Chapter IV: Part 4

Sec. 51. In this, and in all other inflammatory Diseases, the Blood is in a very thick viscid State: and almost immediately on its being drawn, a white tough Skin, somewhat like Leather, is formed on its Top, which most People have seen, and which is called the _pleuritic Crust_. It is thought a promising Appearance, when at each Bleeding it seems less hard, and less thick, than it was at the preceding ones: and this is very generally true, if the Sick feels himself, at the same Time, sensibly better: but whoever shall attend _solely_ to the Appearance of the Blood, will find himself often deceived. It will happen, even in the most violent Inflammation of the Breast, that this Crust is not formed, which is supposed to be a very unpromising Sign. There are also, in this Respect, many odd Appearances, which arise from the smallest Circumstances; so that we must not regulate the Repetitions of our bleeding, solely by this Crust: and in general we must not be over credulous in supposing, that the Appearances in the Blood, received into the Bason, can enable us to determine, with Certainty, of its real State in the Body.

[20] We should however, with the greater Circumspection (of how much the
longer standing the Disease has been, and by how much the more
difficult the viscous Humours are to be melted down and dislodged)
attend to the Coction of the Matter of Expectoration; which Nature
does not often easily effect, and which she effects the more
imperfectly and slowly, the weaker he is. Her last Efforts have
often been attended with such high Paroxysms, as have imposed even
upon very competent Physicians, and have made them open a Vein a
few Hours before the Patients' Death, from their Pulses being
strong, hard and frequent. Excessive Weakness is the Sign, by which
we may discover such unavailing Efforts to be the last. _E. L._

Sec. 52. When the sick Person is in the Condition described (Sec. 47) the Bleeding is not only unattended with Ease; but sometimes it is also pernicious, by the sudden Weakness to which it reduces him. Generally in such a Case all Medicines and Means are insignificant: and it is a very bad Sign in this Disease, when this Discharge is not attended with Ease and Benefit to the Sick; or when there are some Circumstances, which oblige us to be sparing of it.

Sec. 53. The Patient's Legs should every Day, for one half Hour, be put into a Bath of warm Water, wrapping him up closely; that the Cold may not check that Perspiration, which the Bath promotes.

Sec. 54. Every two Hours he should take two Spoonfuls of the Mixture No. 8, which promotes all the Discharges, and chiefly that of Expectoration.

Sec. 55. When the Oppression and Straitness are considerable, and the Cough dry, the Patient may receive the Vapour of boiling Water, to which a little Vinegar has been added. There are two ways of effecting this; either by placing below his Face, after setting him up, a Vessel filled with such boiling hot Water, and covering the Patient's Head and the Vessel with a Linen Cloth, that may inclose the Steam; or else by holding before his Mouth a Spunge dipped in the same boiling Liquor. This last Method is the least effectual, but it fatigues the Patient considerably less. When this bad Symptom is extremely pressing, Vinegar alone should be used without Water; and the Vapour of it has often saved Patients, who seemed to have one Foot in the Grave: but it should be continued for several Hours.

Sec. 56. The outward Remedies directed in No. 9. are also applied with Success to the Breast, and to the Throat.

Sec. 57. When the Fever is extremely high, the Sick should take every Hour, a Spoonful of the Mixture No. 10. in a Cup of the Ptisan [21] but without diminishing on this Account the usual Quantity of his other Drinks, which may be taken immediately after it.

[21] The Use of Acids, in Inflammations of the Breast, requires no
little Consideration. Whenever the sick Person has an Aversion to
them; when the Tongue is moist, the Stomach is heavy and
disordered, and the Habit and Temperament of the Patient is mild
and soft; when the Cough is very sharp without great Thirst, we
ought to abstain from them. But when the Inflammation is joined to
a dry Tongue, to great Thirst, Heat and Fever, they are of great
Service. Slices of China Oranges sprinkled with Sugar may be given
first; a light Limonade may be allowed afterwards; and at last
small Doses of the Mixture, No. 10. if it becomes necessary. _E.
L._--I have chosen to retain this Note of the Editor of _Lyons_,
from having frequently seen the Inefficacy, and sometimes, I have
even thought, the ill Effects of Acids in Peripneumonies and
Pleurisies, in a Country far South of _Swisserland_; and where
these Diseases are very frequent, acute and fatal. On the other
hand I shall add the Substance of what Dr. _Tissot_ says on this
Head in a Note to his Table of Remedies, wherein he affirms, that
he has given in this Disease very large Doses of them, rising
gradually from small ones, and always with great Success;
intreating other Physicians to order this Acid (the Spirit of
Sulphur) in the same large Doses which he directs in this Chapter,
and assuring himself of their thanks, for its good
Consequences--Now the only ill Effect I can surmize here, from
shewing this Diversity of Opinion in these two learned Physicians,
and my own Doubts, is, that the Subjects of this Disease in Country
Places may prove somewhat confused and irresolute by it, in their
Conduct in such Cases. But as all of us certainly concur in the
great Intention of doing all possible Good, by the extensive
Publication of this Treatise, I shall take leave to observe that in
this Disease, and in Pleurisies, more solid Benefit has been
received in _Carolina_, _Virginia_, &c. from the Use of the
_Seneka_ Rattle-snake Root, than from any other Medicine whatever.
Bleeding indeed is necessarily premised to it; but it has often
saved the Necessity of many repeated Bleedings. This Medicine,
which is termed in Latin, the _Polygala Virginiana_, is certainly
rather of a saponaceous attenuating Quality, and betrays not any
Marks of Acidity, being rather moderately acrid. There will be
Occasion to mention it more particularly in the subsequent Chapter,
as such a Liberty can need no Apology to any philosophical
Physician. _K._

Sec. 58. As long as the Patient shall grow worse, or only continue equally bad, the same Medicines are to be repeated. But if on the third Day (tho' it rarely happens so soon) or fourth, or fifth, the Disease takes a more favourable Turn; if the Exasperation returns with less Violence; the Cough be less severe; the Matter coughed up less bloody: if Respiration becomes easier; the Head be less affected; the Tongue not quite so dry; if the high Colour of the Urine abates, and its Quantity be increased, it may be sufficient then to keep the Patient carefully to his Regimen, and to give him a Glyster every Evening. The Exasperation that occurs the fourth Day is often the highest.

