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AN
INAUGURAL ESSAY,
HAEMOPTYSIS
         By JOSEPH BLOODGOOD,
                   m.

             OF ALBANY, NEW YORK.


HONORARY MEMBER OF THE PHILADELPHIA MEDICAL SOCIETY.


       j                k'l ll ,  ft  —^



                       .Vs

       Urget necessitas, non scribendi cacoethes.


                               GREY.
          PHILADELPHIA .■



Printed for the author, by john h. Oswald,
1806. 
 
                 AN







   INAUGURAL DISSERTATION,






                 FOR






              THE DEGREE






                 OF






      DOCTOR OF MEDICINE,






              SUBMITTED TO






           THE EXAMINATION






                OF THE






REV. JOHN ANDREWS, D. D. PROVOST, (ProTem.)






                 THE






   TRUSTEES AND MEDICAL PROFESSORS






                OF THE






       UNIVERSITY OF PENNSYLVANIA,






          On the 21st day of April, 180/? 
 
           TO





BENJAMIN DEWITT, M. D.





          OF





    ALBANY, NEW-TORK.







     THIS ESSAY,






       IS DEDICATED




           AS A





TESTIMONY OF ESTEEM,





          BT HIS





        SINCERE FRIEND,





             AND FORMER PUPIL,





                  THE AUTHOR 
 
AN
    Inaugural  essay,  &c.

              —   m :■»:«——----

  When we  reflect on the size of  the blood
Vessels entering the lungs, and on their minute
ramifications, being delicately dispersed on the
surface of the air-cells, and involved in a cel-
lular substance that can admit of but little re-
sistance,  the frequency of haemorrhagies from
that viscus is  not to be wondered at.   If from
any affection  of the chest, blood is brought up
by coughing, there can be but little doubt  that
it proceeds from the lungs : there are however
cases to be mentioned hereafter, in which  it
will be necessary  to take other circumstances
into consideration to enable us to determine
whether  it proceeds from the fauces, the ad-
joining cavity of the nose, the stomach, or the
lungs.

  In the production of Haemoptysis, its causes
are divided into remote, predisposing, and ex-
citing. (I consider the disease itself the proxi-
mate.)  Of the first, or remote, may be ranked,
                      B 
(  lo  )
  1. Mal-conformation of the  thorax, deri-
ved from ancestors, or acquired by disease.
  2. Sedentary occupations.
  3. Intemperance in eating or drinking.
  4. Suppression of accustomary evacuations,
as of the menses, haemorrhoids,  Sec.
  5. Lifting heavy weights,  or using great
bodily exertions.
  6. The debilitating passions of the mind.
  7. Catarrh.
  8. External violence.
  9. Repelled eruptions,  and
  10. Sudden growth, about the age of pu-
 berty.

  Under the second head I have only to men-
tion debility ; it being the predisposing cause
of all diseases.  That it is instrumental in the
formation of this disease, I infer—

  1. From  the causes that have been enume-
rated : all of which tend either dire&ly, or in-
direclly, to  produce it.
  2. From  its occurring  at those periods, in
which, (from exertions of body or mind) there
is a greater  prostration of strength. 
(   H  )
  3. From its making its appearance at a time
when the lungs are in a passive state,  as when
the patient is sitting,  walking,  or even during
sleep.
  4. I infer it from persons leading sedentary
lives, as studious men, women, and tradesmen,
whose occupations admit of but little exercise,
being most subject to its attacks.
  5. And laftly, From its being a symptom of
Plague, Yellow-fever,  Small-pox,  &c.

  Exciting causes are,

   1. All the causes  that have been enumera-
ted under the firft class—
  2. Sudden vicissitudes  from heat  to cold,
and vice versa.
  3. Stimulating passions.
  4. Diminution of the weight of the atmos-
phere, especially when concurring with exer-
cise, as in ascending a mountain.
  5. Violent exertions of  the  lungs, as in hal-
looing,  singing, or laughing :  and,
  6.  Great heat, or pressure  from clothes. 
(  If  )
              SYMPTOMS.

