GANGRENOUS BRONCHO-PNEUMONIA DUE TO FOREIGN BODIES. 353 



hepatised, and on auscultation one hears large moist rdh's, whilst 

 respiration sometimes appears of a blowing character, and divided by 

 a pause, but there is no tubal souffle. If the patient survive for a 

 certain time, the sounds heard on auscultation undergo change; gurgling 

 noises and sometimes true cavernous souffles are heard, as a result of 

 suppuration in the bronchi and gangrene of one or more areas in the 

 lung. Diffuse gangrene is rare, and the inferior zone is usually the only 

 portion affected. 



During this phase the expired air has an absolutely characteristic 

 gangrenous odour. 



Death occurs by asphyxia and intoxication, but some animals hold 

 out for a fortnight and more. 



Lesions. Post-mortem examination reveals a suppurative but 

 secondary inflammation of the mucous membrane of the nasal 

 cavities, pharynx, larynx, and trachea. 



In the bronchi, sometimes very deeply placed, remains of foreign 

 bodies are found in cases where some solid material has been inhaled. 

 The mucous membrane of the bronchi is violet in colour, in places 

 appears to be sloughing, and is covered b}' gangrenous patches immersed 

 in a reddish-grey putrid fluid of offensive odour. In places the pul- 

 monary tissue has undergone gangrene ; and incision of the diseased 

 centres discovers irregular cavities, filled with a pultaceous, greyish 

 material, which often makes its way into the bronchi. These are the 

 irregular cavities which give rise to the gurgling sounds. The walls of 

 these cavities are formed of disintegrating pulmonary tissue, which 

 again is surrounded by a zone of grey hepatisation. The gangrenous 

 areas may unite, forming vast caverns. If near the surface they 

 cause adhesive or septic pleurisy. 



Diagnosis. The diagnosis is not very difficult, provided that an exact 

 account can be obtained of the circumstances which preceded the appear- 

 ance of the disease. The signs furnished by the discharge, the expired 

 air, percussion and auscultation are sufficiently significant to remove any 

 doubt. 



Prognosis. The prognosis is extremely grave, and in the great 

 majority of cases fatal. 



Treatment. There is very little chance of recovery, no matter what 

 treatment may be employed. The most favourable termination consists 

 in the gangrene remaining limited to the bronchi and to a small frag- 

 ment of the lung, so that the damaged tissues, being gradually delimited 

 and sloughed off, may finally be discharged by coughing. 



This is an exceptional termination, but attempts may be made to 

 assist its evolution by giving alcohol in doses of 8 to 10 ounces per day, 

 and salicylate of soda in doses of 4 to 5 drachms. When the condition 

 D.c. ^ ^ 