Sec. 59. This Distemper is most commonly terminated and carried off by Expectoration, and often by Urine, which on the seventh, the ninth, or the eleventh Day, and sometimes on the Days between them, begins to let fall a plentiful Sediment, or Settling, of a pale red Colour, and sometimes real _Pus_ or ripe Matter. These Discharges are succeeded by Sweats, which are as serviceable then, as they were injurious at the Beginning of the Disease.

Sec. 60. Some Hours before these Evacuations appear, there come on, and not seldom, some very alarming Symptoms, such as great Anguish; Palpitations, some Irregularity in the Pulse; an increased Oppression; convulsive Motions (this being what is called the _Crisis_, the Height, or Turn of the Distemper) but they are no ways dangerous, provided they do not occasion any improper Treatment. These Symptoms depend on the morbid and purulent Matter, which, being dislodged, circulates with the Humours, and irritates different Parts, until the Discharge of it has fairly begun; after which all such Symptoms disappear, and Sleep generally ensues. However I cannot too strongly insist on the Necessity of great Prudence in such Circumstances. Sometimes it is the Weakness of the Patient, and at other times Convulsions, or some other Symptoms, that terrify the By-standers. If, which is most generally the Case, the absurd Practice of directing particular Remedies for such Accidents takes place, such as spirituous Cordials, Venice Treacle, Confections, Castor and Rue; the Consequence is, that Nature being disturbed in her Operations, the _Crisis_ or Turn is not effected; the Matter which should be discharged by Stool, by Urine, or by Sweat, is not discharged out of the Body; but is thrown upon some internal or external part of it. Should it be on some inward part, the Patient either dies at once; or another Distemper succeeds, more troublesome and incurable than the first. Should it be expelled to some outward part, the Danger indeed is less; and as soon as ever such a Tumour appears, ripening Pultices should be apply'd to bring it to a Head, after which it should immediately be opened.

Sec. 61. In order to prevent such unhappy Consequences, great Care must be taken, whenever such terrifying Symptoms come on, [about the Time of the _Crisis_] to make no Change in the Diet, nor in the Treatment of the Patient; except in giving him the loosening Glyster No. 5; and applying every two Hours a Flannel, squeezed out of warm Water, which may cover all the Belly, and in a Manner go round the Body behind the Reins. The Quantity of his Drink may also be increased a little; and that of his Nourishment lessened, as long as this high and violent State continues.

Sec. 62. I have not spoken of Vomits or Purges, as being directly contrary to the Nature of this Disease. Anodynes, or Opiates, to procure Sleep are also, in general, very improper. In a few Cases, however, they may possibly be useful; but these Cases are so very difficult to be sufficiently distinguished, that Opiates should never be admitted in this Disease, without the Presence and Advice of a Physician. I have seen many Patients, who have been thrown into an incurable Hectic, by taking them improperly. When the Disease is not received in a mortal Degree, nor has been injudiciously treated, and proceeds in a benign regular Manner, the Patient may be called very well and safe by the fourteenth Day; when he may, if he has an Appetite, be put upon the Diet of People who are recovering. But if he still retains an Aversion to Food; if his Mouth is foul and furred, and he is sensible of some Heaviness in his Head, he should take the purging Potion No. 11.

Sec. 63. Bleedings from the Nose occur sometimes naturally in this Disease, even after repeated Bleedings by Art; these are very benign and favourable, and are commonly attended with more Ease and Relief than artificial Bleedings. Such voluntary Discharges may sometimes be expected, when the Patient is sensibly mended in many Respects after the Use of the Lancet; and yet complains of a great Pain in his Head, accompanied with quick sparkling Eyes, and a Redness of the Nose. Nothing should be done to stop these voluntary Bleedings, since it would be very dangerous: For when Nature has fulfilled her Intention by them, they cease of themselves. At other times, but more rarely, the Distemper is carried off by a natural Purging, attended with moderate Pain, and the Discharge of bilious Matter.

Sec. 64. If the Expectoration, or hawking up of Matter, stops very suddenly, and is not speedily attended with some other Evacuation; the Oppression and Anguish of the Patient immediately return, and the Danger is great and pressing. If the Distemper, at this Juncture, is not of many Days standing; if the Patient is a strong Person; if he has not as yet been plentifully bled; if there be still some Blood mixed with the Humour he expectorates; or if the Pulse be strong and hard, he should be bled immediately in the Arm; and constantly receive the Steam of hot Water and Vinegar by the Mouth, and drink plentifully of the Ptisan No. 2, something hotter than ordinary. But if his Circumstances, after this Suppression, are different from these just mentioned; instead of bleeding him, two Blisters should be applied to the Legs; and he should drink plentifully of the Ptisan No. 12.

The Causes which oftenest produce this Suppression of his Expectoration are, 1, a sharp and sudden cold Air. 2, too hot a one. 3, over hot Medicines. 4, excessive Sweating. 5, a Purge prematurely and injudiciously timed. and 6, some immoderate Passion of the Mind.

