Pulmonary Gangrene.

Gangrene of the lungs may be circumscribed in character, or it may be uniformly diffused, in which case the entire lung or usually the larger portion of a single lobe will become converted into a disorganized, greenish, black, or colored, pulpy mass, with -a most offensive odor. In the circumscribed form there are evidences of inflammation in the contiguous lung structures, with the natural products of such action filling the air cells and minute bronchi. A portion of the lung structure will break down, become darkened in color and emit an offensive odor. In this form a distinct line of demarcation is present, and abscess formation or a slough occurs, and the offensive dead tissue is expectorated, mixed with blood and the secretion from the bronchial tubes. If the diseased area is not too large recovery will take place, the cavity will be walled off from the healthy tissue and ultimately there will be some contraction of the wall, which will to a large extent close the cavity, especially if the diseased area is contiguous to the pleura. If the pleura should be perforated in the progress of the disease, the dead tissue, with the accompanying offensive fluid, will be thrown into the pleural sac, resulting in empyema, with the probability of immediate systemic infection.

Etiology:—The condition results from a pulmonary embolus or as the result of active circumscribed inflammation. It is more liable to occur after croupous pneumonia than after bronchopneumonia. It may be caused also by the inhalation of a foreign substance into the bronchial tubes, from an injury or blow to the chest walls or other traumatism. The condition is a rare one and seldom attacks females.

Symptomatology:—Usually cough has been present from previous conditions, and is not attributed to the possibility of the occurrence of gangrene, until the expectoration becomes much more abundant, darker in character and exceedingly offensive in odor. Simultaneously with the appearance of this odor is rapidly increasing prostration, a cool sweat, a rapid, feeble and easily compressed pulse, and at first a low temperature, which is followed by rigors and rapidly increasing temperature as soon as infection occurs; there is rapid breathing, which is often greatly oppressed, the cough increasing and becoming persistent. This is due in some cases to the fact that the purulent fluid induces a severe bronchitis from its irritating properties.

When a quantity of the sputum is collected and allowed to stand in a test tube or beaker it separates into three distinct layers; the upper layer is grayish green or yellowish green in color, opaque and frothy; the middle layer is almost clear, of watery appearance or resembling saliva, slightly turbid; the lowest layer is a brownish heavy sediment, consisting of a mixture of the greenish gray, disintegrated lung substance, cells and dark, grumous blood in small quantities.

Prognosis:—These cases usually appearing after the patient has become greatly debilitated from previous severe and protracted disease are apt to result fatally. It is only when they appear early, are distinctly circumscribed or involve a small portion of the lung tissue, that life may be saved. Surgical methods can be applied in the less severe cases with satisfactory results.

Treatment:—In a certain proportion of the cases of severe disease of the lung gangrene should be anticipated, and remedies given which will prevent it, or the formation of an embolus and the necrosis of lung tissue. This can be done to an extent by the use of echinacea or calcium sulphide or by the use of the iodids, and the judicious use of stimulants only when stimulants are needed. The inhalation of volatile antiseptics and the internal use of creosote or small doses of turpentine will be exceedingly beneficial. Careful attention must be paid to the nutrition of the patient. Concentrated foods of a highly nutritious character should be given in small quantities at short intervals and the normal functional operation of the digestive apparatus, maintained, through the influence upon the nervous system and upon the glandular structure of the organs themselves of hydrastis canadensis, nux vomica, collinsonia or other bitter tonics and xanthoxylum as stimulants.

The Eclectic Practice of Medicine with especial reference to the Treatment of Disease, 1910, was written by Finley Ellingwood, M.D.