Volume 1

Diseases of the organs of respiration : a treatise on the etiology, pathology, symptoms, diagnosis, prognosis, and treatment of diseases of the lungs and air-passages / by Samuel West.

  • Samuel West
Date:
1909
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Diseases of the organs of respiration : a treatise on the etiology, pathology, symptoms, diagnosis, prognosis, and treatment of diseases of the lungs and air-passages / by Samuel West. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    415/450 (page 381)
    Sec. 48.] ga:ngrene of THi^'iiuifG.' Lfc^pS. By some authors gangrene is thought to be less rare in children than is usually stated. Thus Barthez and Rilliet refer to 18 cases under 15, the youngest of their series being at the age of 2^ years. Instances have been recorded at still earlier ages, viz., at 4 months and also at a year. The question may bo fairly raised whether the gangi-ene in many of these cases was not secondary to diphtheria. Gangrene is doubtless due to specific infection; but whether it be due to any particular organism or to many—and what these organisms are—are questions that are still undetermined. Putrefactive organisms of all sorts and kinds have been found, but no one which can be regarded as specific. This being so, aetiology has chiefly to concern itself with the conditions under which the infection may arise. General debility or cachexia, whether due to general causes, e.g., ill-health and anaemia, to special diseases such as diabetes, or to bad habits, like drinking, all of which have been assigned as causes of gangrene, owe whatever influence they possess to the diminished vitality of the tissues they cause; in other words, to the lessened power of resistance. In the great majority of cases gangrene is the result of direct infection from some already gangrenous part of tlie body, the germs being brought to the lung ■either by the blood-vessels or the air-tubes. Where the blood-vessels are the channels of infection, gangrene, like abscess, is usually preceded by embolism, but embolism is not of itself sufficient to cause either the one affection or the other, unless associated with the specific organisms, and of the two results, gangrene is the less likely, unless the part from which the embolus is derived is itself gangrenous. It is no doubt through the air-tubes that the infective organisms most frequently reach the lung, and in most cases they are obviously carried by foul discharges, foreign bodies or particles of food, which have gained access to the tubes. Thus gangrene of the lung has been found associated with ulcerations in the larynx, trachea, and bronchi, with noma and other sloughing or diphtheritic lesions in the mouth and pharynx, and it has not infrequently followed operations on the mouth and tongue. Theoretically the existence of lesions in the lung might predispose to the infection, but, as a matter of fact, even in such cases gangrene is far from common. In phthisis gangrene is very rare. I do not remember to have seen it more than two or three times out of several hundredjposi- morterns, though I am unable to give the exact numbers. Boudet observed it once out of 160 autopsies. Wilson Fox,^ however, met with it in no less than 6 cases out of 99, but such an experience must, I think, be quite exceptional. Chronic excavation, whether the result of chronic abscess, bronchiectasis, or phthisis supplies the most favourable conditions, and yet though foetid changes in the contents are not uncommon, gangrene is very rare. The same may be said of putrid bronchitis. Hemorrhage and infarct only lead to gangrene when secondarily infected. It is in connection with croupous pneumonia that the occurrence of gangrene has excited the greatest interest. With ordinary broncho-pneumonia, however, gangrene is hardly ever met with. Grisolle out of 50 cases of gangrene found not one due to pneumonia, and in 305 cases of pneumonia found not one of gangrene. Heschl also failed to find gangrene at all out of 149 cases of pneumonia. On the other hand, Behier met with it 5 times in 114 cases of pneumonia. ^ Wilson Fox, I.e.