Sec. 65. When the Sick has not been sufficiently bled, or not soon enough; and even sometimes, which I have seen, when he has been greatly weakened by excessive Bleeding; so that the Discharges by Stool, Urine, Expectoration and Perspiration, have not been sufficiently made; when these Discharges have been confused by some other Cause; or the Disease has been injudiciously treated; then the Vessels that have been inflamed, do not unload themselves of the Humours, which stuff up and oppress them: but there happens in the Substance of the affected Lung, the same Circumstance we see daily occur on the Surface of the Body. If an inflammatory Tumour or Swelling does not disperse itself, and disappears insensibly, it forms an Imposthume or Abscess. Thus exactly also in the inflamed Lung, if the Inflammation is not dissipated, it forms an Abscess, which, in that part, is called a _Vomica:_ and the Matter of that Abscess, like the external ones, remains often long inclosed in its Sac or Bag, without bursting open its Membrane or Case, and discharging the Matter it contains.

Sec. 66. If the Inflammation was not very deeply seated in the inward Substance of the diseased Lung; but was extended to its Surface, that is, very near the Ribs, the Sac will burst on the Surface of the Lung; and the Matter contained in it must be discharged into the Cavity, or Hollowness of the Breast, between the Lung, the Ribs, and the Diaphragm or Midriff, which is the Membrane that divides the Breast and the Belly. But when the Inflammation is considerably deeper, the Imposthume bursts withinside of the Lung itself. If its Orifice, or Opening is so small, that but little can get out at once; if the Quantity of all the Matter be inconsiderable, and the Patient is at the same Time pretty strong, he coughs up the Matter, and is very sensibly relieved. But if this _Vomica_ be large, or if its Orifice is wide, and it throws out a great Quantity of Matter at once; or if the Patient is very weak, he dies the Moment it bursts, and that sometimes when it is least expected. I have seen one Patient so circumstanced expire, as he was conveying a Spoonful of Soup to his Mouth; and another, while he was wiping his Nose. There was no present Symptom in either of these Cases, whence a Physician might suppose them likelier to die at that Instant, than for some Hours before. The _Pus_, or Matter, is commonly discharged through the Mouth after Death, and the Bodies very soon become putrified.

Sec. 67. We call that _Vomica_ which is not burst, an _occult_ or hidden, and that which is, an evident or open one. It is of considerable Importance to treat exactly and clearly of this Topic; as a great Number of Country People die of these Imposthumes, even without a Suspicion of the Cause of their Death. I had an Instance of it some Days since, in the School-master of a Village. He had an occult and very considerable _Vomica_ in the left Lung, which was the Consequence of an Inflammation of the Breast, that had been treated improperly at the Beginning. He seemed to me not likely to live twenty four Hours; and really died in the Night, after inexpressible Anguish.

Sec. 68. Whatever Distemper is included within the Breast of a living Patient, is neither an Object of the Sight or Touch whence these _Vomicas_, these inward Tumours, are so often unknown, and indeed unsuspected. The Evacuations that were necessary for the Cure, or sometimes for the Prevention, of them, have not taken place, during the first fourteen Days. At the End of this Term, the Patient, far from being cured, is not very considerably relieved; but, on the contrary, the Fever continues to be pretty high, with a Pulse continually quick; in general soft and weak; though sometimes pretty hard, and often fluctuating, or, as it were, waving. His Breathing is still difficult and oppressed; with small cold Shudderings from Time to Time; an Exasperation of the Fever; flushed Cheeks, dry Lips, and Thirst.

The Increase of these Symptoms declare, that _Pus_ or Matter is thoroughly formed: the Cough then becomes more continual; being exasperated with the least Motion; or as soon as ever the Patient has taken any Nourishment. He can repose only on the Side affected. It often happens indeed, that he cannot lie down at all; but is obliged to be set up all Day; sometimes even without daring to lean a little upon his Loins, for fear of increasing the Cough and Oppression. He is unable to sleep; has a continual Fever, and his Pulse frequently intermits.

The Fever is not only heightened every Evening; but the smallest Quantity of Food, the gentlest Motion, a little Coughing, the lightest Agitation of the Mind, a little more than usual Heat in the Chamber, Soup either a little too strong, or a little too salt, increase the Quickness of his Pulse the Moment they occur, or are given. He is quite restless, has some short Attacks of the most terrible Anguish, accompanied and succeeded by Sweatings on his Breast, and from his whole Countenance. He sweats sometimes the whole Night; his Urine is reddish, now frothy, and at other times oily, as it were. Sudden Flushings, hot as Flames, rise into his whole Visage. The greater Number of the Sick are commonly sensible of a most disagreeable Taste in their Mouth; some of old strong Cheese; others of rotten Eggs; and others again of stinking Meat, and fall greatly away. The Thirst of some is unquenchable; their Mouths and Lips are parched; their Voice weak and hoarse; their Eyes hollow, with a kind of Wildness in their Looks. They have a general Disgust to all Food; and if they should ask for some particular Nourishment without seeing it, they reject it the Moment it is brought them; and their Strength at length seems wholly exhausted.

Besides these Symptoms, a little Inflation, or _Bloatedness_, as it were, is sometimes observed on the Breast, towards the Side affected; with an almost insensible Change of Colour. If the _Vomica_ be situated at the Bottom of the affected Lobe of the Lungs, and in its internal Part, that is, nearly in the Middle of the Breast, some _Puffiness_ or light Swelling may be perceived in some Bodies, by gently pressing the Pit of the Stomach; especially when the Patient coughs. In short, according to the Observations of a German Physician, if one strike the open Hand on the Breast, covered only with a Shirt, it retains in the Spot, which is directly opposite to the _Vomica_, a flat heavy Sound, as if one struck a Piece of Flesh; while in striking on the other Side it gives a clear loud Sound, as from a Drum. I still doubt however, whether this Observation will generally hold true; and it would be hazardous to affirm there is no Abscess in a Breast, which does not return this heavy Sound.

