In an 1827 paper published in the Revue Médicale, Dr. Alfred Velpeau discussed three case studies of blood disorders. His first observation provides a detailed clinical history and autopsy report of patient Monsieur Vernis.
History and Treatment
Monsieur Vernis was a married 63-year-old man from Puy-de-Dôme who lived in Paris. He was first a florist, and then later a limonadier; subsequently, he often drank excessively. Although quite a ladies’ man, he never contracted syphilis. He was strong and well constituted, but overweight.
Until age 54, he was never ill, but at that time, he began to complain of a weakness in his lower back. At age 55, he began to have coughing fits. At age 56, fell down a staircase, which caused sharp pains and a fever. He received antiphlogistic treatment for 6 weeks. For four years, he had good health, except for the cough. Then, he had difficulty urinating, and passed kidney stones; baths and diuretics provided relief, and he quit his limonadier profession and retired with his wife.
One year later, he realized that the left side of his stomach was swollen and that there was a hard tumor on that part of his body although he had never had any pain. A doctor told him it was a scirrhus. This tumor continued to grow, without causing any pain, until December of 1825, when his health began to deteriorate, he lost weight, and he began to complain of vague abdominal pains and fever.
On February 16, 1826, he experienced a left-sided stroke. He was admitted to the hôpital de la Faculté on the 18th, where two enormous tumors were detected. His skin was flushed, and his pulse was weak and irregular. His head was heavy, but he retained his usual gaiety. In the evening, he became dejected and cried out during the night, without Vernis able to say where he experienced pain. He died at 3 AM on the 19th.
30 hours after death, Velpeau performed the autopsy.
Exterior: Scaly skin, body had a sour odor, flaccid belly, and very soft muscles.
Skull: Blood vessels were full of thick, black blood.
Thorax: Lungs adhere to the thoracic walls, but these adhesions are old and the tissue seems healthy. The viscera and pleura were red like the brain.
Abdomen: Colorful peritoneum. The spleen was covered in cartilaginous plates and had tissue almost as dense as the liver, weighed 10 pounds, and filled the entire hypochondrium on the left side. The liver had twice its normal volume but its tissue appeared normal. The digestive tract was livid, and either a single ulceration or incomplete scar was found on the mucous membrane of the jejunum. The stomach valves were prominent and thick.
Blood: All the blood examined in the heart, aorta, veins, and other vessels was thick like porridge, looked like red wine lees (color and consistency), and was neither fluid nor coagulated. The blood was the same in both the skull and abdomen. The arteries were ulcerated, although the veins, heart, and ascending aorta were normal.
Velpeau A. Sur la résorption du pus et sur l’altération du sang dans les maladies. Clinique de perfectionnement. Revue médicale française et étrangère. 1827;2:216-240.