Medical management of acute lung abscess.

Within the past decade, the medical regimen for lung abscess has included postural drainage, bronchoscopic aspiration and irrigation, artificial pneumothorax, intravenous injections of arsphenamine and guaiacol, rectal instillations of ether in oil, and the oral administration of potassium iodide and sulfonamides. The data reported by Rosenblatt (1940)’ indicate the hazards and ineffectiveness of such treatment. Of 72 patients with putrid lung abscess treated medically, only 9 per cent were improved or cured, and 91 per cent were either unimproved or dead. Allen and Blackman2 in 1936 collected 2,114 cases of pulmonary abscess from the American literature and found the mortality with medical treatment was 34.4 per cent, and with both medical and surgical treatment was 34.2 per cent. In 1948, Smith3 published a statistical analysis of 2,166 cases compiled by representative hospitals throughout this country from 1936 to 1944 and concluded that no material change in the gross mortality (34.2 per cent) had occurred. With the addition of penicillin an appreciable increase in the number of symptomatic cures of medically treated lung abscess has been reported. Potter,4 however, questions that the follow-up of these cases has been sufficiently long to determine whether spontaneous obliteration of abscess cavities has materially increased.