Sec. 69. When a _Vomica_ is formed, as long as it is not emptied, all the Symptoms I have already enumerated increase, and the _Vomica_ grows in Size: the whole Side of the Lung affected sometimes becomes a Bag or Sac of Matter. The sound Side is compressed; and the Patient dies after dreadful Anguish, with the Lung full of _Pus_, and without having ever brought up any.

To avoid such fatal Consequences, it is necessary to procure the Rupture and Discharge of this inward Abscess, as soon as we are certain of its Existence: And as it is safer it should break within the Lobe affected, from whence it may be discharged by hawking up; than that it should burst and void itself into the Cavity of the Breast, for Reasons I shall give hereafter, we must endeavour, that this Rupture may be effected within the internal Substance of the Lungs.

Sec. 70. The most effectual Methods to procure this are, 1. To make the Patient continually receive, by his Mouth, the Vapour of warm Water. 2. When by this Means that part of the Sac or Abscess is softened, where we could wish the Rupture of it to happen, the Patient is to swallow a large Quantity of the most emollient Liquid; such as Barley Water, Almond Milk, light Veal Broth, or Milk and Water. By this Means the Stomach is kept always full: so that the Resistance to the Lungs being considerable on that Side, the Abscess and its Contents will naturally be pressed towards the Side of the Wind-pipe, as it will meet with less Resistance there. This fulness of the Stomach will also incline the Patient to cough, which may concur to produce a good Event. Hence, 3, we should endeavour to make the Patient cough, by making him smell to some Vinegar, or even snuff up a little; or by injecting into his Throat, by the Means of a small Syringe or Pipe, such as Children make out of short Pieces of Elder-Boughs, a little Water or Vinegar. 4. He should be advised to bawl out aloud, to read loud, or to laugh heartily; all which Means contribute to burst open the Abscess, as well as those two following ones. 5. Let him take every two Hours a Soup-Ladle of the Potion No. 8. 6. He should be put into a Cart, or some other Carriage; but not before he has drank plentifully of such Liquors as I have just mentioned: after which the Shaking and Jolting in the Carriage have sometimes immediately procured that Rupture, or breaking of the Bag or Abscess, we wished for.

Sec. 71. Some Years since I saw a Country Maid Servant, who was left in a languishing Condition after an Inflammation of the Breast; without any Person's suspecting her Ailment. This Woman being put into a Cart, that was sent for a Load of Hay; one of the Wheels run violently against a Tree: she swooned away, and at the same Time brought up a great Quantity of digested Matter. She continued to bring up more; during which I was informed of her Case, and of the Accident, which effectually cured her.

A _Swiss_ Officer, who served in _Piedmont_, had been in a languid State of Health for some Months; and returned home to set himself down as easily as he could, without conceiving any considerable Hopes of Recovery. Upon entering into his own Country, by the Way of _Mount Bernard_; and being obliged to go some Paces on Foot, he fell down; and remained in a Swoon above a Quarter of an Hour: during which Time he threw up a large Quantity of Matter, and found himself that very Moment very greatly relieved. I ordered him a proper Diet, and suitable Medicines: his Health became perfectly established; and the Preservation of his Life was principally owing to this lucky Fall.

Many Persons afflicted with a _Vomica_, faint away the very Instant it breaks. Some sharp Vinegar should be directly held to their Nose. This small Assistance is generally sufficient, where the bursting of it is not attended with such Appearances as shew it to be mortal, in which Case every Application is insignificant.

Sec. 72. If the sick Person was not extremely weak before the Bursting of the Abscess; if the Matter was white, and well conditioned; if the Fever abates after it; if the Anguish, Oppression and Sweats terminate; if the Cough is less violent; if the Patient is sensibly easier in his Situation or Posture; if he recovers his Sleep and Appetite; if his usual Strength returns; if the Quantity he expectorates, or brings up, becomes daily and gradually less; and if his Urine is apparently better, we may have Room to hope, that by the Assistance of these Remedies I shall immediately direct, he may be radically, compleatly cured.

Sec. 73. But if on the contrary; when his Strength is exhausted before the bursting of the Abscess; when the Matter is too thin and transparent, brown, green, yellow, bloody and of an Offensive Smell; if the Pulse continues quick and weak; if the Patient's Appetite, Strength and Sleep do not improve, there remains no hope of a Cure, and the best Medicines are ineffectual: Nevertheless we ought to make some Tryal of them.

Sec. 74. They consist of the following Medicines and Regulations. 1. Give every four Hours a little Barley or Rice Cream. 2. If the Matter brought up is thick and glewy, so that it is very difficult to be loosened and discharged, give every two Hours a Soup-ladle of the Potion No. 8; and between the giving these two, let the Patient take every half Hour a Cup of the Drink No. 13. 3. When the Consistence of the Matter is such, that there is no Occasion for these Medicines to promote the Discharge of it, they must be omitted; tho' the same Sort and Quantity of Food are to be continued; but with the Addition of an equal Quantity of Milk; or, which would be still more beneficial, instead of this Mixture, we should give an equal Quantity of sweet Milk, taken from a good Cow, which, in such a Case, may compose the whole Nourishment of the Patient. 4. He should take four Times a Day, beginning early in the Morning, and at the Distance of two Hours, a Dose of the Powder No. 14, diluted in a little Water, or made into a _Bolus_, or Morsel, with a little Syrup or Honey. His common Drink should be Almond Emulsion, commonly called Almond Milk, or Barley Water, or fresh Water with a fourth part Milk. 5. He should air and exercise every Day on Horseback, or in a Carriage, according as his Strength and his Circumstances will allow him. But of all Sorts of Exercise, that upon a trotting Horse is, beyond all Comparison, the very best, and the easiest to be procured by every Body; provided the Disease be not too far advanced; since in such a Situation, any Exercise, that was only a little violent, might prove pernicious.

