Heinrich Hoensch, a 38-year-old carpenter, was admitted on February 28, 1848 to the Charité in Berlin with diarrhea and left-sided abdominal swelling that was well-defined but not particularly painful when pressed but took up almost the entire left side of his abdomen. The patient had a history of chronic illness, starting 17 years earlier when he was intermittently ill for 10 weeks. Four years earlier, after a serious cold, he experienced recurring diarrhea and pain in the left side of his abdomen. For approximately the last 9 months, the symptoms became more persistent, and he noticed the swelling 2 months before arriving at the hospital.
His diarrhea persisted and he was moderately exhausted, but his appetite was normal and he slept well. In mid-March, he began to have severe headaches and recurring nosebleeds, including a violent nosebleed on March 26 during which he lost more than a quart of blood. The bleeding did not return in April and he began to recover. He left the hospital on June 13, but returned on June 30, now with a fever that increased over time and grew worse in the evenings starting on July 12. The splenic tumor grew rapidly and the nosebleeds resumed. The urine became sedimented and the patient had trouble breathing. In mid-October, the patient developed headaches and dizziness, an increase in dyspnea, and a cough with bloody sputum. He grew unable to sleep; his chest complaints increased, with expectoration growing more difficult, he experienced profuse bilious diarrhea. His fever persisted and his strength declined. The patient died on November 2.
The body was emaciated. There was severe edema of the pia mater and venous hyperemia. The blood in the capillaries of the brain was normal. The thyroid was large and anemic, and the mucous membrane of the trachea was covered with purulent mucus on the posterior surface. The broncial glands were calcified. There were connective tissue masses on the pleura around the 7-8 rib. The blood in the heart, pulmonary arteries, and veins contained large amounts of brittle clots of coagulated pus. The spleen was enlarged, but the liver was normal.
Virchow R. Zur pathologischen Physiologie des Bluts. Virchows Archiv. 1849 Oct 1;2(3):587-98.