PULMONARY APOPLEXY. — This Con sists in extravasation of blood into the air-cells and interstitial pulmonary tissue, as a result of aneurismal rupture, pene trating wounds, ulceration involving a large vessel, septico-pymmia, cerebral disease, and other conditions in which the pulmonary parenchyma is torn.
As here understood, pulmonary apo plexy only applies to rarely-observed cases in which the organ is overwhelmed with blood, which gushes out of the mouth in great volume. Intense dysp noea, collapse, and death follow in quick succession. In some cases the haemor rhage is, so to say, localized, and the In:emoptysis is not severe. Soon, how ever, an abscess and at times gangrene appear, and the patient succumbs from septico-pymia.
Treatment of Pulmonary Haemor rhage. — The treatment of pulmonary haemorrhage not only varies with the cause, but therapeutic measures ad dressed to the cardio-vascular system at large are also necessary. Examination of the upper respiratory tract, the naso pharynx, the pharynx, the larynx, the trachea, the base of the tongue, etc., may reveal a bleeding spot and call for the local application of styptics; besides this, however, measures tending to re duce the vigor of cardiac action—rest, etc.—must be resorted to. A third class of therapeutic indications are those cal culated to prevent the recurrence of the haemorrhages.
If the hemorrhage is a copious one, the patient should at once be placed in a reclining position, his head being turned to one side to enable him to clear his mouth as fast as it is filled. Whatever be the cause of the bleeding, it cannot be clearly established while it lasts; general measures are therefore alone in dicated for the time being. Several remedies at present commonly employed are more pernicious than helpful, par ticularly ergot, digitalis, and the ice poultice. Ergot increases vascular ten sion; digitalis produces the same effect, particularly upon the pulmonary artery; the ice-poultice contracts the peripheral vessels and causes engorgement of the deeper vessels.
Probably the most effective agents are morphine and atropine, grain of the former and 1/10„ grain of the latter, given together hypodermically. At the same time, a large handkerchief, napkin, towel, or bandage should be tightly wound around each extremity, as near the trunk as possible, to momentarily arrest the return of the venous blood to the thoracic organs. This procedure,
if properly carried out, at once reduces the pulmonary engorgement and usually arrests the flow unless it is overwhelm ing. Nitrite of amyl is another remedy which acts promptly. When these agents cannot be obtained, a tablespoon ful of salt dissolved in a tumblerful of water generally arrests the flow when the bandages are also applied as stated.
After the hemorrhage has ceased, the patient should remain where he is an hour or so, then be carried on a litter to a cool room. He should not be allowed to speak. Fainting tends to assist the formation of a clot, and the patient, as a rule, recovers his senses within a short time. The bandages should be removed gradually, fifteen minutes being allowed to elapse between each operation, so as to avoid a sudden tension of the pul monary arteries. Aconite or veratrum viride may then be used with advantage.
The diet should be light, and easily digested food should be selected. Alco holic and other stimulants should be strictly forbidden. Large quantities of liquid of any kind and hot beverages tend to bring on a recurrence of the flow. To assist in preventing this, the forma tion of a clot should be encouraged; this is best accomplished by chloride of cal cium: 10 to 15 grains every two hours, in glycerin. Saline purgatives are valu able to reduce vascular tension, but they should not be utilized when the patient has been greatly weakened by the hm orrhages if other measures are effective.
The hzemoptysis observed in elderly persons, and due to vascular disorders, is, according to Sir Andrew Clark, ag gravated or maintained by the frequent administration of large doses of strong astringents, by the application of ice bags to the chest, and by indulgence in liquids to allay the thirst created by the astringent. The treatment found most successful by him in these cases is diet, quiet, restricted use of liquids, stilling of the cough, calomel, salines, alkalies with iodide of potassium, and frequently renewed counter-irritation. (See also TUBERCULOSIS.