A STUDY 
OF 
ANEURISM OF THE PULMONARY ARTERY. 
WITH THE REPORT OF A CASE. 
BY -' 
CHARLES B. WILLIAMS, A.B., M.D., 
CLINICAL ASSISTANT IN THE SURGICAL AND ORTHOPEDIC DEPARTMENTS OF THE 
PHILADELPHIA POLYCLINIC HOSPITAL. A STUDY 
OF 
ANEURISM OF THE PULMONARY ARTERY. 
WITH THE REPORT OF A CASE. 
BY 
CHARLES B. WILLIAMS, A.B., M.D., 
CLINICAL ASSISTANT IN THE SURGICAL AND ORTHOPEDIC DEPARTMENTS OF THE 
PHILADELPHIA POLYCLINIC HOSPITAL. 
REPRINTED FROM THE 
TRANSACTIONS OF THE PHILADELPHIA COUNTY MEDICAL SOCIETY", 
JANUARY, 1890. 
PHILADELPHIA: 
WM. J. DORNAN, PRINTER. 
1 890. A STUDY OF ANEURISM OF THE PULMONARY 
ARTERY, WITH THE REPORT OF A CASE. 
By CHARLES B. WILLIAMS, A.B., M.D., 
CLINICAL ASSISTANT IN THE SURGICAL AND ORTHOPEDIC DEPARTMENTS OF THE 
PHILADELPHIA POLYCLINIC HOSPITAL. 
[Bead January 8, 1890.] 
A careful study of recorded cases shows several varieties of dila- 
tation of the pulmonary artery. The first and by far the most com- 
mon variety is a general dilatation of the trunk and primary 
branches. Next in frequency comes sacciform dilatation. The artery 
in some cases of sacciform aneurism has been dilated to the size of a 
pomegranate, and the case recorded by Dr. Sydney Coupland,1 in 
1875, showed a dilatation of six and one-eighth inches in circumfer- 
ence. Fusiform dilatation is also found. I have found reports of 
but two cases of dissecting aneurism of the pulmonary artery. 
Finally, we have the arterio-venous aneurism, where there is a com- 
munication between the aneurismal sac and the ductus arteriosus. 
The only case of this variety known to me is that recorded by Drs. 
Balfour and Smith, in 1879.2 The diagnosis in this instance, how- 
ever, was inferential and based on negative signs, for the patient was 
living when the article was published. 
Aneurisms of the pulmonary artery, such as I have been consider- 
ing, are for the most part usually situated on the>trunk. But the 
dilatation has extended to the main branches and even to smaller 
ramifications of the artery. 
Through a process of atheromatous change multiple aneurisms of 
the pulmonary artery are often formed on the walls of old phthisical 
cavities ; and through erosion or sudden bursting of the walls of these 
aneurismal sacs a fatal haemoptysis has frequently occurred. Buhl 
and Zenker* have described such cases, and Jos. Cornet,4 in an elabo- 
1 Vide appended table of cases. 2 Vide table of cases. 
3 Virchow’s Archiv., 1802, p. 183. 
4 Cornet: Contribution a l’etude des anevrysmes de I’artfire pulm. Paris, 1885. 4 
WILLI A MS, 
rate thesis, has recorded thirty-four cases of peripheral aneurism of the 
pulmonary artery occurring in phthisical cavities. 
Dr. William Aitken,1 of Edinburgh, records a case of a soldier who 
had died suddenly of hemorrhage from the lungs. On opening one 
of the tubercle cavities it was found filled with coagulated blood, and 
projecting from a spot on the wall of this pulmonary cavity was a 
round tumor of the size of a walnut. The tumor had ruptured and 
the rupture held a coagulum of blood. The tumor was found to be 
an ectasis or aneurismal dilatation of the pulmonary artery. Several 
other tumors of a similar nature but of much smaller sizes existed in 
other cavities in the lungs, projecting from the pulmonary artery. 
The causes of aneurism of the pulmonary artery are chronic endar- 
teritis or atheroma, syphilis, great pressure in the pulmonary circula- 
tion as in marked mitral stenosis or insufficiency, collapse or emphv- 
sema of lung with great hypertrophy of the right ventricle, and 
patency of the ductus arteriosus. 
