=Gangrene.= Gangrene of the lungs, rarely results from an attack of ordinary pneumonia, but appears more frequently to take place either as a concomitant of pestilential fevers in general, or as an accompaniment of certain cases of tubercular vomicæ of the lungs, or as a primary and peculiar species of inflammatory affection of those organs. In the first instance, a patient suffering a severe form of typhoid fever, presents symptoms of pulmonary disorder, as hurried respiration, livid face, cough, first dry and soon moist, with thick orange-colored and finally dark or bloody and extremely offensive expectoration, and fetid breath. With these symptoms are generally associated great feebleness, delirium, with tendency to gangrene of the extremities and prominent points of the hips, sacrum, etc.; and finally, with increased difficulty in respiration and fetor of breath, death ensues. In the second case, a patient suffering from clearly recognized tubercular disease of the lungs, which has passed on to softening of tubercular masses, and the formation of vomicæ, has an aggravation of all his symptoms, accompanied with the expectoration of a highly offensive dark matter, plainly resulting from a gangrenous condition of the interior of a tubercular cavity. In the third case, the disease comes on at first as an affection of the lungs. The attack commences either as pulmonary inflammation, or bronchial disease, or with spitting of blood with more or less pain in the chest. The patient becomes rapidly worse, the cough increasing, with reddish-brown or bloody sputa, and offensive breath. The countenance is anxious and livid, the eye heavy, sometimes wild and glaring. The fetid breath is not always an early symptom, but when it does appear, the disease in general tends rapidly to a fatal termination, although recovery sometimes takes place.[19] The appearances after death, in cases of gangrene of the lungs, are of two kinds, according as the disease is _diffuse_ or _circumscribed_. “In the _first_ case, a mass of lung, two and a-half or three inches wide, but irregular in figure and outline, is converted into a soft, pulpy, dark, ash-colored substance, which, when it is handled or pressed by the fingers, falls down into a loose, moist mass, emitting a fetid, offensive odor, without trace of the usual structure of the lungs, except a few bronchial tubes, and blood-vessels, and shreds of filamentous tissue. This mass is generally bounded by, but it does not terminate abruptly in, healthy lung. It is soft, dingy, and infiltrated with a dark, ash-colored, dirty, serous liquor. Occasionally the surrounding portion of the lung is hepatized or infiltrated with blood or bloody serum; the bronchial tubes always contain much bloody, viscid mucus; and sometimes the pleura is reddened, covered with lymph or adhesions, and contains fluid in its cavity.”