100 PRACTICE OF MEDICINE. 



pectorated in hsemoptysis. It may come, firsi^ from the mucous 

 membrane of the bronchi ; secondly, from a vessel ulcerated in a 

 tuberculous excavation ; thirdly, from an aneurism of the aorta, or 

 of the large trunks arising from its transverse arch, in which case 

 it will be soon fatal. 



Pathology. — Some few cases of haemoptysis depend on suppres- 

 sion of the menses, and are habitual and not dangerous ; but in by 

 far the majority of cases it depends on disease of the heart, or on 

 the irritation of tubercle. Hypertrophy of the right ventricle is 

 generally supposed to be a frequent cause of pulmonary hemor- 

 rhage ; but the momentum caused by hypertrophy of the right ven- 

 tricle is rarely sufficient to rupture any branch of the pulmonary 

 artery. Dr. Watson states, " that every instance of pulmonary 

 hemorrhage dependent upon organic disease of the heart, which he 

 had observed, coincided with disease on the left side of that organ, 

 mechanically obstructing the return of blood from the lungs. The 

 obstacle has sometimes been placed at the entrance of the aorta ; 

 but it has most commonly consisted of narrowing of the left auriculo- 

 ventricular orifice, and a rigid condition of the mitral valve." 



When these morbid states exist, it is easily brought on by violent 

 exercise, or anything that irritates the lungs. 



Pulmonary hemorrhage may be simple, the blood being all spit 

 up ; or it may be attended with what is most improperly called j)ul' 

 ononary apoplexy ; that is to say an infiltration of blood into the 

 minute tubes and air cells, rendering a portion of lung solid. This, 

 as Dr. Watson has shown, is an accident of pulmonary hemorrhage, 

 and occurs in this way. A portion of the blood instead of being 

 coughed out is drawn back by the patient's inspiratory efforts into one 

 or more small tubes, and fills and blocks up one or more lobules ; 

 giving rise to one or more knobs or masses, composed of blood that 

 has coagulated in the air vesicles. Sometimes, though not often, 

 the latter are broken down and ruptured by it. In other cases, 

 hemorrhage occurs in the minuter tubes and vesicles, and goes on 

 clogging up a large portion of lung progressively ; there being not 

 the circumscribed lumps just described, but a large irregular diffused 

 solidification. 



Symptoms. — Some degree of pain or oppression at the chest, with 

 cough, which brings up mouthfuls of blood, fluid or clotted. The 

 quantity may vary from a teaspoonful to several pints ; so that the 

 patient may be suffocated by the abundance of the hemorrhage. 



The stethoscope is useful as indicating the extent and place of the 

 hemorrhage, for wherever there is blood in the air-tubes or vesicles 

 there will be a corresponding crepitation, or if the lung is solidified 

 there will be absence of respiration. 



After pulmonary apoplexy, the blood is expectorated in dark red 

 sputa, mixed with mucus. 



