On haemoptysis, especially when fatal, in its anatomical and clinical aspects / by Vald. Rasmussen ; translated from the Hospitals-Tidende by William Daniel Moore.

  • Rasmussen, Valdemar.
Date:
1868
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Licence: Public Domain Mark

Credit: On haemoptysis, especially when fatal, in its anatomical and clinical aspects / by Vald. Rasmussen ; translated from the Hospitals-Tidende by William Daniel Moore. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    time under the same disease, he died suddenly of hgemoptjsis. In the upper half of the left lung were found cavities of various sizes, all of which, as well as the bronchi, even the smallest, were filled with freshly coagulated blood. On the inner wall of the largest of these cavities was found a projecting ledge, in the base of which ran a branch of the pulmonary artery of the size of a barrel of a small quill, giving off a smaller branch which ascended to the upper margin of the ledge, where a lid-shaped rupture had taken place.] II.—HtEmorrhages fkom a ruptured Aneurism of the Aorta. Of the twelve cases of fatal hemoptysis which form the basis of this essay, the source of the haemorrhage was, in three, a ruptured aneurism of the aorta. The rupture occurred once in the ascending- aorta and the arch, twice in the descending thoracic aorta. The perforation took place once into the right principal bronchus, once into the left, and once into the left lung. As to the hgemoptysis due to a ruptured aneurism of the aorta, most writers are contented with stating that it is profuse, and that it rapidly causes death. Lebert^ who, in the 83 cases analyzed by him, met with rupture into the bronchi fifteen times, states that the profuse and rapidly fatal hgemoptysis is indeed the most frequent, but that in some cases also it may occur in the last two or three days before death in several violent attacks. Such violent attacks of haemoptysis took place in one patient even three weeks before death.^ The violence of the hgemorrhage depends in this instance, as in aneurisms in general, upon whether the rupture of the organ concerned takes place with a single large rent, or with one or more small openings, or upon whether the coagula enclosed in the aneur- ism are in a condition to offer a greater or less resistance to the pressure of the blood. Only in one of our three cases did the hgemop- tysis occur suddenly and produce immediate death, and in this case coagula were completely wanting. In this, our first observation, the aneurism presented itself during life with all its characteristic signs, so that the diagnosis was beyond all doubt. The patient, a man aged 35, was comparatively well immediately before the rup- ture, which occurred just as he was about to go to bed, during a fit of coughing, and the quantity of blood brought up amounted to one or two quarts. On dissection, the ascending aorta and also the arch were found uniformly dilated ; the boundary of the descending aorta was sharply defined. The walls of the sac-like dilatation thus ' Virchow, Handb. d. spec. Pathologie u. Therapie, 5 Bd. 2 Abth., 1855, p. 24. ^ Slight attacks of haemoptysis frequently occur during the course of aneur- isms of the aorta, without any rupture having necessarily taken place into the air-passages, as they may be due exclusively to disturbances of the circulation in the lungs, produced by pressure of the aneurism. Thus, the celebrated English surgeon Liston, during the space of eight months, frequently brought up small quantities of blood.