Chapter V.Of the Pleurisy.Sect.89.The Pleurisy, which is chiefly known by these four Symptoms, a strong Fever, a Difficulty of Breathing, a Cough, and an acute Pain about the Breast; the Pleurisy, I say, is not a different Malady from the Peripneumony, or Inflammation of the Breast, the Subject of the preceding Chapter; so that I have very little to say of it, particularly, or apart.§ 90. The Cause of this Disease then is exactly the same with that of the former, that is, an Inflammation of the Lungs; but an Inflammation, that seems rather a little more external. The only considerable Difference in the Symptoms is, that the Pleurisy is accompanied with a most acute Pain under the Ribs, and which is commonly termed aStitch. This Pain is felt indifferently over every Part of the Breast; though more commonly about the Sides, under the more fleshy Parts of the Breast, and oftenest on the right Side. The Pain is greatly increased whenever the Patient coughs or draws in the Air in breathing; and hence a Fear of increasing it,by making some Patients forbear to cough or respire, as much as they possibly can; and that aggravates the Disease, by stopping the Course of the Blood in the Lungs, which are soon overcharged with it. Hence the Inflammation of this Bowel becomes general; the Blood mounts up to the Head; the Countenance looks deeply red, or as it were livid; the Patient becomes nearly suffocated, and falls into the State described§ 47.Sometimes the Pain is so extremely violent, that if the Cough is very urgent at the same Time, and the Sick cannot suppress or restrain it, they are seized with Convulsions, of which I have seen many Instances, but these occur almost always to Women; though they are much less subject than Men to this Disease, and indeed to all inflammatory ones. It may be proper however to observe here, that if Women should be attacked with it, during their monthly Discharges, that Circumstance should not prevent the repeated and necessary Bleedings, nor occasion any Alteration in the Treatment of the Disease. And hence it appears, that the Pleurisy is really an Inflammation of the Lungs, accompanied with acute Pain.§ 91. I am sensible that sometimes an Inflammation of the Lungs is communicated also to that Membrane, which lines the Inside of the Breast; and which is called thePleura; and from thence to the Muscles, the fleshy Parts, over and betweenthe Ribs. This however is not very frequently the Case.§ 92. Spring is commonly the Season most productive of Pleurisies: in general there are few in Summer: notwithstanding that in the Year 1762, there were a great many during the hottest Season, which then was excessively so. The Disease usually begins with a violent Shivering, succeeded by considerable Heat, with a Cough, an Oppression, and sometimes with a sensible Straitning, or Contraction, as it were, all over the Breast; and also with a Head-ach, a Redness of the Cheeks, and with Reachings to vomit. The Stitch does not always happen at the very first Onset; often not 'till after several Hours from the first Complaint; sometimes not before the second, or even the third Day. Sometimes the Patient feels two Stitches, in different Parts of the Side; though it seldom happens that they are equally sharp, and the lightest soon ceases. Sometimes also the Stitch shifts its Place, which promises well, if the Part first attacked by it continues perfectly free from Pain: but it has a bad Appearance, if, while the first is present, another also supervenes, and both continue. The Pulse is usually very hard in this Distemper; but in the dreadful Cases described§ 47and90, it becomes soft and small. There often occur at, or very quickly after, the Invasion, such an Expectoration, or hawking up, as happens in an Inflammation of the Breast; at other Times there is not theleast Appearance of it, whence such are named dry Pleurisies, which happen pretty often. Sometimes the Sick cough but little, or not at all. They often lie more at Ease upon the Side affected, than on the sound one. The Progress of this Disease advances exactly like that described in the preceding Chapter: for how can they differ considerably? and the Treatment of both is the same. Large Hæmorrhages, or Bleedings from the Nose, frequently happen, to the great Relief of the Patient; but sometimes such Discharges consist of a kind of corrupted Blood, when the Patient is very ill, and these portend Death.§ 93. This Distemper is often produced by drinking cold Water, while a Person is hot; from which Cause it is sometimes so violent, as to kill the Patient in three Hours. A young Man was found dead at the Side of the Spring, from which he had quenched his Thirst: neither indeed is it uncommon for Pleurisies to prove mortal within three Days.Sometimes the Stitch disappears, whence the Patient complains less; but at the same Time his Countenance changes; he grows pale and sad; his Eyes look dull and heavy, and his Pulse grows feeble. This signifies a Translation of the Disease to the Brain, a Case which is almost constantly fatal.There is no Disease in which the critical Symptoms are more violent, and more strongly marked, than in this. It is proper this shouldbe known, as it may prevent or lessen our excessive Terror. A perfect Cure supervenes sometimes, at the very Moment when Death was expected.