PULMONARY APOPLEXY. 



165 



TREATMENT. The treatment of haemorrhagic infarction can only 

 be a treatment of symptoms. When the affection proceeds from dis- 

 ease of the heart, we must beware of attributing the dyspnoea to 

 an aggravation of the pulmonary hyperaemia. We are aware that its 

 real or chief cause is ansemia of portions of the lung. An injudicious 

 venesection might have the effect of increasing a collapse of the lung 

 already present, and of hastening a fatal issue. It is only when the 

 obstruction of sundry arterial branches in the lung, has given rise to 

 collateral hyperaemia, and to collateral oedema of the rest of the lung, 

 and when the dyspnoea is plainly due in great measure to this cause, 

 that cautious blood-letting, either by cupping or venesection, is ever ad- 

 missible. As a general rule, until the pulse, which usually is feeble, 

 grows stronger, and until the skin, which usually is cool, becomes 

 warmer, we must confine our treatment to stimulation of the patient, 

 and to the application of sinapisms and warm baths to the extremities. 

 The expectoration of blood is rarely so abundant as to call for exhibition 

 of the haemostatic remedies recommended in a previous chapter. The 

 inflammation of the lung or pleura, which often sets in at a later period, 

 may demand local depletion, the application of cold and other anti- 

 phlogistic measures. 



CHAPTER VIII. 



PULMONARY HAEMORRHAGE WITH LACERATION OP THE PARENCHY- 

 MA. APOPLEXY OP THE LUNG. 



ETIOLOGY. In this form of pulmonary haemorrhage the tissues are 

 destroyed by extravasated blood, and an abnormal cavity is established. 

 Capillary haemorrhage scarcely ever destroys the tissues of the lung. 

 It is only erosion or laceration of the larger vessels, especially rupture 

 of the arteries, which produces destruction of this kind. In rare cases 

 atheromatous degeneration of the pulmonary artery causes its aneuris- 

 mal dilatation and final rupture ; but, more commonly, wounds, contu- 

 sions, or concussions of the thorax, are the causes of pulmonary apoplexy. 



ANATOMICAL APPEARANCES. A cavity is found in the lung, con- 

 taining both liquid and coagulated blood, and surrounded by tatters of 

 the lacerated pulmonary substance. If the apoplexy have its seat on 

 the periphery, the pleura, too, is often torn, and blood is poured into its 

 sac. Such haemorrhages are almost always fatal, so that we have little 

 knowledge of the mode of repair of an apoplectic centre. 



SYMPTOMS. Violent and rapidly-fatal haemoptysis, following serious 

 injury of the thorax, or, in other cases, suffocation from effusion of blood 

 into the bronchi, faster than it can be expectorated, or sudden death 