Sec. 75. The Multitude, who are generally illiterate, seldom consider any thing as a Remedy, except they swallow it. They have but little Confidence in _Regimen_, or any Assistance in the Way of Diet, and consider Riding on Horseback as wholly useless to them. This is a dangerous Mistake, of which I should be glad to undeceive them: since this Assistance, which appears so insignificant to them, is probably the most effectual of any: it is that in Fact, without which they can scarcely expect a Cure, in the highest Degrees of this Disease: it is that, which perhaps alone may recover them, provided they take no improper Food. In brief it is considered, and with Reason, as the real Specific for this Disease.

Sec. 76. The Influence of the Air is of more Importance in this Disorder, than in any others; for which Reason great Care should be taken to procure the best, in the Patient's Chamber. For this Purpose it should often be ventilated, or have an Admission of fresh Air, and be sweetened from Time to Time, tho' very lightly, with a little good Vinegar; and in the Season it should be plentifully supplied with agreeable Herbs, Flowers and Fruits. Should the Sick be unfortunately situated, and confined in an unwholsome Air, there can be but little Prospect of curing him, without altering it.

Sec. 77. Out of many Persons affected with these Disorders, some have been cured by taking nothing whatsoever but Butter-milk; others by Melons and Cucumbers only; and others again by Summer Fruits of every Sort. Nevertheless, as such Cases are singular, and have been but few, I advise the Patient to observe the Method I have directed here, as the surest.

Sec. 78. It is sufficient if he have a Stool once in two, or even in three, Days. Hence, there is no Reason for him, in this Case, to accustom himself to Glysters: they might excite a Looseness, which may be very dangerous.

Sec. 79. When the Discharge of the Matter from the Breast diminishes, and the Patient is perceivably mended in every Respect, it is a Proof that the Wound in the Abscess is deterged, or clean, and that it is disposed to heal up gradually. If the Suppuration, or Discharge, continues in great Quantity; if it seems but of an indifferent Consistence; if the Fever returns every Evening, it may be apprehended, that the Wound, instead of healing, may degenerate into an Ulcer, which must prove a most embarrassing Consequence. Under such a Circumstance, the Patient would fall into a confirmed Hectic, and die after some Months Sickness.

Sec. 80. I am not acquainted with any better Remedy, in such a dangerous Case, than a Perseverance in these already directed, and especially in moderate Exercise on Horseback. In some of them indeed Recourse may be had to the sweet Vapours of some vulnerary Herbs in hot Water, with a little Oil of Turpentine, as directed No. 15. I have seen them succeed; but the safest Way is to consult a Physician, who may examine and consider, if there is not some particular Circumstance combined with the Disease, that proves an Obstacle to the Cure of it. If the Cough prevents the Patient from Sleeping, he may take in the Evening two or three Table Spoonfuls of the Prescription No. 16, in a Glass of Almond Milk or Barley Water.

Sec. 81. The very same Causes which suddenly suppress the Expectoration, in an Inflammation of the Breast, may also check the Expectoration from a _Vomica_ already begun: in which Circumstance the Patient is speedily afflicted with an Oppression and Anguish, a Fever and evident Feebleness. We should immediately endeavour to remove this Stoppage, by the Vapour of hot Water; by giving a Spoonful of the Mixture No. 3 every Hour; by a large Quantity of the Ptisan No. 12, and by a proper Degree of Motion or Exercise. As soon as ever the Expectoration returns, the Fever and the other Symptoms disappear. I have seen this Suppression in strong Habits quickly followed with an Inflammation about the Seat of the _Vomica_, which has obliged me to bleed, after which the Expectoration immediately returned.

Sec. 82. It happens sometimes, that the _Vomica_ is entirely cleansed; the Expectoration is entirely finished, or drained off, the Patient seems well, and thinks himself compleatly cured: but soon after, the Uneasiness, Oppression, Cough and Fever are renewed, because the Membrane or Bag of the _Vomica_ fills again: again it empties itself, the Patient expectorates for some Days, and seems to recover. After some Time however, the same Scene is repeated; and this Vicissitude, or Succession, of moderate and of bad Health, often continues for some Months and even some Years. This happens when the _Vomica_ is emptied, and is gradually deterged; so that its Membranes, or Sides touch or approach each other; but without cicatrizing or healing firmly; and then there drops or leaks in very gradually fresh Matter. For a few Days this seems no ways to incommode the Patient; but as soon as a certain Quantity is accumulated, he is visited again with some of the former Symptoms, 'till another Evacuation ensues. People thus circumstanced, in this Disease, sometimes appear to enjoy a tolerable Share of Health. It may be considered as a kind of internal Issue, which empties and cleanses itself from Time to Time; pretty frequently in some Constitutions, more slowly in others; and under which some may attain a good middling Age. When it arrives however at a very considerable Duration, it proves incurable. In its earliest State, it gives way sometimes to a Milk-diet, to riding on Horseback; and to the Medicine No. 14.

