Diseases of the chest and the principles of physical diagnosis . nuded and isolated, butperfectly intact, traverse the cavity. In other instances they are de-stroyed, the open ends being plugged with a thrombus. Occasionallya fatal hemorrhage results from the erosion of one of these vessels. An associated bronchitis is nearly always present. Perforation ofthe visceral layer of the pleura may produce a a pleural effusion is noted. A hemorrhagic effusion occurred1 Boston Med. and Surg. Jour., Juh 9, 1914 DISEASES OF THE LUNGS 509 in one case at the Phipps Institute.
Diseases of the chest and the principles of physical diagnosis . nuded and isolated, butperfectly intact, traverse the cavity. In other instances they are de-stroyed, the open ends being plugged with a thrombus. Occasionallya fatal hemorrhage results from the erosion of one of these vessels. An associated bronchitis is nearly always present. Perforation ofthe visceral layer of the pleura may produce a a pleural effusion is noted. A hemorrhagic effusion occurred1 Boston Med. and Surg. Jour., Juh 9, 1914 DISEASES OF THE LUNGS 509 in one case at the Phipps Institute. In rare instances the gangrenouseschar becomes cicatrized and the patient recovers. Diffuse Gangrene.—This form is very rare. It is characterized bythe absence of a Hmiting zone of inflammation the gangrenous area merg-ing into the surrounding lung tissue. Not uncommonly it involves alarge part of or even an entire lobe. In a case observed at the Phipps Institute the gangrene resulted fromthrombosis of the branch of the pulmonary artery leading to the right. Fig. 316.—Gangrene of the lung. {Philadelphia Hospital.) lower lobe. The affected lobe was dark red and very soft and friable,but necrosis and breaking down of the tissue had not occurred. Therewere a number of areas in which the visceral pleura had one place there was an infarct which was firmer and not so dark incolor as the surrounding tissue. The denudation of the visceral pleurahad resulted in a pneumothorax with a hemorrhagic effusion. Thepatient had a hypertrophied and dilated heart. The bacteriology of gangrene is varied. In addition to the pus-producing germs there are also numerous saprophytic organisms. It isnot clear whether gangrene can be produced by the saprophytes alone or 510 DISEASES OF THE BRONCHI, LUNGS, PLEURA, AND DIAPHRAGM whether an antecedent infection with the pus-producing organisms isalso necessary. It is to be borne in mind that a number of cases ofgangrene have been reported
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