The symptoms of aneurism of the pulmonary artery are lividitv of 
face, dyspnoea, cough, dysphagia, headache, pain in the chest and 
epigastrium. The principal physical signs that have been recorded 
are a systolic pulsation and tremor (sometimes also diastolic) between 
the second and third' ribs of the left side near the sternum, percepti- 
ble in a decreasing degree downward but wholly wanting above the 
clavicle; a very loud, superficial, rough, systolic murmur propagated 
to the left and upward above the clavicles and over the whole prcecor- 
dial region, but loudest upon the prominence between the two ribs 
mentioned. The above physical signs and symptoms are by no 
means constant; and even should they all be present they might be 
caused by aneurism of the aorta or by a mediastinal tumor lying over 
the vessels. 
It is claimed that a means of establishing a differential diagnosis 
between aneurism of the aorta and pulmonary aneurism can be made 
by observing the cardiac hypertrophy and dilatation. If it should 
prove to be on the left side of the heart, aneurism of the aorta is in- 
dicated ; if on the right side, pulmonary aneurism. 
The differential diagnosis between subclavian aneurism and aneu- 
rism of the pulmonary artery may be made from the fact that a pul- 
sating tumor above the clavicle points to subclavian aneurism, while 
such a pulsation, on the other hand, is entirely absent in pulmonary 
aneurism. 
1 Science and Practice of Medicine, by Win. Aitken, M.D. Edinburgh, 1868. ANEURISM OF THE PULMONARY ARTERY. 
5 
The treatment of aneurism of the pulmonary artery is the same 
as in other thoracic aneurisms. And, probably, the method that will 
give most success is that instituted by Mr. Tuffnell; i. e., a careful 
regulation of diet, a definite quantity of solids being administered at 
stated intervals, the object being to support life with as little food and 
drink as possible. Potassium iodide and subcutaneous injections of 
ergotine have been also recommended. 
Lichtheim,1 after a series of thirty-three experiments, mostly made 
on dogs, seems to have shown that ligation of a pulmonary artery is 
without any effect upon arterial blood-pressure, hence, any operative 
treatment of this kind in aneurism of the pulmonary arter y would be 
useless. 
My attention was called to the subject of pulmonary aneurism by 
having the following case put under my professional care by Dr. John 
lk Roberts, a short time before the patient’s death. 
Aneurismal dilatation of the pulmonary artery and it$ primary branches, mis- 
taken for subclavian aneurism.—John B., set. forty, colored, a laborer, applied 
to the Philadelphia Polyclinic Hospital for treatment on July 19, 1887, with 
the following history: 
Family history negative. Personal history: at the age of twenty-two he 
had gonorrhoea and chancroid. In 1875 he had specific disease and chancre, 
but no secondary symptoms followed. In 1879 he took a severe cold fol- 
lowed by cough; and during this time he had a slight hemorrhage, the blood 
being light-colored. Two months later he had haemoptysis, the blood being 
dark-colored. In a short time the patient became very weak. At present 
he has dyspnoea, but no pain. His appetite is poor; bowels are regular. 
On July 21, 1887, Dr. Thomas J. Mays made an examination, and from his 
clinical records the following notes were obtained : 
Physical signs: Dulness on percussion below the left clavicle from the 
sternum to the shoulder-joint. A low systolic bruit is heard over this region, 
as well as a very perceptible thrill to the fingers. The systolic bruit is pro- 
pagated over the whole cardiac area and into the axilla. The maximum 
intensity is, however, at the junction of the first intercostal space with the 
sternum. There was no bulging whatever. No cardiac conditions were noted. 
The left radial and axillary pulse is weaker than on the right side. He 
has frequent pains shooting down his left arm. A diagnosis was made of 
left subclavian aneurism, possibly of syphilitic origin. 
The patient was treated with iodide of potassium, arsenic, nitroglycerin, 
atropine, strophanthus, etc., in accordance with his symptoms; hut no marked 
improvement occurred. He was then transferred to Dr. John B. Roberts’s 
care, who admitted him to his ward in St. Mary’s Hospital on August 20, 
1887. 
1 Licktheim, L.: Die Storungen des Lungenkreislaufs, etc. Breslau, 1876. 6 
WILLIAM S, 
Dr. Roberts now called a consultation of the surgical staff of St. Mary’s 
Hospital, and the diagnosis of subclavian aneurism was concurred in by Drs. 
