The symptoms are difficulty of breathing, perhaps bluish appearance of and cough, with blood-stained watery spit.
Treatment.—The condition is a serious one, and calls for immediate attention and careful treatment, for one cannot tell how extensive the congestion may become in a short time. Treatment may require to be directed to the heart to strengthen it. Stimulants may be necessary. There can be no harm in the use of warm applications to the chest, specially low down on the back. But skill and knowledge are requisite to determine in each case the cause of the condition and its appropriate treatment.
Spitting of Blood (thernoptysis, Bleeding from the Lungs) is to be carefully distinguished from vomiting of blood, in which case the blood comes from the stomach, is commonly dark from contact with the acid juice of the stomach, and is mixed with the contents of the stomach. In htemoptysis the blood comes from the lungs or air-passages in them, and is expelled by cough ing. It may be present in the spit merely as spots or streaks, or it may uniformly colour the spit, or it may come in clots, or in gushes of bright blood, frothy because mixed with air. Where it rushes out in quantity no effort at coughing may exist, or there may be but a slight cough. It must be observed that streaks of blood may be present in the spit and not come from the lungs at all, but from the back part of the nostrils or the pharynx, and may, consequently, mean little or nothing. Further, bleeding may take place from the nostrils so far back that the blood finds its way into the back of the throat, and is expelled by a very slight effort. The true nature of such cases will be revealed by an examination of the back of the throat with a strong light, when a fine line of blood is likely to be observed down the back wall of the pharynx from above.
Bleeding from the lungs may be the result of many varied diseases, such as congestion, inflammation, or ulceration. It may be appa
rently the first occurrence in an attack of con sumption. Persons may be repeatedly attacked with haemorrhage from the lung and no special sign of lung disease be discovered. The bleed ing may return at intervals, and consumptive disease not show itself for years. At the same time consumption may speedily follow the first attack. Bleeding is also a frequent occurrence in the progress of consumption, vessels being opened into by the destructive process. In pneumonia (p. 368) loss of blood from the con gested vessels gives the rusty appearance to the spit, and in bronchitis streaks of blood in the spit are not uncommon. The bursting of an aneurism (p. 324) into the lungs, or one of the bronchial tubes, will occasion profuse bleeding, the patient dying speedily. Cancer also causes bleeding.
Where the loss of blood is considerable the nervous shock to the patient is usually great.
Treatment.—A person who has suddenly coughed up a considerable quantity of blood should be put to bed, the shoulders being raised. The room should be cool and perfectly quiet. Ice in small pieces given for socking aids in checking the bleeding. The best medi cines are dilute sulphuric acid (30 drops every three hours) in water, gallic acid 10. grains, every two or three hours as long as necessary, or ergotine 3 to 5 grains repeated as required, or to 1 tea-spoonful of liquid extract of ergot instead.
Stimulants are not, as a rule, advisable, tending, as they do, to excite the heart, and so increase the bleeding. Food should be given cold for some time after the bleeding has ceased.
If the attack comes as a surprise to the patient, who has seemed a moderately healthy person, it should induce him or her to have a careful examination made of the lungs and heart specially, and its warning should not be disregarded.