We mean here to treat of that discharge of blood from the lungs only which is called an hæmoptoe, or spitting of blood. Persons of a slender make, and a lax fibre, who have long necks and strait breasts, are most liable to this disease. It is most common in the spring, and generally attacks people before they arrive at the prime or middle period of life. It is a common observation, that those who have been subject to bleeding at the nose when young, are afterwards most liable to an hæmoptoe.
CAUSES.——An hæmoptoe may proceed from excess of blood, from a peculiar weakness of the lungs, or a bad conformation of the breast. It is often occasioned by excessive drinking, running, wrestling, singing, or speaking aloud. Such as have weak lungs ought to avoid all violent exertions of that organ, as they value life. They should likewise guard against violent passions, excessive drinking, and every thing that occasions a rapid circulation of the blood.
This disease may likewise proceed from wounds of the lungs. These may either be received from without, or they may be occasioned by hard bodies getting into the wind-pipe, and so falling down upon the lungs, and hurting that tender organ. The obstruction of any customary evacuation may occasion a spitting of blood; as neglect of bleeding or purging at the usual seasons, the stoppage of the bleeding piles in men, or the menses in women, &c. It may likewise proceed from a polypus, scirrhous concretions, or any thing that obstructs the circulation of the blood in the lungs. It is often the effect of a long and violent cough; in which case it is generally the forerunner of a consumption. A violent degree of cold suddenly applied to the external parts of the body will occasion an hæmoptoe. It may likewise be occasioned by breathing air which is too much rarified to be able properly to expand the lungs. This is often the case with those who work in hot places, as furnaces, glasshouses, or the like. It is likewise said to happen to such as ascend to the top of very high mountains, as the Peak of Teneriff, &c.
Spitting of blood is not always to be considered as a primary disease. It is often only a symptom, and in some diseases not an unfavourable one. This is the case in pleurisies, peripneumonies, and sundry other fevers. In a dropsy, scurvy, or consumption, it is a bad symptom, and shews that the lungs are ulcerated.
SYMPTOMS.——Spitting of blood is generally preceded by a sense of weight, and oppression of the breast, a dry tickling cough, hoarseness, and a difficulty of breathing. Sometimes it is ushered in with shivering coldness of the extremities, costiveness, great lassitude, flatulence, pain of the back and loins, &c. As these shew a general stricture upon the vessels, and a tendency of the blood to inflammation, they are commonly the forerunners of a very copious discharge. The above symptoms do not attend a discharge of blood from the gums or fauces, by which means these may always be distinguished from an hæmoptoe. Sometimes the blood that is spit up is thin, and of a florid red colour; and at other times it is thick, and of a dark or blackish colour; nothing however can be inferred from this circumstance, but that the blood has lain a longer or shorter time in the breast before it was discharged.
Spitting of blood, in a strong healthy person, of a sound constitution, is not very dangerous; but when it attacks the tender and delicate, or persons of a weak lax fibre, it is with difficulty removed. When it proceeds from a scirrhus or polypus of the lungs, it is bad. The danger is greater when the discharge proceeds from the rupture of a large vessel than of a small one. When the extravasated blood is not spit up, but lodges in the breast, it corrupts, and greatly increases the danger. When the blood proceeds from an ulcer in the lungs, it is generally fatal.
REGIMEN.——The patient ought to be kept cool and easy. Every thing that heats the body or quickens the circulation, increases the danger. The mind ought likewise to be soothed, and every occasion of exciting the passions avoided. The diet should be soft, cooling, and slender; as rice boiled with milk, small broths, barley-gruels, panado, &c. The diet, in this case, can scarce be too low. Even water-gruel is sufficient to support the patient for some days. All strong liquors must be avoided. The patient may drink milk and water, barley-water, whey, butter-milk, and such like. Every thing however should be drank cold, and in small quantities at a time. He should observe the strictest silence, or at least speak with a very low voice.
MEDICINE.——This, like the other involuntary discharges of blood, ought not to be suddenly stopped by astringent medicines. More mischief is often done by these than if it were suffered to go on. It may however proceed so far as to weaken the patient, and even endanger his life; in which case proper means must be used for restraining it.
The body should be kept gently open by laxative diet; as roasted apples, stewed prunes, and such like. If these should not have the desired effect, a tea-spoonful of the lenitive electuary may be taken twice or thrice a-day, as is found necessary. If the bleeding proves violent, ligatures may be applied to the extremities, as directed for a bleeding at the nose.
If the patient be hot or feverish, bleeding and small doses of nitre will be of use; a scruple or half a drachm of nitre may be taken in a cup of his ordinary drink twice or thrice a-day. His drink may likewise be sharpened with acids, as juice of lemon, or a few drops of the spirit of vitriol; or he may take frequently a cup of the tincture of roses.