  In this  disease, as in many others,  we find
two states, which are termed by  Dr.  Cullen,
the active, and passive ; but which I shall stile
'* state of  great and weak  morbid action," as
being terms less  exceptionable than  those of
the Edinburgh Professor.  Its first state is usu-
ally ushered in by coldness of the extremities,
pain in the back and loins, costiveness, flatu-
lency, and lassitude ; a sense of heat, pain, and
weight in  the chest; difficulty of  breathing,
and  frequently a saltish  taste  is  perceived in
the mouth.   After these symptoms have con-
tinued for a longer or shorter time, a tickling
sensation  is experienced  in  the  trachea, at-
tended with a cough, bringing up blood of a
florid and frothy appearance,  producing a
noise similar  to  air  passing through a fluid.
The  blood brought up, in this manner, is ge-
nerally, at firft, in small, but  in some cases
from the very commencement it  appears in
large quantities :  not preceded by the premo-
nitory symptoms ;  appears suddenly, and re-
turns at dated periods.  The pulse in  this state
pf the disease is  frequent, quick, and  tense; 
(  IS  )
sometimes full and round, without tension, or
with a tense,  but small stroke.

   If the disease has continued for any length
of time, or the  discharge  been  profuse,  the
symptoms of  weak morbid action make their
appearance:  the  pulse becomes small,  and
frequent; the difficulty of breathing continues
to an alarming degree, the strength of the bo-
dy becomes greatly diminished, the face pale,
the extremities  cold,  syncope,  tremors, con-
vulsions, and lastly death.

   Blood thrown out by the mouth is not al-
ways derived from the lungs ;  but sometimes
it proceeds  from the fauces,  posterior nares,
and stomach.   When from  the fauces or  pos-
terior nares,  'tis  for the most part brought
 out  by hawking ;  and  by  inspection,  we
 have it often in our power to detect the bleed-
 ing vessel.   Hasmorrhagies from the fauces
 are a more rare occurrence than  those from
 the lungs, and are seldom attended with fever.
 When they  proceed from the flomach,  they
 may be known from the absence of the symp-
 toms mentioned above, and by being  attend- 
(   1*  )
 ed with pain,  anxiety, and a sense of weight
 referrible to that viscus: from the  dark and
 grumous  appearance  of the  discharge, and
 from its being mixed with alimentary  matter,


          METHOD OF CURE.

   The  remedies I fhall divide into fuch as
 are proper
   lft. For its state of  great morbid  aftion;
 and
   2d. Into such as are proper for its state of
 weak morbid action.
   The  remedies  under the first division are
 such as aft by  abstracting stimuli, and there-
 by decreasing the irregular  or  convulsive ac-
tion of  the blood-veffels, and such  as divert
morbid  a&ion from the lungs to a part less
essential to life, viz.  bloodletting, cathartics,
emetics, nitre, common salt, saccharum satur-
ni, cold  applications, blisters,  and the  feda-
tive passion of fear.  And—1st
               ——■»*«■——

         OF BLOOD-LETTING.

  In the use of this noble remedy we should be 
(  IS  )
governed by the pulse, the cronometer of the
system. If it imports to the fingers any degree
of tenfion or fulness, small, and repeated bleed*
ings ought to be our chief dependence. For its
efficacy, and the extent  to which  it may  be
used, the case of Dr. Smith, President of Prince-
ton College is a  striking example.  In the
space of ten days,  by two and thirty bleed-
ings, he lost TWO GALLONS OF BLOOD*.

   The superiority of blood-letting over other
depleting remedies in cases of  great morbid
action, is fully illustrated by professor  Rush,
in his  defence of blood-letting. +
              CATHARTICS

  « Are useful in discharging acrid faeces, and
bile, from the  bowels  in fevers.  They act,
moreover, by  creating an artificial weak part,
and thus invite morbid excitement  from  the
blood-vessels to  the  bowels.  They  likewise

  * Phil. Med. Mus. No*  1. vol. 2. | Med. Inqui. vol. 4. 
(  is  )
lessen the quantity of blood, by preventing
frefh accession of chyle being added  to  it."
Dr. Hoffman,f relates the case of  a  young
clergyman, of a plethoric  habit, who  having
exerted his voice, was seized with a spitting of
blood, and was relieved by the usual remedies:
in a  few days the disease returned ;  several
remedies were Used with some success, though
the discharge did not cease:  on eating the
root of the sow-bread he was seized with  vio-
lent  gripes, which ending in  a copius diar-
rhoea, put an end to the  pulmonary haemor-
rhage.


