H AE M 726 H AE M however, more frequent from the second cause. Tumours, styled tubercles, as we have said, frequently contract the cavity of the chest, and occasion the most dangerous haemoptysis; as from the increased impetus, which occasions the haemorrhage, inflammation is induced, and a suppuration of an unkindly nature follows. If, from weakness, the vertebrae are distorted, the child, to relieve itself, bends on the opposite side, and by this double curvature greatly contracts the cavity. Tight ligatures round the chest, while the child is growing, equally prevent its expansion; and the mode of carrying children, by grasping them on each side of the sternum, produces the same effect. When we treat of haemorrhages, we shall find that those styled active are attended with a febrile exacerbation, which, we have seen, destroys the balance of the circulation, and throws a large proportion of the blood on the internal parts. In such circumstances the occurrence of haemoptoe is not surprising, when any of the predisposing causes, formerly mentioned, exist. Independent, however, of fever, the disease may happen from the contraction alone, since, in every situation, any considerable stricture, as we have seen (v. Febris), or as we shall more fully show (v. Inflammation), increases the action of the vessels a tergo; and should the slightest cause of increased general impetus or topical weakness concur, the disease must inevitably be produced. Whether any contraction of the bony covering of the chest has a tendency to bring on tubercles, has not been shown; but the very frequent consequence of tubercular consumption, from almost any haemorrhage of the pulmonary vessels, seems to show either that this is the case, or that tubercles exist in almost every constitution, which, from dissection, appears not to be true.

These considerations lead to important consequences in the means of preventing haemoptysis, and the consequent hectic. The first rule which they suggest is the propriety of guarding against every cause of increased impetus, by the mildest food, the gentlest exercise, and avoiding excess of every kind. Another is, the propriety of inducing some steady permanent discharge from the thorax, if any part of the chest appears particularly diseased. This is ascertained by pain, particularly felt on a full inspiration, or by the inability to lie on one side. The decubitus difficulis is a problem in pathology of no little intricacy; but, in general, in cases of this kind the patient cannot lie on the side affected; probably because the weight of the contents of the sound side contributes to check the very little action that remains. Whatever, however, becomes of the explanation, the fact is well established; and a blister, or a seton, can be continued on the side which is known, from this circumstance, to be diseased, without any inconvenience to the patient. If the disease cannot be discovered from this criterion, the blister should be placed on the sternum, near its lower part. In this place it will certainly contribute, though in a less degree, to take off inflammatory tension from every part of the thorax.

When haemoptysis has come on, it must be combated by other remedies; and one of the most common, apparently the most useful, is generally bleeding. This, if preferred, should be actively employed; for small bleedings, frequently repeated, exhaust the patient instead of relieving the disease. We are confident, however, in adding, that this remedy is used too frequently, and with too little discrimination. An active, plethoric young man, labouring under haemoptysis, from excess, from strains, or accident, may be bled freely, and frequently. A weak, debilitated person, with a contracted chest, may, for a moment, be relieved; but the remedy, together with the disease, contributes to sink the strength, and the habit is soon established, which requires this assistant discharge. It must be remembered, also, that haemoptysis is sometimes owing to the contraction of the chest with debility, and but little, if any, assistance from increased impetus. In this case the advantages of bleeding, though considerable, are temporary, and its disadvantages numerous; yet it is an indispensable remedy.

As a blister will prevent, so it will often lessen, pulmonary haemorrhage; and is indeed a very unequivocal remedy, though we so often hear of the stimulus it occasions during its early action. Whatever it may be-in other respects, we know from experience that it is not injurious in haemoptysis.

Another class of remedies is more suspicious; we mean emetics. We need not repeat what we have said under that head; but would chiefly limit their use to active haemorrhages from the lungs, after bleeding; though even in a very debilitated state we suspect they may be useful. In this, however, they have not been tried; and they are certainly, in such circumstances. precarious.

Sedatives, particularly those which repress the activity of the circulation, are highly useful. Of these the chief are nitre and digitalis, to which some others have been added.

Nitre, if taken early in this disorder, is much to be depended on. The following method is convenient and useful: Sal. nitri ss. conservae rosarum iv. m. cap. q. n. m. major. 3tia. quaq. hora pro re nata. But this remedy is much more effectual when given in the coldest water, and swallowed while dissolving. Ten grains, in urgent cases, may be given every hour, or even more frequently.

Digitalis has not been employed so actively as the urgency of the disease seems to require; but it may be given every hour, increasing each time the dose by a quarter of a grain of the powder. Its worst effect will be that of vomiting, which we have no reason to dread. As nitre, in the way recommended, is only a form of cold, so cold drinks, recommended by De Haen, may be equally useful, except that the bulk, required to produce a sufficiently sedative effect, may be inconvenient. Another sedative that has been employed is opium; but this has been avoided, as it is suspected of stimulating in its first operation. We have found it, however, an useful medicine, without the slightest inconvenience from the supposed effect.

Cicuta has not, we believe, been given in such circumstances; yet, as it acts with safety as a narcotic in consumptive cases, we should expect some advantage from it. The belladonna and tobacco, also, which powerfully affect the nervous system, may, in emergency, be tried. Tobacco in clysters often produces fainting.

A remedy employed freely in America, with much confidence, is a table spoonful of common salt dissolved in a very small proportion of water. This cannot, like nitre, act as a sedative; but probaly operates as an unh AE M 727 H AE M diffused stimulus on the oesophagus and stomach, which, by increasing the action of the vessels of their internal membranes, relieves the neighbouring organs, without increasing the impetus of the circulation. Does the vitriolated magnesia act in a similar way ? It is undoubtedly an useful medicine in this disease, independent of its laxative powers. But gentle laxatives are always necessary to prevent the straining required for the evacuation of a costive motion, and to relieve every impediment to the circulation in the chylopoietic viscera.

Astringents, often relied on, are of little real utility. The bark is injurious; and, indeed, when we reflect that whatever constricts the fibres increases the disproportion between the capacity of the vessels and their contents, we must be satisfied that medicines of this kind are hurtful. Alum indeed is not without the suspicion of possessing a sedative quality, and kino is not manifestly an astringent. Yet each seems of little real utility in this complaint. In the passive haemoptyses. astringents are apparently more proper, but even in these nitre is preferable; for in the lowest weakness of the animal actions, the heart and arteries often beat with the most inflammatory violence.

If the cough be troublesome, demulcents are necessary; and to these opium may be safely joined, even by those who dread its stimulus in other circumstances: but care must be taken that laxatives be interposed, lest an inconvenient and dangerous constipation should ensue. See Wallis's Sydenham. London Medical Observations, etc. vol. iv. p. 206; and Medical Museum, vol. ii. p. 257 - 259. Cullen's First Lines, vol. ii. p. 336, edit. 4.