148 DISEASES OF THE PARENCHYMA OF THE LUNG. 



esis that consumption of the lungs always arises from tubercular de- 

 posit. Unbiassed and careful observation of patients, who, without 

 warning and often in the midst of exuberant health, have been attacked 

 by pneumorrhagia or haemoptysis, and who, without rallying, have per- 

 ished hi a few months of a phthisis florida, a "galloping consumption," 

 has taught me that such patients scarcely ever succumb to a pulmonary 

 tuberculosis in its stricter sense, but that they usually die of a form of 

 consumption as yet but little thought of, and of which bronchial haemor- 

 rhage is the immediate cause, Laennec to the contrary notwithstanding. 

 When, after a bronchial haemorrhage, coagulated blood is retained in 

 the air-vesicles and bronchi, its irritating effect is quite as great 

 upon surrounding parts as is that of a thrombus .or coagulum within 

 a vein upon the vascular tissues. 



The bronchitis and pneumonia arising from such a source may result in 

 various ways. (See below.) A very common consequence is, that both 

 clot and inflamed pulmonary tissue undergo a caseous metamorphosis, 

 with subsequent decay. These pathological and anatomical processes 

 agree closely with the type which consumption assumes when it imme- 

 diately follows a bronchial haemorrhage in an individual previously vig- 

 orous and healthy, and proves fatal in the course of a few months. 



Finally, I may observe that the bronchial haemorrhages which occur 

 in an established case of consumption also cause chronic pneumonia 

 and destruction of the tissues, and thus hasten the fatal termination. 

 The fact that the occurrence of haemoptysis in the course of a pneu- 

 monia is a serious event, and that the disease often rapidly grows worse 

 immediately afterward, is generally admitted by physicians, although, 

 as a rule, it has been falsely interpreted ; it being a common supposition 

 (but one which is rarely the true one) that fresh tubercles have formed, 

 which, by some, are thought to have caused the haemorrhage, and by 

 others to have accelerated the consumption. 



As my opinions regarding the relations between bronchial haemor- 

 rhage and pulmonary consumption differ in some respects from the 

 prevailing views upon this subject, I propose briefly to state them in the 

 following paragraphs : 



1. Bronchial haemorrhage occurs oftener than is generally believed, 

 in persons who are not consumptive at the time of the bleeding, and 

 who never become so. 



2. Copious bronchial haemorrhage frequently precedes consumption, 

 there being, however, no relation of cause and effect between the 

 haemorrhage and the pulmonary disease. Here both events spring from 

 the same source from a common predisposition on part of the patient 

 both to consumption and to bleeding. 



3. Bronchial bleeding may precede the development of coosump 



