When the spitting of blood arises from rupture, a great quantity will be
evacuated, and sometimes from an obvious cause, such as a fall, straining
of the voice, and the like; and sometimes from an obscure cause, such as
plethora, or immoderate cold; for cold, as Hippocrates says, occasions
rupture of the veins. If it proceed from erosion, the discharge of blood
will not be rapid, but in small quantity, and will have been preceded by
acrid and unwholesome food, or abstinence, or an acrid defluxion. When
it arises from exhalation, none of the afore-mentioned circumstances,
unless, perhaps, the plethora precedes; but a more moistening and heating
diet, the use of immoderate baths, and living in very hot places, may
appear to occasion it: and it will neither supervene upon inflammations,
nor fevers, nor pains, as in the case of erosion; but, on the contrary,
the patients will appear in all probability to be relieved by the
evacuation. If the hemorrhoidal or the menstrual discharge in women be
suppressed, the renewal of these will remove the danger; and the like
good effects will result from discharges of blood by rupture, when the
disease is connected with plethora, unless the ulcer, or the greatness of
the loss of blood prove injurious. When the discharge of blood is from
erosion, it is never productive of good. If it is brought up by vomiting,
it is clear that it comes from the stomach or bowels, from which parts it
is sometimes evacuated by the anus; but, if by coughing, it comes from
the respiratory organs; but if it is frothy and whitish, and is brought
up at intervals, without pain and oppression, it is clear that it is
brought up from the lungs, upon which, in process of time, a continual
fever will supervene, more especially if occasioned by erosion; and part
of the substance of the lungs, bronchia, or veins, will be brought up.
I knew a certain person affected with spitting of blood from the lungs,
who, after a time, with much coughing, and full evacuation of blood, spit
up four or five stones, rough as caltrops, and of the weight of three
or four siliquæ; and he was immediately relieved, but soon after fell
into a consumption and died. If the discharge consist of phlegm, with
a slight cough or hawking, and the expectoration be frothy and light,
you may know that it comes from the trachea. But if it consist of black
and grumous blood, and there is pain in the part, it indicates that the
discharge is from the thorax, being transmitted by the lungs or bronchia.
If it be brought up with hawking, it is by the palate from the parts
about the pharynx. But if it flow from the head, it is evacuated with
some tickling and cough, for it runs down into the windpipe, and is again
brought up. Such discharges are commonly preceded by an acrid defluxion,
headach, or heaviness. Sometimes the evacuation of blood is from the
palate, owing to a leech having been swallowed, and fixing on some of the
parts there. But of this case we will treat on the subject of Poisons.
_The cure._ Those who have a spitting of blood from catarrh are to be
immediately bled (unless the defluxion be very acrid), and a quantity
of blood taken away proportionate to the strength. Ligatures are to
be applied around the extremities, and the whole body, excepting the
head, is to be rubbed with hot old oil, or with Sicyonian. Farinaceous
food, containing the juice of some austere fruit, such as that of
pomegranate, of apples, or of pears, is to be taken; or let these be
boiled with it. When going to sleep, give them the trochisk from amber;
and on the third day give some boiled honey to lick. If these do not
succeed, and the disease is protracted, shave the head, and use the
application from wild-pigeon’s dung; and after three hours remove this
application, and put the patient into a bath, taking care not to anoint
the head. Then, having given him spoon-meats for food, administer to
him the theriac antidote at bedtime, and repeat this next day; and rub
in like manner the whole body, except the head, but to it apply the
cerate from thapsia, or the like, and again use the spoon-meats. When
the complaint is protracted, apply a cupping-instrument to the back part
of the head. But if the defluxion be of a very acrid nature, we must
abstain from venesection, and have recourse to the food and remedies
formerly described when treating of Catarrh, and such as are now to be
mentioned. When the spitting of blood proceeds from cold, the chest
should be warmed, along with remedies which are of a desiccative nature;
and we must give the medicine from two peppers, with the trochisk of
amber. Those who bring up blood from the respiratory organs, owing to
rupture or anastomosis of the vessels, are to be bled from a vein,
unless the discharge of blood be great. In every case, the patient is
to be laid in a well-ventilated place, upon a steady couch, in an erect
position; and he ought to abstain from strong respiration and talking.
