(Hemoptysis)
=Osteopathic Etiology= and =Pathology=.—Pulmonary congestion; croupous
pneumonia; tuberculosis; hemorrhagic infarction; ulcers of the larynx,
trachea or bronchi; gangrene of the lung; fibrinous bronchitis,
carcinoma of the lung; lesions of the ribs or vertebræ from the second
to the seventh dorsal inclusive, may cause diseases of the bronchial
tubes or lungs, that result in hemoptysis, or the hemorrhage may be
caused directly by extreme congestion resulting from the disordered
vasomotor nerves; diseases of the heart, such as mitral disease,
causing pulmonary congestion; aneurism of the branches of the pulmonary
artery; vicarious menstruation from deranged menstrual functions;
diseases of the vessel walls, or blood, as scurvy, anemia, hemophilia,
etc.
=Pathologically= in many cases, the lesions are microscopic, consisting
of ruptured capillaries. In other cases larger vessels may be ruptured,
or are the seat of erosion. Many other lesions may be observed. After
death the bronchial mucosa is occasionally found inflamed and the lung
tissues paler than normal.
=Diagnosis.=—A differential diagnosis must be made between epistaxis,
hemoptysis and hematemesis.
In =epistaxis= the blood may flow from the posterior nares into the
pharynx; it causes coughing and a discharge of the blood may occur the
same as in hemoptysis. A careful examination of the nasal region alone
can determine the source of the bleeding.
In =hemoptysis= the history of the case as to pulmonary or cardiac
diseases is to be considered. There is a feeling of weight and of
uneasiness in the chest. A salty taste and a tickling of the throat
precedes the bleeding. The blood is ejected by coughing and is bright
red, frothy, very little coagula, and is alkaline in reaction.
In =hematemesis= the history would indicate disease of the stomach,
spleen, liver or heart. Uneasiness, and occasionally nausea and
faintness, precedes the bleeding. The blood is ejected by vomiting, and
is dark, clotted or fluid, mixed with food, and is of acid reaction.
In a few instances the blood due to hemoptysis may be swallowed, and
vomited.
=Treatment.=—In all these cases of hemoptysis the patient should be
placed in bed and absolute rest demanded. An attempt should at once
be made to correct any lesion that may be found influencing the cause
of the bleeding. Correcting lesions to the vasomotor nerves of the
lungs and bronchial tubes, and equalizing the disturbed vascular area,
may be sufficient in a number of cases. These lesions will be found
principally in the upper dorsal region. In some cases, perhaps, there
is an impairment of the trophic nerves by the same lesions, thus
interfering with the tone of the vessel walls and pulmonary tissues.
The diet should be light, nutritious and non-stimulating. The use of
hot drinks is to be avoided. The rapidity of the heart’s action should
be reduced. This is best performed by thorough treatment of the dorsal
spinal nerves of the left side over the heart, and by inhibition in the
suboccipital region. The ice-bag to the precordia is also helpful. Iced
drinks and the eating of ice is of aid. Stimulation of the systemic
circulation will be of value in helping to relieve the pulmonary
congestion, although the two systems are somewhat independent of each
other. Also, hot foot baths and the evacuation of the bowels may be of
additional value. In cases due to organic disease of the heart, the
mind and body should receive absolute rest, so that the diseased areas
may be strengthened as much as possible; besides a tonic treatment for
the heart’s action is necessary.
After the hemorrhage has subsided care should be taken that bleeding
does not occur again. All irritations of the respiratory tract should
be avoided. A stimulating diet, tobacco and alcohol should be avoided.
Nutritious food and a moderate amount of exercise is indicated.