Emphysema

[brownegaz]

My grandfather served in the RFA from enlistment in 1914 then he was transfered to 182 Labour Corps in September 1918

He was in a Convalesent Hospital in Orpington from 12/10/1918 to 18/3/1919 the disease looks like Empylima? (possibly emphysema) on his hospital admission sheet.

He was aspirated 8 times and was injected with Eusol ?, he was then transfered to Eastbourne Convalesent Hospital and was discharged on 12 July 1919 to dispersal area NoXC Crystal Palace, he was Category B on a pension of 8/3d a week.

He lived for another 48 years after being discharged so if the disease was emphysema he made a good recovery.

Can somone please tell me if emphysema was a common disease encountered in the trenches, I assume that most soldiers would have contracted some sort on lung infection from time spent in the trenches and by their exposure to gas on occasions.

Also can someone please tell what is meant by dispersal area XC and what does Category B mean?

Thank you for any replies

Gary

[alliekiwi]

Empyema is where pus collects in the 'pleural space'. That's the potential space between the lungs and the chest wall on the inside, but it can fill with fluid or air. If it fills with air it's called a pneumothorax (that's the injury Robert Graves suffered as recounted in 'Goodbye to All That'). If it fills with fluid it's called 'a pleural effusion'. If that fluid is pus, it's called an empyema.

Empyema is usually a complication of pneumonia, so was common in the pre-antibiotic days.

Aspiration is where the fluid is drawn away, usually with a syringe.

Allie

[Doc2]

Agree with diagnosis of EMPYEMA, not Emphysema. Aspiration and injection with Eusol would have been standard treatment in those pre-antibiotic days. Sorry no knowledge of "dispersal area XC " or " Category B". Doc2

[brownegaz]

Thanks Allie and Doc2 for your prompt replies, I am getting a little more knowledge from this site every day.

I assume that this empyema would have been a common complaint by the end of the war?

Regards

Gary

[ian turner]

Gary,

I wonder if this was as a result of the 1918 'flu, and if he developed pneumonia as a result?

Ian

[brownegaz]

Hi Ian

Im not sure if he had the flu, I do seem to recall reading about an influenza epidemic at the time, maybe you are right and he suffered complications afterwards.

I had assumed that he may have been suffering after 4 years of trench warfare, exposure, gassing etc.

Gary

[Frank_East]

One of the major causes of emphysema is said to be cigarette smoking.

Cigarettes were highly subsided for the British soldier of both wars.Smoking became a ritual in the bonding process where groups fought, slept, eat and died together.Easy access to tobacco was thought to be the key to maintaining morale for those in service where the soldier was guaranteed access to his "smokes". Given that many soldiers had a preservice habit of smoking, it is not surprising that there were many cases of pulmonary disease.

Even in the 1950s on overseas service, cigarettes were dirt cheap and used be on sale in metal drums holding 25 cigarettes.I remember Players being available in this packaging as "Duty Free." whilst on overseas duty.

[ian turner]

I also think that Emphysema was prevalent amongst miners?

Ian

[Michael Johnson]

In my grandfather's case pneumonia came first. Then they did an empyema operation, but according to his brother-in-law he was thrashing so much that the ether spilled into his eye, destroying it. He was given a pension for both the eye and the operation.

This was Spring 1916.

[Desdichado]

In my grandfather's case pneumonia came first. Then they did an empyema operation, but according to his brother-in-law he was thrashing so much that the ether spilled into his eye, destroying it. He was given a pension for both the eye and the operation.

This was Spring 1916.

According to the ever reliable Principles and Practice of Medicine by McRae and Ostler, Purulent Pleurisy is due to:

(a) infection from within, as a rule directly from a patch of pneumonia or a septic focus in the lung, or in some cases a tuberculous broncho-pneumonia; involvement from without, as in fracture of a rib, penetrating wound, disease of the oesopheagus, etc. It frequently follows infectious diseases, particularly scarlet fever.... A good many cases were met with in the streptococcus empyema during the War...

The book does not describe the operation your grandfather had but it does discuss how sufferers had their lungs aspirated, which I imagine was not a pleasant procedure.

[Ron Clifton]

Hello Gary

The experts seem to have put the empyema/emphysema issue to bed (so to speak) but to answer one of your other questions:

Category B was the medical category which contained men fit for active service abroad, but not for the full rigours of front-line service (which would be category A). Category C was for those fit for service only at home, and categories D and E those who were temporarily or permanently unfit for service altogether.