To the affected parts we may apply sponges soaked in tepid oxycrate;
but after the seventh day, unwashed wool, with the oil of roses, of
myrtle, or of lentisk, sometimes with vinegar, and sometimes with austere
wine; or, if the discharge be great, we may apply fine flour and manna,
with vinegar, or alum and acacia, or pomegranate rind, or galls with
vinegar, or dates with polenta and quinces boiled in austere wine.
Afterwards we may put on the plaster from willows, more particularly
if the discharge be moderate. But the following things are to be taken
by the mouth: Purslain when eaten is of use (but its juice when drunk
is more powerful), the flowers also of the wild pomegranate, the fruit
of the bramble and its flowers, the fibrous part of the common oak,
and the membrane under the shell of the acorn (but these are used more
especially in decoction); and yet those of the fagus and ilex are more
powerful remedies. The Samian aster applies to every spitting of blood,
and also the Lemnian earth, and bloodstone finely triturated with the
juice of pomegranate or knot-grass. The dose of the stone should be
one scruple. The following compound remedies are useful; namely, the
trochisk from amber, that from coral, and that from Egyptian thorn, also
the powder composed of the earth called Samian aster, Lemnian earth,
coral, comfrey, and starch, of each, equal parts. When the disease is
occasioned by erosion, more especially if a catarrh precede, we may mix
half a part of opium. And the composition admitting of equal parts of
Samian aster, agerat stone, and Lemnian earth, is an excellent remedy
when drunk to the amount of two spoonfuls (cochlearia) in two cupfuls
(cyathi) of plantain-juice.—_Another_: Of Lemnian sealed earth, dr. xvj;
of Samian aster, dr. xviij; of starch, dr. viij; of sarcocolla, dr. iv;
of gum, dr. ij. Of this in powder let one spoonful be taken with two
cyathi of the decoction of dates. Let them also take cold oxycrate, or
the decoction of dates, of apples, of pears, of vine tendrils, or the
like. They may take food, if the strength urgently requires it, about the
second or third hour, but if otherwise, about the fourth. Let it consist
of bread that has been soaked in cold water, or halica, or chondrus,
with some of the refrigerant juices, such as those of pomegranate, or
myrtles, or with honey and unripe grapes mixed together, or eggs softly
boiled, or cakes prepared from milk with some astringent. Of pot-herbs
they may take endive, succory, plantain, boiled with the oil of unripe
olives and vinegar. Of autumnal fruits they may use apples, pears,
medlars, pomegranates, and the fruit of the cornel-tree. When they have
no fever, their drink may consist of a small quantity of diluted wine;
but, when they have fever, of some of the afore-mentioned draughts, or
Cibyratic hydromel. Those who vomit blood may be treated on the same
plan, only they must abstain from taking food often. They are easily
cured, because the remedies taken by the mouth are applied directly to
the parts from which the blood flows. When blood is coagulated in the
stomach, let the patient drink of rennet, more especially that of a
hare, or the lixivial ashes of figs with water, or thyme, or savory with
vinegar; or evacuations may be produced by means of milk divided into
parts (_lac scissum_), or of aloes. Those who hawk blood from the palate
must use astringent gargles, and apply to the forehead and the rest of
the head the remedies for bleeding from the nose. Such is the treatment
of spitting of blood, which must be carefully attended to, on account of
the danger from an immoderate discharge of it; for if a great quantity be
evacuated, it will bring instant death, as in the case of a slaughtered
animal; but a continuance of the complaint threatens a conversion into
phthisis. Wherefore, when everything is properly attended to, and the
discharge of blood ceases, their strength must be recruited by getting
fish and the feet and brains of young swine. We must also direct them to
get their bodies rubbed, to abstain from the frequent use of baths, from
drinking wine, and from mental emotions and venery.
* * * * *
COMMENTARY. See Hippocrates (de Morbis, et alibi); Galen (Meth. Med. v,
and sec. loc. iv and vii); Aretæus (de Morb. Acut. ii, 2); Aëtius (viii,
65); Celsus (iv, 5); Alexander (vii, 1); Oribasius (Synops. ix, 2); Leo
(iv, 30); Actuarius (Meth. Med. i, 17); Octavius Horatianus (ii, 2, 9);
Nonnus (128); Scribonius Largus (83); Marcellus (de Med. 17); Serapion
(ii, 25); Averrhoes (Collig. vi, 34); Mesue (de Ægr. Pect. 6); Avicenna
(iii, 10, 3, 4); Avenzoar (i, 16, 5); Haly Abbas (Theor. ix, 26; Pract.
vi, 10); Alsaharavius (xii, 6); Rhases (ad Mansor. ix, 59; Contin. ix.)
