The problems with Consumption have progressed through several states, with later conditions discussed becoming worse to some extent as the manuscript progresses.   The Spitting of the blood is not as bad as a state of consumption with dark to black bile expelled along with the phlegm.   This black material is actually the infected lung tissue decaying away and expelled from the lung cavity due to the consumption, a typical sign of late stage tuberculosis.   The spitting of blood due to consumption would actually precede the later states.  But in this case, the blood is being expelled as well due to other forms of the disease setting into other parts of the body.

The spitting of blood, noted just before the onset of decay, perhaps represents conditions considered to be even worse by Osborn.   Whereas the expulsion of black bile perhaps represents a leakage of hours through the stomach and lungs, the expulsion of blood, in particular from the throat and stoamch, perhaps signifies the spread of this disease into other body parts.   With this theory, this disease state is progressing from the lungs to the intestines and then the heart and circulation–thus the loss of blood.  This precedes the even worse condition–a state of Decay–for which the entire body is now becoming ill and less able to assist in the recovery process.    The use of purging pills represents an attempt to purge or clear the body of any disease causing substances.  Again, there is a blending of old and new traditions here.  Notice how the Elixir proprietatis, has a 16th century origin linked to the very famous alchemist Paracelsus, was maintained well into the 18th century practice of apothecary and even appears in some professional pharmacopoeias.