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quent one, is external heat; which, even when in no great degree, will bring on the disease in spring, and the beginning of summer, while the heat rare, fies the blood more than it relaxes the solids, which had been before contracted by the cold of winter. Another exciting cause is a sudden diminution of the weight of the atmosphere, especially when con curring with any effort in bodily exercise. Thiş effort, too, alone, may often, in the predisposed, be the exciting cause; and, more particularly, any violent exercise of respiration. In short, in the predisposed, any degree of external violence also may bring on the disease.
837. Occasioned by one of other of these cayses (836) the disease comes on with a sense of weight and anxiety in the chest, some uneasiness in breath, ing, some pain of the breast or other parts of the thorax, and some sense of heat under the sternum ; and very often, before the disease appears, a saltish taste is perceived in the mouth.
838. Immediately before the appearance of blood, a degree of irritation is felt at the top of the larynx. To relieve this, a hawking is made, which brings up a littļe blood, of a Morid colour, and somewhat frothy: The irritation returns ; and, in the same manner, more blood of a like kind is brought up, with some noise in the wind. pipe, as of air passing through a fluid.
839. This is commonly the manner in which the hæmoptysis begins; but sometimes at the very first the blood comes up by coughing, or at least somewhat of coughing accompanies the hawking just now mentioned.
840. The blood issuing is sometimes at first in very small quantity, and soon disappears altogether : but, in other cases, especially when it repeatedly occurs, it is in greater quantity, and frequently continues to appear at times for several days together. It is sometimes profuse ; but rarely in such quantity as, either by its excess, or by its sudden suffocation, to prove immediately mortal. It commonly either ceases spontaneously, or is stopped by the remedies employed.
841. When blood is thrown out from the mouth, it is not always easy to determine from what internal part it proceeds; whether from the internal surface of the mouth itself, from the fauces, or adjoining cavities of the nose, from the stomach, . or from the lungs. It is, however, very necessary to distinguish the different cases; and, in most instances, it may be done by attending to the following considerations.
842. When the blood spit out proceeds from some part of the internal surface of the mouth it. self, it comes out without any hawking or cough.
ing: and generally, upon inspection, the particular source of it becomes evident.
i 843. When blood proceeds from the fauces, or adjoining cavities of the nose, it may be brought out by hawking, and sometimes by coughing, in the manner we have described in 837 and 839; so that, in this way, a doubt may arise concerning its real source. A patient often lays hold of these circumstances to please himself with the opinion of its coming from the fauces, and he may be allowed to do so : but a physician cannot readily be deceived, if he consider, that a bleeding from the fauces is more rare than one from the lungs; that the former seldom happens but to persons who have been before liable either to an hæmorrhagy of the nose, or to some evident cause of erosion; and, in most cases, by looking into the fauces, the distillation of the blood, if it comes from thence, will be perceived..
• 844. When blood proceeds from the lungs, the manner in which it is brought up will commonly shew from whence it comes : but, independent of that, there are many circumstances which may con. cur to point it out, such as the period of life, the habit of body, and other marks of a predisposition, (833, 835); and, together with these, the 'occasional causes (836) having been immediately 'before applied.
845. When vomiting accompanies the throwing out of blood from the mouth, as vomiting and coughing often mutually excite each other; so they may be frequently joined, and render it doubtful whether the blood thrown out proceeds from the lungs or from the stomach. We may however generally decide, by considering, that blood does not so frequently proceed from the stomach as from the lungs : that blood proceeding from the stomach commonly appears in greater quantity than when it proceeds from the lungs : that the blood proceeding from the lungs is usually of a florid colour, and mixed with a little frothy mucus only; whereas the blood from the stomach is commonly of a darker colour, more grumous, and mixed with the other contents of the stomach : that the coughing or vomiting, according as the one or the other first arises, in the cases in which they are afterwards joined, may sometimes point out the source of the blood : and, lastly, that much may be learned from the circumstances and symptoms which have preceded the hæmorrhagy. · Those which precede the hæmoptysis enumerated in 837, are most of them evident marks of an affection of the lungs. And, on the other hand, the hæmatemesis, or issuing of blood from the stomach, has also its peculiar symptoms and circumstances preceding it ; as, for instance, some morbid affection of this organ, or at least some pain, anxiety, and sense of weight, referred distinctly to the region of the stomach. To all this may be added, that the vomiting of blood happens more frequently to females than to males; and to the former, in consequence of a suppression of their menstrual flux : and by attending to all these considerations (842, 845), the presence of the hæmop. tysis may commonly be sufficiently ascertained.
Of the Cure of Hemoptysis. 846. This disease is sometimes attended with little danger ; as, when it happens to females in consequence of a suppression of the menses; when without any marks of a predisposition, it arises from external violence; or when, from whatever cause arising, it leaves behind it no cough, dyspnea, ot other affection of the lungs. Even in such cases, however, a danger may arise from too large an wound being made in the vessels of the lungs; from a quantity of red blood being left to stagnate in the cavity of the bronchiæ; and particularly, from any determination of the blood made into the vessels of the lungs, which, by renewing the hæ. morrhagy, may have dangerous consequences. In every instance therefore of hæmoptysis, the effu. sion is to be moderated by the several means men. tioned, 792, to 795.
847. These measures are especially necessary when the hæmoptysis arises in consequence of pre