82 PRACTICE OF MEDICINE. 



weather, horse exercise should be taken, and the invalid, to promote 

 his recovery, should remove to a milder climate. 



In cases where there is laryngeal or tracheal irritation, leeches 

 should be applied over the part most affected, and a mild mercurial 

 treatment had recourse to. Calomel and opium, or blue pill with 

 opium, should be given so as to slightly affect the mouth. Blisters 

 may be then applied to the nape of the neck and to the sternum. 



An individual in perfect health, or labouring perhaps under a 

 slight cold, is attacked with copious haemoptysis, accompanied with 

 considerable excitement of the heart. The hemorrhage having sub- 

 sided, we find the respiration hurried and the pulse quick ; the cough 

 continues, and there may be local pain. The upper portion of one 

 side sounds dull, and here the respiration is decidedly feeble, although 

 generally with little crepitus. In these cases, the tubercular deve- 

 lopment is very rapid, no interval occurring from the first invasion. 

 In a considerable number of patients, it is in this way phthisis makes 

 its outbreak. It is not uncommon, however, to see persons whose 

 health is perfectly re-established after a first haemoptysis, so that it 

 does not appear to be connected with anything serious. At the end 

 of a longer or shorter time, a second haemoptysis supervenes, then 

 a third, and again they are restored to health; finaily, they have a 

 new attack of spitting of blood, and this time their health does not 

 return ; they cough, and have oppressed breathing ; and all the 

 symptoms of pulmonary consumption develope themselves. 



The treatment of this form consists in subduing the haemoptysis 

 by proper means, and then paying assiduous attention to the condi- 

 tion of the respiratory apparatus, especially the upper lobes of the 

 lungs. 



Dr. Cheyne strongly recommends bleeding in the haemoptysical 

 variety of consumption ; and in bronchial hemorrhage, threatening 

 consumption, he advises small bleedings at intervals of a week. He 

 considers bleeding to be justified during haemoptysis, or any symp- 

 tom or sign of inflammation. Laennec observes, — " I shall content 

 myself with asserting briefly, in this place, that bleeding can neither 

 prevent the formation of tubercles nor cure them when formed. It 

 ought never to be employed in the treatment of consumption, except 

 to remove inflammation or active determination of blood, with which 

 the disease may be complicated ; beyond this, its operation can only 

 tend to an useless loss of strength." Tartarized antimony, in nau- 

 seating doses, is a useful remedy. Dr. Cheyne combines a quarter 

 of a grain of the antimony with fifteen grains of nitre, and places 

 much confidence in the combination. 



When phthisis is complicated with pneumonia, we must have re- 

 course to frequent local depletions by leeches, continued counter-irri- 

 tation, the use of setons, and a mild course of mercury. The idea 

 of arresting the progress of scrofulous ulceration of the lung by 



