CHAPTER XX.

TREATMENT OF SPECIAL DISEASES.—Continued.

DISEASES OF THE RESPIRATORY SYSTEM.

=Gangrene of the Lung.=—_Definition._—A putrefactive necrosis of the lung.

_Cause._—Many putrefactive bacteria thrive in the necrotic soil, but whether they are the cause or the result is not known.

_Pathology._—When the gangrene is due to the plugging of one of the large branches of the pulmonary artery, a large part of the lung becomes dark, greenish brown, or a black fetid mass, softening rapidly in the center, forming an irregular cavity, containing a foul-smelling disgusting, greenish fluid.

_Treatment._—Give complete arterial injection. Inject the pleural sac on the affected side through the first intercostal space or through the apex of the cavity. Spray fluid into the mouth and nose and close them with absorbent cotton. For shipment of these cases govern yourself according to the transportation rules.

=Pulmonary Hemorrhage.=—_Synonyms._—Hemoptysis; Broncho-pulmonary hemorrhage; Bronchorrhagia; Pneumorrhagia.

_Definition._—An expectoration of blood, due to hemorrhage from the mucous membrane of the bronchi, trachea, or larynx and from erosion or rupture of capillaries in lung cavities.

_Cause._—The hemorrhage may result from congestion of the lungs, due either to pulmonary lesions or from cardiac derangements. It may accompany malignant affections, infectious fevers, scurvy, cancer of the lung, gangrene, and abscess of the lung.

_Pathology._—There is, in most cases rupture of the capillaries of the bronchial mucous membranes. If tubercular cavities are formed, a ruptured aneurism is sometimes seen, or large blood vessel eroded by ulceration. If pulmonary apoplexy has existed, the parenchyma may be lacerated.

_Treatment._—Some operators wait until fluid passes from the mouth before taking steps to stop the hemorrhage due to the injection of fluid. We prefer to use plaster of paris and cotton, making a paste of them and forcing the paste down upon the epiglottis to prevent the waste of fluid from that source. When the cause of death is known, this operation must be done before the injection is begun or the throat will have to be dried out before the plaster of paris will set properly. Another treatment to prevent the leakage of fluid would be to tie off the trachea just above the upper border of the sternum.

The body is usually emaciated and should be injected arterially with comparatively mild fluid, in order to avoid drying or dessication of the features. Whenever fermentation exists in the abdomen, the cavity should be injected; otherwise it is not usually necessary. The amount of fluid for the injection should be based on the amount that will be taken by the vessels of a body the size of the one being injected. For transportation of these cases the provisions of the transportation rules should be your guide.

=Pulmonary Abscess.=—_Synonyms._—Abscess of the lungs; Suppurative pneumonitis.

_Definition._—A collection of pus in the lung, accompanied by degeneration of tissue.

_Pathology._—The abscess may involve one or more lobules, or engage almost the entire lobe, or the abscesses may be scattered throughout the whole lung.

_Treatment._—Should hemorrhage occur, treat this case the same as for pulmonary hemorrhage. If no hemorrhage occurs, give the body a complete injection with a mild fluid and inject the pleural sacs from the first intercostal space or the apex of the cavity. For transportation, govern yourself according to the provisions of the transportation laws.

=Pneumonia.=—This disease is divided into different subdivisions as follows: Lobar Pneumonia, broncho-pneumonia, and chronic interstitial pneumonia.

(A) _Lobar Pneumonia._—_Synonyms._—Croupous or Fibrinous Pneumonia; Pneumonitis; Inflammation of the lungs; and Winter fever.

_Definition._—This is an acute infectious disease characterized by an inflammation of the lung tissue in which there is, first, congestion and engorgement, second, exudation or consolidation; and third, resolution or suppuration.

_Pathology._—The right lung is more frequently affected than the left, and one lobe, or one entire lung, rather than both lungs at the same time.

_Treatment._—Should suppuration occur, turn the body on its side, press on the sternum and cause the suppurative matter to leave the windpipe by purging it into the folds of a towel which should be placed at the mouth. Spray the mouth with fluid and close the oral and nasal cavities with absorbent cotton.

Give the body a thorough arterial and cavity injection, paying especial attention to the pleural sacs, which should be injected independently from the first intercostal space on each side or from the apex of the cavity. Drain blood and disinfect the contents of the blood bottle before disposing of same. For transportation, govern yourself according to the provisions of the transportation laws.

(B) _Broncho-Pneumonia_—_Synonyms._—Capillary Bronchitis; Lobular Pneumonia; Catarrhal Pneumonia.

_Definition._—An inflammation of the terminal bronchi, air vesicles, and interstitial tissue of a few or many of the lobules.

_Pathology._—The interstitial tissue between the air cells and the capillaries are greatly weakened. In most cases the lung will float when placed in water, though the small mahogany-colored nodules found distributed throughout the lung when excised sink in water.

_Treatment._—The nature of the disease is such that preservation is comparatively simple, the disease affecting the extremities of the respiratory system. Arterial injection together with special attention to the pleural sacs will suffice for the cases. For transportation, govern yourself according to the provisions of the transportation rules.

(C) _Chronic Interstitial Pneumonia._—_Synonyms._—Cirrhosis of the lungs; Fibroid Pneumonia.

_Definition._—A chronic inflammation of the lungs, in which the normal air cells are replaced by fibrous or connective tissue, followed by induration and atrophy of the lung.

_Pathology._—The disease is nearly always confined to one lung, though, in very rare cases, both lungs may be involved, while localized areas are the rule. The affected lung becomes atrophied and in extreme cases, may be no larger than the closed hand. As a result of the shrinkage of the lung tissue, the heart undergoes hypertrophy. When tuberculosis exists, cavities of varying size and number are found, and the interstitial tissue between the capillaries and the air cells is very much weakened.

_Treatment._—Should this disease be followed by a rupture of the capillaries during the injection, thereby causing a hemorrhage from the oral and nasal openings, treat it as you would a case of pulmonary hemorrhage. Otherwise give the body a thorough arterial and cavity injection with special attention to the pleural sacs. For transportation, govern yourself according to the provisions of the transportation laws.

=Hydrothorax.=—_Synonyms._—Thoracic dropsy; Dropsy of the chest; Dropsy of the pleura.

_Definition._—A collection of serous fluid within the pleural cavity without inflammation.

_Pathology._—Hydrothorax, unless due to cardiac affections, is usually bilateral. The quantity of fluid varies, and is generally greater on one side than on the other. The fluid is free, and of a low specific gravity, alkaline in character, clear, and of an amber color.

_Treatment._—To prevent the formation of blisters on the posterior surface of the thorax, aspirate the serous fluid from the pleural sacs, introducing the trocar through the apex of the cavity, and extending it into the cavity until it has almost reached the diaphragm. This must be done with both the right and left sacs. Give the body a complete injection, using normal fluid throughout the entire injection. Inject the pleural sacs after the serous fluid has been withdrawn. For prevention of post-operative dangers such as bursting blisters, etc., line the casket with rubber for a distance of 3 inches above the bottom. For transportation of these cases, govern yourself according to the provisions of the transportation laws.