Sec. 83. Some may be surprized, that in treating of an Abscess of the Lungs, and of the Hectic, which is a Consequence of it, I say nothing of those Remedies, commonly termed _Balsamics_, and so frequently employed in them, for Instance, Turpentines, Balsam of Peru, of Mecca, Frankincense, Mastich, Myrrh, Storax and Balsam of Sulphur. I shall however say briefly here (because it is equally my Design to destroy the Prejudice of the People, in favour of improper Medicines, and to establish the Reputation of good ones) that I never in such Cases made use of these Medicines; because I am convinced, that their Operation is generally hurtful in such Cases; because I see them daily productive of real Mischief; that they protract the Cure, and often change a slight Disorder into an incurable Disease. They are incapable of perfect Digestion, they obstruct the finest Vessels of the Lungs, whose Obstructions we should endeavour to remove; and evidently occasion, except their Dose be extremely small, Heat and Oppression. I have very often seen to a Demonstration, that Pills compounded of Myrrh, Turpentine and Balsam of Peru, have, an Hour after they were swallowed, occasioned a Tumult and Agitation in the Pulse, high Flushings, Thirst and Oppression. In short it is demonstrable to every unprejudiced Person, that these Remedies, as they have been called, are truly prejudicial in this Case; and I heartily wish People may be disabused with Respect to them, and that they may lose that Reputation so unhappily ascribed to them.

I know that many Persons, very capable in other Respects, daily make use of them in these Distempers: such however cannot fail of disusing them, as soon as they shall have observed their Effects, abstracted from the Virtues of the other Medicines to which they add them, and which mitigate the Danger of them. I saw a Patient, whom a foreign Surgeon, who lived at _Orbe_, attempted to cure of a Hectic with melted Bacon, which aggravated the Disease. This Advice seemed, and certainly was, absurd; nevertheless the Balsamics ordered in such Cases are probably not more digestible than fat Bacon. The Powder No. 14 possesses whatever these Balsamics pretend to: it is attended with none of the Inconveniencies they produce; and has all the good Qualities ascribed to them. Notwithstanding which, it must not be given while the Inflammation exists; nor when it may revive again; and no other Aliment should be mixed with the Milk.

The famous Medicine called the _Antihectic_, (_Antihecticum Poterii_) has not, any more than these Balsamics, the Virtues ascribed to it in such Cases. I very often give it in some obstinate Coughs to Infants with their Milk, and then it is very useful: but I have seldom seen it attended with considerable Effects in grown Persons; and in the present Cases I should be fearful of its doing Mischief.

Sec. 84. If the _Vomica_, instead of breaking within the Substance of the Lungs affected, should break without it, the Pus must be received into the Cavity of the Breast. We know when that has happened, by the Sensation or Feeling of the Patient; who perceives an uncommon, a singular kind of Movement, pretty generally accompanied with a Fainting. The Oppression and Anguish cease at once; the Fever abates; the Cough however commonly continues, tho' with less Violence, and without any Expectoration. But this seeming Amendment is of a short Duration, since from the daily Augmentation of the Matter, and its becoming more acrid or sharp, the Lungs become oppressed, irritated and eroded. The Difficulty of Breathing, Heat, Thirst, Wakefulness, Distaste, and Deafness, return, with many other Symptoms unnecessary to be enumerated, and especially with frequent Sinkings and Weakness. The Patient should be confined to his _Regimen_, to retard the Increase of the Disease as much as possible; notwithstanding no other effectual Remedy remains, except that of opening the Breast between two of the Ribs, to discharge the Matter, and to stop the Disorder it occasions. This is called the Operation for the _Empyema_. I shall not describe it here, as it should not be undertaken but by Persons of Capacity and Experience, for whom this Treatise was not intended. I would only observe, it is less painful than terrifying; and that if it is delayed too long, it proves useless, and the Patient dies miserably.

Sec. 85. We may daily see external Inflammations turn gangrenous, or mortify. The same Thing occurs in the Lungs, when the Fever is excessive, the Inflammation either in its own Nature, extremely violent, or raised to such a Height by hot Medicines. Intolerable Anguish, extreme Weakness, frequent Faintings, Coldness of the Extremities, a livid and foetid thin Humour brought up instead of concocted Spitting, and sometimes blackish Stripes on the Breast, sufficiently distinguish this miserable State. I have smelt in one Case of this Kind, where the Patient had been attacked with this Disease (after a forced March on Foot, having taken some Wine with Spices to force a Sweat) his Breath so horribly stinking, that his Wife had many Sinkings from attending him. When I saw him, I could discern neither Pulse nor Intellect, and ordered him nothing. He died an Hour afterwards, about the Beginning of the third Hour.

Sec. 86. An Inflammation may also become hard, when it forms what we call a _Scirrhus_, which is a very hard Tumour, indolent, or unpainful. This is known to occur, when the disease has not terminated in any of those Manners I have represented; and where, tho' the Fever and the other Symptoms disappear, the Respiration, or Breathing, remains always a little oppressed; the Patient still retains a troublesome Sensation in one Side of his Breast; and has from Time to Time a dry Cough, which increases after Exercise, and after eating. This Malady is but seldom cured; though some Persons attacked with it last many Years, without any other considerable Complaint. They should avoid all Occasions of over-heating themselves; which might readily produce a new Inflammation about this Tumour, the Consequences of which would be highly dangerous.

Sec. 87. The best Remedies against this Disorder, and from which I have seen some good Effects, are the medicated Whey No. 17, and the Pills No. 18. The Patient may take twenty Pills, and a Pint and a half of the Whey every Morning for a long Continuance; and receive inwardly, now and then, the Vapour of hot Water.

Sec. 88. Each Lung, in a perfect State of Health, touches the _Pleura_, the Membrane, that lines the Inside of the Breast; though it is not connected to it. But it often happens, after an Inflammation of the Breast, after the Pleurisy, and in some other Cases, that these two Parts adhere closely to each other, and are never afterwards separated. However this is scarcely to be considered as a Disease; and remains commonly unknown, as the Health is not impaired by it, and nothing is ever prescribed to remove it. Nevertheless I have seen a few Cases, in which this Adhesion was manifestly prejudicial.

