Chapter IV.

Chapter IV.Of an Inflammation of the Breast.Sect.46.The Inflammation of the Breast, or Peripneumony, or a Fluxion upon the Breast, is an Inflammation of the Lungs, and most commonly of one only, and consequently on one Side. The Signs by which it is evident, are a Shivering, of more or less Duration, during which the Person affected is sometimes very restless and in great Anguish, an essential and inseparable symptom; and which has helped me more than once to distinguish this Disease certainly, at the very Instant of its Invasion. Besides this, a considerable Degree of Heat succeeds the Shivering, which Heat, for afew ensuing Hours, is often blended as it were, with some Returns of Chilliness. The Pulse is quick, pretty strong, moderately full, hard and regular, when the Distemper is not very violent; but small, soft and irregular, when it is very dangerous. There is also a Sensation of Pain, but rather light and tolerable, in one Side of the Breast; sometimes a kind of straitning or Pressure on the Heart; at other times Pains through the whole Body, especially along the Reins; and some Degree of Oppression, at least very often; for sometimes it is but very inconsiderable. The Patient finds a Necessity of lying almost continually upon his Back, being able to lie but very rarely upon either of his Sides. Sometimes his Cough is dry, and then attended with the most Pain; at other times it is accompanied with a Spitting or Hawking up, blended with more or less Blood, and sometimes with pure sheer Blood. There is also some Pain, or at least a Sensation of Weight and Heaviness in the Head: and frequently a Propensity to rave. The Face is almost continually flushed and red: though sometimes there is a Degree of Paleness and an Air of Astonishment, at the Beginning of the Disease, which portend no little Danger. The Lips, the Tongue, the Palate, the Skin are all dry; the Breath hot; the Urine little and high coloured in the first Stage: but more plentiful, less flaming, and letting fall much Sediment afterwards. There is a frequent Thirst, and sometimes an Inclinationto vomit; which imposing on the ignorant Assistants, have often inclined them to give the Patient a Vomit, which is mortal, especially at this Juncture. The Heat becomes universal. The Symptoms are heightened almost every Night, during which the Cough is more exasperated, and the Spitting or Expectoration in less Quantity. The best Expectoration is of a middling Consistence, neither too thin, nor too hard and tough, like those which are brought up at the Termination of a Cold; but rather more yellow, and mixed with a little Blood, which gradually becomes still less, and commonly disappears entirely, before the seventh Day. Sometimes the Inflammation ascends along the Wind-pipe, and in some Measure suffocates the Patient, paining him considerably in Swallowing, which makes him think he has a sore Throat.§ 47. Whenever the Disease is very violent at first, or increases to be such, the Patient cannot draw his Breath, but when he sits up. The Pulse becomes very small and very quick; the Countenance livid, the Tongue black; the Eyes stare wildly; and he suffers inexpressible Anguish, attended with incessant Restlessness and Agitation in his Bed. One of his Arms is sometimes affected with a sort of Palsy; he raves without Intermission; can neither thoroughly wake nor sleep. The Skin of his Breast and of his Neck is covered (especially in close sultry Weather, and when the Distemper is extremely violent) with livid Spots, more or less remarkable,which should be calledpetechialones, but are improperly termed thepourpre, or purple. The natural Strength becomes exhausted; the Difficulty of breathing increases every Moment; he sinks into a Lethargy, and soon dies a terrible Death in Country Places, by the very Effects of the inflaming Medicines they employ on such Occasions. It has been known in Fact, that the Use of them has raised the Distemper to such a Height, that the very Heart has been rent open, which the Dissection of the Body has demonstrated.§ 48. If the Disease rushes on at once, with a sudden and violent Attack; if the Horror, the Cold and Shivering last many Hours, and are followed with a nearly scorching Degree of Heat; if the Brain is affected from the very Onset; if the Patient has a small Purging, attended with aTenesinus, or straining to Stool, often termed aNeedy; if he abhors the Bed; if he either sweat excessively, or if his Skin be extremely dry; if his natural Manner and Look are considerably changed; and if he spits up with much Difficulty, the Disease is extremely dangerous.§ 49. He must directly, from the first Seizure in this State, be put upon a Regimen, and his Drink must never be given cold. It should either be the Barley WaterNº. 2, the Almond EmulsionNº. 4, or that ofNº. 7. The Juices of the Plants, which enter into the last of these Drinks, are excellent Remedies in this Case; asthey powerfully attenuate, or melt down, the viscid thick Blood, which causes the Inflammation.The Advantage of Bleeding:As long as the Fever keeps up extremely violent; while the Patient does not expectorate sufficiently; continues raving; has a violent Head-ach, or raises up pure Blood, the GlysterNº. 5must be given thrice, or at least twice, in twenty four Hours. However the principal Remedy is Bleeding. As soon as ever the preceding cold Assault is over, twelve Ounces of Blood must be taken away at once; and, if the Patient be young and strong, fourteen or even sixteen. This plentiful Bleeding gives him more Ease, than if twenty four Ounces had been drawn, at three different Times.§ 50. When the Disease is circumstanced as described (§ 46) that first Bleeding makes the Patient easy for some Hours; but the Complaint returns; and to obviate its Violence, as much as possible, we must, except things promise extremely well, repeat the Bleeding four Hours after the first, taking again twelve Ounces of Blood, which pretty often proves sufficient. But if, about the Expiration of eight or ten Hours, it appears to kindle up again, it must be repeated a third, or even a fourth Time. Yet, with the Assistance of other proper Remedies, I have seldom been obliged to bleed a fourth Time, and have sometimes found the two first Bleedings sufficient.If the Disease has been of several Days Duration, when I have first been called; if the Feveris still very high; if there be a Difficulty of Breathing; if the Patient does not expectorate at all, or brings up too much Blood; without being too solicitous about the Day of the Disease, the Patient should be bled, though it were on the tenth.20§ 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 thepleuritic 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 attendsolelyto 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, whicharise 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.§ 52. When the sick Person is in the Condition described (§ 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.§ 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.§ 54. Every two Hours he should take two Spoonfuls of the MixtureNº. 8, which promotes all the Discharges, and chiefly that of Expectoration.