150 DISEASES OF THE PARENCHYMA OF THE LUNG. 



the air-passages, and is of still more frequent occurrence in disease of 

 the heart, from obstructive hyperaemia, seldom results seriously, and 

 rarely imperils the patient's life. 



Very profuse haemorrhages, of a very different nature, often arise 

 from a morbid inability of the capillary walls to resist the pressure of 

 their contents, and it is to these that we usually allude, when we em- 

 ploy the terms " spitting of blood " (haemoptysis) and " bursting of a 

 blood-vessel " (pneumorrhagia). In such cases an observant physician 

 may long foretell the occurrence of a haemorrhage in patients of the 

 constitutional habit above described, especially if they have often bled 

 at the nose, and have suffered now and then from palpitation of the 

 heart, and oppression of breathing. It is but occasionally, however, 

 that the attack itself is preceded by warning symptoms or by sensations 

 of constriction of the chest. Far more commonly the long-dreaded 

 haemorrhage sets in suddenly. The patient feels as though a warm 

 liquid were oozing up from beneath the sternum ; he perceives a strange 

 sweetish taste in his mouth, and, upon attempting to clear the throat, 

 finds that he expectorates pure blood or bloody mucus, " that he is 

 raising blood." Such a discovery generally has a very depressing 

 effect, even upon individuals of the utmost courage. The saying of 

 Mephistopheles, " Blood is a quite peculiar juice," stands out here in 

 its full reality. Though the bleeding may have been trifling, yet we 

 often find the patient tremulous, pale, and almost fainting. Soon after 

 " raising " the first blood, a sense of titillation induces inclination to 

 cough. Coarse, moist rales and a gurgling sound are audible in the 

 chest; a short, full, loose cough follows, and frothy, brigmVred blood 

 gushes from the mouth, and often, too, from the nose. Short pauses 

 intervene between the coughing-fits, during which more blood seems to 

 be escaping and collecting in the tubes, and, in this manner, large quan- 

 tities of it are often ejected in a short time. (The quantity of blood 

 lost may vary from an ounce or two to a pound or more.) The attack 

 may subside in course of half an hour, sometimes sooner ; at times not 

 for several hours. The mucus continues to retain a bloody stain, or is 

 mixed with blood, but the blood is no longer pure. Attacks of haemop- 

 tysis are rarely solitary, however. They almost always recur in course 

 of a few hours, or perhaps the next day " in spite of the most careful 

 treatment ! " Indeed, the attacks are generally repeated for two or 

 three days, or even a week, until at length the patient, who has grown 

 pale and feeble, obtains a respite from his haemorrhage, which may last 

 for mouths or even years. 



In such cases, and, indeed, in most others, the course of bronchial 

 haemorrhage is singularly uniform, whether it occur in consumption, or 

 attack persons whose lungs are exempt from tubercle or any othei 

 known disease. 