§ 94. This Malady is one of the most common and the most destroying kind, as well from its own violent Nature, as through the pernicious Treatment of it in Country Places. That Prejudice, which insists on curing all Diseases by Sweating, entirely regulates their Conduct in treating a Pleurisy; and as soon as a Person is afflicted with a Stitch, all the hot Medicines are immediately set to Work. This mortal Error destroys more People than Gunpowder; and it is by so much the more hurtful, as the Distemper is of the most violent kind; and because, as there is commonly not a Moment to be lost, the whole depends on the Method immediately recurred to.§ 95. The proper Manner of treating this Disease, is exactly the same in all Respects, with that of the Peripneumony; because, I again affirm, it is the very same Disease. Hence the Bleedings, the softening and diluting Drinks, the Steams, the Glysters, the PotionNº. 8, and the emollient Poultices are the real Remedies. These last perhaps are still more effectual in the Pleurisy; and therefore they should be continually applied over the very Stitch.The first Bleeding, especially if there has been a considerable Discharge, almost constantly abates the Stitch, and often entirely removes it: thoughit more commonly returns, after an Intermission of some Hours, either in the same Spot, or sometimes in another. This shifting of it is rather favourable, especially if the Pain, that was first felt under the Breast, shifts into the Shoulders, to the Back, the Shoulder-blade, or the Nape of the Neck.When the Stitch is not at all abated, or only a little; or if, after having abated, it returns as violently as at first, and especially if it returns in the same Spot, and the Height of the other Symptoms continue, Bleeding must be repeated. But if a sensible Abatement of the Stitch continues; and if, though it returns, it should be in a smaller Degree, and by Intervals, or in these Places I have mentioned above; if the Quickness, or the Hardness of the Pulse, and all the other Symptoms are sensibly diminished, this repeated Bleeding may sometimes be omitted. Nevertheless, in a very strong Subject, it seems rather prudent not to omit it, since in such Circumstances it can do no Mischief; and a considerable Hazard may sometimes be incurred by the Omission. In very high and dangerous Pleurisies a frequent Repetition of bleeding is necessary; except some Impediment to it should arise from the particular Constitution of the Patient, or from his Age, or some other Circumstances.If, from the Beginning of the Disease, the Pulse is but a little quicker and harder than in a healthy State; if it is not manifestly strong; if the Head-ach and the Stitch are so moderate asto prove supportable; if the Cough is not too violent; if there is no sensible Oppression or Straitness, and the Patient expectorate, or cough up, Bleeding may be omitted.With Respect to the administering of other Remedies, the same Directions are to be exactly followed, which have been already given in the preceding Chapter, to which the Reader is referred from§ 53to66.§ 96. When the Disease is not very acute and pressing, I have often cured it in a very few Days by a single Bleeding, and a large Quantity of a Tea or Infusion of Elder-flowers, sweetened with Honey. It is in some Cases of this kind, that we often find the WaterFaltrancsucceed, with the Addition of some Honey, and even of Oil: though the Drink I have just directed is considerably preferable. That Drink which is compounded of equal Quantities of Wine and Water, with the Addition of much Venice Treacle, annually destroys a great Number of People in the Country.§ 97. In those dry Pleurisies, in which the Stitch, the Fever, and the Head-ach are strong and violent; and where the Pulse is very hard and very full, with an excessive Dryness of the Skin and of the Tongue, Bleeding should be frequently repeated, and at small Intervals from each other. This Method frequently cures the Disease effectually, without using any other Evacuation.