PUTRID BRONCIIITIS.—In this disease the odor resembles somewhat that of acacia-blossoms. The sputum does not contain disintegrated lung-tissue and is less dense. A history of bronchitis can usually be obtained, and the marasmus attending gangrene is not present. In early cases, however, the distinction can only be based upon the odor of the breath and expectoration.
Etiology. — Almost any pulmonary disorder may be followed by gangrene when the nutrition of parenchyma or its continuity have become impaired. In the latter case the bacteria of putrefac tion, the staphylococcus albus or aureus, are the active etiological factors. It may occur as a complication of phthisis, pneu monia, influenza, bronchiectasis, wounds, contusions, variola, measles, typhus, etc. In children it sometimes presents itself as a sequel of cancrum oris.
Case of gangrene of the lung that fol lowed an attack of uraemia. The breath was offensive, sputum dark, and there were frequent haemorrhages of varying amounts. There were moderate fever and emaciation. The physical signs con sisted of restricted respiratory move ments and increased percussion-dullness over the apex of the left lung, including rftles and bronchial breathing. The symptoms improved, only to recur for several months. Permanent recovery finally ensued. A. McPliedran (Amer. Med.-Surg. Bull., Aug. 29, '96).
Compression by tumors or aneurisms may occlude the arteries and arrest nu- 1 trition of the lung, while emboli due to the introduction of putrid substances may cause it by arresting the flow of blood through the smaller vessels. Cir cumscribed gangrene of this kind is often accompanied by cerebral abscess, through migration to the brain of a de tached fragment of embolus, which in turn arrests the circulation in the cere bral region involved. Detached thrombi may also start a gangrenoid process in other parts of the lung. Gangrene may also be started by the penetration of foreign bodies, food, etc., into the bron chi, the bacteria of putrefaction enter ing simultaneously. It is more likely to occur in persons weakened by various diseases, or any habit tending to weaken the organism. Diabetes mellitus and
alcoholism may thus predispose to gan a Pathology.—The circumscribed areas arc blackish or greenish, presenting ragged edges. The lung around the foci is inflamed, and the air-spaces contain epithelium, fibrin, and pus. Once formed, they may increase in size, the adjoining veins becoming filled with infectious thrombi. Portions of the lat ter may be carried into the circulation and set up inflammatory foci in various parts of the body. The vessels may also be eroded and thus be the source of copious haemorrhage. If the patient re covers, the gangrenous portion of the lungs is entirely removed and a cavity is formed, the walls of which are changed into connective tissue. It may remain in this condition for a long time or be come contracted. (Delafleld.) Pulmonary gangrene due to perfora tion of the oesophagus is rarely seen, and is almost always fatal, Case observed by writer terminated favorably. Schroe der (Centralb. f. inn. Med., Jan. 15, '98).
Case of a woman under treatment for diarrhoea and emaciation. Bothriocepha lus-eggs were found in the stools and three worms were expelled by treatment. The symptoms persisted. Signs of infil tration of the lower lobe of the right lung appeared, bacilli staining by the usual methods for tubercle bacilli were found in the sputum, and the diagnosis was changed to tuberculosis of the lungs and intestine. Three days after the dis covery of the pulmonary dullness the pa tient died. Autopsy showed broncbiec tasis, small gangrenous abscesses of the lung, and ulcerative enterocolitis. Ex aminations showed the complete absence of tuberculous lesions and proved that the bacilli belonged to the group of smegma bacilli. Pappenheim (Berl. klin. Woch., No. 37, '93).
Prognosis.—The prognosis of diffuse gangrene is obviously of the gravest kind. In circumscribed gangrene, how ever, the case is difficult if the affected areas are not restricted, the greatest danger being exhaustion and fatal lim orrhages. The latter may cause death when recovery seems assured. The prog nosis is rendered far more favorable, however, if surgical measures are re sorted to.