§ 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 withsuch 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.§ 56. The outward Remedies directed inNº. 9.are also applied with Success to the Breast, and to the Throat.§ 57. When the Fever is extremely high, the Sick should take every Hour, a Spoonful of the MixtureNº. 10. in a Cup of the Ptisan21but without diminishing on this Account the usual Quantity of his other Drinks, which may be taken immediately after it.§ 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 sufficientthen 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.§ 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 realPusor ripe Matter. These Discharges are succeeded by Sweats, which are as serviceable then, as they were injurious at the Beginning of the Disease.§ 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 theCrisis, 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, theCrisisor 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.§ 61. In order to prevent such unhappy Consequences, great Care must be taken, whenever such terrifying Symptoms come on, [about the Time of theCrisis] to make no Change in the Diet, nor in the Treatment of the Patient; except in giving himthe loosening GlysterNº. 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.§ 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 takethe purging PotionNº. 11.§ 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 stopthese 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.§ 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 PtisanNº. 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 heshould drink plentifully of the PtisanNº. 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.§ 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 aVomica: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.§ 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 isthe 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 thisVomicabe 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. ThePus, or Matter, is commonly discharged through the Mouth after Death, and the Bodies very soon become putrified.§ 67. We call thatVomicawhich is not burst, anoccultor 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 considerableVomicain the left Lung, which was theConsequence 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.§ 68. Whatever Distemper is included within the Breast of a living Patient, is neither an Object of the Sight or Touch whence theseVomicas, 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, thatPusor 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 hisLoins, 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, orBloatedness, as it were, is sometimes observed onthe Breast, towards the Side affected; with an almost insensible Change of Colour. If theVomicabe 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, somePuffinessor 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 theVomica, 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.§ 69. When aVomicais formed, as long as it is not emptied, all the Symptoms I have already enumerated increase, and theVomicagrows 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 ofPus, 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 maybe 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.§ 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-Ladleof the PotionNº. 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.§ 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 herAilment. 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.ASwissOfficer, who served inPiedmont, 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 ofMount 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 becameperfectly established; and the Preservation of his Life was principally owing to this lucky Fall.Many Persons afflicted with aVomica, 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.§ 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.§ 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.§ 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 PotionNº. 8; and between the giving these two, let the Patient take every half Hour a Cup of the DrinkNº. 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 PowderNº. 14, diluted in a little Water, or made into aBolus, 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.§ 75. The Multitude, who are generally illiterate, seldom consider any thing as a Remedy, except they swallow it. They have but little Confidence inRegimen, 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.§ 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.§ 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.§ 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.§ 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.§ 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 sweetVapours of some vulnerary Herbs in hot Water, with a little Oil of Turpentine, as directedNº. 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 PrescriptionNº. 16, in a Glass of Almond Milk or Barley Water.§ 81. The very same Causes which suddenly suppress the Expectoration, in an Inflammation of the Breast, may also check the Expectoration from aVomicaalready 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 MixtureNº. 3every Hour; by a large Quantity of the PtisanNº. 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 theVomica, which has obliged me to bleed, after which the Expectoration immediately returned.§ 82. It happens sometimes, that theVomicais entirely cleansed; the Expectoration is entirelyfinished, 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 theVomicafills 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 theVomicais 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 MedicineNº. 14.§ 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 termedBalsamics, 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 theymay 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 atOrbe, 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 PowderNº. 14possesses 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 theAntihectic, (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.§ 84. If theVomica, instead of breaking withinthe 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 hisRegimen, 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 theEmpyema. 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.§ 85. We may daily see externalInflammationsturn 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 fœtid 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.§ 86. An Inflammation may also become hard, when it forms what we call aScirrhus, which is a very hard Tumour, indolent, or unpainful. This is known to occur, when the diseasehasnot 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 manyYears, 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.§ 87. The best Remedies against this Disorder, and from which I have seen some good Effects, are the medicated WheyNº. 17, and the PillsNº. 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.