__Chapter V.__

_Of the Pleurisy._

__Sect.__ 89.

The Pleurisy, which is chiefly known by these four Symptoms, a strong Fever, a Difficulty of Breathing, a Cough, and an acute Pain about the Breast; the Pleurisy, I say, is not a different Malady from the Peripneumony, or Inflammation of the Breast, the Subject of the preceding Chapter; so that I have very little to say of it, particularly, or apart.

Sec. 90. The Cause of this Disease then is exactly the same with that of the former, that is, an Inflammation of the Lungs; but an Inflammation, that seems rather a little more external. The only considerable Difference in the Symptoms is, that the Pleurisy is accompanied with a most acute Pain under the Ribs, and which is commonly termed a _Stitch_. This Pain is felt indifferently over every Part of the Breast; though more commonly about the Sides, under the more fleshy Parts of the Breast, and oftenest on the right Side. The Pain is greatly increased whenever the Patient coughs or draws in the Air in breathing; and hence a Fear of increasing it, by making some Patients forbear to cough or respire, as much as they possibly can; and that aggravates the Disease, by stopping the Course of the Blood in the Lungs, which are soon overcharged with it. Hence the Inflammation of this Bowel becomes general; the Blood mounts up to the Head; the Countenance looks deeply red, or as it were livid; the Patient becomes nearly suffocated, and falls into the State described Sec. 47.

Sometimes the Pain is so extremely violent, that if the Cough is very urgent at the same Time, and the Sick cannot suppress or restrain it, they are seized with Convulsions, of which I have seen many Instances, but these occur almost always to Women; though they are much less subject than Men to this Disease, and indeed to all inflammatory ones. It may be proper however to observe here, that if Women should be attacked with it, during their monthly Discharges, that Circumstance should not prevent the repeated and necessary Bleedings, nor occasion any Alteration in the Treatment of the Disease. And hence it appears, that the Pleurisy is really an Inflammation of the Lungs, accompanied with acute Pain.

Sec. 91. I am sensible that sometimes an Inflammation of the Lungs is communicated also to that Membrane, which lines the Inside of the Breast; and which is called the _Pleura_; and from thence to the Muscles, the fleshy Parts, over and between the Ribs. This however is not very frequently the Case.

Sec. 92. Spring is commonly the Season most productive of Pleurisies: in general there are few in Summer: notwithstanding that in the Year 1762, there were a great many during the hottest Season, which then was excessively so. The Disease usually begins with a violent Shivering, succeeded by considerable Heat, with a Cough, an Oppression, and sometimes with a sensible Straitning, or Contraction, as it were, all over the Breast; and also with a Head-ach, a Redness of the Cheeks, and with Reachings to vomit. The Stitch does not always happen at the very first Onset; often not 'till after several Hours from the first Complaint; sometimes not before the second, or even the third Day. Sometimes the Patient feels two Stitches, in different Parts of the Side; though it seldom happens that they are equally sharp, and the lightest soon ceases. Sometimes also the Stitch shifts its Place, which promises well, if the Part first attacked by it continues perfectly free from Pain: but it has a bad Appearance, if, while the first is present, another also supervenes, and both continue. The Pulse is usually very hard in this Distemper; but in the dreadful Cases described Sec. 47 and 90, it becomes soft and small. There often occur at, or very quickly after, the Invasion, such an Expectoration, or hawking up, as happens in an Inflammation of the Breast; at other Times there is not the least Appearance of it, whence such are named dry Pleurisies, which happen pretty often. Sometimes the Sick cough but little, or not at all. They often lie more at Ease upon the Side affected, than on the sound one. The Progress of this Disease advances exactly like that described in the preceding Chapter: for how can they differ considerably? and the Treatment of both is the same. Large Haemorrhages, or Bleedings from the Nose, frequently happen, to the great Relief of the Patient; but sometimes such Discharges consist of a kind of corrupted Blood, when the Patient is very ill, and these portend Death.

Sec. 93. This Distemper is often produced by drinking cold Water, while a Person is hot; from which Cause it is sometimes so violent, as to kill the Patient in three Hours. A young Man was found dead at the Side of the Spring, from which he had quenched his Thirst: neither indeed is it uncommon for Pleurisies to prove mortal within three Days.

Sometimes the Stitch disappears, whence the Patient complains less; but at the same Time his Countenance changes; he grows pale and sad; his Eyes look dull and heavy, and his Pulse grows feeble. This signifies a Translation of the Disease to the Brain, a Case which is almost constantly fatal.

There is no Disease in which the critical Symptoms are more violent, and more strongly marked, than in this. It is proper this should be known, as it may prevent or lessen our excessive Terror. A perfect Cure supervenes sometimes, at the very Moment when Death was expected.

Sec. 94. This Malady is one of the most common and the most destroying kind, as well from its own violent Nature, as through the pernicious Treatment of it in Country Places. That Prejudice, which insists on curing all Diseases by Sweating, entirely regulates their Conduct in treating a Pleurisy; and as soon as a Person is afflicted with a Stitch, all the hot Medicines are immediately set to Work. This mortal Error destroys more People than Gunpowder; and it is by so much the more hurtful, as the Distemper is of the most violent kind; and because, as there is commonly not a Moment to be lost, the whole depends on the Method immediately recurred to.

Sec. 95. The proper Manner of treating this Disease, is exactly the same in all Respects, with that of the Peripneumony; because, I again affirm, it is the very same Disease. Hence the Bleedings, the softening and diluting Drinks, the Steams, the Glysters, the Potion No. 8, and the emollient Poultices are the real Remedies. These last perhaps are still more effectual in the Pleurisy; and therefore they should be continually applied over the very Stitch.