                EMETICS.

  "  They discharge offensive  and irritating
matters from the ftomach ; they lessen the ful-
ness of the blood-vessels, by determining the
serum  of the blood through the pores;  and
they equalize the excitement of the system,
by  inviting its excessive degrees  from  the
blood-vessels to the stomach and muscles,"

   Dr. Cullen (upon the authority of Bryan
$ Pract. vol. 1. 
(  I?  )
Robinson of Dublin)  exhibited  emetics  in
several cases of haemoptysis with advantage.
In one it increased the haemorrhage to such
an  alarming degree as  to deter him from
making further trials of them.   Ipecacuanha,
when combined with opium,  Dr. Barton in-
forms us, is a  valuable remedy,  not only  in
this  species  of haemorrhagies;  but  also  in
haemorrhages from the uterus, bowels, &c.
  Dr. Mosely* relates several cases in which
his vitriolic solution, administered in nauseating
doses, every eight hours, produced the happk
est effects,


                 NITRE.

  Dr. Dicksonf when speaking upon nitre in
the cure of haemoptysis observes, that the good
effects of  this  remedy  have  astonished him,
and that he can depend upon it in that disease,
as much as bark in the cure of  intermittents.
The most commodious method  of  exhibiting
* Dis. of Trop. Clim.
f Med. observ. 
(  »  1
Jt, he found was in the following electuary-*-
       Sal Nitre      02. s$.
       Con : Ros:   oz. iv.
  The size of a large nutmeg was directed to
be  taken,  four, six, or eight times a  day*
according  to the urgency of the case.  This
remedy was attended with the like success  iri
the hands of Dr. Gibbons.   It operates  not
only by the  nausea it  produces,  but wheft
given in powder  and dissolving in the sto-
mach, by the cold  it generates,  it lessens  thfe
energy of  the circulation,  like cold water iri-
ternally taken,  or externally applied.


            COMMON S/LT.

   for the publicity of this remedy, tye arfe in-
debted to Dr.  Rush: it is given with the like
success  in haemoptysis of  great  and weak
morbid action.  As soon as possible after the
appearance of the haemorrhage, a tea or table
Spoonful of clean fine salt should be swallow-
ed : this quantity is generally found sufficient
to check it.  The dose ought to be repeated
daily for three or four days.  If the above 
                  ( w  )
quantity should be found insufficient, the dose
must be increased to two  table spoonfuls.
               ---~mm»&m^—--

       SACCHARUM  SATURNI.  '

   Sir George Baker* asserts, that there is  no
medicine more  powerful  in  restraining has-
morrhagies than sugar of lead.

   Dr. Reynolds of Londont used it with great
success in the case of a young gentleman in
haemoptysis, in the following form.

     Jl Saccji: Satur gr: j.
        ConserV: Ros ;  gr. jv.
        Tinct. Theb. gutt iij. M.