§ 88. Each Lung, in a perfect State of Health, touches thePleura, 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 IV.Of an Inflammation of the Breast.Sect.46.The Inflammation of the Breast, or Peripneumony, or a Fluxion upon the Breast, is an Inflammation of the Lungs, and most commonly of one only, and consequently on one Side. The Signs by which it is evident, are a Shivering, of more or less Duration, during which the Person affected is sometimes very restless and in great Anguish, an essential and inseparable symptom; and which has helped me more than once to distinguish this Disease certainly, at the very Instant of its Invasion. Besides this, a considerable Degree of Heat succeeds the Shivering, which Heat, for afew ensuing Hours, is often blended as it were, with some Returns of Chilliness. The Pulse is quick, pretty strong, moderately full, hard and regular, when the Distemper is not very violent; but small, soft and irregular, when it is very dangerous. There is also a Sensation of Pain, but rather light and tolerable, in one Side of the Breast; sometimes a kind of straitning or Pressure on the Heart; at other times Pains through the whole Body, especially along the Reins; and some Degree of Oppression, at least very often; for sometimes it is but very inconsiderable. The Patient finds a Necessity of lying almost continually upon his Back, being able to lie but very rarely upon either of his Sides. Sometimes his Cough is dry, and then attended with the most Pain; at other times it is accompanied with a Spitting or Hawking up, blended with more or less Blood, and sometimes with pure sheer Blood. There is also some Pain, or at least a Sensation of Weight and Heaviness in the Head: and frequently a Propensity to rave. The Face is almost continually flushed and red: though sometimes there is a Degree of Paleness and an Air of Astonishment, at the Beginning of the Disease, which portend no little Danger. The Lips, the Tongue, the Palate, the Skin are all dry; the Breath hot; the Urine little and high coloured in the first Stage: but more plentiful, less flaming, and letting fall much Sediment afterwards. There is a frequent Thirst, and sometimes an Inclinationto vomit; which imposing on the ignorant Assistants, have often inclined them to give the Patient a Vomit, which is mortal, especially at this Juncture. The Heat becomes universal. The Symptoms are heightened almost every Night, during which the Cough is more exasperated, and the Spitting or Expectoration in less Quantity. The best Expectoration is of a middling Consistence, neither too thin, nor too hard and tough, like those which are brought up at the Termination of a Cold; but rather more yellow, and mixed with a little Blood, which gradually becomes still less, and commonly disappears entirely, before the seventh Day. Sometimes the Inflammation ascends along the Wind-pipe, and in some Measure suffocates the Patient, paining him considerably in Swallowing, which makes him think he has a sore Throat.§ 47. Whenever the Disease is very violent at first, or increases to be such, the Patient cannot draw his Breath, but when he sits up. The Pulse becomes very small and very quick; the Countenance livid, the Tongue black; the Eyes stare wildly; and he suffers inexpressible Anguish, attended with incessant Restlessness and Agitation in his Bed. One of his Arms is sometimes affected with a sort of Palsy; he raves without Intermission; can neither thoroughly wake nor sleep. The Skin of his Breast and of his Neck is covered (especially in close sultry Weather, and when the Distemper is extremely violent) with livid Spots, more or less remarkable,which should be calledpetechialones, but are improperly termed thepourpre, or purple. The natural Strength becomes exhausted; the Difficulty of breathing increases every Moment; he sinks into a Lethargy, and soon dies a terrible Death in Country Places, by the very Effects of the inflaming Medicines they employ on such Occasions. It has been known in Fact, that the Use of them has raised the Distemper to such a Height, that the very Heart has been rent open, which the Dissection of the Body has demonstrated.§ 48. If the Disease rushes on at once, with a sudden and violent Attack; if the Horror, the Cold and Shivering last many Hours, and are followed with a nearly scorching Degree of Heat; if the Brain is affected from the very Onset; if the Patient has a small Purging, attended with aTenesinus, or straining to Stool, often termed aNeedy; if he abhors the Bed; if he either sweat excessively, or if his Skin be extremely dry; if his natural Manner and Look are considerably changed; and if he spits up with much Difficulty, the Disease is extremely dangerous.§ 49. He must directly, from the first Seizure in this State, be put upon a Regimen, and his Drink must never be given cold. It should either be the Barley WaterNº. 2, the Almond EmulsionNº. 4, or that ofNº. 7. The Juices of the Plants, which enter into the last of these Drinks, are excellent Remedies in this Case; asthey powerfully attenuate, or melt down, the viscid thick Blood, which causes the Inflammation.The Advantage of Bleeding:As long as the Fever keeps up extremely violent; while the Patient does not expectorate sufficiently; continues raving; has a violent Head-ach, or raises up pure Blood, the GlysterNº. 5must be given thrice, or at least twice, in twenty four Hours. However the principal Remedy is Bleeding. As soon as ever the preceding cold Assault is over, twelve Ounces of Blood must be taken away at once; and, if the Patient be young and strong, fourteen or even sixteen. This plentiful Bleeding gives him more Ease, than if twenty four Ounces had been drawn, at three different Times.§ 50. When the Disease is circumstanced as described (§ 46) that first Bleeding makes the Patient easy for some Hours; but the Complaint returns; and to obviate its Violence, as much as possible, we must, except things promise extremely well, repeat the Bleeding four Hours after the first, taking again twelve Ounces of Blood, which pretty often proves sufficient. But if, about the Expiration of eight or ten Hours, it appears to kindle up again, it must be repeated a third, or even a fourth Time. Yet, with the Assistance of other proper Remedies, I have seldom been obliged to bleed a fourth Time, and have sometimes found the two first Bleedings sufficient.If the Disease has been of several Days Duration, when I have first been called; if the Feveris still very high; if there be a Difficulty of Breathing; if the Patient does not expectorate at all, or brings up too much Blood; without being too solicitous about the Day of the Disease, the Patient should be bled, though it were on the tenth.20§ 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 thepleuritic 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 attendsolelyto 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, whicharise 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.§ 52. When the sick Person is in the Condition described (§ 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.§ 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.§ 54. Every two Hours he should take two Spoonfuls of the MixtureNº. 8, which promotes all the Discharges, and chiefly that of Expectoration.