Gangrene of the Lung.
Definition.—A Putrefactive Necrosis of the Lung, either circumscribed or diffuse.
Etiology.—Gangrene of the lung can only occur where the organ has previously been weakened, hence is always a secondary affection. Putrefactive bacteria thrive in the necrotic soil, but whether the cause or the result of the necrosis is a mooted question. It may follow lobar pneumonia, aspiration-pneumonia, broncho-pneumonia, fetid bronchitis, thrombosis of the pulmonary artery, rupture of a bronchus, from an ulcerated or cancerous esophagus, from pressure due to tumors or thoracic aneurism, and from sepsis due to protracted adynamic fevers.
Pathology.—In the diffuse, when due to lobar pneumonia or the plugging of a large branch of the pulmonary artery, a large part; of the lung becomes a dark, greenish brown, or a black, fetid, pultaceous mass, from the center of which softening rapidly proceeds, forming an irregular cavity, containing a foul-smelling, disgusting, greenish fluid.
In the circumscribed form, the disease may involve one or both lungs, usually selecting the dependent portions, and the right more often than the left. The part affected assumes a dark-brown or greenish hue, becomes soft, and early assumes a fetid purplish mass; necrosis beginning in the center, a cavity soon forms. If located near the pleura, putrefaction may occur, giving rise to pyopneumothorax. A bronchitis is always an accompanying lesion, the bronchi containing an offensive and often putrid mucus.
Not infrequently there is found in connection with this lesion, abscess of the brain, liver, and spleen.
Symptoms.—In addition to the symptoms of the primary disease, the cough becomes more pronounced, and is attended by profuse expectoration of a peculiarly offensive character. When allowed to stand, the expectorated material separates into three layers; the upper, a yellowish, turbid brown froth; the middle layer, a clear watery fluid; and the bottom layer, the heavier material, blood, pus, and shreds of lung tissue. The microscope reveals putrefactive bacteria, pus, elastic tissue, fat, crystals, and granular material.
The respiration is slightly increased in frequency, and the breath is offensive. Where erosion of the blood-vessels occurs, hemorrhages take place, sometimes of an alarming character.
There is some fever present in all cases; the patient loses flesh and strength, becomes anemic, chills and night-sweats follow, and the evidence of sepsis is pronounced. There is dullness on percussion in the earlier stages, followed by the sign of cavity formation in later stages.
Diagnosis.—The intense fetor of sputum and breath, the character of the expectoration, the septic fever, and great emaciation, are symptoms that can hardly mislead one in naming the disease.
Prognosis.—Though not necessarily fatal, the disease is always grave. Where the former health of the patient has been. good and there is no tubercular taint, and the patient is young or in middle life, recovery will occasionally take place.
Treatment.—The treatment is largely antiseptic, and the Eclectic materia medica is rich in antiseptics. First in importance stands echinacea. This should be given every one or two hours, two drams, to water four ounces, a teaspoonful at each dose. Baptisia, sodium sulphite, hydrochloric acid, and potassium chlorate, with hydrastis, will each have their special indications for use. Eucalyptus used with an atomizer will be found useful as a local remedy. The appetite should be encouraged by nux vomica, hydrastin, chionanthus, etc. The diet should be nourishing, easily digested, and given at frequent intervals. Drainage by surgical means will have to be considered in some cases.