154 DISEASES OF THE PARENCHYMA OF THE LUNG. 



passages, but who, in other respects, seem to be in good health ; and it 

 would be very extraordinary if haemorrhage from small, latent cavities 

 were to be of much more frequent occurrence than from large and 

 recognizable ones. But we have direct proof that the blood lost in 

 pneumorrhagia does not come from a large vessel ; at all events, not 

 from a branch of the pulmonary artery. According to the classical pic- 

 ture of RokitansJcy, the branches of the pulmonary artery, as a rule, 

 soon become obliterated in the various forms of consumption. Some- 

 times, however, they become perforated by erosion, or suffer rupture. 

 In them runs the most venous and darkest blood of the entire body, 

 Now, in almost every case, not only of haemoptysis, but of pneumor- 

 rhagia, the blood is of a remarkably bright-red color, so that, in the differ- 

 ential diagnosis between haemoptysis and haematemesis, great stress is 

 laid upon the light color of blood which flows from the lungs and air- 

 passages. (See above.) It is only when large quantities of dark blood 

 are ejected, that we are justified in inferring that a branch of the pul- 

 monary artery has become eroded or ruptured. A striking example 

 of this kind occurred in my clinique, and has been made public (see 

 Burger's treatise). Such accidents, however, are extraordinarily rare, in 

 comparison with the frequence of haemorrhages of bright-red blood. 

 This bright-red blood can only come from the bronchial mucous mem- 

 brane ; or, at all events, either from a branch of the bronchial artery or 

 of the pulmonary vein. 



PROGNOSIS. The prognosis, as regards immediate danger to life, is, 

 as we have shown, on the whole, favorable, in spite of the alarming 

 character of the symptoms. The prognosis, however, as to complete re- 

 covery, is exceedingly bad. The slighter the provocation, the less ap- 

 parent the cause of the haemorrhage, so much the graver is the omen. 

 The prognosis is better when rupture of the capillaries has been caused 

 by excessive hyperaemia, due to direct injuries, excessive action of the 

 heart, or other serious irritants, provided that the irritation thus set up 

 can be allayed. Suppressed menstruation and repressed haemorrhoids 

 can only be counted among these causes with extreme reserve, much as 

 the patients may be inclined to attribute their blood-spitting to such 

 anomalies, and readily as they may become satisfied, when the physician 

 partakes in their belief. Absence of the menses is much more often the 

 consequence of the disease than the cause of it, and the same holds good 

 for any haemorrhoidal bleeding which may have existed prior to the 

 attack, and wlncn has ceased during or immediately after it. 



TREATMENT Indicatio Causalis. If excessive hyperaemia of the 

 bronchial mucous membrane play a material part in the origin of a bron- 

 chial haemorrhage, or if it be attributable solely to increased lateral pres- 

 sure upon the capillary walls from within, the mdicatio causalis may, iu 