§ 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 withsuch 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.§ 56. The outward Remedies directed inNº. 9.are also applied with Success to the Breast, and to the Throat.§ 57. When the Fever is extremely high, the Sick should take every Hour, a Spoonful of the MixtureNº. 10. in a Cup of the Ptisan21but without diminishing on this Account the usual Quantity of his other Drinks, which may be taken immediately after it.§ 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 sufficientthen 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.§ 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 realPusor ripe Matter. These Discharges are succeeded by Sweats, which are as serviceable then, as they were injurious at the Beginning of the Disease.§ 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 theCrisis, 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, theCrisisor 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.§ 61. In order to prevent such unhappy Consequences, great Care must be taken, whenever such terrifying Symptoms come on, [about the Time of theCrisis] to make no Change in the Diet, nor in the Treatment of the Patient; except in giving himthe loosening GlysterNº. 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.§ 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 takethe purging PotionNº. 11.§ 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 stopthese 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.§ 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 PtisanNº. 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 heshould drink plentifully of the PtisanNº. 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.§ 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 aVomica: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.§ 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 isthe 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 thisVomicabe 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. ThePus, or Matter, is commonly discharged through the Mouth after Death, and the Bodies very soon become putrified.§ 67. We call thatVomicawhich is not burst, anoccultor 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 considerableVomicain the left Lung, which was theConsequence 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.§ 68. Whatever Distemper is included within the Breast of a living Patient, is neither an Object of the Sight or Touch whence theseVomicas, 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, thatPusor 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 hisLoins, 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, orBloatedness, as it were, is sometimes observed onthe Breast, towards the Side affected; with an almost insensible Change of Colour. If theVomicabe 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, somePuffinessor 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 theVomica, 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.§ 69. When aVomicais formed, as long as it is not emptied, all the Symptoms I have already enumerated increase, and theVomicagrows 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 ofPus, 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 maybe 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.§ 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-Ladleof the PotionNº. 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.§ 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 herAilment. 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.ASwissOfficer, who served inPiedmont, 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 ofMount 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 becameperfectly established; and the Preservation of his Life was principally owing to this lucky Fall.Many Persons afflicted with aVomica, 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.§ 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.§ 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.§ 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 PotionNº. 8; and between the giving these two, let the Patient take every half Hour a Cup of the DrinkNº. 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 PowderNº. 14, diluted in a little Water, or made into aBolus, 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.§ 75. The Multitude, who are generally illiterate, seldom consider any thing as a Remedy, except they swallow it. They have but little Confidence inRegimen, 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.§ 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.§ 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.§ 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.§ 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.§ 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 sweetVapours of some vulnerary Herbs in hot Water, with a little Oil of Turpentine, as directedNº. 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 PrescriptionNº. 16, in a Glass of Almond Milk or Barley Water.§ 81. The very same Causes which suddenly suppress the Expectoration, in an Inflammation of the Breast, may also check the Expectoration from aVomicaalready 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 MixtureNº. 3every Hour; by a large Quantity of the PtisanNº. 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 theVomica, which has obliged me to bleed, after which the Expectoration immediately returned.§ 82. It happens sometimes, that theVomicais entirely cleansed; the Expectoration is entirelyfinished, 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 theVomicafills 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 theVomicais 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 MedicineNº. 14.§ 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 termedBalsamics, 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 theymay 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 atOrbe, 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 PowderNº. 14possesses 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 theAntihectic, (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.§ 84. If theVomica, instead of breaking withinthe 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 hisRegimen, 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 theEmpyema. 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.§ 85. We may daily see externalInflammationsturn 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 fœtid 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.§ 86. An Inflammation may also become hard, when it forms what we call aScirrhus, which is a very hard Tumour, indolent, or unpainful. This is known to occur, when the diseasehasnot 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 manyYears, 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.§ 87. The best Remedies against this Disorder, and from which I have seen some good Effects, are the medicated WheyNº. 17, and the PillsNº. 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.§ 88. Each Lung, in a perfect State of Health, touches thePleura, 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.****

