BLOOD-SPITTING. 141 



often succeed in this object by placing leeches upon the groins of these patients 

 immediately before the period when the vicarious menstruation is expected, and by 

 putting their feet at the same time into hot water, or even by laying the patient in 

 a warm bath. 



In all cases of bleeding from the stomach the attendance of a medical man is 

 necessary. 



BLOOD-SPITTING. 



If a person spit up more than a few drops of blood, we should advise him to 

 see his doctor and have his chest examined. Quite a large quantity of blood may 

 be spat up, and nothing come of it; but still it is well to be cautious, and in such a 

 case as this it is really absolutely necessary that the matter should be thoroughly 

 investigated. The most common cause of blood-spitting is consumption ; but there 

 are other causes, and it does not absolutely follow because a man spits blood that he 

 is consumptive. Sometimes the blood comes up without any warning ; but people 

 who are subject to haemoptysis as spitting of blood is technically called often 

 know by experience what is about to happen. It is generally coughed up a 

 mouthful at a time, but sometimes we have seen it come up in gushes nay, almost 

 in torrents. The quantity may vary from a mere streak to a pint or more. The 

 blood is generally bright red and frothy; but occasionally, especially when it is 

 discharged suddenly, it is dark in colour. There may be clots, but usually it 

 is entirely liquid. The attack varies much in duration : it may be all over in a 

 minute or two, or the expectoration may be tinged with blood for days 

 together. 



In a person disposed to bleeding from the lungs, the onset of an attack may be 

 determined by a variety of causes. Anything which hurries the circulation \\ill 

 have a tendency to excite the haemorrhage straining of any kind, great bodily 

 efforts, active exercise, much talking, and more especially public speaking or 

 singing, or playing on wind instruments. 



When a man brings up blood we must try and find out where it comes from 

 does it come from the lungs or from the stomach 1 Sometimes this problem is easy 

 enough to solve; at others it is most difficult. If a man is known to be consumptive, 

 we suppose that the blood comes from his lungs ; and if a young woman has long 

 suffered from symptoms of ulcer of the stomach, we naturally enough conclude that 

 the haemorrhage is gastric in origin. Even when we know nothing about the 

 previous history of the patient, the circumstances of the attack may serve to throw 

 some light on the subject. In bleeding from the lungs the blood is generally 

 coughed up in mouthfuls ; but in bleeding from the stomach it is vomited profusely. 

 When the blood comes from the lungs it is frothy, and of a florid red colour ; when 

 from the stomach it is not frothy, and is dark in colour. When the blood comes 

 from the lungs, it is mingled with phlegm ; when from the stomach, it is mixed with 

 food. After bleeding from the stomach, the motions are often black or contain 

 blood ; but in bleeding from the lungs this symptom is absent. For convenience 

 of reference and comparison we have arranged these symptoms in parallel 

 columns : 



