In this complaint there is a discharge of blood of a florid colour and often frothy; sometimes from the lungs, but more frequently from the lining membrane of the air passages, brought up with more or less of coughing or hawking, and preceded usually by a saltish taste in the saliva, a sense of weight about the chest, sometimes difficult respiration, and a pain in some part of the chest.

It is easily to be distinguished from vomiting of blood, as in the last complaint the blood is usually thrown up in considerable quantities; is moreover of a darker colour, more grumous, and mixed with the other contents of the stomach, and is unattended by any cough; whereas blood proceeding from the lungs or air passages is usually of a small quantity, is of a florid colour, fluid, mixed with a little frothy mucus, and brought up by coughing.

Spitting of blood arises most usually between the ages of sixteen and twenty-five, and may be occasioned by any violent exertion either in running, jumping, wrestling, singing, speaking loud, or blowing wind instruments; as likewise by wounds, plethora of the system, inflammation of the lungs, weak vessels, hectic fever, coughs, full living, excessive drinking, or the suppression of some accustomed discharge. It may likewise be occasioned by changes of atmospheric temperature, sudden exposure to cold after being overheated, or breathing air which is too much rarefied to be able properly to expand the lungs.

Persons with narrow chests and high shoulders, or who are of a delicate make and sanguine temperament, or of a scrofulous habit, or who have had previous affections of the same disease, seem much predisposed to this hemorrhage. It is frequent in persons with crooked spines; in tailors who sit continually in a stooping posture; in young women who lace their stays too tightly; and even in those who labour under dropsy, or other cause of distension of the belly.

Spitting of blood is not always to be considered a primary disease; it is often only a symptom; and in some diseases, such as pleurisy and many fevers, often arises, and is a presage of a favourable termination, if only very slight.

Spitting of blood is a very common result of a stoppage of the monthly discharge in females. The following case, related by Pinel, is an example.

A female, 58 years old, born of healthy and robust parents, of strong constitution, of a sanguine and plethoric temperament, and of great sensibility, had lived in the Salpetriere, and had therefore been under constant observation, from the age of 14. She enjoyed excellent health till she was 16 years old. In her 16th year the menstrual discharge commenced without mishap or difficulty; but this, her first menstruation, was suddenly suppressed, in consequence of the fright and agitation produced by the sight of an epileptic patient in strong convulsions. From that time the discharge never reappeared, nor did any kind of discharge take place from the genital organs; but at the next period when regular menstruation ought to have come on, the girl was attacked with violent spitting of blood. The hemorrhage was preceded by vague pains in the womb and the loins, and by other symptoms. It lasted two days, during which time she expectorated nearly a quart of blood. With one interval only of exception, this woman continued to menstruate through her lungs at each monthly period,, from her 16th to her 58th year, that is, during 42 years of her life. The coming on of the hemorrhage was sometimes a little accelerated by strong mental excitement; sometimes a little retarded by causes of a contrary nature. It was suspended during one whole year, without any serious impairment of the general health, or the occurrence of any other hemorrhage: during this interval, however, the patient suffered most severe headaches. Occasionally the spitting was complicated with vomiting of blood. The duration of the blood-spitting was generally confined to a single day, and it never exceeded three days. It recurred with tolerable exactness at monthly periods; sometimes the interval was longer, and then the hemorrhage continued longer, but was less abundant, and, upon the whole, about the same quantity of blood was lost on each occasion. This woman continued plump, and otherwise healthy, though liable to some thickness of the breath upon unusual exertion.

Cases of this kind are not at all uncommon; although the vicarious hemorrhage seldom persists so long and so steadily. They are not usually attended with much peril. At the "change of life," when menstruation comes naturally to an end, the hemorrhage also ceases forever.

Unfortunately, hemorrhage from the mucous membrane of the air passages is dependent, in a very large proportion of cases, upon incurable disease. The hemorrhage is secondary, and the diseases of which it is symptomatic are Tubercular Phthisis, and organic disease of the heart. Trousseau holds that from 16 to 40 secondary Haemoptysis is generally dependent upon tubercular disease of the lungs; after 40, and still more after 50, upon disease of the heart.

While spitting of blood is thus actually symptomatic of disease of the lungs, there may be a long interval, even years, between the first attack of Haemoptysis and the first symptoms of unequivocal consumption. There are others in whom the first attack of Haemoptysis is immediately followed by all the signs which announce the presence of tubercles in the lungs. Many, again, do not spit blood until the lung disease has acquired a considerable degree of development, and the phthisical symptoms have been for some time clearly marked; and now and then, in these cases, the first hemorrhage proves fatal. Lastly, it is far from being an uncommon thing to see pulmonary consumption run its whole course, and terminate in death, without having been attended with any spitting of blood.

Treatment

The patient must be kept as quiet and cool as possible. All kinds of exertion are to be avoided; and the diet must be light and nourishing, but unstimulating. The patient may take the following:

Aromatic Sulphuric Acid...................Two Drams.

Tincture of Digitalis.........................Three Drams.

Syrup.............................................Six Drams.

Compound Infusion of Roses, sufficient to make Half a pint A tablespoonful three times a day.

Finely Powdered Sugar of Load............Twelve Grains.

Powdered Opium..............................Six Grains.

Crumb of Bread sufficient to make.......24 Pills.

One to be taken three times a day, along with the Mixture.

If the cough is troublesome at night, the patient may take five grains of Extract of Poppies, or five grains of Extract of Henbane, at bedtime.