Died suddenly after seeking
medical attention, complaining of feeling unwell. When the doctor returned
from getting treatment (ice), Charles was found already dead. Autopsy
revealed significant lung disease (pneumonia) and blood in the lung tissue, Pulmonary
Charles was a young well looking man prior to this with no other health
problems. His sudden death could have been the result of the work he
performed as a brick maker. The smoke from brick kilns tends to cause acute
respiratory disease and chronic obstructive lung
disease in adults. Deadly bacteria can be found in
wet water and mud, although rare, given the opportunity, can cause severe
Synonyms.-Hemoptysis; Broncho-pulmonary Haemorrhage; Bronchorrhagia;
Definition.-An expectoration of blood, due to haemorrhage from the mucous
membrane of the bronchi, trachea, or larynx, and more rarely from erosion or
rupture of capillaries in lung cavities or parenchymatous tissue.
Bronchorrhagia.-When the haemorrhage is from the bronchial tubes, the term
bronchorrhagia should be used, while an escape of blood into the air-cells
and interstitial tissue is known as pneumorrhagia.
Aetiology.-Although hemoptysis is not necessarily a serious condition,
occasionally occurring in young persons of seemingly good health, it is
usually one of the early symptoms of pulmonary tuberculosis, and should
suggest to the physician a thorough examination of his patient.
The haemorrhage may result from congestion of the lungs, due either to
pulmonary lesions or from cardiac derangements, especially mitral
affections. In capillary bronchitis, not infrequently the distended
capillaries give way, and haemorrhage results. Broncho-pneumonia, especially
when it is the forerunner of tuberculosis, may also be a cause; severe
congestion of the bronchi or ulceration of the larynx, trachea, and bronchi
may also give rise to it by erosion of some of the arterial twigs. It may
accompany malignant affections, infectious fevers, scurvy, purpura
hemorrhagica, haemophilia, and other lesions. Cancer of the lung, gangrene,
and abscess must be regarded as causal factors.
Pulmonary apoplexy, or an escape of blood into the air-cells and
interstitial tissue, with or without laceration of the parenchyma, may be
diffuse or circumscribed. It may be due to penetrating wounds or ruptures of
a thoracic aneurism.
Vicarious hemoptysis is most likely an early symptom of tuberculosis rather
than a substitute for the menstrual flow.
Pathology.-There is, in most cases, rupture of the capillaries of the
bronchial mucous membranes, which at first are swollen and red, but soon
become very pale. If tubercular cavities are formed, a ruptured aneurism is
sometimes seen, or large blood vessels eroded by ulceration. If pulmonary
apoplexy has existed, the parenchyma may be lacerated; otherwise, the
air-cells and interstitial tissue are infiltrated with blood, which gives
them a reddish-brown cast.
Symptoms.-Usually the haemorrhage comes on suddenly, generally after some
severe exertion, or undue excitement from coughing, or great vocal effort;
while at other times it comes on when least expected, as during sleep. One
of my cases invariably had his haemorrhage after going to sleep, though
during the day his labor was quite severe.
The first evidence of the haemorrhage is a welling up in the mouth of a
warm, salty fluid. The quantity varies greatly, though always appearing to
the patient much larger than it really is. It may be that a mouthful may be
coughed up every few minutes for an-hour or more, then cease for several
days or weeks. Again, an occasional mouthful will be expectorated for
several days in succession. Where there is a rupture of an aneurysm there
may be an alarming gush of blood that proves rapidly fatal. One such case
occurred in my practice about ten years ago, when a child, suffering from
pulmonary tuberculosis, suddenly startled the mother by a frightful gush of
blood, and died within five minutes.
Where the haemorrhage is profuse and prolonged, there is usually more or
less dyspnea, the patient assuming a distressed appearance and soon becoming
anaemic. The blood is usually bright red and frothy, containing air-bubbles,
though where the blood wells up in the mouth without coughing, the patient
is apt to swallow more or less of it, and when this is spit up or vomited it
will be dark and clotted.
Diagnosis.-This consists in determining the source of the haemorrhage. That
from the lungs and smaller tubes is bright red and frothy. From the
posterior nares and pharynx, the expectoration is streaked with blood and is
airless. From the stomach, the blood is dark and clotted.
Prognosis.-Although hemoptysis usually signifies tuberculosis, it is not
necessarily of this character, and the patient may live for years, finally
dying of other lesions. I have in mind a lady who, thirty-five years ago,
had several haemorrhages, and of whom it was said she would die early of
consumption, who is still living, and has two grown daughters.
While alarm is usually felt by the patient, immediately fatal results very
seldom occur. I have known of only one such case in twenty-five years of
practice. The prognosis, then, as to life, is generally favourable, save
from the rupture of an aneurysm or erosion of large branches of the
Treatment.-The patient should be placed in the recumbent position,
and his fears allayed as to the results of his attack. All excitement is to
be avoided and the patient encouraged as to the outcome. Small bits of
ice may be swallowed, and cold drinks encouraged. Gallic acid in five to
ten grain doses may be given every thirty or sixty minutes, or a mixture of
oil of cinnamon and equal parts of oil of erigeron may be given, five to ten
drops. on sugar, every twenty, thirty, or sixty minutes.
Should the haemorrhage be active, with a full, strong, bounding pulse, add
tincture of veratrum 1/2 drachm to water four ounces, and give a teaspoonful
every half hour until an impression is made upon the heart, when the remedy
should be given every one or two hours.
If the haemorrhage is passive in character, carbo. veg. will be a good
remedy. Dr. Scudder placed great reliance upon this agent, and, from its use
in other passive haemorrhages, I would advise its use. Of the first
trituration, give two or three grains every hour. Mangifera indica is used
where the haemorrhage is passive in character. Dose, three to five drops in
water, every one, two, or three hours.
Lycopus Virginicus is a favorite remedy with Eclectics, and may be given as
an infusion or the spec. tincture. Where the haemorrhage is due to cardiac
lesions, cactus, digitalis, and like remedies, will be given. One must not
forget ipecac in these cases. It may be given to arrest haemorrhage, but is
especially useful during the interim of attacks. The powder in grain doses
or the spec. tincture may be given.
Of the domestic remedies, salt and alum should not be overlooked. Following
an attack of haemorrhage, the patient should be kept quiet and in the
recumbent position for a few days, especially when the haemorrhage has been
severe, and remedies given to counteract the loss of tone due to the
The administration of iron, the bitter tonics, and a nutritious and easily
digested food will be good treatment. The patient, as he gains strength,
should take light exercise and be much in the open air. To allay fear of a
future haemorrhage, it is well to provide the patient with a few ten-grain
gallic-acid powders, with instruction to take one at the first symptom of an