152 DISEASES OF THE PARENCHYMA OF THE LUNG. 



muco-purulent sputum. If, besides these signs, we find dulness upon 

 percussion at some point in the chest, the respiratory murmur feeble, or 

 indistinct, if the patient manifestly be growing thinner and more miser- 

 able, we shall have very strong reason to fear that a destructive process 

 has been set up in the lung, and that the patient will die of phthisis ; 

 nevertheless, all hope is not to be abandoned. In many cases, after a 

 few weeks, the fever, the pain, the dyspnoea, the cough, and the expec- 

 toration, all subside, the patient " feels as though he had had a severe 

 fit of sickness." His recovery is rapid and complete. Physical exam- 

 ination shows a depressed spot in the thorax, in the neighborhood of 

 which percussion is somewhat deadened and flat, while the respiratory 

 murmur is enfeebled. The pneumonia has resulted in wasting and con- 

 traction of the inflamed portion of the lung. In the dissertation before 

 referred to, two cases of this kind (one of which concerned a former 

 assistant of mine) are carefully detailed, and, since then, I have ascer- 

 tained, by a large number of observations, that such a result is a very 

 common one. 



If a chronic pneumonia, proceeding from profuse bronchial haemor- 

 rhage, do not take a turn for the better ; if the patient, on the contrary, 

 fail more and more under the effect of intense fever with evening exa- 

 cerbations, and profuse night-sweats ; if the sputa become more copious 

 and purulent ; if physical evidence of the formation of caverns arise, we 

 may conclude that the chronic pneumonia has terminated in cheesy met- 

 amorphosis and disintegration of the inflamed pulmonary tissue. 



I may finally repeat that persons, who have suffered a severe haem- 

 orrhage from the lungs, even though it may not have been followed by 

 any ill effects, and although they may have recovered from it entirely, 

 are, nevertheless, in danger of dying, sooner or later, of pulmonary 

 tuberculosis, or of pulmonary consumption. 



DIAGNOSIS. Haemorrhage from the bronchi, not unfrequently, is 

 confounded with epistaxis, particularly if the latter proceed from the 

 posterior nares. or if the patient lie upon his back during the bleeding. 

 Here the blood flowing into the pharynx reaches the larynx, and is then 

 frequently coughed and hawked up, to the great terror of the patient 

 and his relatives. Long before the physician makes his appearance, the 

 regulation doses of salt and vinegar have been administered, and it is of 

 importance, in order that he be not deceived himself in the midst of the 

 general consternation, that he should deliberately inspect nose, gums, 

 and palate, and inform himself precisely whether the patient have not 

 bled at the nose on the previous evening. 



The distinction between haemoptysis and haemorrhage from the 

 stomach may also have its difficulties, particularly if we have to decide 

 upon the source of a haemorrhage which has taken place years before 



