6 Waldenburg, op. cit., p. 28.
Morton's7 (1689) language partly is: "Decantatum istud medicorum adagium, quod pus sequitur sanguinem;" and then, translated, he says: "It (the adage) appears to have originated in the fact that 'purulence' of the lungs, or phthisis pulmonalis, usually follows hæmoptysis more quickly and oftener than any other disease." In the sentence immediately following he suggests this result may be due to a putrefaction of clots that the hæmoptysis has left behind in the lungs, or to a copious effusion of humors from the whole body to the tender lungs, or to an erosion of some vessel.
7 Phthisiological Ed., 1727, lib. 111, chap. v. p. 95.
Another theory appears in Hoffmann's language,8 and was probably suggested, directly or indirectly, by Sylvius's description of tubercles: "The blood is easily extravasated into the pulmonary vesicles, stagnates there and putrefies, corrodes the neighboring parts, and finally destroys the air-passages or they are converted into nodes or tubercles." The blood becomes tubercularized, and the phthisis ab hæmoptoe is established. This idea is found at different periods, and we find a recent French author arguing against this hypothesis.
8 Peter, loc. cit., p. 244; Young, p. 211, Opera; Hoffmann, Physico-medica, Geneva, 1740.
The reversal of these ideas is generally acknowledged as the results of Laennec's energy and genius, yet similar opinions to his had been expressed by French and English physicians. Bayle does not place phthisis ab hæmoptoe in his classification. Desault,9 one of Laennec's countrymen, near a hundred years before him, "insists that tubercles constitute the essence of consumption, being generally anterior to hæmoptysis." Mudge10 says that hæmoptysis is often the consequence of the obstruction produced by tubercles. A preparation for the positive opinions of Laennec is discernible in these and other authors. His views on this particular topic were opposed by Andral. The latter modified his earliest expressions to some extent.
9 Young, p. 220, Desault sur les Maladies venériennes, la Rage et la Phthisic, Bordeaux, 1733.
10 Young, loc. cit., Radical Cure for a Recent Catarrhic Cough, London, 1779, 2d ed.
The next important historical epoch in the causative relations of hæmoptysis and phthisis is in the energetic protests of Niemeyer. They were in some respects a return to the Hippocratic doctrine, in that he asserted the predominance of hæmoptysis as cause; but he gave the doctrine a basis better adjusted to a better pathology, in that he made the important element of inflammatory lesions the medium between the effusion of blood and the final purulence or ulceration (ulcus pulmonum) of the ancients. He energetically advocated the doctrine of the positive effect of effusion of blood in the bronchi or pulmonary substance in producing disorganization of the lungs, without reference to any hereditary or predisposing element or existence of tubercles.
Jaccoud11 calls attention to the fact that Graves had anticipated Niemeyer in the partial revival of the Hippocratic doctrine and the teachings of Morton and Hoffmann on phthisis ab hæmoptoe.