Phthisis : its morbid anatomy, etiology, symptomatic events and complications, fatality and prognosis, treatment and physical diagnosis ... / by Austin Flint.

  • Flint, Austin, 1812-1886.
Date:
1875
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Licence: Public Domain Mark

Credit: Phthisis : its morbid anatomy, etiology, symptomatic events and complications, fatality and prognosis, treatment and physical diagnosis ... / by Austin Flint. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    merous, in which, with ever so much practical ability in auscul- tation and percussion, positive signs are not determinable. As bearing upon the inquiry under consideration, post-mortem ex- aminations in cases in which bronchial hemorrhage has occurred without the evidence of phthisis are especially important. It is desirable that the examinations should have been made soon after the occurrence of the hemorrhage, for, if much time elapse, there is room for the supposition that some tubercles may have existed and all traces of their existence have disappeared. But a bronchial hemorrhage proves fatal in so small a number of cases that the opportunity for an examination after death is very rarely offered soon after the occurrence of haemoptysis. In Niemeyer's work, referred to above, the author says: I have repeatedly failed to find post-mortem traces of pulmonary tuber- cle, or of any other destructive disorder in the lungs of indi- viduals who have died suddenly of pneumorrhagia (bronchor- rhagia?) while in the enjoyment of apparent health. This state- ment would carry with it much more force if the number of exami- nations under these circumstances had been given. The same author states that patients nearly always survive the attack, and hence it is fair to conclude that his examinations must have been very few. The opportunity of examining in a fatal case in which death was due to bronchial hemorrhage, the signs and symptoms of phthisis being absent, has not offered itself to me, although I may fairly assume that my field for observation has been very much larger than that of Niemeyer. The following case, however, is instructive from the fact that the post-mortem examination was not very long after the occurrence of haemop- tysis, and careful physical examinations of the chest were made and noted at the time of the hemorrhage and subsequently. Dr. S. had an attack of haemoptysis, July 23d, 1867. Three days afterward I made an examination of the chest, and found only some relative feebleness of the respiratory murmur, with slight sub-crepitant rales in the left infra-clavicular region. The haemoptysis occurred when he was quiet; it was not preceded nor followed by cough, and he considered himself well at the time of its occurrence. His duties confined him in the hospital dead-house and the dissecting-room. My advice to him was to act as if the haemoptysis were a forerunner of phthisis. In ac- cordance with this advice, he suspended his labor and went to