The Treatment of Lung Abscess

¹ Houston, Texas

1) The majority of lung abscesses occur by means of aspiration through the bronchogenic route.

2) The anaerobic character of the infection in the majority of abscesses is emphasized.

3) Various forms of collapse treatment have been tried and found wanting and are definitely contraindicated.

4) Fifteen to twenty per cent of lung abscess cases do heal spontaneously but it is a serious offense to hold a case on so-called conservative treatment indefinitely because eighty to eighty-five per cent will get worse and after a time develop a bronchiectasis or an empyema which would require radical surgery or else permit no help at all.

5) Various medical procedures used in the treatment of lung abscesses have no definite therapeutic value except as an adjunct. Whatever improvement occurs with their use alone is probably the result of spontaneous healing.

6) A plea for definite standard criteria for the evaluation of statistics is made.

7) A brief mention is made of a personal series of eighteen cases with a mortality of one case.

8) In answer to the question, "How soon should we operate?", the statement is made: "As soon as a definite abscess cavity can be demonstrated and localized accurately, it should be opened and drained." No one questions the advisability of open drainage of a brain abscess, ischiorectal abscess, appendiceal abscess, or one on the finger or toe. Therefore, it is difficult to understand why one should make an exception to the long recognized treatment of localized pus, merely because it occurs in the lung.