§ 98. The Pleurisy terminates, like any other inward Inflammation, either by some Evacuation; by an Abscess; in a Mortification; or in a Scirrhosity or hard Tumour; and it often leaves Adhesions in the Breast.The Gangrene or Mortification sometimes appears on the third Day, without having been preceded by very vehement Pains. In such Cases the dead Body often looks very black, especially in the Parts near the Seat of the Disease: and in such the more superstitious ascribe it to some supernatural Cause; or draw some unhappy Presage from it, with Respect to those who are yet unattacked by it. This Appearance however is purely a natural Consequence, quite simple, and cannot be otherwise; and the hot Regimen and Medicines are the most prevailing Causes of it. I have seen it thus circumstanced in a Man in the Flower of his Age, who had taken Venice Treacle in Cherry Water, and the Ingredients ofFaltrancinfused in Wine.§ 99.Vomicasare sometimes the Consequences of Pleurisies; but their particular Situation disposes them more to break22outwardly; which is the most frequent Cause of anEmpyema§ 84. “To prevent this, it is highly proper to apply, at the first Invasion of the Disease, to the Spot where the Pain chiefly rages, a small Plaister, which may exactly fit it; since if the Pleurisy should terminate in an Abscess or Imposthume,the purulent Matter will be determined to that Side.“As soon then as it is foreseen that an Abscess is forming (see§ 68) we should erode, by a light Caustic, the Place where it is expected; and as soon as it is removed, Care should be taken to promote Suppuration there. By this Means we may entertain a reasonable Hope, that the Mass of Matter will incline its Course to that Spot, where it will meet with the least Resistance, and be discharged from thence. For this Heap of Matter is often accumulated between thePleura, and the Parts which adhere to it.”This is the Advice of a very23great Physician; but I must inform the Reader, there are many Cases, in which it can be of no Service; neither ought it to be attempted, but by Persons of undoubted Abilities.With Regard to the Scirrhosity, or Hardness, and to the Circumstances of Adhesions, I can add nothing to what I have said in§ 86and87.§ 100. It has been observed that some Persons, who have been once attacked by this Disease, are often liable to Relapses of it, especially such as drink hard. I knew one Man, who reckoned up his Pleurisies by Dozens. A few Bleedings, at certain proper Intervals, might prevent these frequent Returns of it; which, joinedto their excessive Drinking, make them languid and stupid, in the very Flower of their Age. They generally fall into some Species of an Asthma, and from that into a Dropsy, which proves the melancholy, though not an improper, Conclusion of their Lives. Such as can confine themselves to some proper Precautions, may also prevent these frequent Returns of this Disease, even without bleeding; by a temperate Regimen; by abstaining from Time to Time, from eating Flesh and drinking Wine; at which Times they should drink Whey,or some of those Diet-DrinksNº. 1,2,4; and by bathing their Legs sometimes in warm Water; especially in those Seasons, when this Disease is the most likely to return.§ 101. Two Medicines greatly esteemed in this Disease among the Peasantry, and even extolled by some Physicians, are the Blood of a wild He Goat, and the24Soot in an Egg. I do not contest the Cure or Recovery of many Persons, who have taken these Remedies; notwithstanding it is not less true, that both of them, as well as the Egg in which the Soot is taken, are dangerous: For which Reason it is prudent, at least, never to make use of them; as there is great Probability, they may do a little Mischief; and a Certainty that they can do no Good. TheGenipi, or25Wormwood of the Alps, has also acquired great Reputation in this Disease, and occasioned many Disputes between some very zealous Ecclesiastics, and a justly celebrated Physician. It seems not difficult however to ascertain the proper Use of it. This Plant is a powerful Bitter; it heats and excites Sweat: it seems clear, that, from such Consequences, it should never be employed in a Pleurisy, while the Vessels are full, the Pulse hard, the Fever high, and the Blood inflamed. In all such Circumstances it must aggravate the Disease; but towards the Conclusion of it, when the Vessels are considerably emptied, the Blood is diluted, and the Fever abated, it may then be recurred to; but with a constant Recollection that it is hot, and not to be employed without Reflection and Prudence.26