Keen, Mears, and Grove. It was decided to ligate the subclavian and carotid 
arteries unless improvement followed confinement to bed and very restricted 
diet associated with large doses of potassium iodide. The patient was 
accordingly put to bed, allowed exceedingly small quantities of milk and 
beef tea, not permitted to leave his bed even to go to the water-closet, but 
was enjoined to lie perfectly quiet and given as large doses of potassium 
iodide as he could take without toxic symptoms. 
As soon as interference with digestion or irritation of the mucous mem- 
branes resulted from iodism, the dose was diminished. The exact quantity 
taken in twenty-four hours cannot now be definitely determined. It was, 
probably, in the neighborhood of two drachms per diem. Under this treat- 
ment he continued for about twelve weeks. His condition improved, the 
thrill in the subclavicular region became almost extinct, and in every respect 
the patient was vastly better. Confinement to bed, however, became so 
irksome to him that he finally insisted upon getting up and returning to his 
home on December 4, 1887. 
Dr. Roberts saw him once or twice at his own home during the winter of 
1887 and 1888, and finding him not as well as when he was in the hospital, 
but in a very fair condition, advised at that time the operation mentioned 
above. This was, however, declined by the patient. 
Nothing further was heard of the patient until the spring of 1889, when 
Dr. Roberts was asked to see him subsequent to a profuse haemoptysis. It 
was then stated by the patient that in the interim of treatment he had got 
along quite well and had been frequently out and about the streets and was 
well enough had he been a man of affairs to have attended to ordinary busi- 
ness engagements, though, of course, heavy physical labor would have been 
impossible. He was treated with fluid extract ergot, ammonium bromide, 
tonics, etc., for the haemoptysis, excessive cough, and grave debility. It was 
stated that at one time he lost about one pint of blood. This seemed to 
relieve the dyspnoea and he was, therefore, made more comfortable. There 
was also profuse muco-purulent expectoration. He was then admitted into 
Dr. Roberts’s ward at St. Agnes’s Hospital, June 22, 1889. 
In May, 1889, a note was made that there was marked bronchial breathing 
on the right side of the chest, subcrepitant rales on both sides, and a good 
deal of cough—though cough was not so excessive as it had been. 
The fact that the aneurism had not increased in size since Dr. Roberts had 
seen him previously, which was nearly a year and a half, and that there was 
no bulging forward or evidence of erosion of the sternum or ribs, made him 
suspicious as to the aneurismal character of the growth, and he, therefore, 
suggested the possibility of the disease being a vascular sarcoma located 
within the chest. Operation had been deferred at the time the patient was 
in St. Mary’s Hospital because of the improvement under medicinal treat- 
ment. And at the present time the fact that no increased development was 
apparent rendered operation questionable, especially as the man evidently 
was the subject of phthisis. 
Upon his admission to St. Agnes’s Hospital the patient was very weak, 
had great dyspnoea, was the subject of harassing cough with expectoration, ANEURISM OF THE PULMONARY ARTERY. 
7 
and was evidently in a precarious condition. June 22, 1889, a physical ex- 
amination was made by Dr. J. P. Crozer Griffith, an abstract of whose notes 
made by Dr. Thomas Vincent, the resident physician, is as follows: 
No abnormal pulsations were noticed in the neck. Dyspnoea generally 
marked on talking. Expansion of the right side was much greater than that 
of the left side. Supra-clavicular fossa was more clearly depressed on the 
right side than on the left side. No bulging anywhere in the intercostal 
spaces; they were about normal on both sides. No marked difference in vocal 
fremitus. 
Percussion of lungs: right side anterior, full and resonant. Left side 
supra-clavicular fossa, resonance over clavicle, and extending downward to 
about the first intercostal space decidedly impaired. 
The resonance of the manubrium was normal, the impairment commencing 
with the cardiac dulness. 
Axillary resonance normal. 
Right supra-spinous and back of supra-clavicular fossa: fine crackling 
rales heard on inspiration. Expiration prolonged and somewhat bronchial. 
Infra-clavicular fossa gave much the same inspiration, and the expiration 
was prolonged. Over the right side of chest a murmur was noted, and fine 
rales occurring with expiration. Left supra-clavicular fossa: numerous 
small mucous and some fine rales, with the bruit over the respiratory sound. 
Over the left chest: respiratory sounds feeble, with numerous mucous and 
submucous rales. Posteriorly, infra-spinous fossa: both sides somewhat im- 
paired. Infra-spinous fossa, negative. Elsewhere in the chest, negative. 
