BRONCHIAL HJSMORRHAGE. 



153 



111 haemoptysis, the irritation of the cough often provokes retching and 

 vomiting, or the blood may be swallowed, and afterward thrown up. 

 Conversely, violent haamatemesis is almost always attended by cough- 

 ing, small quantities of blood getting into the larynx ; hence, the pa- 

 tients are not always able to tell, exactly, whether they have coughed 

 up the blood or vomited it up. In treating of haemorrhage of the 

 stomach, we shall enlarge more fully upon the distinction between the 

 two conditions, and merely remark, that we must, first of all, inquire 

 whether the cough have been followed by vomiting, or the vomiting by 

 cough ; secondly, that we must accurately ascertain whether cardialgic 

 distress have preceded the gush of blood or not ; thirdly, examine care- 

 fully as to whether the bleeding have been followed by black, tar-like 

 stools, or whether the patient have voided mucus tinged with blood for 

 a few days after the attack. If, moreover, we have opportunity to ex- 

 amine the blood which has been discharged, that from the air-passages 

 is usually bright red, frothy, with alkaline reaction. Should a clot form, 

 it will be soft, and specifically light, as it contains bubbles of air. On 

 the other hand, blood which has been vomited is dark, and even black, 

 excepting where a great artery of the stomach has been eroded. It is 

 not mixed with air-bubbles, but contains remains of food ; its reaction 

 is usually acid, and the clot, if it forms one, is firm and heavy. 



We have now to add a few words regarding the distinction of haem- 

 orrhage of the bronchial capillaries from the bleeding arising from a 

 wound in the tissue of one of the larger vessels, which traverse the walls 

 of a cavity. It is admitted, by some authors, that a haemorrhage of 

 moderate degree, a haemoptysis, proceeds generally from the capillaries 

 of the mucous membrane, but that all profuse bleeding, amounting to a 

 pneumorrhagia, springs from rupture, or erosion of larger vessels. So 

 convinced are they of the justness of this view, that they assume that 

 any one who has had a violent haemorrhage, be he never so healthy in 

 appearance, has cavities in his lungs, which have heretofore escaped ob- 

 servation. The objection, that so large an effusion of blood cannot pos- 

 sibly flow from the bronchial capillaries, is untenable ; since capillary 

 haemorrhages from the nasal mucous membrane are often so profuse as 

 to endanger life, and a haemorrhage from the bronchi of equal activity, 

 if it flow from a sufficiently large surface, may very easily yield so much 

 blood as to fully warrant application to it of the term "bursting a 

 blood-vessel," instead of " raising blood." Moreover, many people who 

 have spit blood are prone to exaggeration, and talk of "gushes of 

 blood," and of " coughing up blood by the pint," while the actual 

 amount lost has not been nearly so large. Besides, it is highly improb- 

 able that there should be undiscovered cavities in the lungs of all per- 

 sons who have suffered from severe and profuse bleeding from the air 