Chapter V.Of the Pleurisy.Sect.89.The Pleurisy, which is chiefly known by these four Symptoms, a strong Fever, a Difficulty of Breathing, a Cough, and an acute Pain about the Breast; the Pleurisy, I say, is not a different Malady from the Peripneumony, or Inflammation of the Breast, the Subject of the preceding Chapter; so that I have very little to say of it, particularly, or apart.§ 90. The Cause of this Disease then is exactly the same with that of the former, that is, an Inflammation of the Lungs; but an Inflammation, that seems rather a little more external. The only considerable Difference in the Symptoms is, that the Pleurisy is accompanied with a most acute Pain under the Ribs, and which is commonly termed aStitch. This Pain is felt indifferently over every Part of the Breast; though more commonly about the Sides, under the more fleshy Parts of the Breast, and oftenest on the right Side. The Pain is greatly increased whenever the Patient coughs or draws in the Air in breathing; and hence a Fear of increasing it,by making some Patients forbear to cough or respire, as much as they possibly can; and that aggravates the Disease, by stopping the Course of the Blood in the Lungs, which are soon overcharged with it. Hence the Inflammation of this Bowel becomes general; the Blood mounts up to the Head; the Countenance looks deeply red, or as it were livid; the Patient becomes nearly suffocated, and falls into the State described§ 47.Sometimes the Pain is so extremely violent, that if the Cough is very urgent at the same Time, and the Sick cannot suppress or restrain it, they are seized with Convulsions, of which I have seen many Instances, but these occur almost always to Women; though they are much less subject than Men to this Disease, and indeed to all inflammatory ones. It may be proper however to observe here, that if Women should be attacked with it, during their monthly Discharges, that Circumstance should not prevent the repeated and necessary Bleedings, nor occasion any Alteration in the Treatment of the Disease. And hence it appears, that the Pleurisy is really an Inflammation of the Lungs, accompanied with acute Pain.§ 91. I am sensible that sometimes an Inflammation of the Lungs is communicated also to that Membrane, which lines the Inside of the Breast; and which is called thePleura; and from thence to the Muscles, the fleshy Parts, over and betweenthe Ribs. This however is not very frequently the Case.§ 92. Spring is commonly the Season most productive of Pleurisies: in general there are few in Summer: notwithstanding that in the Year 1762, there were a great many during the hottest Season, which then was excessively so. The Disease usually begins with a violent Shivering, succeeded by considerable Heat, with a Cough, an Oppression, and sometimes with a sensible Straitning, or Contraction, as it were, all over the Breast; and also with a Head-ach, a Redness of the Cheeks, and with Reachings to vomit. The Stitch does not always happen at the very first Onset; often not 'till after several Hours from the first Complaint; sometimes not before the second, or even the third Day. Sometimes the Patient feels two Stitches, in different Parts of the Side; though it seldom happens that they are equally sharp, and the lightest soon ceases. Sometimes also the Stitch shifts its Place, which promises well, if the Part first attacked by it continues perfectly free from Pain: but it has a bad Appearance, if, while the first is present, another also supervenes, and both continue. The Pulse is usually very hard in this Distemper; but in the dreadful Cases described§ 47and90, it becomes soft and small. There often occur at, or very quickly after, the Invasion, such an Expectoration, or hawking up, as happens in an Inflammation of the Breast; at other Times there is not theleast Appearance of it, whence such are named dry Pleurisies, which happen pretty often. Sometimes the Sick cough but little, or not at all. They often lie more at Ease upon the Side affected, than on the sound one. The Progress of this Disease advances exactly like that described in the preceding Chapter: for how can they differ considerably? and the Treatment of both is the same. Large Hæmorrhages, or Bleedings from the Nose, frequently happen, to the great Relief of the Patient; but sometimes such Discharges consist of a kind of corrupted Blood, when the Patient is very ill, and these portend Death.§ 93. This Distemper is often produced by drinking cold Water, while a Person is hot; from which Cause it is sometimes so violent, as to kill the Patient in three Hours. A young Man was found dead at the Side of the Spring, from which he had quenched his Thirst: neither indeed is it uncommon for Pleurisies to prove mortal within three Days.Sometimes the Stitch disappears, whence the Patient complains less; but at the same Time his Countenance changes; he grows pale and sad; his Eyes look dull and heavy, and his Pulse grows feeble. This signifies a Translation of the Disease to the Brain, a Case which is almost constantly fatal.There is no Disease in which the critical Symptoms are more violent, and more strongly marked, than in this. It is proper this shouldbe known, as it may prevent or lessen our excessive Terror. A perfect Cure supervenes sometimes, at the very Moment when Death was expected.