HAEMORRHAGIC INFARCTION OF THE LUNG. 163 



embarrassing effect upon respiration. The sputa, from the strong admix- 

 ture of blood which they contain, bear a certain resemblance to pneu- 

 monic sputa, but they are less tough and almost always darker ; and, 

 moreover, the expectoration of this secretion is continued for a much 

 longer time than is the expectoration of pneumonia. The former may 

 persist for a week or even a fortnight. Circumscribed condensation of 

 the pulmonary tissue can only be detected when the hsemorrhagic in- 

 farction is of comparatively large size, and has extended to the surface 

 of the lung. The sound upon percussion then becomes dull, and crepi- 

 tation and bronchial sounds are audible over a limited region of the 

 chest. Although such cases occur, they are rare. The diagnosis may 

 be confirmed, a few days after the attack of dyspnoea and bloody expec- 

 toration, by the development of extensive pneumonic infiltration, or of 

 inflammatory effusions into the pleural sac, as we find that haemorrhagic 

 infarctions often produce inflammation of the surrounding pulmonary 

 tissue, and still more frequently cause inflammation of the pleura. 



Besides the symptoms hitherto described, and which are all imme- 

 diately dependent upon stoppage of one or more branches of the pulmo- 

 nary artery, there are, in many cases, other symptoms, which proceed 

 from the thrombosis of the right heart, and hence are to be regarded 

 as indirect tokens of haemorrhagic infarction. These are, a sudden 

 irregularity of the pulse, a sudden widening of the cardiac dulness, and 

 the sudden cessation of an adventitious murmur, which had previously 

 existed. This sudden subsidence of a loud, morbid sound is not only 

 a most striking occurrence, but one which is generally very significant. 

 My attention was first called to the full meaning of this symptom by the 

 work of Gerhardt above alluded to ; but I can fully confirm both the 

 occurrence of the sign and its full diagnostic importance from my own 

 experience. The picture of a hasmorrhagic infarction becomes very 

 well marked, when. the latter group of symptoms coexists with those 

 described above. But emboli may break off, and be washed away from 

 cardiac thromboses so small, that they produce no characteristic phe- 

 nomena ; hence, even where there are no signs of cardiac thrombosis, 

 where the pulse remains regular, and where the cardiac dulness con- 

 tinues unchanged, we may still confidently diagnosticate haemorrhagic 

 infarction, whenever unequivocal signs of disorder of the circulation 

 and capillary haemorrhage of the lungs suddenly arise in the course of 

 disease of the heart. 



Finally, if we bear in mind that the characteristic expectoration of 

 the blood from the air-vesicles is not always observed in haemorrhagio 

 infarction, and, moreover, that violent fits of dyspnoea may arise from a 

 great variety of causes ID disease of the heart, and that infarctions, 

 seated deep within the lung, cause no physical signs, it is easy to under- 



