Hemoptysis.
Synonyms:—Hemorrhage from the lungs; spitting blood; bronchial hemorrhage; bronchorrhagia.
Definition:—The expectoration or coughing up of small quantities of blood from the respiratory structures. It may be from the mucous lining of the bronchial tubes, from the bronchioles or from an ulcerating surface in the lung structure contiguous to cavities in tuberculosis.
Etiology:—This condition is an accompaniment of phthisis. It follows acute pulmonary congestion, from whatever cause, and small particles of blood are found in the expectoration of pneumonia. It may follow direct injury to the chest walls and any wound of the lung structure. Excessive physical exercise induces it, as well as the inhalation of irritating vapors and hot air. In croupous pneumonia there is actual capillary rupture as a cause of slight hemorrhage. The condition may be present also from ulceration in the larynx, trachea or bronchi. It sometimes follows pulmonary congestion, secondarily induced, by serious disease of the heart, and it occurs from blood dyscrasia, and rarely as a complication in acute infectious disease.
Symptomatology:—The first appearance is that of a small quantity of blood coughed up. It may be mixed with saliva and the usual expectoration, or there may be a warm, salty taste in the mouth, with only a slight paroxysm of coughing, when a small quantity of bright, frothy blood will be spit out of the mouth. The blood is not clotted in pulmonary hemorrhage. While the quantity is usually very small there is often a flush of heat over the body, some slight palpitation, vertigo and weakness, with momentarily increased respiration. The pulse is apt to be rapid, soft and compressible. When the quantity is larger there is actual shock and prostration, out of proportion to the amount lost. In extreme and rare cases a small mouthful of blood may be coughed up at one time, and the hemorrhage may continue in repeatedly coughed up particles for some hours. With this there is extreme pallor, coldness of the extremities, cold sweat, great weakness, anxiety or alarm, vertigo, rapid breathing and a feeble and usually a very rapid pulse. This may be followed by fever and a mild form of delirium or by restlessness and sometimes nervous excitability.
In the late stages of phthisis, where there are large cavities, the blood may escape into a cavity and all the constitutional symptoms of hemorrhage appear, with no blood, or but little blood in the expectoration. This has resulted in death, a blood clot being found upon post-mortem to fill a large cavity.
Diagnosis:—The condition of the blood, as named above—frothy, in small quantity, bright colored, not clotted, with constitutional symptoms out of proportion to the amount of blood lost—all distinguish pulmonary hemorrhage.
It is distinguished from nasal hemorrhage by the larger quantity of blood, in the latter case, which is venous, dark in character usually and occurs in a steady flow or in drops, when from the nose. Cough may be induced by this blood entering the larynx, but the quantity and dark color determine its source. In hemorrhage from the stomach there is nausea and vomiting of a large quantity of blood mixed with the stomach contents.
Prognosis:—The condition is one of more or less gravity in the prognosis of the disease, which underlies it. But while it causes alarm, anxiety, fear and apprehension it seldom causes death.
Treatment:—Perfect quiet and rest must be enjoined, and if the face is flushed, the skin hot and the patient excitable, cooling applications to the head, or the bathing of the face and neck and hands in cold water will be beneficial. If the patient is chilly and the skin cool or cold, with cold extremities, a hot foot bath or hot drinks will be necessary. Mild stimulants internally may be needed if there is sudden prostration. If the stomach was not previously disordered I give at once a half teaspoonful of the tincture of erigeron and cinnamon, made by dissolving a dram each of the oils of erigeron and cinnamon in two ounces of officially dilute alcohol. This is given in an ounce of cold water and may be repeated in half an hour if necessary. This will have an immediate effect, but it cannot be long persisted in, as it may produce disorder of the stomach. Ten grains of gallic acid may be given soon after the above medicine is given, and this should be repeated every two hours until the tendency to hemorrhage has long passed. Ergot is a prompt remedy in its hemostatic influence, but its depressing influence upon the general circulation contraindicates its use in the markedly congestive types, with impairment of the capillary circulation.