§ 94. This Malady is one of the most common and the most destroying kind, as well from its own violent Nature, as through the pernicious Treatment of it in Country Places. That Prejudice, which insists on curing all Diseases by Sweating, entirely regulates their Conduct in treating a Pleurisy; and as soon as a Person is afflicted with a Stitch, all the hot Medicines are immediately set to Work. This mortal Error destroys more People than Gunpowder; and it is by so much the more hurtful, as the Distemper is of the most violent kind; and because, as there is commonly not a Moment to be lost, the whole depends on the Method immediately recurred to.§ 95. The proper Manner of treating this Disease, is exactly the same in all Respects, with that of the Peripneumony; because, I again affirm, it is the very same Disease. Hence the Bleedings, the softening and diluting Drinks, the Steams, the Glysters, the PotionNº. 8, and the emollient Poultices are the real Remedies. These last perhaps are still more effectual in the Pleurisy; and therefore they should be continually applied over the very Stitch.The first Bleeding, especially if there has been a considerable Discharge, almost constantly abates the Stitch, and often entirely removes it: thoughit more commonly returns, after an Intermission of some Hours, either in the same Spot, or sometimes in another. This shifting of it is rather favourable, especially if the Pain, that was first felt under the Breast, shifts into the Shoulders, to the Back, the Shoulder-blade, or the Nape of the Neck.When the Stitch is not at all abated, or only a little; or if, after having abated, it returns as violently as at first, and especially if it returns in the same Spot, and the Height of the other Symptoms continue, Bleeding must be repeated. But if a sensible Abatement of the Stitch continues; and if, though it returns, it should be in a smaller Degree, and by Intervals, or in these Places I have mentioned above; if the Quickness, or the Hardness of the Pulse, and all the other Symptoms are sensibly diminished, this repeated Bleeding may sometimes be omitted. Nevertheless, in a very strong Subject, it seems rather prudent not to omit it, since in such Circumstances it can do no Mischief; and a considerable Hazard may sometimes be incurred by the Omission. In very high and dangerous Pleurisies a frequent Repetition of bleeding is necessary; except some Impediment to it should arise from the particular Constitution of the Patient, or from his Age, or some other Circumstances.If, from the Beginning of the Disease, the Pulse is but a little quicker and harder than in a healthy State; if it is not manifestly strong; if the Head-ach and the Stitch are so moderate asto prove supportable; if the Cough is not too violent; if there is no sensible Oppression or Straitness, and the Patient expectorate, or cough up, Bleeding may be omitted.With Respect to the administering of other Remedies, the same Directions are to be exactly followed, which have been already given in the preceding Chapter, to which the Reader is referred from§ 53to66.§ 96. When the Disease is not very acute and pressing, I have often cured it in a very few Days by a single Bleeding, and a large Quantity of a Tea or Infusion of Elder-flowers, sweetened with Honey. It is in some Cases of this kind, that we often find the WaterFaltrancsucceed, with the Addition of some Honey, and even of Oil: though the Drink I have just directed is considerably preferable. That Drink which is compounded of equal Quantities of Wine and Water, with the Addition of much Venice Treacle, annually destroys a great Number of People in the Country.§ 97. In those dry Pleurisies, in which the Stitch, the Fever, and the Head-ach are strong and violent; and where the Pulse is very hard and very full, with an excessive Dryness of the Skin and of the Tongue, Bleeding should be frequently repeated, and at small Intervals from each other. This Method frequently cures the Disease effectually, without using any other Evacuation.§ 98. The Pleurisy terminates, like any other inward Inflammation, either by some Evacuation; by an Abscess; in a Mortification; or in a Scirrhosity or hard Tumour; and it often leaves Adhesions in the Breast.The Gangrene or Mortification sometimes appears on the third Day, without having been preceded by very vehement Pains. In such Cases the dead Body often looks very black, especially in the Parts near the Seat of the Disease: and in such the more superstitious ascribe it to some supernatural Cause; or draw some unhappy Presage from it, with Respect to those who are yet unattacked by it. This Appearance however is purely a natural Consequence, quite simple, and cannot be otherwise; and the hot Regimen and Medicines are the most prevailing Causes of it. I have seen it thus circumstanced in a Man in the Flower of his Age, who had taken Venice Treacle in Cherry Water, and the Ingredients ofFaltrancinfused in Wine.