Causes, over-exertion in plethoric, glanders, pulmonary tubercle,
petechial fever, embolism, aneurism, ulcerated new formations,
anthrax, septicæmia, hæmorrhagic diathesis. Symptoms. Inappetence,
cough, cold limbs, rigor, hard pulse, jugular pulse, violent heart
beats, unsteady gait. Discharge, bloody, crimson, frothy, with cough,
without acid, excited breathing, debility. Indications from
pre-existing disease. Treatment, quiet, elevated head, cold
irrigation, ice bags, acetate of lead, opium, ergot, matico, tannin,
iron, oil of turpentine, laxatives, cool stable.
The term _hæmoptysis_ (αιμα, blood, πτυω, I spit,) is now entirely
restricted to bleeding from the lungs and lower air passages. It is a
very rare complaint in the lower animals, but is sometimes seen in both
horse and ox. In very plethoric subjects the overloaded circulatory
organs give way in the delicate membrane, lining the ultimate bronchial
tubes and the air cells. The exciting cause in such cases is usually
some severe effort of draught, a violent gallop, or other unwonted
exertion. It occurs in glanders from rupture of caseated pulmonary
nodules. It does not appear to be so common in phthisis in the lower
animals as in man, but one case occurred under the eye of the writer in
which the bursting of a large tubercle in the lung of a cow involved the
rupture of a considerable vessel with a fatal result. Pulmonary embolism
and infarction, petechial fever, aneurism, ulcerated neoplasms, anthrax,
and septicæmia are additional causes. Lastly hæmoptysis sometimes takes
place in hæmorrhagic subjects without any appreciable rupture of
vessels, the blood sweating from the surface of the bronchial mucous
membrane.
Premonitory symptoms are sometimes noticed, such as dulness, and
lassitude, loss of appetite, a frequent short cough, coldness of the
limbs and surface, shivering, full, hard pulse, pulsation in the
jugulars, tumultuous action of the heart, and unsteadiness of gait.
More commonly it comes on suddenly as the result of severe muscular
strain or excitement. The blood flows from the nose, and rarely from the
mouth in solipedes, but indiscriminately from both in other animals. It
is bright red, clear, frothy, or mixed with mucus, and variable in
amount. It is easily distinguished from nasal hæmorrhage, which is not
frothy, and from bleeding from the stomach, which is clotted and
blackened, with an acid odor from the presence of the gastric juice. The
cough of hæmoptysis contrasts with the sneezing of epistaxis and the
retching of hæmatemsis. The rattling cough increases the discharge, as
does also a dependent position of the head. Besides the cough there is
usually an anxious countenance, accelerated breathing and considerable
lifting of the flank. When the loss is excessive there is weakness,
giddiness, rolling of the eyes, and pallor of the visible mucous
membranes.
The previous ill-health of the patient, the presence of tubercle as
ascertained by auscultation and percussion, and the hæmorrhagic
constitution as shown by occurrence of bleeding from other parts of the
system will lessen the chances of a favorable termination. Sometimes,
too, the flow is so profuse that the blood cannot be coughed up, and
filling the bronchial tubes it destroys life suddenly by suffocation.
_Treatment._ When brought on by severe exertion absolute quiescence will
usually check hæmoptysis. Keeping the head in an elevated position
favors its arrest. The application of cold water to the head, neck and
thorax, and the giving of iced water, strongly acidulated by vinegar or
one of the mineral acids may sometimes be required. In threatening or
obstinate cases one drachm of acetate of lead may be given thrice daily
to check by its astringent effect on the vessels, and the addition of a
drachm of opium is of great value in suppressing the cough. Ergot,
tannin, matico, and oil of turpentine have each been employed with
advantage, and when costiveness exists a saline laxative (one pound
sulphate of soda) may be usefully resorted to. The patient should be
kept in a cool, airy dwelling, and should rest for fifteen or twenty
days after an attack.