GANGRENE OF THE LUNGS Gangrene of the lungs is comparatively less frequently observed in the infant than in the adult. It occurs, however, at all periods of life. Occurring exceedingly seldom as a primary condition, it constitutes a secondary manifestation of various diseases in weak and delicate indi viduals, under which circumstances it develops mostly as a result of bronchopneumonia. It is most frequently brought about by tuberculosis of the lungs and of the bronchial glands, measles, typhoid fever, broncho pneumonia, gastro-enteritis; next by aspiration of foreign bodies, noxious material in noma, diphtheria, ulcerative stomatitis; and again, as the result of embolism in gangrene of the skin, and of the vulva, and comparatively often in caries of the petrous portion of the temporal bone and fetid otorrhom (Guillemot). As a sequela of croupous pneumonia it is exceedingly rare (Henoch, d' lispine). Most likely, specific, anaCTobic, and septic bacteria, are to be regarded as the cause of the gangrene (VeilLon and Zuher). The disease usually attacks infants in a circum scribed form; but sometimes multiple areas are found. The right lung is more frequently involved than the left.
The symptoms are often less marked than in adults, and the fact that gangrene is present is frequently only established on post-mortem examination. The offensive breath is often absent as is expectora tion on account of the age of the child. On the other hand, children suffering from pulmonary gangrene expectorate decidedly more than under other circumstances. The expectoration presents the well-known characteristics (offensive odor, dirty grayish green, separating into three layers, and containing fibre-like shreds of lung tissue). It is frequently bloody. During the subsequent course of the disease severe haimoptysis may take place, a condition otherwise seldom observed in children even in pulmonary tuberculosis. If the area extends even as far as the pleura,
a purulent pleurisy rapidly develops, or a pyopneumothorax, the occur rence of which should always arouse a suspicion of pulmonary gangrene. Sometimes all characteristic symptoms are absent, and only the rapid prostration, the deep pallor, the weak pulse, the high remittent tempera ture in the course of a bronchopneumonia, lead one to suspect the nature of the clisease, which almost always terminates fatally within one to three weeks. Although recovery is rare, its occurrence has been defi nitely established.
A definite diagnosis can be made only- when the characteristic expectoration containing shreds of pulmonary parenchyma is present. In fetid bronchitis or in bronchiectasis the offensive odor of the expectoration is not so great, and the general condition is under all circumstances not so bad; however, pulmonary gangrene may occur in the course of these diseases. Gangrene of lung may be readily over looked, in cases where the existing mouth or pharyngeal affection is held to be sufficiently responsible for the offensive odor of the breath. The local symptoms in the lungs do not as a rule furnish us with a guide towards differentiation from simple bronchopneumonia. Only very sel dom do rapidly appearing cavernous signs permit us to diagnosticate the presence of a gangrenous cavity.
The treatment is directed towards maintaining the strength of the patient, and toward arresting the progress of the gangrene by inhalations of carbolic acid or turpentine, and by the internal administration of preparations of creosote.