Of an Inflammation of the Breast.

Sect.46.

Sect.46.

The Inflammation of the Breast, or Peripneumony, or a Fluxion upon the Breast, is an Inflammation of the Lungs, and most commonly of one only, and consequently on one Side. The Signs by which it is evident, are a Shivering, of more or less Duration, during which the Person affected is sometimes very restless and in great Anguish, an essential and inseparable symptom; and which has helped me more than once to distinguish this Disease certainly, at the very Instant of its Invasion. Besides this, a considerable Degree of Heat succeeds the Shivering, which Heat, for afew ensuing Hours, is often blended as it were, with some Returns of Chilliness. The Pulse is quick, pretty strong, moderately full, hard and regular, when the Distemper is not very violent; but small, soft and irregular, when it is very dangerous. There is also a Sensation of Pain, but rather light and tolerable, in one Side of the Breast; sometimes a kind of straitning or Pressure on the Heart; at other times Pains through the whole Body, especially along the Reins; and some Degree of Oppression, at least very often; for sometimes it is but very inconsiderable. The Patient finds a Necessity of lying almost continually upon his Back, being able to lie but very rarely upon either of his Sides. Sometimes his Cough is dry, and then attended with the most Pain; at other times it is accompanied with a Spitting or Hawking up, blended with more or less Blood, and sometimes with pure sheer Blood. There is also some Pain, or at least a Sensation of Weight and Heaviness in the Head: and frequently a Propensity to rave. The Face is almost continually flushed and red: though sometimes there is a Degree of Paleness and an Air of Astonishment, at the Beginning of the Disease, which portend no little Danger. The Lips, the Tongue, the Palate, the Skin are all dry; the Breath hot; the Urine little and high coloured in the first Stage: but more plentiful, less flaming, and letting fall much Sediment afterwards. There is a frequent Thirst, and sometimes an Inclinationto vomit; which imposing on the ignorant Assistants, have often inclined them to give the Patient a Vomit, which is mortal, especially at this Juncture. The Heat becomes universal. The Symptoms are heightened almost every Night, during which the Cough is more exasperated, and the Spitting or Expectoration in less Quantity. The best Expectoration is of a middling Consistence, neither too thin, nor too hard and tough, like those which are brought up at the Termination of a Cold; but rather more yellow, and mixed with a little Blood, which gradually becomes still less, and commonly disappears entirely, before the seventh Day. Sometimes the Inflammation ascends along the Wind-pipe, and in some Measure suffocates the Patient, paining him considerably in Swallowing, which makes him think he has a sore Throat.