Right side, auscultation negative. Left side, auscultation supra-spinous 
fossa: numerous mucous rales heard. Inspiration feeble. Infra-spinous 
fossa, and elsewhere over the chest, numerous rales. Respiration bronchial 
in character. 
Heart: In first left interspace from the boundary of the sternum outward 
about two inches, was a very distinct thrill, but no expansile pulsation. 
Apex beat very feeble, and only felt in the fourth and fifth interspaces within 
the nipple line when the patient was leaning outward, or on full and held 
inspiration. 
Auscultation of heart: at apex of heart a low-pitched systolic murmur was 
heard. Second sound clear. Over the xiphoid cartilage a ringing second 
sound was noted, and a high-pitched systolic murmur. Over a portion of the 
chest there was a loud systolic bruit. There was no diastolic murmur. A 
systolic murmur could be heard faintly in the left carotid, and likewise a loud 
murmur above the left clavicle. The murmur was faintly heard in the left 
axilla. There was a faint murmur in the left supra-spinous fossa, but none 
elsewhere in the back. 
Right radial artery: normally full tension. Left radial artery: scarcely 
perceptible. 
The patient died August 14, 1389. 
An autopsy was made bv Dr. C. L. Bower, and it was found that the patient 
had tuberculosis of both lungs and an aneurism of the pulmonary artery 
and its primary branches. The pleura was noted to be full of adhesions. 
The remaining organs were normal in their condition. 
An examination of the aneurism showed that the pulmonary artery for 8 
WILLI A MS, 
about four inches from the heart was dilated symmetrically—the dilatation 
extending also to the primary branches. There was no sacculation, the form 
being more like that of a fusiform aneurism. The cavity at the greatest 
diameter of its dilatation was about two inches, and corresponded with the 
position of the ductus arteriosus. The ductus arteriosus seemed wider than 
normal, and on the pulmonary side appeared to be patulous. On the aortic 
aspect, however, it was normally closed. The inner coat of the pulmonary 
artery showed no disease, and was not the seat of fibrinous clots, but con- 
tained chicken-fat clots. The aorta showed several atheromatous patches. 
Dr. W. H. Porter, Curator of the Presbyterian Hospital, New York 
City, has compiled a record of cases of pulmonary aneurism. I have 
added a few more cases not contained in Dr. Porter’s list, and think 
that this list now contains nearly all recorded cases up to date. 
Recorded Cases of Pulmonary Aneurism. 
Previous to 1561: Ambroise Pare.—Body of artery dilated to the size of a 
fist, and its lining membrane quite ossified. Patient died suddenly from 
rupture of vessel while playing at ball. Observations on Aneurism. By John 
E. Erichsen. London, 1844. 
1749: Lanciscus.—The patient, a hatter, “in consequence of too great ex- 
ertions, especially of an afternoon, in beating the felt of which hats are made, 
and inhaling at the same time coal-smoke mixed with a watery vapor, became 
affected with dilatation of the pulmonary artery.” De motu cordis et 
Aneurismatibus. Lugduni Bat. 1749. 
1810: Starts.—The aneurism arose during life at the right side of the thorax 
to the size of two fists: callus of sternum, and of fourth and fifth ribs, were 
separated from termini of osseous part of ribs, and the aneurism was thus 
placed outside of the thoracic cavity. Abh. d. Phys. Med. Soc. Zu Erlangen, 
1810, I. 472. 
1825: Mr. Adam.—Vessel considerably dilated, to nearly four times its 
natural size, probably aneurismal. Sudden death from spontaneous rupture 
of the pulmonary artery. Aorta and other large vessels issuing from its arch 
completely ossified. Trans. Calcutta Med. Soc., vol. ii., 1826. 
1841: Mr. Foster.—Male, set. forty-one. Aneurism of the branches of the 
pulmonary artery. Cause of death, hemoptysis. Lancet, 1841. 
1843: Dr. Peacock.—Male, set. twenty-nine. Aneurism of the branches of 
the pulmonary artery. Cause of death, hsemoptysis. London and Edinburgh 
Monthly Journal Med. Sci., vol. iii., 1843. 
1844: Skoda.—Trunk of pulmonary artery dilated to the size of a goose’s 
egg. The tunics of the aneurismally enlarged pulmonary artery exhibited 
the same changes seen in aneurisms of the aorta. Abhandlung fiber Perk, 
und Auskult. Wien, 1844, p. 311. 
