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advantage than those pointed out in 824; because, though those suggested here may prevent the coming on of the hæmorrhagy for the present, they certainly however dispose to the return of that plethoric state which required their being used; and there can be no proper security against returns of the disease, but by pursuing the means proposed in 823.
827. When the hæmorrhagy of the nose happens to persons approaching to their full growth, and when its returns have been preceded by the symptoms 813, it may be supposed, that, if the returns can be prevented by the measures proposed in 825, these may be safely employed ; as the plethoric state induced will be rendered safe, by the change which is soon to take place in the balance of the system. This, however, cannot be admitted ; as the evacuations practised upon this plan will have all the consequences, which I have already observed may follow the recurrence of the hæmorrhagy itself...
828. When the hæmorrhagy of the nose shall be found to make its returns at nearly stated periods, the measures for preventing it (825) may be practised with greater certainty; and, upon every repetition of blood-letting, by diminishing the quantity taken away, its tendency to induce a plethora may be in some measure avoided. When, VOL. I.
indeed, the repetition of evacuations is truly una voidable, the diminishing them upon every repetition is properly practised; but it is a practice of nice and precarious management, and should by no means. be trusted to, so far as to supersede the measures proposed in 825, wherever these can be admitted.
829. When the hæmorrhagy of the nose happens in consequence of a venous plethora in the vessels of the head, as in 772, the flowing of the blood pretty largely may be allowed, especially when it happens after the suppression or ceasing of the menstrual or hæmorrhoidal fox. But though the flowing of the blood is, on its first occurring, to be allowed, there is nothing more proper than guarding against its returns. This is to be done, not only by the measures proposed in 789, et seq. but, as the effects of a plethoric state of the vessels of the head are very uncertain, so, upon any ap pearance of it, and especially upon any threatening of hæmorrhagy, the plethora is to be removed, and the hæmorrhagy to be obviated immediately by proper evacuations; as blood-betting, purging, and issues, or by restoring suppressed evacua. tions, where this can be done.
OF THE HEMOPTYSIS, OR HÆMORRHAGY FROM THE
Of the Phenomena and Causes of Hæmoptysis. 830. W hen, after some affection of the breast, blood is thrown out from the mouth, and is brought out with more or less coughing, there can be no doubt that it comes from the lungs; and this generally ascertains the disease of which I am now to treat. But there are cases in which the source of the blood spit out is uncertain; and therefore, some other considerations, to be mentioned here. after, are often necessary to ascertain the existence of an hæmoptysis.
831. The blood-vessels of the lungs are more numerous than those of any other part of the body of the same bulk. These vessels, of the largest size, as they arise from the heart, are more immediately than in any other part, subdivided into vessels of the smallest size; and these small vessels spread out near to the internal surfaces of the
bronchial cavities, are situated in a loose cellular texture, and covered by a tender membrane only: so that, considering how readily and frequently these vessels are gorged with blood, we may understand why an hæmorrhagy from them is, next to that of the nose, the most frequent of any; and particularly, why any violent shock given to the whole body, so readily occasions an hæmoptysis.
832. An hæmoptysis may be occasioned by external violence at any period of life ; and I have explained above (760) why, in adult persons, while the arterial plethora still prevails in the system, that is, from the age of sixteen to that of five-and-thirty, an hæmoptysis may at any time be produced, merely by a plethoric state of the
883. But it has been also observed above (761) · that an hæmoptysis more frequently arises from a faulty proportion between the capacity of the vessels of the lungs and that of those of the rest of the body. Accordingly, it is often a hereditary disease, which implies a peculiar and faulty con. formation. And the disease also happens especially to persons who discover the smaller capacity of their lungs, by the narrowness of their chest, and by the prominency of their shoulders; which last is a mark of their having been long liable to a dif. ficult respiration.
834. With these circumstances also the disease happens especially to persons of a sanguine tem- ' perament; in whom, particularly, the arterial plethora prevails. It happens likewise to persons of a slender delicate make, of which a long neck is a mark'; to persons of much sensibility and irritability, and therefore of quick parts, whose bodies are generally of a delicate structure; to persons who have been formerly liable to frequent hæmorrhagies of the nose; to persons who have suffered a suppression of any hæmorrhagy they had formerly been liable to, the most frequent instance of which is in females who have suffered a suppres. sion of their menstrual flux; and lastly, to persons who have suffered the amputation of any considerable limb.
835. In most of these cases (834) the disease happens especially to persons about the time of their coming to their full growth, or soon after it, and this for the reasons fully set forth above.
836. From all that has been said from 831 to 835, the predisponent cause of hæmoptysis will be sufficiently understood, and the disease may happen from the mere circumstance of the predisponent cause arising to a considerable degree. In the predisposed, however, it is often brought on by the concurrence of various occasional and exciting causes. One of these, and perhaps a fre