The father of medicine has mentioned this disease casually, but has not
given a full account of it. We may mention, however, that he refers
one species to disease of the liver. (Coac. 450.) Aristotle states
that vomiting of blood is not dangerous when connected with obstructed
menstruation. (H. N. vii, 10.)
The description given by Aretæus is exceedingly accurate. Blood that is
discharged by the mouth, he remarks, may come from the fauces, nose,
and palate, in which cases it is seldom attended with danger; or from
the lungs and arteria trachea, which is exceedingly dangerous, and may
prove fatal either suddenly, or by terminating in consumption; or from
the stomach, which is less dangerous, as the remedies can be applied
direct to the part affected; or from the liver and spleen, which is a
more dangerous case, as the remedies cannot be so readily applied to
them. They all arise, he says, from rupture, erosion, or rarefaction. By
rarefaction (ἀραιῶσις) he means the same as _exhalation_ (ἀναστόμωσις).
If the blood be black and thick, it comes from a vein; and if florid
and thin, from an artery. Of these cases that in which it proceeds from
rarefaction is said to be the least dangerous, as it may readily be cured
by astringents. The circumstances and characters of all the other cases
are stated with great accuracy and at some length. He concludes with the
remark, that in hemoptysis the patient despairs from the first, whereas
in consumption he flatters himself with the hopes of recovery to the
last. With regard to the treatment he directs that the patient be laid on
a firm couch (as all motion increases the complaint), in a cool place,
and that he abstain from speaking and all mental emotions. In every case,
if the patient’s strength will permit, he recommends venesection at the
elbow. Ligatures, not so tight as to occasion pain, are to be applied to
the extremities. Over the place from which the blood flows he directs
us to apply wool or sponges soaked in austere wine and rose-oil, or in
vinegar. In certain cases he directs us to put an astringent plaster
upon the chest. With regard to the medicines taken by the mouth, he
recommends astringents, especially coral, when the disease is occasioned
by dilatation. These, however, are only to be given when no fever is
present. The diet is the same as that recommended by our author.
The account given by Celsus is very similar, and highly interesting.
He approves of bleeding, the internal and external use of vinegar, and
cold water to drink. Part of his treatment deserves to be given in his
own inimitable language: “Præter hæc necessaria sunt quies, securitas,
silentium. Caput cujus quoque cubantis sublime esse debet, rectèque
tondetur. Facies sæpe aquâ frigidâ fovenda est. At inimica sunt vinum,
balneum, venus, in cibo oleum, acria omnia, item calida fomenta, conclave
calidum et inclusum, multa vestimenta corpori injecta, etiam frictiones.
In hoc casu per hiemem, locis maritimis; per æstatem, mediterraneis opus
est.”
Scribonius Largus, among other remedies, mentions sponging the chest with
vinegar.
Pliny the elder recommends the juice of henbane in hemoptysis. (H. N.
xxvi, 15.) See also Marcel. Empir. (17); Plin. Valerian. (iv, 69.)
The account given by Aëtius is full and judicious, but mostly borrowed
from Galen. He approves of the internal use of vinegar, and of applying
to the chest wool soaked in the same.
Oribasius, Actuarius, and Nonnus recommend internal remedies like those
of our author.
Alexander’s observations are exceedingly judicious; but we can only
afford room to state his opinion of external applications. He approves of
embrocations by means of wool soaked in rose-oil, or the like, with some
vinegar or austere wine not very old; but recommends us to change the
application frequently, as by allowing it to remain it will only irritate
and provoke the flow of blood. With such precautions Octavius Horatianus,
in like manner, approves of sponging the chest with sour wine and water,
or vinegar. Alexander properly forbids us to give anything warm, and
cautions against violent exercise, anger, venery, and saltish food.
Galen expounds the pathology and principles of treatment so fully, that
we cannot even venture to give an abridgment of his account, but will
venture to recommend it to the serious attention of the medical reader.
We must not omit, however, what he says respecting the use of cold and
astringent applications to the chest: “I do not, like most physicians,
approve of applying externally astringents, or things which are of a
cooling nature without astringency, in cases of hemorrhage; for it
appears to me that they have sometimes a contrary effect from what they
are intended to produce, as they occasion a determination inwardly, and
congestion in the deep-seated veins. I have therefore known cases of
persons affected with spitting of blood who were evidently hurt by the
application of cold to the chest. Wherefore, in cases of hemorrhage, I
do not approve of the indiscriminate use of cold applications.” (Meth.
