Etiopathogenesis of suppurative diseases of the lungs.

My task is to clarify some fundamental problems of etiology and pathogenesis of .suppurative diseases of the lungs on the basis of works of Soviet scientists and my own observations during the last 10 years. First: the question of terminology. Is it expedient and pqssible to strictly distinguish between abscess and pulmonary gangrene on the basis of clinical manifestation? Judging from a large number of clinical patients observed, one must come to the conclusion that the clinical distinction of abscess and pulmonary gangrene is possible only in the minority of cases, in those cases which are so to say on the contrary poles, i.e. where the symptoms of gangrene or abscess are shown more clearly. In the majority of cases it is difficult and almost impossible to clearly differentiate between gangrene and abscess on the basis of a clinical picture. Besides this the clinical course of the disease often changes acquiring features which are peculiar now more to abscess, now more to pulmonary gangrene; there is no doubt that in the course of the disease abscess may change into gangrene and gangrene into an abscess. As it is shown by the pathologic data simultaneous existence in the lungs of the changes peculiar to abscess as well as to gengrene is possible. That is why the majority of Soviet clinicians in accord with the late academician S. I. Spasokukotzky, the most prominent pulmonary surgeon, widely use the term suppurative diseases of the lungs. The microflora of the sputum does not show the character of pulmonary disease-that is whether it is gangrene or abscess. We shall come to that question later. A correct choice of treatment of any disease presupposes as its premise a correct notion of its etiology and pathogenesis. We shall not dwell on those etiopathogenic cases the significance of which in the origin of pulmonary suppurations doesn’t call forth doubts. Therefore we shall put aside the pulmonary suppurations of embolic, aspirative and traumatic origins, suppurations connected with the presence of bronchogenic cancer of the lungs, etc. We shall only say that according to the statistics of various authors,