Laryngeal Disorders.—In cancer and sarcoma of the larynx, angular foreign bodies in the laryngeal cavity, rupture of a superficial vessel, especially after straining or vomiting and laryngitis sicca, lnemoptysis is of occasional occur rence. Here, also, the blood usually comes up as would ordinary mucus, but it is often unmixed and distinctly ar terial. When due to the presence of tumors, shreds of detritus are often coughed up simultaneously.
Aneurism.—This is not an uncommon cause of lnemoptysis, through the press ure exerted by the aneurismal mass upon the pulmonary structures and erosions of their tissues. The trachea is fre quently pressed upon in this manner by aortic and innominate aneurisms, and the bleeding spot may occasionally be located with the aid of the laryngoscope. Aneurisms of the pulmonary artery, when they rupture, suddenly fill the lung with blood, causing death. Aortic aneurisms may also rupture into the bronchial tract. The blood is ejected in mouthfuls and the secondary mani festations—pallor, unconsciousness, etc. —rapidly follow.
Vascular Fibrosis.—In atheromatous degeneration, especially in elderly per sons, the pulmonary capillaries and small vessels of the bronchi sometimes yield, giving rise to a more or less copious flow. This form of hmmoptysis has been called by Sir Andrew Clark "arthritic hmmop tysis," since it is usually met with in arthritic subjects. It has occasionally
proved fatal; but, as a rule, it constitutes a benign form of hoemoptysis.
Emphysema.—This affection is some times attended by hmmorrhage. The blood, unless the quantity be great, is not brought up as it leaves the ruptured capillaries; it usually sojourns some time in dilated alveoli, and is coughed up in thick masses, which sometimes assume the shape of the smaller tubes and are voided as casts.
Thoracic Injuries.—Blows upon the chest, besides penetrating and crushing wounds, often cause Immoptysis, which may continue several days. (See THO RAX, INJURIES OF.) UV assignable Causes.—Finally, recur rent hxmoptysis sometimes occurs with out apparent cause, notwithstanding careful search, and the subject, after a period of great anxiety, does not find his health to have become impaired. and lives many years—sometimes as a stand ing negation of an injudicious and hasty diagnosis. Now that microscopical examination of the sputum alone forms the basis of the decision when tubercu losis is suspected, such errors are not as frequent. Cases of this kind, however, should be watched, and, if the patient be weakly and anaemic, measures tending to improve the general tone should be instituted and continued long enough to restore the patient to perfect health.