HEMORRHAGES - the diseases included in this division are in great measure independent of the lesion in virtue of which the blood is poured out. They are only met with casually during its existence ; each of them is found in association with a con siderable variety of causes ; and they form well-marked subdivisions, accord ing to the organs from which the hemorrhage occurs.
The distinctive character by which they are recognized is essentially an objective phenomenon ;—blood is poured out, and is to be known by its sensi ble qualities. Those forms of disease are no less genuine hemorrhages in which blood is poured into an internal cavity ; but, fortunately, they are not of common occurrence, and must be regarded merely as the effect of internal injury, jest as the bleeding of a wound is the effect of laceration. The cases which we have to consider as belonging to the class of hemorrhages occur either as the result of a general condition of system. or as the effect of local disease : this distinction is more evident in some members of the class than in others.
§ 1. Epistaxis.—In young persons, bleeding from the nose is no necessary indication of disease ; slight exertion, wringing 'of the nose, or a blow in the face readily excites it in those predis posed to its occurrence ; it seems, indeed, to act as a sort of out let by which injury to the brain from an excessive supply of blood—" plethora," is obviated. It may become a habit, and under such circumstances be excessive, or more than the necessi ties of the system require. In adults, a general condition of ple thora deman.ds more attention; when it is merely local, and cephalic congestion is associated with epistaxis, it is frequently dependent on dise,ase of the heart.
Epistaxis is sometimes the form of bleeding which indic,ates the existence of the hemorrhagic diathesis. In this condition, the bleeding from a slight wound is stopped with difficulty, and hemor rhages from various organs are met with when there is no other evidence of disease. It also ae,companies poverty of blood, with wasting of the albuminous principle and colored corpuscles, in ansimia, and especially in albuminuria. In such cases, a condi tion of simple hypertrophy of the heart, so often associated with disease of the kidney, may possibly have something to do with its occurrence ; but this is certainly not its constant cause. As a consequence of local disease, it most commonly arises from poly poid or fungoid growths in the nose.
§ 2. spitting of blood; the term is now restricted to hemorrhage from the lungs. The appearance of blood
in the sputa from any other source may be called spurious, that from the lungs genuine ha3moptysis.
A. Spurious; a very frequent occurrence in hysterical females; or a consequence of a relaxed or aphthous state of the tonsils, or sponginess of the g,ums; it is derived in both cases from the mouth or fauces. In the latter, their altered condition will be seen on inspection; in the former, the general state of health, and the presence of hysterical symptoms, will serve to confirm the opinion we are led to form from ap. examination of the sputa. The blood, which appears as streaks or small clots, is mixed with brownish and sometimes fetid saliva, which has a glairy appear ance. is free from froth, and is only partially internuxed with bronchial mucus. the secretion from the lungs floats upon the saliva, is untinge,d with blood, and does not differ from that which is occasionally expectorated by all persons in health.
B. Genuine htemoptysis occurs in very varying quantity, from a slight streak in the frothy mucus secreted by irritated air-tubes, such as is' met with in early phthisis or bronchitis, to an incredi ble amount ofitpuri e unmixed blood. In the former, there is little difficulty in m teng out that its sonrce is pulmonic, when we have the evidence of existing cough, accompanied by expectoration clearly coming from the lungs, with which blood of a florid color is evidently intermixed; but when the quantity is larger, it is sometimes not e,asy to say whether the blood come from the tra chea or from the oesophagus—whether the case be one of Inemop tysis or hsamatemesis. We are guided in great measure by the history of the precursory symptoms, and especially by the exist ence of_cough ; this one fact, indeed, is often conclusive. Pain, if it exist, is referred to the middle of the sternum, or said to ex tend right across the thorax in hiemoptysis ; it is referred to the epigastrium in hamatemesis. In ha3moptysis there is first a sen sation of tickling in the throat, and then the blood comes up with a hawking, or a true cough; in luematemesis, the first sensation is of sickness, and an effort of retching is accompanied by a free discharge of blood, or of blood and glairy mucus; subsequently, if a considerable quantity continue to be brought up, it seems to be accomplished by retching in both cases, and then the diagnosis may be more obscure.