BRONCHIAL HAEMORRHAGE. 151 



Very rarely is life directly endangered. It is important that we 

 should bear in mind that patients nearly always survive the attack, in 

 spite of intense prostration, tendency to syncope, and other signs of im- 

 pending dissolution. Death from bronchial obstruction and impeded 

 respiration is somewhat more common than death from haemorrhage. 

 Physical examination of the chest gives negative results, with the excep- 

 tion of a few coarse, moist rdles ; and it is both useless and imprudent 

 to agitate the patient by constant and inconsiderate percussion and 

 auscultation. If blood enough pass into the vesicles to expel the air 

 from any considerable portion of the lung, the percussion-sound over 

 that point is flat and dull, and the respiratory murmur either feeble and 

 indistinct, or else bronchial. 



In many cases the patients, after expectorating small masses of 

 bloody mucus, and of clotted blood, for a while, recover rapidly. If 

 blood have lodged in a bronchus, so as to close it and render it imper- 

 meable to air, its color is no longer bright red, but grows dark, inclin- 

 ing to black. 



In most patients, and even in those who soon regain their health 

 after " a haemorrhage," by attentive observation, during the few days 

 immediately following the bleeding, we shall discover a more or less 

 violent inflammatory condition of the lungs and pleura. I at least, ever 

 since my attention has been drawn to the occurrence of this consecutive 

 pleuro-pneumonia, have almost always succeeded, two or three days after 

 an haemoptysis, in finding an elevation of temperature, and increase in 

 the frequence of the pulse, constitutional disturbance, and lancinating 

 pains of more or less severity in the sides of the chest. Moreover, I 

 have frequently found a slight dulness, or a friction sound, with sub- 

 crepitant rdles. Even in cases where considerable time had elapsed 

 since the haemorrhage, I have usually been able to discover, by careful 

 examination, that, immediately after the occurrence of the bleeding, 

 symptoms, more or less distinct, had arisen, of inflammation of the res- 

 piratory organs. I cannot comprehend why these sequelae of bronchial 

 haemorrhage, which are almost constant, should hitherto have attracted 

 so little attention, and why they are hardly anywhere mentioned in 

 books on the subject. 



The most frequent termination by far, of this consecutive inflamma- 

 tion, is resolution. The symptoms often vanish in a few days, and the 

 patient becomes completely convalescent. 



In other instances the elevation of temperature and increased fre- 

 quence of pulse continue. The general health is also influenced by the 

 persistence of the fever. The pain in the chest, too, continues in a mild 

 form, and is generally ascribed, by the patient, to rheumatism. The 

 respiration remains hurried, and the patient coughs, expectorating a 



