BRONCHIAL HAEMORRHAGE. 155 



such cases, but only in such cases, demand venesection. In most cases, 

 lateral pressure has but little to do with the bleeding. It does not 

 cease, though the pressure be relieved, the vessels empty, and the pa- 

 tient be almost dead from haemorrhage. Let us but call to mind those 

 waxy, pallid sufferers from epistaxis, whose nostrils we often have to 

 tampon, in order to master the bleeding, and our lancet will stay in its 

 case as long as the heart's action is moderate. Indeed, we must restrict 

 blood-letting to cases where, in spite of the bronchial haemorrhage, there 

 is a persistent and alarming hyperaemia of the lung. 



Since we are unable to assign a reason for the delicacy and thinness 

 of the capillary walls, which is the chief source of bronchial bleeding, 

 we are forced to admit, that the indicatio causalis cannot generally be 

 met that it is not in our power to combat the haemorrhagic diathesis by 

 any rationally specific means. At all events, it is scarcely possible, after 

 haemoptysis has set in, to effect any rapid change in the abnormal state 

 of the capillary wall. It is preferable, in dealing with patients threat- 

 ened with this affection, or who have already suffered an attack, to pre- 

 serve them with peculiar care from ah 1 hurtful agents which could injure 

 their nutritive condition. We should order simple, unexciting, nourish- 

 ing food ; moderate bodily exercise in the open air ; should carefully 

 regulate the action of the bowels ; should prohibit all excess in baccho 

 et venere, and enjoin avoidance of mental excitement. Where there is 

 a decided want of red corpuscles in the blood, the exhibition of the 

 milder preparations of iron, the employment of Pyrmont-water, or that 

 of Driburg or Imnau, are to be recommended, and the neglect of these 

 measures is a gross blunder. 



The indicatio morbi, above all things, demands a cautious regimen. 

 We should, in the first place, seek to calm the spirits of the patient, 

 which are always much excited ; and, inasmuch as these attacks are al- 

 most always repeated several times, it is well to save him from further 

 agitation, by straightway informing him that there is more blood to 

 come, while, at the same time, we should absolutely deny the possibil- 

 ity of his bleeding to death. Indeed, we are certainly warranted here 

 in deceiving the patient, by affecting to make light of the affair, and 

 even to represent the haemorrhage as a salutary process.* 



With a little tact, the physician may leave his patient in a state of 

 comfort and peace of mind, whom he has found in the most painful un- 

 easiness a success of no slight importance. Take care that the cham- 

 ber be cool ; forbid all hot drinks, and let all food be eaten cold. In- 

 terdict all conversation, and make the patient stoutly resist the provoca- 

 tion to cough. Coughing in haemoptysis is quite as hurtful as is snuf- 



* I here call to mind the effect of conjuration and penance on the spirits, and in 

 lirectly upon haemorrhage. 