§ 47. Whenever the Disease is very violent at first, or increases to be such, the Patient cannot draw his Breath, but when he sits up. The Pulse becomes very small and very quick; the Countenance livid, the Tongue black; the Eyes stare wildly; and he suffers inexpressible Anguish, attended with incessant Restlessness and Agitation in his Bed. One of his Arms is sometimes affected with a sort of Palsy; he raves without Intermission; can neither thoroughly wake nor sleep. The Skin of his Breast and of his Neck is covered (especially in close sultry Weather, and when the Distemper is extremely violent) with livid Spots, more or less remarkable,which should be calledpetechialones, but are improperly termed thepourpre, or purple. The natural Strength becomes exhausted; the Difficulty of breathing increases every Moment; he sinks into a Lethargy, and soon dies a terrible Death in Country Places, by the very Effects of the inflaming Medicines they employ on such Occasions. It has been known in Fact, that the Use of them has raised the Distemper to such a Height, that the very Heart has been rent open, which the Dissection of the Body has demonstrated.

§ 48. If the Disease rushes on at once, with a sudden and violent Attack; if the Horror, the Cold and Shivering last many Hours, and are followed with a nearly scorching Degree of Heat; if the Brain is affected from the very Onset; if the Patient has a small Purging, attended with aTenesinus, or straining to Stool, often termed aNeedy; if he abhors the Bed; if he either sweat excessively, or if his Skin be extremely dry; if his natural Manner and Look are considerably changed; and if he spits up with much Difficulty, the Disease is extremely dangerous.

§ 49. He must directly, from the first Seizure in this State, be put upon a Regimen, and his Drink must never be given cold. It should either be the Barley WaterNº. 2, the Almond EmulsionNº. 4, or that ofNº. 7. The Juices of the Plants, which enter into the last of these Drinks, are excellent Remedies in this Case; asthey powerfully attenuate, or melt down, the viscid thick Blood, which causes the Inflammation.

The Advantage of Bleeding:

As long as the Fever keeps up extremely violent; while the Patient does not expectorate sufficiently; continues raving; has a violent Head-ach, or raises up pure Blood, the GlysterNº. 5must be given thrice, or at least twice, in twenty four Hours. However the principal Remedy is Bleeding. As soon as ever the preceding cold Assault is over, twelve Ounces of Blood must be taken away at once; and, if the Patient be young and strong, fourteen or even sixteen. This plentiful Bleeding gives him more Ease, than if twenty four Ounces had been drawn, at three different Times.

§ 50. When the Disease is circumstanced as described (§ 46) that first Bleeding makes the Patient easy for some Hours; but the Complaint returns; and to obviate its Violence, as much as possible, we must, except things promise extremely well, repeat the Bleeding four Hours after the first, taking again twelve Ounces of Blood, which pretty often proves sufficient. But if, about the Expiration of eight or ten Hours, it appears to kindle up again, it must be repeated a third, or even a fourth Time. Yet, with the Assistance of other proper Remedies, I have seldom been obliged to bleed a fourth Time, and have sometimes found the two first Bleedings sufficient.

If the Disease has been of several Days Duration, when I have first been called; if the Feveris still very high; if there be a Difficulty of Breathing; if the Patient does not expectorate at all, or brings up too much Blood; without being too solicitous about the Day of the Disease, the Patient should be bled, though it were on the tenth.20

§ 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 thepleuritic 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 attendsolelyto 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, whicharise 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.

