3d. The bursting of some of the blood-vessels of the lungs, independent of external injury, and owing to a faulty conformation of the chest, and the slenderness of the vessels.
4th. Certain small tumours, called tubercles, in the lungs.
The first cause I have mentioned is an external bruise or wound.
An accident of that kind happening to the lungs, is more dangerous and difficult to cure, than when the same takes place in most other parts of the body; because the lungs are vital organs, essentially necessary to life, and when their motion is impaired, other animal functions are thereby injured; because they are of an uncommonly delicate texture, in which a rupture having once taken place, will be apt to increase; because they are in constant motion and exposed to the access of external air, both of which circumstances are unfavourable to the healing of wounds, and because the mass of blood distributed to the whole body passes previously through the lungs, and consequently the blood-vessels of this organ are more numerous than those of any other part of the body.
When we consider these peculiarities, it is natural to conclude, that every wound of the lungs must necessarily prove mortal; but experience has taught the contrary. Many wounds of the lungs heal of themselves, by what is called, the first intention. The physician may prevent a fever, by ordering the patient to lose blood in proper quantities, and he may regulate the diet; but the cure must be left to nature, which she will perform with greater certainty, if she is not disturbed by any of those balsams which the wounded are sometimes directed to swallow on such occasions. But when the wound, either from injudicious treatment, or from its size, or from the bad habit of the patient, degenerates into an ulcer attended with hectic symptoms, the disease must be treated as if it had arisen from any of the other causes.
The pleurisy, or inflammation of the lungs, is a disease more frequent in cold countries than in mild; in the spring than in the other seasons; and more apt to seize people of a sanguine constitution than others.
Plentiful and repeated bleedings, fomentations, blisters near the affected part, and a cooling, diluting regimen, generally remove it, without its leaving any bad consequence. Sometimes, by the omission of bleeding in due quantity at the beginning, and sometimes in spite of all possible care, it terminates in an abscess, which, on bursting, may suffocate the patient; or, if the matter is coughed up, becomes an open ulcer, and produces the disease in question.
The third cause of the pulmonary consumption above mentioned, is, a spitting of blood, from the bursting of vessels of the lungs, independent of external wound or bruise. People of a fair complexion, delicate skin, slender make, long neck, and narrow chest, are more subject to this than others. Those who have a predisposition to this complaint, by their form, are most apt to be attacked after their full growth: women from fifteen to three-and-thirty; men two or three years later. In Great Britain, a spitting of blood generally occurs to those predisposed to it, in the spring, or beginning of summer, when the weather suddenly changes from cold to excessive hot; and when the heat is supposed to rarify the blood, before the solids are proportionably relaxed from the contracted state they acquire during the cold of winter. When a spitting of blood happens to a person who has actually lost brothers or sisters, or other near relations, by the pulmonary consumption, as that circumstance gives reason to suspect a family taint or predisposition, the case will, on that account, be more dangerous.
Violent exercise may occasion the rupture of blood-vessels in the lungs, even in those who have no hereditary disposition to such an accident; it ought therefore to be carefully avoided by all who have. Violent exercise, in the spring, is more dangerous than in other seasons; and, when taken at the top of high mountains, by those who do not usually reside there, it has been considered as more dangerous than in vallies. The sudden diminution of the weight of the atmosphere, co-operating with the exercise, renders the vessels more apt to break. Of all things the most pernicious to people predisposed to a spitting of blood, is, playing upon wind-instruments. Previous to the spitting of blood, some perceive an uneasiness in the chest, an oppression on the breath, and a saltish taste in the spittle; but these symptoms are not constant.