Hczmoptysis. 249 



from nasal haemorrhage, which is not frothy, and from bleeding 

 from the stomach, which is clotted and blackened, with an acid 

 odor from the presence of the gastric juice. The cough of haem- 

 optysis contrasts with the sneezing of epistaxis and the retching of 

 haematemesis. The rattling cough increases the discharge, as does 

 also a dependent position of the head. Besides the cough there 

 is usually an anxious countenance, accelerated breathing and con- 

 siderable lifting of the flank. When the loss is excessive there 

 is weakness, giddiness, rolling of the eyes, and pallor of the visi- 

 ble mucous membranes. 



The previous ill-health of the patient, the presence of tubercle 

 as ascertained by auscultation and percussion, and the hsemor- 

 rhagic constitution as shown by occurrence of bleeding from 

 other parts of the system will lessen the chances of a favorable 

 termination. Sometimes, too, the flow is so profuse that the 

 blood cannot be coughed up, and filling the bronchial tubes it 

 destroys life suddenly by suffocation. 



Treatment. When brought on by severe exertion absolute 

 quiescence will usually check hsemoptj'sis. Keeping the head 

 in an elevated position favors its arrest. The application of cold 

 water to the head, neck and thorax, and the giving of iced water, 

 strongly acidulated by vinegar or one of the mineral acids may 

 sometimes be required. In threatening or obstinate cases one 

 drachm of acetate of lead may be given thrice daily to check by 

 its astringent effect on the vessels, and the addition of a drachm 

 of opium is of great value in suppressing the cough. Ergot, 

 tannin, matico and oil of turpentine have each been employed 

 with advantage, and when costiveness exists a saline laxative 

 (one pound sulphate of soda) may be usefully resorted to. The 

 patient should be kept in a cool, airy dwelling, and should rest 

 for fifteeen or twenty days after an attack. 