   The  dose was increased  in two  days  to
Sacch: saturni gr.j.ss;  Tinet. Theb. gutt. v.
Before taking the above  prescription he had
been bled several times ; nitre and other neu-
trals bad been administered freely, and an ab_
stemious diet observed : his pulse 108 in a ixii-
* Med. Trans. Vol. I.   t Med. Trans. Vol. IIL 
(  *<>  )
 nute ; in four days his pulse became soft, less
 full, and beat 70 in a minute; his haemorrhage
 ceased on the fourth day after taking the pills.
 Dr.  Barton,  in a  communication  to  Dr.
 Simmes,  relates a case of haemoptyfis " which
 " threatened the speedy death of his patient.
 " I gave,  (says he)  "  the sugar of lead,  in do-
 <* ses of six grains every two hours,  for several
 " hours together.   I  ascribe the compleat re-
 '' covery of my patient, solely to this treat-
 " ment.   This  was one of the  first cases in
 " which I exhibited the medicine, and I should
 " not have ventured On such doses  (for I had
 rt been taught to believe, that the preparations
 " of lead ought always to be exhibited with
 " the greatest  circumspection,)  had I  not
 " thought the patient irrecoverable by any 0-
 " ther means.  I had no cause, however, to
 " regret  the  employment of the lead ; for it
 « produced not the least inconvenience/' The
 following case  communicated  to  me by Dr.
 Rogers, being a very important one, I shall
 insert it here,  as  an additional proof of the
 efficacy of our remedy.  « On the 18th of Jan-
" uary,  1804,  I visited W—W—, who had
 " been subjea  to  formidable attacks of this 
(  *1  >
" disease.   He had on former occasions, been
" successfully treated by Dr. Barton, who had
" likewise visited him  at the commencement
" of the present attack.   But that eminent
" physician having himself become indisposed,
" referred  his  patient  to  me. Several days
K elapsed before I was sent for, in consequence
" of the patient's anxious desire to be treated
" by  the  physician  who had formerly saved
« his life."

   " Upon seeing the patient, I was almost de-
" terred  from  making any  effort to relieve
" him ; so desperate did the  case appear.   I
" was informed by  his  family,  that he eject-
" ed, by coughing and gently forcing the air
" from his lungs, at least  two pints of blood
" daily, since the 15th.  And it was supposed
" that during the twenty four hours preceding
" my visit, no less than four pints  of florid
" blood were  discharged from his lungs.  We
* may perhaps make some allowance for ex-
" aggcration.   Indeed some of his friends as-
w serted that a much larger quantity had been
" lost. 
I ™  )
   <f He had not slept for three days and nights,
" nor was he able to respire  in  a horizontal
" posture.   He had no appetite—his strength
'* was rapidly declining—and it was expected
that he could not live many hours."

   " I need not be prolix in relating his treat-
*' ment.  He took four grains of  the Saccha-
" rum Saturni,  every six  hours, uncombined
" with opium,  or any other active substance;
" When he had used a scruple of the medicine*
" he was able to lie a few hours with considera-
t( ble ease ; and the haemorrhage was so far re-
" strained,  that the expectorated mucus was
" barely streaked with blood*  Opiates were
" now employed to  remove his  cough, and
{( other remedies were prescribed to restore his
e( strength, which was accomplished in a few
" days."

   " On the 27th he  was seized with cholic :
t( this effect of the lead would not have taken
(( place, had it been  administered in conjunc-
" tion with opium;  but this affection did not
*' prove troublesome.  I have never observed
ft lead, when combined  with opium, in the 
\ **  J
fi manner directed by Dr. Barton,  to pro-
v duce cholic."

  Dr. Barton, whose practice with this article
has, I believe, been more extensive than that of
any other physician  in  Philadelphia,  and to
whom we are indebted for rnany useful obser^
vations on its power, recommends it as a va~
luable and powerful remedy in uterine and Or
ther haemorrhagies, and observes that it  may
be exhibited, with perfect safety, in both states
of the disease, and that in at least  one hun-
dred and fifty cases of haemorrhagies  in which
he  had  administered  the  remedy, there  was
not one instance in which it produced any se-
rious inconvenience.   He always  combines it
with a small quantity of opium, and supposes
that it may be given in larger doses with, than
without,  that narcotic.


               DIGITALIS.

   Dr. Ferriar has the highest opinion Of  this
article i«i the cure of  the disease under consi-
deration. He has used it with great success, To 
(  24  )
his expererience  may be added that of Dr.
Barton, and Dr. Currie, of Liverpool.
        COLD APPLICATIONS.

   Dr. Ghise of Cremona, relates  the case of
a young man, who had  a frequent spitting
of blood,  and a violent fever;  after  trying
repeated bleedings, and other remedies,  with-
out success, he gave him  water rendered  ex-
tremely cold, with ice, ordering  him to take
a cup of it every  quarter of an hour at leaft;
in a few hours the spitting of blood ceased,
the fever and cough abated, and in a few days'
he entirely recovered.

