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advantage than those pointed out in 824; because, though those suggested here -may prevent the coming on of the haemorrhagy 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 haemorrhagy 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 haemorrhagy itself.
828.When the haemorrhagy 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,
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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 haemorrhagy 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 menstrua) or hemorrhoidal flux. 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 783, et serj, but, as the effects of a plethoric state of the vessels of the head are very uncertain, so, upon any appearance of it, and especially upon any threatening of haemorrhagy, the plethora is to be removed, and the haemorrhagy to be obviated immediately by proper evacuations; as blood-letting, purging, and issues, or by restoring suppressed evacuations, where this can be done*
»F THE Hjemoptvsts, OK H.EMORRHAGY FROM THE lUNGS.
SECT. I. Of the Phenomena and Causes of Haemoptysis.
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 hereafter, are often necessary to ascertain the existence of an hemoptysis.
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 haemorrhagy 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 hemoptysis.
832. An hsemoptysis 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 nve-and-thirty, an haemoptysis may at any time be produced, merely by a plethoric state of the lungs.
883. But it has been also observed above (761) that an haemoptysis 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 conformation. And the disease also happens especially to persons wno 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 difficult respiration.
834. With these circumstances also the disease happens especially to persons of a sanguine temperament; 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 haemorrhagies of the nose; to persons who have suffered a suppression of any haemorrhagy they had formerly been liable to, the most frequent instance of which is in females who have suffered a suppression 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 haemoptysis 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