BRONCHIAL HEMORRHAGE. 149 



tion as its cause, the haemorrhage leading to chronic inflammation and 

 destruction of the lung. 



4. Haemorrhage from the bronchi occurs in the course of established 

 consumption more frequently than it precedes it. It sometimes, although 

 i-arely, appears where the disease is as yet latent. 



5. When bronchial haemorrhage takes place during the course of 

 consumption, it may accelerate the fatal issue of the disease, by causing 

 chronic destructive inflammation.* 



ANATOMICAL APPEARANCES. Upon post-mortem examination of 

 those who have died of bleeding from the bronchi, the air-passages are 

 found more or less extensively and completely filled up with masses of 

 clotted blood. Sometimes the mucous membrane has a uniform dark- 

 red stain, from effusion of blood into its tissues, and it is swollen, re- 

 laxed, and bleeds upon pressure. In other cases, again, the entire con- 

 tents of the capillaries seem to have been discharged, the mucous 

 membrane presenting a pale and bloodless appearance. The source of 

 bleeding is never found to be of the nature of a mechanical or ulcer-a- 

 live lesion. 



The lungs, at points where the blood has descended into the air- 

 vesicles, are heavier, denser, and more or less reddened. If the bronchi 

 remain filled with their bloody contents, escape of air from the air-cells 

 is prevented, and the lungs remain inflated when the chest is opened. 

 Where death has been caused by haemorrhage, there is extreme anaemia 

 of all organs. 



In cases where death has taken place some time after the haemor- 

 rhage has ceased, either no trace whatever of the former bleeding is 

 found in the lungs and, indeed, this is most commonly tlie case or 

 else the signs are found of chronic inflammation in its different stages, 

 which, however, is never to be ascribed to the haemorrhage, unless a 

 greater or less amount of broken-down blood-clots, in a state of fatty 

 degeneration, be also found in the bronchi. I have published a case 

 from my clinique, in which the post-mortem appearances exhibited the 

 entire process, in the most striking manner, in which coagula, bearing a 

 perfect resemblance to old thrombosis of the veins,* were found in the 

 bronchi. 



SYMPTOMS AND COURSE. The admixture of small quantities of 

 blood in catarrhal expectoration occurring in the form of minute 

 streaks traversing the mass is a very common and quite harmless 

 symptom. The expectoration of a somewhat larger amount of blood 

 either pure or mingled with bloody mucus which sometimes follows 

 jpon the inhalation of acrid vapors, or after other severe irritation of 



* " Upon the relation of bronchial and pulmonary haemorrhage to pulmonary con 

 sumption." Inaugural dissertation of Doctor Biirger. Tiibingen, 1864. 



