It sometimes happens that the large external veins of the legs burst, and effuse their blood; but this occurs most frequently in the veins of the intestines, as the vena portarum is liable to suffer from a schirrus of the liver opposing the progression of the blood, which is absorbed from the intestines. Hence the piles are a symptom of hepatic obstruction, and hence the copious discharges downwards or upwards of a black material, which has been called melancholia, or black bile; but is no other than the blood, which is probably discharged from the veins of the intestines.
J.F. Meckel, in his Experimenta de Finibus Vasorum, published at Berlin, 1772, mentions his discovery of a communication of a lymphatic vessel with the gastric branch of the vena portarum. It is possible, that when the motion of the lymphatic becomes retrograde in some diseases, that blood may obtain a passage into it, where it anastomoses with the vein, and thus be poured into the intestines. A discharge of blood with the urine sometimes attends diabetes, and may have its source in the same manner.
Mr. A——, who had been a hard drinker, and had the gutta rosacea on his face and breast, after a stroke of the palsy voided near a quart of a black viscid material by stool: on diluting it with water it did not become yellow, as it must have done if it had been inspissated bile, but continued black like the grounds of coffee.
But any other part of the venous system may become quiescent or totally paralytic as well as the veins of the intestines: all which occur more frequently in those who have diseased livers, than in any others. Hence troublesome bleedings of the nose, or from the lungs with a weak pulse; hence hæmorrhages from the kidneys, too great menstruation; and hence the oozing of blood from every part of the body, and the petechiæ in those fevers, which are termed putrid, and which is erroneously ascribed to the thinness of the blood: for the blood in inflammatory diseases is equally fluid before it coagulates in the cold air.
Is not that hereditary consumption, which occurs chiefly in dark-eyed people about the age of twenty, and commences with slight pulmonary hæmorrhages without fever, a disease of this kind?—These hæmorrhages frequently begin during sleep, when the irritability of the lungs is not sufficient in these patients to carry on the circulation without the assistance of volition; for in our waking hours, the motions of the lungs are in part voluntary, especially if any difficulty of breathing renders the efforts of volition necessary. See Class I. 2. 1. 3. and Class III. 2. 1. 12. Another species of pulmonary consumption which seems more certainly of scrophulous origin is described in the next Section, [No. 2.]
I have seen two cases of women, of about forty years of age, both of whom were seized with quick weak pulse, with difficult respiration, and who spit up by coughing much viscid mucus mixed with dark coloured blood. They had both large vibices on their limbs, and petechiæ; in one the feet were in danger of mortification, in the other the legs were œdematous. To relieve the difficult respiration, about six ounces of blood were taken from one of them, which to my surprise was sizy, like inflamed blood: they had both palpitations or unequal pulsations of the heart. They continued four or five weeks with pale and bloated countenances, and did not cease spitting phlegm mixed with black blood, and the pulse seldom slower than 130 or 135 in a minute. This blood, from its dark colour, and from the many vibices and petechiæ, seems to have been venous blood; the quickness of the pulse, and the irregularity of the motion of the heart, are to be ascribed to debility of that part of the system; as the extravasation of blood originated from the defect of venous absorption. The approximation of these two cases to sea-scurvy is peculiar, and may allow them to be called scorbutus pulmonalis. Had these been younger subjects, and the paralysis of the veins had only affected the lungs, it is probable the disease would have been a pulmonary consumption.
Last week I saw a gentleman of Birmingham, who had for ten days laboured under great palpitation of his heart, which was so distinctly felt by the hand, as to discountenance the idea of there being a fluid in the pericardium. He frequently spit up mucus stained with dark coloured blood, his pulse very unequal and very weak, with cold hands and nose. He could not lie down at all, and for about ten days past could not sleep a minute together, but waked perpetually with great uneasiness. Could those symptoms be owing to very extensive adhesions of the lungs? or is this a scorbutus pulmonalis? After a few days he suddenly got so much better as to be able to sleep many hours at a time by the use of one grain of powder of foxglove twice a day, and a grain of opium at night. After a few days longer, the bark was exhibited, and the opium continued with some wine; and the palpitations of his heart became much relieved, and he recovered his usual degree of health, but died suddenly some months afterwards.
In epileptic fits the patients frequently become black in the face, from the temporary paralysis of the venous system of this part. I have known two instances where the blackness has continued many days. M. P——, who had drank intemperately, was seized with the epilepsy when he was in his fortieth year; in one of these fits the white part of his eyes was left totally black with effused blood; which was attended with no pain or heat, and was in a few weeks gradually absorbed, changing colour as is usual with vibices from bruises.
The hæmorrhages produced from the inability of the veins to absorb the refluent blood, is cured by opium, the preparations of steel, lead, the bark, vitriolic acid, and blisters; but these have the effect with much more certainty, if a venesection to a few ounces, and a moderate cathartic with four or six grains of calomel be premised, where the patient is not already too much debilitated; as one great means of promoting the absorption of any fluid consists in previously emptying the vessels, which are to receive it.