§ 52. When the sick Person is in the Condition described (§ 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.

§ 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.

§ 54. Every two Hours he should take two Spoonfuls of the MixtureNº. 8, which promotes all the Discharges, and chiefly that of Expectoration.

§ 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 withsuch 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.

§ 56. The outward Remedies directed inNº. 9.are also applied with Success to the Breast, and to the Throat.

§ 57. When the Fever is extremely high, the Sick should take every Hour, a Spoonful of the MixtureNº. 10. in a Cup of the Ptisan21but without diminishing on this Account the usual Quantity of his other Drinks, which may be taken immediately after it.

§ 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 sufficientthen 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.

§ 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 realPusor ripe Matter. These Discharges are succeeded by Sweats, which are as serviceable then, as they were injurious at the Beginning of the Disease.

§ 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 theCrisis, 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, theCrisisor 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.

§ 61. In order to prevent such unhappy Consequences, great Care must be taken, whenever such terrifying Symptoms come on, [about the Time of theCrisis] to make no Change in the Diet, nor in the Treatment of the Patient; except in giving himthe loosening GlysterNº. 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.

§ 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 takethe purging PotionNº. 11.

§ 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 stopthese 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.

§ 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 PtisanNº. 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 heshould drink plentifully of the PtisanNº. 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.

§ 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 aVomica: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.

§ 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 isthe 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 thisVomicabe 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. ThePus, or Matter, is commonly discharged through the Mouth after Death, and the Bodies very soon become putrified.

§ 67. We call thatVomicawhich is not burst, anoccultor 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 considerableVomicain the left Lung, which was theConsequence 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.

§ 68. Whatever Distemper is included within the Breast of a living Patient, is neither an Object of the Sight or Touch whence theseVomicas, 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, thatPusor 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 hisLoins, 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, orBloatedness, as it were, is sometimes observed onthe Breast, towards the Side affected; with an almost insensible Change of Colour. If theVomicabe 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, somePuffinessor 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 theVomica, 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.

§ 69. When aVomicais formed, as long as it is not emptied, all the Symptoms I have already enumerated increase, and theVomicagrows 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 ofPus, 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 maybe 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.

§ 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-Ladleof the PotionNº. 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.

§ 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 herAilment. 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.

ASwissOfficer, who served inPiedmont, 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 ofMount 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 becameperfectly established; and the Preservation of his Life was principally owing to this lucky Fall.

Many Persons afflicted with aVomica, 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.

§ 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.

§ 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.

§ 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 PotionNº. 8; and between the giving these two, let the Patient take every half Hour a Cup of the DrinkNº. 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 PowderNº. 14, diluted in a little Water, or made into aBolus, 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.

§ 75. The Multitude, who are generally illiterate, seldom consider any thing as a Remedy, except they swallow it. They have but little Confidence inRegimen, 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.

§ 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.

§ 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.

§ 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.

§ 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.

§ 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 sweetVapours of some vulnerary Herbs in hot Water, with a little Oil of Turpentine, as directedNº. 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 PrescriptionNº. 16, in a Glass of Almond Milk or Barley Water.

§ 81. The very same Causes which suddenly suppress the Expectoration, in an Inflammation of the Breast, may also check the Expectoration from aVomicaalready 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 MixtureNº. 3every Hour; by a large Quantity of the PtisanNº. 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 theVomica, which has obliged me to bleed, after which the Expectoration immediately returned.

§ 82. It happens sometimes, that theVomicais entirely cleansed; the Expectoration is entirelyfinished, 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 theVomicafills 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 theVomicais 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 MedicineNº. 14.

§ 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 termedBalsamics, 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 theymay 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 atOrbe, 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 PowderNº. 14possesses 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 theAntihectic, (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.

§ 84. If theVomica, instead of breaking withinthe 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 hisRegimen, 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 theEmpyema. 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.

§ 85. We may daily see externalInflammationsturn 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 fœtid 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.

§ 86. An Inflammation may also become hard, when it forms what we call aScirrhus, which is a very hard Tumour, indolent, or unpainful. This is known to occur, when the diseasehasnot 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 manyYears, 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.

§ 87. The best Remedies against this Disorder, and from which I have seen some good Effects, are the medicated WheyNº. 17, and the PillsNº. 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.

§ 88. Each Lung, in a perfect State of Health, touches thePleura, 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.

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