1848: Dr. Dlauhy.—Sacciform aneurism of the size of a large walnut. The 
pulmonary artery was in a state of well-marked atheromatous degeneration. 
Viertelj. ffir Prakt. Heilk., 1848. 
1849: Dr. Hope.—Pulmonary artery dilated to four and a half inches in 
circumference. Diseases of the Heart, by Hope, 1849, and case 84 Table 
of Arteries. ANEURISM OF THE PULMONARY ARTERY. 
9 
1859: Dr. Bristowe.—Thickening and dilatation of the pulmonary artery 
and its ramifications. Pulmonary artery up to its bifurcation uniformly 
dilated. Circumference before bifurcation, four and seven-eighths inches. 
Trans. Path. Soc. London, 1859-60, vol. xi. p. 80. 
1866 : Dr. Conway Evans.—General dilatation of the pulmonary artery and 
hypertrophic thickening of its walls, with atheroma of the internal coat, and 
a contracted mitral orifice. Trans. Path. Soc. London, 1866. 
1866: Prof. Gilewski..—Sacciform dilatation of pulmonary artery, circum- 
ference of vessel being equal to that of a pomegranate. The sac involved 
the trunk of the artery, and its two short branches arose immediately from 
the sac. Wiener med. Woch., Nos. 33-38, 1868. 
1874: Dr. Doivse.—Woman, aet. nineteen. At the root of the pulmonary 
artery was a globular tumor of the size of a pullet’s egg. Vegetations on the 
pulmonary valves; right ventricle dilated and tricuspid valve incomplete.— 
Lancet, 1874, vol. ii. 
1875 : Dr. Sydney Coupland.—Man, set. seventy-five. Dilatation of pulmo- 
nary artery and its branches. Main trunk dilated to a circumference of six 
and one-eighth inches. Valves incompetent and arterial walls greatly 
thinned. Great hypertrophy and dilatation of right heart. Marked emphy- 
sema of lungs and some degree of patency of foramen ovale. Path. Trans., 
vol. xxvi., 1875. 
1879: Drs. George W. Balfour and A. Wood Smith.—Probable case of aneu- 
rism of the pulmonary artery and the ductus arteriosus Diagnosis inferen- 
tial and based on negative signs. Glasgow Medical Journal, 1879, xii. pp. 
103-108. 
1881: Dr. J. F. Duffield.—Female, set. fifty. Pulmonary artery and its 
right and left branches widely dilated throughout. Pulmonary valve and 
artery showed marked evidence of advanced atheromatous degeneration. 
The right pulmonary artery was the site of a large aneurism which com- 
menced at the junction of the superior and anterior portion as a dissecting 
aneurism. Diameter of tumor was two inches. The left pulmonary artery 
had an aneurism of the same size and situated at the same point. The arteries 
springing from the left aneurism were also dilated even to the very surface 
of the lung. Amer. Journ. Med. Sci., N. S., vol. lxxxiii. pp. 77-82. 
1881: M. Revilliod.—Female, set. thirty-six. A communication between 
the two ventricles. Stenosis of the pulmonary artery and a dissecting aneu- 
rism of the same artery. The pulmonary artery was a little retracted from its 
origin. It measured sixty millimetres in circumference and showed a trans- 
verse rupture which dissected the internal and middle coats. The artery 
was covered with a great number of atheromatous patches. Bull, de la Soc. 
Anat. de Paris, 1881, pp. 589-591. » 
1882 : A. Wolfram.—Diagnosis: insufficiency of mitral valve* subsequent 
hypertrophy and dilatation; pulmonary emphysema. Aneurism of pulmo- 
nary artery, probably congenital; branches gradually dilated. Bronchitis, 
parenchymatous nephritis; general anasarca. Gaz. lek. Warszawa, 1883, 2 
s. iii. 447-466, 
1884 :W. J. Grigoriev.—Insufficiency of valves of pulmonary artery near 
the division of the right and left branches of the artery. Sacciform aneu- 10 
WILLIAMS, 
rism of the pulmonary artery, thrombus of the left popliteal artery near the 
termini of the posterior tibial artery. Med. Obozr. Mosk., 1886, xxv, 3-7. 
