436 PHILOSOPHICAL TKANSACTIOXS. [aNN6 I76O. 



the same quantity of blood as before. He was now advised to increase the quan- 

 tity of elixir of vitriol, had a bolus of extractum campechense every 6 hours, 

 and had a leech applied to a blind pile that had long appeared after going to 

 stool. On the Qth, at the same hour, he had again the same discharge as before. 

 That these haemorrhages were from the pulmonary artery, rather than the bron- 

 chial, appears from the sudden exspuition, the quantity, the fioridity, and from 

 the discharge being without pain, and unmixed with phlegm. 



As he had no feverish symptoms, either when he first awaked, or during the 

 day, no more blood was taken from him ; and as he constantly slept profoundly 

 from 10 o'clock till 2, when the complaint seized him, he was now advised to be 

 awakened, and rise out of his bed, at one in the morning, and remain awake till 

 3, omitting all medicines. He continued to rise from bed for a week, and has 

 ever since used himself to awake at the same time ; and has not only been en- 

 tirely free from this complaint, and that without any further discharge from the 

 haemorrhoidal vessels; but has got more flesh, and his head-aches are become 

 even inconsiderable. Dr. D. says, he ought not here to omit, that he had a 

 vomit given him on the 12th, and twice repeated at the intervals of 3 or 4 days. 

 As the patient, from a former hemiplegia, had probably many parts of his 

 body rendered less irritable than is natural, and as he constantly slept profoundly, 

 and the haemoptoe always awaked him after 4 hours sleep, Dr. D. was led to 

 conclude that, during this sleep, the lungs were not sufficiently sensible to push 

 forwards the whole circulation; and that hence the blood, gradually accumulated, 

 ruptured some minute branches of the pulmonary artery, before the uneasiness 

 became great enough to awake the patient. And as much as the evidence of a 

 single case in medicine may be estimated, the successful cure would seem to 

 evince the truth of this doctrine. 



He adds, that the anxiety with which patients reduced to great weakness 

 awake from their sleep, and the hurried pulse, have by others been observed to 

 be owing to an accumulation of blood in the lungs, during their state of de- 

 creased sensibility; and how detrimental, in these cases, might be the admini- 

 stration of opium, or nitre; while the want of sleep, or the recurring haemor- 

 rhage, might seem, to the unwary practitioner, to need their assistance. 



After a few days, observing some cough remain, it seemed advisable to give 

 2 or 3 vomits ; as, from late experience, they did not endanger a renewal of the 

 discharge, and must promote tlie expectoration of the eschar, or any extrava- 

 sated blood; which otherwise, by its delay acquiring a putrid acrimony, perhaps 

 most frequently erodes the contiguous vessels, and, forming new ulcerations, 

 becomes the general cause of consumptions, subsequent to accidental spittings 

 of blood. 