The first Bleeding, especially if there has been a considerable Discharge, almost constantly abates the Stitch, and often entirely removes it: though it more commonly returns, after an Intermission of some Hours, either in the same Spot, or sometimes in another. This shifting of it is rather favourable, especially if the Pain, that was first felt under the Breast, shifts into the Shoulders, to the Back, the Shoulder-blade, or the Nape of the Neck.

When the Stitch is not at all abated, or only a little; or if, after having abated, it returns as violently as at first, and especially if it returns in the same Spot, and the Height of the other Symptoms continue, Bleeding must be repeated. But if a sensible Abatement of the Stitch continues; and if, though it returns, it should be in a smaller Degree, and by Intervals, or in these Places I have mentioned above; if the Quickness, or the Hardness of the Pulse, and all the other Symptoms are sensibly diminished, this repeated Bleeding may sometimes be omitted. Nevertheless, in a very strong Subject, it seems rather prudent not to omit it, since in such Circumstances it can do no Mischief; and a considerable Hazard may sometimes be incurred by the Omission. In very high and dangerous Pleurisies a frequent Repetition of bleeding is necessary; except some Impediment to it should arise from the particular Constitution of the Patient, or from his Age, or some other Circumstances.

If, from the Beginning of the Disease, the Pulse is but a little quicker and harder than in a healthy State; if it is not manifestly strong; if the Head-ach and the Stitch are so moderate as to prove supportable; if the Cough is not too violent; if there is no sensible Oppression or Straitness, and the Patient expectorate, or cough up, Bleeding may be omitted.

With Respect to the administering of other Remedies, the same Directions are to be exactly followed, which have been already given in the preceding Chapter, to which the Reader is referred from Sec. 53 to 66.

Sec. 96. When the Disease is not very acute and pressing, I have often cured it in a very few Days by a single Bleeding, and a large Quantity of a Tea or Infusion of Elder-flowers, sweetened with Honey. It is in some Cases of this kind, that we often find the Water _Faltranc_ succeed, with the Addition of some Honey, and even of Oil: though the Drink I have just directed is considerably preferable. That Drink which is compounded of equal Quantities of Wine and Water, with the Addition of much Venice Treacle, annually destroys a great Number of People in the Country.

Sec. 97. In those dry Pleurisies, in which the Stitch, the Fever, and the Head-ach are strong and violent; and where the Pulse is very hard and very full, with an excessive Dryness of the Skin and of the Tongue, Bleeding should be frequently repeated, and at small Intervals from each other. This Method frequently cures the Disease effectually, without using any other Evacuation.

Sec. 98. The Pleurisy terminates, like any other inward Inflammation, either by some Evacuation; by an Abscess; in a Mortification; or in a Scirrhosity or hard Tumour; and it often leaves Adhesions in the Breast.

The Gangrene or Mortification sometimes appears on the third Day, without having been preceded by very vehement Pains. In such Cases the dead Body often looks very black, especially in the Parts near the Seat of the Disease: and in such the more superstitious ascribe it to some supernatural Cause; or draw some unhappy Presage from it, with Respect to those who are yet unattacked by it. This Appearance however is purely a natural Consequence, quite simple, and cannot be otherwise; and the hot Regimen and Medicines are the most prevailing Causes of it. I have seen it thus circumstanced in a Man in the Flower of his Age, who had taken Venice Treacle in Cherry Water, and the Ingredients of _Faltranc_ infused in Wine.

Sec. 99. _Vomicas_ are sometimes the Consequences of Pleurisies; but their particular Situation disposes them more to break [22] outwardly; which is the most frequent Cause of an _Empyema_ Sec. 84. "To prevent this, it is highly proper to apply, at the first Invasion of the Disease, to the Spot where the Pain chiefly rages, a small Plaister, which may exactly fit it; since if the Pleurisy should terminate in an Abscess or Imposthume, the purulent Matter will be determined to that Side.

[22] That is, into the Cavity of the Breast, rather than within the
Substance of the Lungs.

"As soon then as it is foreseen that an Abscess is forming (see Sec. 68) we should erode, by a light Caustic, the Place where it is expected; and as soon as it is removed, Care should be taken to promote Suppuration there. By this Means we may entertain a reasonable Hope, that the Mass of Matter will incline its Course to that Spot, where it will meet with the least Resistance, and be discharged from thence. For this Heap of Matter is often accumulated between the _Pleura_, and the Parts which adhere to it."

This is the Advice of a very [23] great Physician; but I must inform the Reader, there are many Cases, in which it can be of no Service; neither ought it to be attempted, but by Persons of undoubted Abilities.

[23] This is, undoubtedly, Baron _Van Swieten_, with whom he had
premised, he agreed considerably, in all the Diseases they had both
treated of. _K._

With Regard to the Scirrhosity, or Hardness, and to the Circumstances of Adhesions, I can add nothing to what I have said in Sec. 86 and 87.

Sec. 100. It has been observed that some Persons, who have been once attacked by this Disease, are often liable to Relapses of it, especially such as drink hard. I knew one Man, who reckoned up his Pleurisies by Dozens. A few Bleedings, at certain proper Intervals, might prevent these frequent Returns of it; which, joined to their excessive Drinking, make them languid and stupid, in the very Flower of their Age. They generally fall into some Species of an Asthma, and from that into a Dropsy, which proves the melancholy, though not an improper, Conclusion of their Lives. Such as can confine themselves to some proper Precautions, may also prevent these frequent Returns of this Disease, even without bleeding; by a temperate Regimen; by abstaining from Time to Time, from eating Flesh and drinking Wine; at which Times they should drink Whey, or some of those Diet-Drinks No. 1, 2, 4; and by bathing their Legs sometimes in warm Water; especially in those Seasons, when this Disease is the most likely to return.