  The late Dr. Bond  cured himself  of  an
alarming  haemoptysis  by  applying a  sheet
dipped in vinegar  and water, to his naked bo-
dy.

  Van Swieten  also mentions the case  of a
person  cured by clothes  wetted  with cold
wine and water, and applied to  the scrotum. 
                 ( 25  )

  Dr.  Hoffman has  seen  several dangerous
cases yield to cold water alone.


               BLISTERS,

  From their efficacy  in  diseases, after  the
system has  been reduced to what is  happily
called the " blistering point" by blood-letting
and  other  depleting  remedies,  have  de-
servedly obtained a conspicuous  place  in the
materia medic a.  They have been found very
efficacious in this disease by diverting morbid
excitement from the lungs, to a part less essen-
tial to life.  They are alike effectual, whether
applied to the extremities, or chest.
                  FEAR,

  From its effects in decreasing the  action of
the heart, and arteries.   From this passion in-
terrupting the flow of blood from a vein in the
operation of phlebotomy,  the  propriety  of
encouraging it is evident.   " We should be
" cautious (as Dr. Falconer justly  observes)
" how we attempt to  raise the spirits, or agi- 
(  26  )
s* tate  the mind of those labouring under a
" present dangerous  haemorrhage.   Low
" spirits and a certain degree of despondency
et for a time, may be of service in restraining
" the impetus of the blood, and allowing a
" thrombus  to  be formed.   On  this account
" we should not be  too forward with  assur-
" ances of safety, but  rather  leave them in
u some degree  of doubt and  apprehension.
" Much injury has, I think,  been done in
" pulmonary   consumption  attended   with
 " haemoptoe, by assurances of safety by well
 " meaning but imprudent friends; they tend to
" stimulate  the spirits, already too much agi-
ee tated, and of consequence to accelerate the
" circulation and discharge of blood."
   During the use of the above remedies,  rest
of body, and more  especially  of the lungs
ought to be strictly enjoined.  The diet should
 consist of vegetables. Meats of all kinds " are
sacred and ought not to be touched."  We
now proceed to the remedies proper—-
   2. For its state of weak morbid aftion.
   Under his head may be included all such
 remedies as, by " exciting action in the sto-
 * mach, bowels,  brain, nerves,  muscles, and 
(  27  )
" skin, equalize the excitement of the whole
" system, and  thereby indirectly destroy a
" weak, but morbid  action in blood-vessels,
" by imparting to them more  vigorous  and
" healthy a£tion."  Among  the first to be
mentioned under  this head is Opium.   In
the  use  of this remedy we should be regula-
ted  by  the pulse, as much as in the use of
the  lancet :  by it we discover the point at
which stimuli  are proper, and when they
ought to be repeated.  To be  serviceable, a
second dose should always  be given before
the first has had time to lose its  influence, or
its effects wear away ; the quantity also should
be carefully accommodated to the state of the
system.
   Bark  will be found a valuable remedy in
this state of the disease.   Its various substi-
tutes, as the cornus florida, sericea, &c.  may
also be used here.
   Wine is a very agreeable  and manageable
stimulant, and one that should be employed
when this class of medicines is indicated, and
when it does not prove unfriendly to the sto_
 mach.
   Porter,  This is highly entitled to our no- 
(  28  )
tice, as being a liquid which the stomach re-
tains when all others are offensive to it.  Of
this we have a convincing proof in the case of
Dr. Smith, formerly alluded to ; he made  it
his sole drink for several  months, without re-
ceiving from it the slightest inconvenience.
   Acids.   These may be administered, with
a  view to their tonic operation, in  combina-
tion with some of the remedies above men-
tioned, with great advantage;  here the mine-
ral acids appear preferable.
   Much  advantage will be derived  from a
light and cordial diet.   White meats, oysters,
&c. are  most proper.   These should be ren-
dered agreeable to the palate  by the addition
of condiments, the patient here, as in conval-
escence from other low states of disease, should
eat in small quantities, and his meals be often
repeated, that an equable excitement may  be
preserved in the stomach, and the system not
suffer from the alternate plenitude  and inani-
tion of that viscus.
FINIS. 
 
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