No date.—Specimen No. 90 in Museum of St. Bartholomew’s Hospital, 
London. Aneurism of the left branch of the pulmonary artery with a deposit 
of fibrin. The case was that of a female set. fifty-three. 
1889: Dr. C. B. Williams.—Male, set. forty. Aneurism of the pulmonary 
artery and its primary branches. Pulmonary artery for about four inches 
from the heart was dilated symmetrically, the dilatation extending also to 
the primary branches. A fusiform aneurism, the greatest diameter of which 
was about two inches and corresponded with the position of the ductus 
arteriosus. 
The following are recorded cases of aneurism of the pulmonary 
artery, all, or nearly all, of which are cases of peripheral aneurism 
occurring in phthisical cavities : 
Bennett: Dublin Quart. Journ. Med. Sci., 1872. 
Birkett: Med. Times and Graz., London, 1869. 
Bramwell: Edinb. Med. Journ., 1877. 
Buchwald: Deut. med. Wochenschr., 1878. 
Carrien : Gaz. hebd. Montpel., 1879. 
Church: Trans. Path. Soc., London, 1869. 
Cotton: Med. Times and Gaz., London, 1866. 
Cotton (A. P.): Brit. Med. Journ., London, 1868. 
Dlauhy: Viertlj. f. pr. Ileilk., Prag, 1848. 
Fagge: Trans. Path. Soc. London, 1877. 
Fearn: Lancet, London, 1840. 
Finlaxjson: Brit. Med. Journ., London, 1877. 
Franks: Dublin Journ. Med. Sci., 1876. 
Green: Trans. Path. Soc. London, 1871. 
Headland: Lancet, London, 1870. 
Heath : Trans. Path. Soc. London, 1867. 
Homolle: Progres Med., Paris, 1876. 
Laure : Lyon Med., 1873. 
Lebert: Berlin, klin. Wochenschr., 1876. 
Lepine : Bull. Soc. Anat., Paris, 1874. 
Lionville: Ibid., 1875. 
Moxon: Trans. Path. Soc., London, 1867. 
Regnaud: Bull. Soc. Anat., Paris, 1874. 
Refleximate : Rec. d. med., etc., 1822. 
Rindu: Bull. Soc. Anat., Paris, 1874 
Salazar: Siglo Med., Madrid, 1874. 
Sevestre: Bull. Soc. Anat., Paris, 1873, etc. 
Silver: Trans. Path. Soc., London, 1873. 
Smith: Glasgow Med. Journ., 1879. 
Verardini: Rend. Accad., Bologna, 1870. 
Williams: Trans. Path. Soc., London, 1866. 
Aneurisms of Pulmonary Artery. ANEURISM OF THE PULMONARY ARTERY 
List of Cases recorded since 1880 
Damaschino: Union Med., Paris, 1883. 
Mioton: New Orleans Med. and Surg. Journ., 1880, 1, N. S. viii. 
Poupon: France Med., Paris, 1884, I. 687. 
West: Lancet, London, 1884, I. 70. 
Ducartel: Bull, et mem. Soc. med. et Hop. de Paris, 1884, 4, s. I. 154. 
Cornet: Contribution a l’etude des anevrysmes de l’artere pulm., No. 315, 
Paris, 1885. 
Haushaltos: Un cas d’anevrysmes, etc. Rev. de med, Paris, 1889, ix. 368. 
Osier ( W.): Aneurismal dilatation of branches of pulmonary artery on the 
walls of phthisical cavities. Montreal General Hosp., 1877, I. 30. 
West (S.): Two cases of pulmonary aneurism of large size, with profuse 
and recurrent haemoptysis, etc. Trans. Path. Soc. London, 1883, 4, xxxv. 93. 
Kidd[P.): Unusual cases of pulmonary aneurism. Trans. Path. Soc. 
London, 1883, 4, xxxv. 98. 
West (S.): Case of aneurism of branch of pulmonary artery. Trans. Path. 
Soc. London, 1878, xxix. 41. 
Duffield (J. F.): Aneurism of right and left pulmonary arteries. Amer. 
Journ. Med. Sci., Phila., 1882, N. S. lxxxiii. 77. 
West (#.) / Case of—. Trans. Path. Soc. London, 1881, xxxii. 67. 
Williams (J.): Sudden death from haemoptysis in consequence of rupture 
of an aneurism of a branch of the pulmonary artery. Australian Med. Journ., 
Melbourne, 1881, N. S. iii. 349.