HEMOPTYSIS.
Absolute rest in bed is essential in all but trivial cases, and the patient should lie upon the affected side when this is already known to the physician by a previous examination. lly this plan regurgitation of the blood into the bronchi of the sound lung is prevented. The shoulders mav be raised, and most patients find this posture more comfortable than lying hat because it diminishes the tendency to cough. All avoidable mental excitement must be prevented. A calm assurance that the danger of suffocation is but a trilling one will do much to allay the feeling of apprehension which often keeps the heart action tumultuous and aggravates the luemorrhagic process. A small hypodermic dose of Morphia often works wonders by acting in the same manner.
Speaking or using the voice in any way above a necessary whisper is to be prohibited. The room should he cool and well ventilated, and the bedclothes as light as t he season will permit. Ice be freely allowed in small quantities. I t assuages thirst, which is always present, -and it prevents the tickling cough when nothing is corning up; unnecessary cough is to he checked, as it raises temporarily the intrathoracie pressure, and thereby does harm, but if the cough centre is paralysed by a large dose of morphia asphyxia may result.
The diet should consist of liquid nourishment administered in small quantities at a tune and quite cold; Alcohol is as a rule contra-indicated. Gelatin in the form of a flavoured jelly is an ideal article of diet, and may be given freely.
The ice-bag or wetted towels containing pieces of ice between their folds may be placed in contact with the thoracic wall. The continuous applica tion of cold to the chest-wall will, after the expiration of less than r hour, cause a hyperaemia of the bronchial surface to replace the anaemic condition which soon follows after the ice has been first applied. This change increases the haemorrhage, and if ice be used its application should be intermittent. Every st hour the bag or towel should be removed in fat subjects, and every 20 minutes in thin ones, and the cold reapplied after the lapse of a similar period. An excellent routine, which the writer has
carried out for many years, is to saturate the atmosphere of the sick-room with the vapour of Oil of Turpentine. Owing to the volatility of the drug this can rapidly be accomplished without appreciably elevating the temperature of the chamber by pouring the drug into a small basin partially filled with hot water, or the oil nay be freely sprinkled upon pine sawdust or shavings. Its local haanostatic action is especially useful in cases where the haemorrhage is capillary, but it may be used in all forms of haAnoptysis, and can do no harm even when the bleeding is proceeding from a ruptured iniliary aneurism in the wall of a phthisical cavity, since it usually also acts as it respiratory sedative and allays cough; moreover, its antiseptic action must not be lost sight of in a condition which threatens sometimes to infect a large portion of the entire pulmonary tract.
Internal remedies are to be used with caution. Mention has been made of the value of a small hypodermic dose of _Morphia to allay mental excitement. This also prevents unnecessary coughing, but the dose should not be repeated. Better results can be obtained by small doses of Heroin when the cough is incessant.
Chloride or Lactate of Calcium is the only reliable internal hemostatic, and 6o to too grs. should be at once given by the rectum or 3o grs. by the mouth every 2 hours. Drugs which increase the systemic pressure, as digitalis and adrenalin, only tend to increase the escape of the blood from the ruptured vessels, and should not be administered. In heart failure, when a cardiac tonic is indicated, Strychnine hypodermically may be given.
When the hallnorrhage is profuse and blood is being coughed up at very frequent intervals, the physician may allay the mental excitement of the patient by so arranging that a small dose of the internal haemostatic may be given every i j or 3o minutes, as the sufferer feels that death may occur before the next dose of his remedy may become due when this is prescribed to be taken at long intervals.