A Case of Lung Abscess

THE following case is of clinical interest for three reasons: (a) The etiological possibilities, (b) The therapeutic problem, (c) A good result after prolonged and hazardous illness. R. MCC., AGED 50 YEARS; OCCUPATION-PRINTER. This iman, who is well known to me, had no history of previous illness except periodic indefinite dyspeptic symptoms. On the evening of the 2nd October, 1936. he was seized with sudden violent abdominal pain. I saw him some thirty minutes later, when he presented typical signs and symptoms of an acute abdominal catastrophy. He was immediately admitted to the Royal Victoria Hospital, where a laparotomy under general anaesthesia was performed by Mr. C. A. Calvert. He found free fluid in the abdominal cavity and a large perforated ulcer at the pylorus. This was sealed in the usual manner and the abdomen closed with drainage. His post-operative condition appeared reasonably good until the 9th October, wvhen he had severe malaena. An alarming condition of shock and profound secondary anaemia was only slightly improved by a blood transfusion. Haemorrhage recurred twice within a few days, necessitating two further blood transfusions. He was now very toxic, and in the third post-operative week started running a hectic temperature. On the 5th November a radiogram of the thorax and upper abdomen showed elevation of the right cupola of the diaphragm, and as his condition showed marked deterioration, Mr. Calvert resected his twelfth rib and explored the subphrenic spaces, without however finding any localised abscess formation. His condition continued to be most critical for the next two weeks, when he unaccountably showed signs of improvement. This continued, and he was discharged from hospital on 3rd December, 1936, without signs or symptoms except a not unnatural secondary anaemia. He remained under my supervision for the next inonth, and during this time he continued to improve in general health, remaining unscathed during our local epidemic of influenza. Towards the end of January he went to Newcastle, and after ten days returned wkith complaint of severe cough and a ventral hernia. This cough was paroxysmal in character, almost without sputum, and worse at night. Clinical sigIns were slight, showving some relative dullness and imiipairedl air-entrv at the posterior aspect of the miiiddle zone of the right lung.