Pulmonary Congestion, Active.
Synonyms:—Hyperemia of the lungs; congestion of the lungs; acute pulmonary hyperemia.
Definition:—A sudden engorgment of the capillary circulation of the lungs and smaller bronchial tubes.
Etiology:—An active congestion of the capillary circulation exists as a precedent pathological condition—the initial condition of active inflammation of any organ, and is especially apparent, as preceding the phenomena of inflammation in the lungs and bronchial tubes. But an extreme engorgement independent of the phenomena of inflammation may exist as the result of persistent inhalation of very cold air, or the inhalation of cold air heavily charged with moisture, or as the result of prolonged talking in the cold air. This form of congestion I desire to consider here, although it may be the precursor often of bronchopneumonia. The writer treated a typical case in a middle-aged man of previous excellent health, who as auctioneer, had a few hours before the attack, sold at auction the entire equipment of a large farm. The man had stood in an elevated position in the wind, with the temperature about ten degrees above zero, and had talked violently for six or eight hours. He was attacked during the following night with great oppression of breathing, with at first but little change in the temperature. He had been chilled during the day and the sensation of chilliness had continued. The skin was cold and the patient had great disinclination to any exertion. From the onset of the attack he was inclined to yield to it and give up without effort. The pulse was at first slow and labored, but as the difficulty of breathing increased, as it did rapidly, the pulse became rapid and feeble and easily compressed. The face became livid and finally cyanosed, the lips blue and the breath seemed cool. The breathing increased greatly in rapidity as the congestion advanced.
Other causes of active congestion of the lungs are the inhalation of caustic and pungent vapors and of steam and other irritating substances.
Symptomatology:—The symptoms as narrated in the above case, although exaggerated, are peculiar to those cases in which the cause does not irritate the mucous membrane of the respiratory passages. When such irritation is induced there is apt to be more or less cough, with the expectoration of blood. There are but few other symptoms. Percussion reveals a uniform dullness over the entire lung structure, as the condition usjally involves the entire breathing surface to greater or less extent. Ag the disease advances, while the chilliness may remain, there is a rise in the temperature, and if the congestion is relieved by active treatment so thai the respiration may become free, symptoms of inflammation of the lungs or of the bronchial tubes may appear at once and run the full course of an ordinary acute inflammation.
Diagnosis:—The history of a recent exposure, with some difficulty of breathing since the exposure, slowly increasing, with a tendency to coldness and extreme difficulty of breathing, suddenly occurring and rapidly increasing, are unmistakable evidences to one who has had any experience with this class of cases.
A careful consideration of both causes and evidences will make it possible to readily distinguish between pulmonary congestion and pulmonary apoplexy.
Prognosis:—If seen early and subjected to the most vigorous treatment these patients recover with no serious results from the attack. Those in which the cause was extreme, inducing profound congestion quickly, may die before benefit can be obtained from the treatment. Inflammation following primary acute congestion is resistant to treatment and is likely to result fatally.
Treatment:—The most perfect, the most rational, the physiological antagonist of congestion, is persistent heat. The physiological medicinal antagonist is belladonna, which may be associated with other stimulants. In the case above narrated the patient's chest was wrapped in flannels wrung from hot mustard water, the feet, legs and hands were immersed in a hot bath and the patient was made to breathe warm, moist air. Internally a drop or two of the tincture of belladonna was given every half hour, with occasionally a tablespoonful of equal parts of brandy and water, sweetened. This was in every way sufficient for the congestive phenomena. The extreme heat was without doubt the most potent factor in overcoming the congestion.
When the condition is induced by the inhalation of irritating substances, the cause must be removed, the air should be warm and charged with some soothing medicament; heat should then be applied over the entire surface of the chest. When respiration becomes relieved to a degree, a little turpentine may be rubbed over the chest walls after the skin has been thoroughly dried, and a kaolin or other plastic dressing should be applied and well covered, and hot water bottles or a rubber water bag should be placed outside of this. The position of the patient should be frequently changed to avoid hypostatic congestion. As the temperature rises and characteristic fever develops, the use of aconite in small doses, with belladonna, is important. Bryonia, with small doses of arnica, in the proportion of ten drops of the former with five drops of the latter, in a three-ounce mixture, a teaspoonful every hour, will be of great service; later, asclepias tuberosa, and small doses of sanguinaria or ipecac, will serve to rapidly ameliorate the symptoms. Other remedies which will find a place in the hands of the careful prescriber are sticta, lycopus, and in an occasional case lobelia. The use of stimulants, more or less freely, will be demanded in certain of the cases, and occasionally better results will be obtained from frequent small doses of atropin than from belladonna. The strychnin arsenate will be found exceedingly useful during convalescence.