Categories A, B and C were further subdivided into A1 to A4, B1 to B3 and C1 to C3, representing refinements of the main system.

A number of the divisions which suffered heavy casualties in Spring 1918 were re-constituted with category B men and used in "quiet" trench sectors, but some of these gave very good accounts of themselves in the final three months of the war.

Ron

[Michael Johnson]

The book does not describe the operation your grandfather had but it does discuss how sufferers had their lungs aspirated, which I imagine was not a pleasant procedure.

I believe they were the same thing. Cut a hole, put in a tube, suck it clean. His discharge papers speak of a "pyemeia scar".

[brownegaz]

Thanks everyone for your replies

Im getting a clearer picture of just what these poor fellows went through at this time, everyone talks of my granfather as a quiet withdrawn man with a short fuse, I can understand why that might be the case now, he spent two and a half years fighting exposed to all sorts of horrors then 8 months in hospital with empyema.

I imagine civilian life after the war in the early 1920s would have been pretty tough, there was no such thing as trauma couselling in those days.

Cheers

Gary

[Robert Dunlop]

This drawing illustrates the difference between empyema and emphysema:

The lungs sit within the chest cavities. They are only attached to the rest of the body via the two main branches of the windpipe, one branch to the left and one to the right lung. Each lung is covered with a thin membrane called the pleura. The membrane is a bit like the lining of the inside of the mouth. At the point where the lung is attached to the branch of the windpipe, the pleural membrane folds out and then lines the inside of the rib cage. It may help to think of the situation where you partially blow up a balloon and then seal it off. You then push your fist into the balloon up to your wrist. The balloon would be folded in on itself around your hand. Some of the balloon would be touching your hand, the remainder would be exposed to the outside. In the case of a lung, the 'outside' is in fact the inside of the rib cage. The two surfaces of the pleura are held together (I have put a space into the diagram for illustration purposes) by a vaccuum - otherwise your lungs would collapse, as indeed happens when you puncture the chest wall and let air into the pleural space, or when the lung punctures (pneumothorax) and lets air out into the pleural space.

Empyema is a collection of pus (forgive the colour I have used ) inside the pleural space, usually as a result of pneumonia where the bugs get from the lung into the pleural space. If the pus is not drained, it becomes a serious chronic infection. It is very difficult for the body to clear the infection unless you put a tube (not just a syringe) into the collection and drain it off. The outer (parietal) pleural membrane is extremely sensitive, as anyone who has experienced pleurisy will know. Putting a tube in, and leaving it there, causes a lot of pain - which can be controlled with appropriate interventions.

Emphysema is destruction of the walls of the little air sacs, causing big cavities to occur and impairing the lung function. Chronic smoking is a cause, after many years not just during the course of the war. It occurs spontaneously in a few people who have an enzyme problem, and it may occur with other things that damage the lungs, eg from mining.

Robert

[PhilB]

it may occur with other things that damage the lungs, eg from mining.

Robert

Nothing to add except that, in those days, many occupations subjected people to dust, pollution and fumes etc. It was the days of steam locos and coal fires (& fogs!) and vaccuum cleaners were unknown. Houses were cleaned with a stiff brush so even at home you weren`t safe!

[truthergw]

Draining a lung was done with a large syringe with a long nozzle. A fearsome looking instrument which looked worse than it really was. In the days before effective local anaesthetics and dangerous general anaesthetics, a painful procedure since knocking you out was dangerous and hurting like billyo wasn't.

[Frank_East]

The point to bear in mind was that The Miners Compensation Scheme administered by the NCB did not include emphysema in compensation considerations.The disease was considerated to be the result of smoking.

However following the dissoving of the NCB and privatisation,the newly created Government scheme recogised both emphysema and bronchitis to be related to to industrial exposure and were accepted for compensation.

Whether this change of attitude was due to an update in the medical research and appreciation of the diseases or not,I do not know.

[lizzie10]

hi, haven't written for quite a while, and happened to come across this post. I am actually writing in response to the diagram which has been drawn, it is just incidental, but I have actually had\suffered from empyema, and would like to comment that it was a very painful experience which has left a weakness in my lung unfortunately. I was quite pleased to see this illustrated as I have actually never been informed as to what it really is and how it can occur, so thanks for that. Not that I have ever smoked, so not exactly sure how it happened. So just would like to thank the gentleman who put in the diagram. I know that this has nothing to do with the original post, but at least it has given me an insight now.As I said, incidental and for me, coincidental.

