The pathologic etiology should naturally engage our attention first and foremost in a discussion of the subject of hemoptysis dependent on tuberculosis. Broadly speaking, we may subdivide the cases in (a) those occasioned by congestion of the bronchial mucosa and lung texture and (b) those due to ulceration or erosion of vessels, or rupture of miliary aneurisms.
BLEEDING DUE TO PULMONARY CONGESTION.
When hemorrhage takes place before gross lesions are detectable by means of the physical signs or the x-ray in tuberculosis, we ascribe them offhand to congestion of the bronchial mucous membrane and of the lung texture. The earliest pathologic changes in this disease are not directly connected with blood vessels, although the adjacent tissues are the seat of inflammatory processes which may manifest a hemorrhagic tendency. The query is pertinent: Can we ascribe the principal hemorrhages of the earlier stages to congestion?It may be reasonably questioned, as