Over the past few years, the treatment of lung abscess has been undergoing various radical changes that have led to the improvement of knowledge of the mechanics and the physiology behind its treatment. Among the major changes in the medical field that have led to the improvement in the treatment of Lung abscess is the surgical handling of tuberculosis. Treating tuberculosis through surgical means has created more confidence in attempting surgical treatment on the Lungs, a procedure that was previously regarded as extremely hazardous. This paper will seek to discuss various ways in the treatment of Lung abscess as explained by J. Emerson Dailey in his medical Journal The Treatment Of Lung Abscess.
Although some authors claim that lung Abscesses occur as an embolic disease, Emerson is inclined to the notion that the majority of abscesses occurs by means of aspiration through the bronchogenic route (Emerson). He largely emphasizes on the anaerobic character in the bacteriology and the infection of abscesses. Emerson quotes previous study’s that shows that 80% of all pulmonary abscesses contain anaerobic organisms while the remaining 20% contains the aerobic organisms. He further acknowledges the fact that there are various Lung abscesses, about 15-20%, that heal spontaneously without any special form of treatment. However, it is Practically impossible to tell which case will fall into this group or into the much larger group in which progression of the disease occurs (Emerson). In addition, it is a serious offence to hold a case on the so-called conservative treatment indefinitely since most of the patients will tend to
get worse and after a time develop bronchiectasis or an empyema which would end up calling for a surgery (Emerson).
The medical procedures used in the treatment of this disease include postural drainage, bronchoscopic aspiration and irrigation (Emerson). This may also involve intravenous injections of arsphenamine and guiacol, rectal instillations of ether in oil and the oral administration of iodides, sulfanilamide, sulfapyridine, sulfathiazole among other drugs. In case of a surgery, the accepted surgical treatment is referred to as the open drainage. This procedure involves removing the ribs and unroofing the abscess cavity with the cautery. This surgical process is usually carried out in either one-stage or two-stage procedure. The two-stage involves the removal of ribs and packing to promote adhesions and later opening into the abscess cavity. On the other hand, the One-stage procedure involves opening into the abscess all in one operation. However, the Two-stage is by far the safest procedure and does not permit the possibility of a complicating empyema.
Through this article, J. Emerson Dailey manages to table different questions for discussions and also provide the most appropriate solutions. For instance the question in regard to which is the best approach to dealing with a case of Lung abscess, he argues that, instead of the medical treatment being set entirely apart from the surgical treatment, both the medical doctor and the surgeon should work in very close cooperation with each other. Therefore, we can conclude that all lung abscess cases should be treated with the early postural drainage and Bronchoscopy should only be used as a diagnostic procedure and also in those cases in which a foreign body is suspected.
References
J. Emerson Dailey The Treatment Of Lung Abscess. Chest. 1942; 8(7):204-208. Available at
http://journal.publications.chestnet.org/article.aspx?articleid=1051615 Retrieved June 21,2013
