The capacity of the patient to endure a long-continued suppurative discharge is principally determined by his natural vigor and his ability to assimilate food, other elements, such as extent of injury to the lung, being the same. A well-defined superficial cavity would be more favorable, because within surgical relief.
In the pyæmic variety the force of the infectious element will determine largely the result. Chills and sweats are important prognostic elements in such a case.
In the secondary abscesses of either the empyematous or hepatic variety prognosis is grave—more so in the latter than in the former, because surgical procedure would be more promising in the former, and because of the implication of an organ so liable to destructive inflammation as the liver. A long and tedious course of suppuration is possible in either. The dangers in an established abscess arise from liabilities to septic infection and exhaustion consequent on want of reparative power and persistent suppuration.
TREATMENT.—The treatment of abscess differs little if at all from that of gangrene of the lung. The tendencies of the two diseases toward exhaustion and infection are similar, but are less pronounced in the former. The same remedies are necessary in both, such as stimulants, tonics, antiseptics, anodynes, and expectorants internally, inhalations and drainage externally; brandy and malt liquors as stimulants; nourishing and concentrated food at frequent intervals; quinine as tonic and antiseptic; carbolic acid and turpentine as most valuable antiseptics (the latter being also an excellent stimulant); eucalyptus in cases of profuse as well as fetid discharge; carbonate of ammonia, senega, as expectorants; morphine and codeine or anodynes to control cough; carbolic acid for inhalation; and in cases of definitely localized cavities a free opening to be made with antiseptic injections.
Successful cases of surgical interference are reported, and such treatment is now recognized as proper when the system is giving way under septic poison, evinced in chills, sweats, and great prostration, where the purulent discharge is fitful and imperfect, and where the physical signs are clear enough to show the locality of the abscess.
GANGRENE OF THE LUNG.
BY WILLIAM CARSON, M.D.