§ 99.Vomicasare sometimes the Consequences of Pleurisies; but their particular Situation disposes them more to break22outwardly; which is the most frequent Cause of anEmpyema§ 84. “To prevent this, it is highly proper to apply, at the first Invasion of the Disease, to the Spot where the Pain chiefly rages, a small Plaister, which may exactly fit it; since if the Pleurisy should terminate in an Abscess or Imposthume,the purulent Matter will be determined to that Side.“As soon then as it is foreseen that an Abscess is forming (see§ 68) we should erode, by a light Caustic, the Place where it is expected; and as soon as it is removed, Care should be taken to promote Suppuration there. By this Means we may entertain a reasonable Hope, that the Mass of Matter will incline its Course to that Spot, where it will meet with the least Resistance, and be discharged from thence. For this Heap of Matter is often accumulated between thePleura, and the Parts which adhere to it.”This is the Advice of a very23great Physician; but I must inform the Reader, there are many Cases, in which it can be of no Service; neither ought it to be attempted, but by Persons of undoubted Abilities.With Regard to the Scirrhosity, or Hardness, and to the Circumstances of Adhesions, I can add nothing to what I have said in§ 86and87.§ 100. It has been observed that some Persons, who have been once attacked by this Disease, are often liable to Relapses of it, especially such as drink hard. I knew one Man, who reckoned up his Pleurisies by Dozens. A few Bleedings, at certain proper Intervals, might prevent these frequent Returns of it; which, joinedto their excessive Drinking, make them languid and stupid, in the very Flower of their Age. They generally fall into some Species of an Asthma, and from that into a Dropsy, which proves the melancholy, though not an improper, Conclusion of their Lives. Such as can confine themselves to some proper Precautions, may also prevent these frequent Returns of this Disease, even without bleeding; by a temperate Regimen; by abstaining from Time to Time, from eating Flesh and drinking Wine; at which Times they should drink Whey,or some of those Diet-DrinksNº. 1,2,4; and by bathing their Legs sometimes in warm Water; especially in those Seasons, when this Disease is the most likely to return.§ 101. Two Medicines greatly esteemed in this Disease among the Peasantry, and even extolled by some Physicians, are the Blood of a wild He Goat, and the24Soot in an Egg. I do not contest the Cure or Recovery of many Persons, who have taken these Remedies; notwithstanding it is not less true, that both of them, as well as the Egg in which the Soot is taken, are dangerous: For which Reason it is prudent, at least, never to make use of them; as there is great Probability, they may do a little Mischief; and a Certainty that they can do no Good. TheGenipi, or25Wormwood of the Alps, has also acquired great Reputation in this Disease, and occasioned many Disputes between some very zealous Ecclesiastics, and a justly celebrated Physician. It seems not difficult however to ascertain the proper Use of it. This Plant is a powerful Bitter; it heats and excites Sweat: it seems clear, that, from such Consequences, it should never be employed in a Pleurisy, while the Vessels are full, the Pulse hard, the Fever high, and the Blood inflamed. In all such Circumstances it must aggravate the Disease; but towards the Conclusion of it, when the Vessels are considerably emptied, the Blood is diluted, and the Fever abated, it may then be recurred to; but with a constant Recollection that it is hot, and not to be employed without Reflection and Prudence.26
Of the Pleurisy.
Sect.89.
Sect.89.
The Pleurisy, which is chiefly known by these four Symptoms, a strong Fever, a Difficulty of Breathing, a Cough, and an acute Pain about the Breast; the Pleurisy, I say, is not a different Malady from the Peripneumony, or Inflammation of the Breast, the Subject of the preceding Chapter; so that I have very little to say of it, particularly, or apart.
§ 90. The Cause of this Disease then is exactly the same with that of the former, that is, an Inflammation of the Lungs; but an Inflammation, that seems rather a little more external. The only considerable Difference in the Symptoms is, that the Pleurisy is accompanied with a most acute Pain under the Ribs, and which is commonly termed aStitch. This Pain is felt indifferently over every Part of the Breast; though more commonly about the Sides, under the more fleshy Parts of the Breast, and oftenest on the right Side. The Pain is greatly increased whenever the Patient coughs or draws in the Air in breathing; and hence a Fear of increasing it,by making some Patients forbear to cough or respire, as much as they possibly can; and that aggravates the Disease, by stopping the Course of the Blood in the Lungs, which are soon overcharged with it. Hence the Inflammation of this Bowel becomes general; the Blood mounts up to the Head; the Countenance looks deeply red, or as it were livid; the Patient becomes nearly suffocated, and falls into the State described§ 47.
