CHAPTER VII. ON HÆMOPTYSIS, SCHMÜCKER, at page 20, considers “ hæmoptysis as proof of wound of the substance of the lung.” So also do Stromeyer, Schwartz, and others. John Bell says, at page 281,-“ If the patient spits blood I fear a wound of the lung; if he has an emphysema I am sure of it.” Guthrie is quite of opinion that hæmoptysis is proof of lung wound. See case of General Cole, page 467, and others at pages 474 and 475. At page 453 he relates as follows:-“ A soldier of the 9th regiment was wounded at Roliga, in 1808, by the point of a sword in the left side ; it penetrated the chest, making a wound somewhat more than an inch long, through which air passed readily, accompanied by a very little frothy blood, which was also spit upon any effort being made to cough, leaving no doubt of the lung having been injured, that viscus appearing to be retained against the wall of the chest.” A. F. Hecker, at page 793, considers spitting of blood as the sign of lung wound. A case, H. Ashton, is given at page 63 of the Director-General's Report, wherein hæmoptysis took place, “ rendering it highly probable that the lung had been injured”; and at page 70 a similar case is mentioned. The fact of the former having recovered, and having been sent to England in 1854, raises doubts in my mind. He was not at Chatham in 1858. Where was he? Either dead; or perhaps recovered, and joined his regiment. In the former case there was no recovery; in the latter case the lung had not been wounded. At page 67, two cases are given where no hæmoptysis occurred, and the lungs were badly wounded. In a case recorded in the Lancet of the 16th of January, 1830, Mr. Lawrance says: -“Two circumstances which, viewed in combination, showed that the lung had suffered direct injury, viz., hæmoptysis and emphysema.” Also, Dr. John Thomson, in his observations, at page 80, says, “ That the lungs having been wounded may be inferred with certainty in every case in which a person spits blood immediately or soon after receiving a wound of the chest.” Several of the appended cases contradict Samuel Cooper's statements that " at all events, when no blood is spit or coughed up, the lungs can never be deeply penetrated.” In the Lancet of the 21st June, 1856, page 682, Mr. Binnie, writing from the Crimea, shows that lung wound was diagn om a rec “ hæmoptysis”; also, in the same number of the Lancet, Mr. Hancock mentions several cases of recovery: but he takes his proof of lung wound “ evidenced by expectoration of blood.” Similar opinions prevail in the works of most writers, Dr. Ballingall, for instance, at page 308; and in almost all recorded cases of alleged lung wound “hæmoptysis” is taken as the certain pathognomonic proof. As an illustration of this state of opinion, attention may be drawn to a remarkable case, of which there is a preparation recently put up in the College of Surgeons' Museum. . “ Henry Barrott, age 27, 1st Life Guards, was wounded on the 18th of June, 1815, at the battle of Waterloo. The ball passed through the muscle of left humerus, fractured two ribs, and entered left thorax; no wound of exit. He lived forty-two years and a hundred and seventeen days after the receipt of the wound. At the post mortem the left lung was found completely solidified and firmly bound to the spine. Mr. Leash goes on to say :“On separating the adhesions, a large abscess in the lung was opened, which contained about a pint of fætid pus. In detaching the lung from the posterior wall a cyst was accidentally opened, which contained the ball, which escaped for the moment into the cavity of the chest.” Mr. Leash observes :— "My own impression is, that the ball having entered the chest, and being nt, instead of passing at once into the substance of the lung, glided down posteriorly between the lung and ribs, and slightly wounding the lung, became fixed.” .. “That the lung was wounded, the hæmoptysis proves ; and that violent inflammation followed, the bleedings spoken of go far to prove." I ask, where is the proof that the lung was wounded ? A cyst would seem to have been formed around the ball between the pleurapulmonalis and costalis, and consequently external to the lung. The presence of the abscess, unless the ball had been found within its walls, which it was not, is no proof of an actual wound of the lung. When hæmorrhage does occur to such an extent, as to threaten suffocation, it becomes a hæmorrhage from the mouth, and indicates a wound of a large blood vessel, with wound of the trachea, or some large bronchial tube. A case, illustrative of the above remark, is given in volume vii, page 315, of the Transactions of the Medico-Chirurgical Society, of stab wound of the trachea. Great hæmoptysis occurred. This is what should be expected. A preparation may be seen in St. George's Hospital Museum, in which there is a laceration, about four inches in length and two in depth, and gaping one inch, of the right lung. There was no hæmoptysis; but if ever it is to happen it should have occurred in this instance. The patient died on the eighth day. The lung was found much congested, but no hepatisation or other sign of pneumonia. |