Medicine in Games – Rust Lung
In the Gears of War universe, there is an affliction named Rust Lung, which afflicts those who breathe in vapors of the fictional fuel imulsion. It’s referred to as Rust Lung because of the brown-red colored phlegm/sputum that people would cough up after contracting the disease (likely blood). This wasn’t a problem pre-Gears, because most of the imulsion on the planet Sera was a liquid found underground. At the end of the first Gears of War game, however, the main character’s squad exploded a bomb in the middle of the stuff and ended up vaporizing it, causing this new disease to surface in the populace.
It’s a phenomenon not wholly unseen in the real world.
In reality, diseases similar to Rust Lung can be found in miners. One’s called Coal Worker’s Pneumoconiosis, colloquially referred to as Black Lung, due to individuals afflicted with the disease having blackened lungs. The other is Silicosis (or Potter’s Rot), an affliction caused by similar conditions, except with silica instead of coal. Normally, when you breathe in foreign objects, they irritate your respiratory tract and are then expelled. However, in the case of Potter’s Rot and Black Lung, very fine particles of silica and coal get into the alveoli, where oxygen and carbon dioxide are exchanged. Here, they can’t be expelled or destroyed by the body, but are still recognized as foreign objects. As a result, macrophages, white blood cells that assist in the adaptive immune system, attempt to destroy the particles and set off inflammation responses by releasing cytokines such as tumor necrosis factors and interleukin-1. These then cause scar tissue to form around the affected areas, causing the tissues to harden and preventing fluids from flowing through the affected tissue. This process is called fibrosis, and is normally a good thing (it’s the process that heals external wounds). However, such a process destroys the alveoli, meaning the area afflicted is no longer viable for ovygen-carbon dioxide transfer. What this means is that essentially more and more of the lung hardens and becomes useless fibrotic tissue; this process is irreversible, and prolonged periods will cause severe respiratory symptoms, and can ultimately lead to death.
A similar disease hits closer to home with Popcorn Lung Disease, which sounds funny, but ultimately has the same effect. It’s so named because of workers in popcorn factories as well as a case involving a consumer, and is caused by the presence of the chemical diacetyl, which is used in artificial flavoring to give a buttery taste to candies, wines, and yes, microwave popcorn. This disease mainly affects the bronchioles, which are the small branches in the lung that connect the alveoli to the larger lung branches. However, the end result is the same, and in advanced stages only a lung transplant will cure the disease.
In terms of medicine, Rust Lung is certainly a possible disease; its specific site and pathway of respiratory tract destruction ultimately depends on the chemical makeup of imulsion, but I believe that it operates similarly to diacetyl in that it’s actually vapor. The problem that Rust Lung ultimately faces, however, is the question of why only certain portions of the population were affected. It was made clear that detonating the bomb at the end of Gears of War ended up vaporizing the imulsion, which then directly caused the disease, but if the air in and around Jacinto (the city introduced in the second game) has such concentrated imulsion that a sizable portion of the populace are contracting the disease, shouldn’t everyone without proper protection be afflicted? Let’s just hope we don’t find any of that stuff deep in our own planet.