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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    tysis, tliough not to any very considerable extent. In January 1865 he was for three weeks under treatment in hospital for the same symptoms. On 1st and 2d April, the latter returned with some violence. On the 7th, very violent hsemoptysis set in, and was arrested by the employment of the ordinary m.eans. It returned, however, in the evening, and terminated fatally. [The author details the post-mortem appearances at full length, and proceeds to make the following remarks :—] In this instance, the signs of chronic pulmonary phthisis com- pletely masked the aneurism, which, as is frequently the case, especially with aneurisms of the descending aorta, did not reveal its presence by any more prominent symptom,—for even the pains in the back, which may often cause the existence of aneurism to be suspected, were also wanting. The dyspnoea was indeed very con- siderable, amounting even to orthopnoea 5 but was, during life, readily explained by the complication with severe bronchitis. As to the haem- optysis, which clinically was necessarily placed in connexion with the established pulmonary phthisis, the careful post-mortem examina- tion leaves us in doubt whether it proceeded both from the aneurism and from the cavity discovered. With respect to the hasmoptysis which occurred three years before, only conjectures can be formed; but it is probable that this proceeded from the cavity, and the later haemoptysis from the aneurism, the softness of whose coagula permitted the blood to ooze through. In our third case, a large aneurism of the descending thoracic aorta was met with in a man aged 45, attached by strong adhesions to the posterior surface of the upper lobe of the left lung, and open- ing, in a circumscribed situation, into the lung. The latter had thus become highly infiltrated with blood, which was met with also in the bronchi and trachea. At the same time there was exudative pleuritis on the right side, and incipient granular atrophy of the kid- neys. There were very violent and increasing attacks of dyspnoea, and the haemoptysis was present during the four days preceding death, at first in a moderate form, subsequently it was very violent. In conclusion, I shall make some further remarks, although of a more aphoristic nature, and directly elicited by Niemeyer's work,^ recently published and quoted in this Journal, namely, on the rela- tion between hsemoptysis and phthisis. It is well known that, until the time of Laennec, haemoptysis was looked upon as one of the most frequent causes, though far from being the sole cause, of phthisis, and the so often repeated pro- position, Pus sanguinem sequitur, can be traced back to the Aphorisms of Hippocrates. Laennec described this theory as an inconsiderate application of the so frequently misused axiom, Post ergo propter. He does not recognise any other phthisis than that due to tubercles, and haemoptysis is for him an undoubted sign 1 Klinische Vortrage iiber die Lungen-schwindsucht, mitgetheilt v. Dr Ott., 2 Aufl., 1867; Hospitalstidende, 1867, Nos. 37, 38, 39, and 40.