BRONCHIAL, HAEMORRHAGE. 



cipient, or even of established tuberculosis, although the patient may 

 present no symptoms, either subjective or objective, of disease of the 

 lungs, and when, soon after the occurrence of haemoptysis, signs of con- 

 sumption have arisen, they confidently assume that the bleeding has 

 been caused by the presence of tubercle, or by the process of its deposit 

 in the lungs. 



I must earnestly protest against this opinion, as altogether unwar- 

 ranted, and fraught with danger to the patient. Cases undoubtedly 

 occur, in which tubercles and inflammatory processes form in the lungs, 

 in a manner so latent that no tokens of the disease are manifested by 

 the individual affected, until he is suddenly attacked by a fit of haemor- 

 rhage. Such instances, however, are exceptional. 



In the very great majority of cases in which the first attack of hae- 

 moptysis has not been preceded by either cough, dyspnoea, or other 

 sign of pulmonary disorder, the lungs are free, and by no means the 

 seat of tubecuular deposit, at the commencement of the bleeding. 



It is true that such subjects rarely die of haemorrhage, so that we do 

 not often have an opportunity of examining their condition^ostf mortem. 

 However, if we collate the reports scattered through our literature and 

 compare their statements, we shall assure ourselves that they substan- 

 tiate the correctness of the above remarks. I have repeatedly failed to 

 find post-mortem traces of pulmonary tubercle, or of any other destruc- 

 tive disorder in the lungs of individuals who have died suddenly of 

 pneumorrhagia, while in enjoyment of apparent health. 



That bronchial haemorrhage is by no means so rare an event, where 

 there is no grave disease of the lungs, is shown, moreover, by the tol- 

 erably numerous cases in which persons, after suffering one or more 

 attacks of pneumorrhagia, regain their health completely, and indeed 

 often live to an advanced age, and after death present no discoverable 

 traces of extinct tuberculosis in their lungs. 



That bronchial haemorrhage, as a rule, should precede the disease of 

 the lung, in the cases where the initial signs of consumption follow im- 

 mediately upon an attack of haemoptysis is also strongly in contradic- 

 tion of the theories of Xaennec, to which, nevertheless, most modern 

 physicians adhere without question. According to Laennetfs view, 

 there is but one kind of consumption tubercular consumption. " As 

 bronchial haemorrhage can never produce a deposit of tubercle, all genetic 

 connection between such haemorrhage and the consumption must be 

 denied absolutely. Hence, where the first symptoms of consumption 

 follow close upon a haemoptysis or pneumorrhagia, we may assume 

 confidently that the tubercular deposit has formed either simultaneously 

 with or prior to the occurrence of the bleeding." Such argument, 

 though logical, is fallacious, because based upon the erroneous hypoth- 