Med. v, 6.) See also de Const. Artis Med. (16.) Galen mentions that blood
may run down from the fauces into the windpipe, and thereby occasion
groundless apprehensions of hemoptysis.
It deserves to be remarked that Dioscorides, Pliny, Galen, Alexander, and
Paulus agree in recommending the hæmatite, or bloodstone for hemoptysis.
It is a native oxyde of iron.
To the long and accurate account given by Cælius Aurelianus it is
impossible to do justice in a short abstract. Passing over entirely his
description of the symptoms, and explanation of the sources from which
the blood is discharged, we shall merely dwell upon a few points of his
practice. He insists with proper earnestness on the necessity of complete
rest, coolness, and abstinence from everything of a stimulant nature;
and recommends the practice already often mentioned of applying to the
part affected sponges or compresses soaked in cold water, or in water
and vinegar, or in some astringent decoction. He also approves of the
application of ointments or plasters composed of galls, alum, the rind of
the pomegranate, and the like. From among his many internal medicines we
would point out the composition consisting of gum acacia, alum, and the
decoction of poppies. When the discharge does not stop before the third
day, he recommends venesection. But if pain, difficulty of breathing,
or a dry cough should come on, he approves of bleeding at an earlier
period of the disease. He then directs us to give emollient epithemes,
electuaries containing frankincense and opium, and the like. When the
pain is protracted, he recommends us to apply cupping-instruments or
leeches to the part affected. Food of a middle quality, milk, and
the like are to be given. From his strictures upon the practice of
the others, it appears that some of the medical sects had condemned
venesection, but it is satisfactory to know that most of the authorities
were agreed about the propriety of it. The Methodist forbids it when
there are no symptoms of inflammation present. It seems there were
disputes also about the propriety of ligatures to the extremities, but
Cælius pronounces in favour of this practice. He informs us further
that some questioned the propriety of giving vinegar, but he decidedly
approves of it. When there is any inflammation, he disapproves entirely
of astringents. He also condemns sudorifics and diuretics. He allows
exercise only when the complaint has abated.
Marcellus condemns ligatures to the extremities, but approves of applying
to the chest a sponge soaked in cold water or acrid vinegar.
We have not room for many extracts from the Arabians, who, however,
supply little additional information, although they treat fully of the
disease. We would refer to Avicenna’s account as being particularly full
and excellent. He approves of the internal use of vinegar, and when
there is a tickling cough, of anodynes, such as mandragora, henbane, and
poppy. Rhases and Serapion approve of sponging the chest with vinegar.
Averrhoes, who is fond of contradicting preceding authorities, condemns
the practice of giving vinegar in hemoptysis. Mesue recommends the use
of chalybeate water for drink. He approves in general of astringents.
Haly Abbas gives a very full and interesting account of the causes
and varieties of the disease, and modifies his treatment accordingly.
He recommends bleeding from the basilic vein, to be repeated if
circumstances require, purging with gentle laxatives, such as myrobalans
and rhubarb, giving demulcents, such as gum arabic and starch, to which
poppy is sometimes to be added, for allaying irritation. He directs the
bath, strong exercise, and vociferation to be avoided. When the disease
arises from a cold cause (he means in cases of passive hemorrhage), he
forbids venesection, and recommends stimulants, such as frankincense and
myrrh. In certain cases he allows astringents, such as alum, balaustine,
galls, sumach, &c. He also directs us to apply to the breast an
astringent cerate containing roses, plantain, purslain, &c. Alsaharavius
recommends bleeding, cold applications to the chest, opiates, and
astringents, according to circumstances. Rhases states that opium, by
thickening or congealing the blood, proves useful in hemoptysis. He
approves very much of a milk-diet. In general he recommends venesection.
He directs the physician to be at pains to ascertain from what part the
blood proceeds.
Cold applications to the chest are not now generally resorted to in this
disease, although it will be seen that the ancient authorities generally
approve of this practice. It will be remarked, however, that Galen
condemns the indiscriminate use of this remedy; and Rhases also states
that he had seen mischief produced by the unseasonable application of
cold to the chest. In short, like every other mode of practice, it ought,
no doubt, to be applied with proper caution and discrimination.