14:6 DISEASES OF THE PARENCHYMA OF THE LUNG. 



2. Much more frequently we find similar tendency to profuse capil- 

 lary haemorrhage from the bronchi in young people, between the ages 

 of fifteen and twenty-five years, of delicate health, and having marked 

 weakness of constitution. Such patients frequently have been orphans 

 from an early age, having lost then- parents by consumption. They 

 have suffered from rickets, or scrofula, in infancy, have often bled at the 

 nose, and have rapidly grown tall, without at the same time acquiring 

 any corresponding development of the various organs of the body. 

 Then* long bones are thin, their chest narrow, and even their skin 

 seems unusually delicate and transparent ; their cheeks redden easily, 

 and blue veins may be traced over the ridge of the nose and the tem- 

 ples. One might almost be tempted to attribute the remarkable fre- 

 quence of bronchial haemorrhage in persons of this type to a deficience 

 of vital material, which, having been immoderately expended during the 

 maladies of childhood, and by the rapidity of the growth, has proved 

 insufficient to maintain normal nutrition of the capillary walls, just as we 

 are accustomed to ascribe the occurrence of spontaneous bleeding after 

 severe illness, tedious suppuration, or great loss of blood, to a kindred 

 source of exhaustion of the nutritive principle. Such an hypothesis, 

 however, does not explain why the seat of haemorrhage should first be 

 in the nose, and afterward in the bronchi, and why haemorrhage scarcely 

 ever occurs into the brain, or into other organs, in patients of this class. 



3. There is a great predisposition to capillary haemorrhage from the 

 bronchi in persons suffering from tuberculosis and consumption. The 

 frequence of abundant haemorrhage in all stages of these diseases arises 

 partly because individuals who are liable to such bronchial bleeding are 

 equally liable to tuberculosis, and to consumption of the lungs, and be- 

 cause the tendency to bleed does not cease when the lungs become 

 affected, and partly because deposit of tubercle and chronic inflammation 

 cause the pulmonary tissues and the bronchial mucous membranes to 

 become relaxed, so that the capillaries which are imbedded in the relaxed 

 tissues (now no longer capable of resisting their undue dilatation) suffer 

 excessive distention and attenuation of their walls, whereby they be- 

 come more easy of rupture. 



Finally, coalescent masses of tubercle and centres of inflammation, 

 by compression of vessels, give rise to fluxionary and obstructive hyper 

 aemia, by which rupture of the capillaries is favored. 



Prejudice in favor of the narrow views of Laennec and a belief in 

 the ancient Hippocratic theorem, Epi aimatos emeto phthoe Jcai toil 

 puou katharsis ano, have seriously biased the judgment of physicians as 

 to the relation between bronchial bleeding and pulmonary tuberculosis, 

 and have given rise to extravagant and erroneous ideas. Many physi- 

 cians do not hesitate to accept a brisk haemoptysis as a sure sign of in- 