[Robert Dunlop]

My pleasure, hellas. Thank you for the feedback. I have always enjoyed making the art (and science) of medicine more understandable to non-medics.

Robert

[josquin]

Splendid post, all! With awards for distinction merited by Allie for making the diagnosis and for Robert for providing the clearest explanation of

the intricacies of Chronic Obstructive Pulmony Disease vs. pulmonary infections in a form comprehensible to the non-medical majority.

As Phil reminds us, the almost ubiquitous exposure to particulates at the time was a strong contributor not only to COPD but to the incidence of

the various Restrictive Lung Diseases, as well.

Regards

Trelawney

[Robert Dunlop]

The Forum has an excellent group of health care professionals, representing the spectrum of medicine, nursing and other disciplines. The breadth of information about illness, trauma and the clinical practices of the time is one of the many strengths of the Forum. Given that these issues played such a key role in the lives and deaths of many relatives, long may it continue. Here is the opportunity for colleagues to take a bow as well <drum roll...>

Robert

[brownegaz]

I think I started this thread several years ago so a much belated thank you to everyone who replied to it, this is my first post here for a while, I have been chasing up other non combatants in my family tree.

Thanks

brownegaz

[Liz in Eastbourne]

...

Not that I have ever smoked, so not exactly sure how it happened

...

A very interesting thread - but please could the health professionals come back and clarify this point for me? I have gathered from Robert's explanation that the smoking issue only applies to emphysema/COPD and that a diagnosis of empyema doesn't imply this, or other longterm exposure to particulates, but an infection usually arising as a complication of pneumonia. Is that right?

And does it mean that there was more empyema than COPD with frontline troops in WW1as it was an acute rather than a chronic problem? I mean anyone with COPD would be more likely not to get to the front in the first place, though of course if they survived they might develop it later for the reasons mentioned.

But then I suppose (if I have understood Trelawney correctly) that you might be more likely to get an infection if you had had such exposure.

Liz

[Ice Tiger]

A very interesting thread - but please could the health professionals come back and clarify this point for me?

Hello

I have gathered from Robert's explanation that the smoking issue only applies to emphysema/COPD and that a diagnosis of empyema doesn't imply this,

Yes

or other long term exposure to particulates, but an infection usually arising as a complication of pneumonia. Is that right?

Not neccessarily linked to Pneumonia. the small air sacks in the lungs are Alvoli and they need to be "elastic" to expand/contract when you breath. Emphysema is basicaly a reduction in this elasticity. This is a gradualy degenerative an non reversable chronic condition. As you say usualy related to smoking,

And does it mean that there was more empyema than COPD with frontline troops in WW1 as it was an acute rather than a chronic problem?

No proof to back up my opinion but I would say you are on the money. See next answer for my reasoning

I mean anyone with COPD would be more likely not to get to the front in the first place,

unlikely to get through even the most basic physical training

though of course if they survived they might develop it later for the reasons mentioned.

True

But then I suppose (if I have understood Trelawney correctly) that you might be more likely to get an infection if you had had such exposure.

Don't try to make the link. One does not preceed or preclude the other. They are seperate but not exclusive of each other.

Liz

Hope this helps you

Andy

(24 years in the NHS Ambulance Service)

[Doc2]

A very interesting thread - but please could the health professionals come back and clarify this point for me? I have gathered from Robert's explanation that the smoking issue only applies to emphysema/COPD and that a diagnosis of empyema doesn't imply this, or other longterm exposure to particulates, but an infection usually arising as a complication of pneumonia. Is that right?

And does it mean that there was more empyema than COPD with frontline troops in WW1as it was an acute rather than a chronic problem? I mean anyone with COPD would be more likely not to get to the front in the first place, though of course if they survived they might develop it later for the reasons mentioned.

But then I suppose (if I have understood Trelawney correctly) that you might be more likely to get an infection if you had had such exposure.

Liz

Liz, it may just be a typographical error, but you are referring to two different things with similar names, and probably should clarify. Emphysema is one thing, Empyema is something totally different.

I assume you are really asking about Emphysema, since it is related to COPD, but Empyema is an infection with pus formation. Doc