The same applies to the breath and to the cough. The sputum is rather profuse,
and soon after being expectorated it separates into layers an upper laver, \\•lk]] is mucopurulent and covered wit 11 froth ; a middle laver, \vhich is more watery ; and a lower laver. which is almost enfirelv purulent. smeary, and yellowish-green. The lower laver also contains smaller or larger mal odorous plugs, which are especially characteristic of pulmonary gangrene.
When only a circumscribed gangrenous area (a patch of gangrene) is present, recovery is not impossible ; hut the disease is always a very pro tracted one, lasting for months or years. The stronger and younger the patient, and the smaller the diseased area, the more hopeful the outlook.
In order to prevent the disease, great care should be taken when feeding unconscious patients ; and those who suffer from disturbances of swallow ing should be carefully watched. It necessary, artificial feeding with a throat catheter should he resorted to. Children should . be taught not to take foreign bodies into their mouths. They, as well as grown persons, should accustom themselves to eat slowly, and without talking. The medical treat ment includes a careful dietary and a judicious use of antiseptics, which only the physician can determine.
Pneumonia.—Inflammation of the lungs ; a disease which is characterised by a comparatively regular course. It usually develops at a time when the patient is in the best of health, progresses very acutely to a crisis, and ends abruptly either in recovery or in death. The individual attacked is suddenly affected by a violent chill, which is followed by a sudden rise in temperature. ,1 fter a few hours the patient usually suffers from acute pains in the affected side of the chest ; his face becomes flushed, and he develops a short, painful cough, superficial breathing, and a severe feeling of oppression. The sputum, owing to a slight admixture of blood, very soon gets a rusty appearance. This bloody sputum is peculiar to many forms of inflammation of the lungs, and is not necessarily a had prognostic sign. The lips often show an eruption of blisters. During the further course of the disease the shortness of breath and the oppressive sensation become worse, the cough grows more violent and painful, and, if respiration is laboured, the face may become somewhat bluish. The patient seems to grow worse and worse until the crisis appears. This occurs between the fifth and the ninth day of the disease ; usually on the fifth or seventh day. Then the fever suddenly subsides, and the patient is bathed in a profuse sweat (see Fig. 261). The respirations become deeper and more quiet, the cough loosens, the pains all disappear and the appetite returns. In short, the patient has, with one hound as it were, escaped death. Although the patient may feel comparatively well after the crisis, it is important for him to remember that the morbid changes are still present in the lungs, and do not subside for several days. In rare cases the disease resolves, itself, not suddenly. by crisis. but gradu ally, by what is known as /ysis. In most cases the seat of the affection is in the lower lobes of the lung, more often in the right lung than in the left. The inflammatory process, however, may involve also the apexes of the lungs ; and migrating inflammations (that is. such as attack the various parts of the lungs in succession) also occur.