Volume 1

Diseases of the organs of respiration : a treatise on the etiology, pathology, symptoms, diagnosis, prognosis, and treatment of diseases of the lungs and air-passages / by Samuel West.

  • Samuel West
Date:
1909
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Diseases of the organs of respiration : a treatise on the etiology, pathology, symptoms, diagnosis, prognosis, and treatment of diseases of the lungs and air-passages / by Samuel West. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    School ntc Sec. 49.] H^MbPTYSIs'.^'i^ • 889^ If the haemorrhage be small and come from the lungs, the blood is bright in colour, alkaline, frothy, mixed with sputum, brought up with a cough, does not clot, while the symptoms and physical signs show the lungs to be the seat of disease. If the haemorrhage be small, and come from the stomach, the blood will be dark in colour, often acid, contain no air-bubbles, be mixed with the contents of the stomach and brought up by vomiting, while the symptoms and signs indicate the stomach as the seat of disease. If the hasmorrhage be copious, it will be in either case bright in colour, alkaline, not frothy, not obviously mixed with the sputum or the contents of the stomach, and will clot. The diagnosis must then be made by the general signs and symptoms. But in profuse ha;moptysis the respiratory symptoms are so well marked that a mistake in diagnosis would be difficult. The diagnosis is, however, not so easy when the amount of hffimorrhacre is not large, or where we have to depend only upon the history of the attack from the patient or the patient's friends. Bleeding whether from the lungs or from the stomach, in each case alike stops gradually. In the stomach it may not be enough to cause vomiting, but It will pass on into the intestine, and appear in the motions, giving them the characteristic black colour, mel^na. H^matemesis may therefore stop suddenly But though the vomiting of blood stop suddenly the bleeding does not as the presence of metena for some days shows. From the lungs the blood can only be got nd of by expectoration, therefore the blood-spitting will continue for a day or two at least, and only stop gradually. The best question, then, to ask is this—Whether the patient continued to bring up blood for two or three days after the first attack, and whether the bleeding only ceased gradually. If so, it is a case of hemoptysis and not hsematemesis. _ HEMOPTYSIS is the technical term given to that form of blood-spitting in which the blood comes from the respiratory organs. The causes fall naturally into two groups. In the first the heemorrhage takes place through the lungs, but is due to disease outside them, as, for instance, the rupture of a thoracic aneurysm. In the second the haemorrhage is due to causes which lie in the lung itself, for example, phthisis, and they might be named extrinsic and intrinsic respectively. A. EXTRINSIC—the cause of the hemoptysis lying outside the respiratory _ Thoracic aneunjs?n.—When the final rupture occurs, the blood is brought up m gushes m large quantity and quickly suffocates the patient, so that in a few minutes from the commencement of the attack the patient is dead. _ When a thoracic aneurysm presents beneath the sldn, however thin the coverings mav be it IS rare for the rupture to take place externally. It bursts, almost without exception, internal'lv and generally, as would be expected, into the lung or air-tubes. Nor does the final hiumorrhaae occur without some warning of its approach. It is preceded by slight leaking, which shows itself either in the form of streaky hremoptysis or occasionally in the expectoration of an abundant tnm, watery, blood-stained fluid like saliva, and containing but few air-bubbles. The latter form ' IS met with only I believe, where the trachea is involved and perforation is threatened through It. I have seen both kinds of expectoration continue regularly or intermittently for as much as three weeks before the final rupture took place. New growth.—Slight htemoptysis in malignant intrathoracic growths is not uncommon, but profuse haemoptysis is rare. In the latter case the tumour must have involved the lungs or bronchi as well as some large or fairly large vessel Almost any vessel within the thorax may be opened out in this way, even the aorta Itself. So also with a malignant growth in the neck, the end may be brought about by the rupture of the carotid into the trachea. 26