Sometimes the Pain is so extremely violent, that if the Cough is very urgent at the same Time, and the Sick cannot suppress or restrain it, they are seized with Convulsions, of which I have seen many Instances, but these occur almost always to Women; though they are much less subject than Men to this Disease, and indeed to all inflammatory ones. It may be proper however to observe here, that if Women should be attacked with it, during their monthly Discharges, that Circumstance should not prevent the repeated and necessary Bleedings, nor occasion any Alteration in the Treatment of the Disease. And hence it appears, that the Pleurisy is really an Inflammation of the Lungs, accompanied with acute Pain.
§ 91. I am sensible that sometimes an Inflammation of the Lungs is communicated also to that Membrane, which lines the Inside of the Breast; and which is called thePleura; and from thence to the Muscles, the fleshy Parts, over and betweenthe Ribs. This however is not very frequently the Case.
§ 92. Spring is commonly the Season most productive of Pleurisies: in general there are few in Summer: notwithstanding that in the Year 1762, there were a great many during the hottest Season, which then was excessively so. The Disease usually begins with a violent Shivering, succeeded by considerable Heat, with a Cough, an Oppression, and sometimes with a sensible Straitning, or Contraction, as it were, all over the Breast; and also with a Head-ach, a Redness of the Cheeks, and with Reachings to vomit. The Stitch does not always happen at the very first Onset; often not 'till after several Hours from the first Complaint; sometimes not before the second, or even the third Day. Sometimes the Patient feels two Stitches, in different Parts of the Side; though it seldom happens that they are equally sharp, and the lightest soon ceases. Sometimes also the Stitch shifts its Place, which promises well, if the Part first attacked by it continues perfectly free from Pain: but it has a bad Appearance, if, while the first is present, another also supervenes, and both continue. The Pulse is usually very hard in this Distemper; but in the dreadful Cases described§ 47and90, it becomes soft and small. There often occur at, or very quickly after, the Invasion, such an Expectoration, or hawking up, as happens in an Inflammation of the Breast; at other Times there is not theleast Appearance of it, whence such are named dry Pleurisies, which happen pretty often. Sometimes the Sick cough but little, or not at all. They often lie more at Ease upon the Side affected, than on the sound one. The Progress of this Disease advances exactly like that described in the preceding Chapter: for how can they differ considerably? and the Treatment of both is the same. Large Hæmorrhages, or Bleedings from the Nose, frequently happen, to the great Relief of the Patient; but sometimes such Discharges consist of a kind of corrupted Blood, when the Patient is very ill, and these portend Death.
§ 93. This Distemper is often produced by drinking cold Water, while a Person is hot; from which Cause it is sometimes so violent, as to kill the Patient in three Hours. A young Man was found dead at the Side of the Spring, from which he had quenched his Thirst: neither indeed is it uncommon for Pleurisies to prove mortal within three Days.
Sometimes the Stitch disappears, whence the Patient complains less; but at the same Time his Countenance changes; he grows pale and sad; his Eyes look dull and heavy, and his Pulse grows feeble. This signifies a Translation of the Disease to the Brain, a Case which is almost constantly fatal.
There is no Disease in which the critical Symptoms are more violent, and more strongly marked, than in this. It is proper this shouldbe known, as it may prevent or lessen our excessive Terror. A perfect Cure supervenes sometimes, at the very Moment when Death was expected.
§ 94. This Malady is one of the most common and the most destroying kind, as well from its own violent Nature, as through the pernicious Treatment of it in Country Places. That Prejudice, which insists on curing all Diseases by Sweating, entirely regulates their Conduct in treating a Pleurisy; and as soon as a Person is afflicted with a Stitch, all the hot Medicines are immediately set to Work. This mortal Error destroys more People than Gunpowder; and it is by so much the more hurtful, as the Distemper is of the most violent kind; and because, as there is commonly not a Moment to be lost, the whole depends on the Method immediately recurred to.
§ 95. The proper Manner of treating this Disease, is exactly the same in all Respects, with that of the Peripneumony; because, I again affirm, it is the very same Disease. Hence the Bleedings, the softening and diluting Drinks, the Steams, the Glysters, the PotionNº. 8, and the emollient Poultices are the real Remedies. These last perhaps are still more effectual in the Pleurisy; and therefore they should be continually applied over the very Stitch.
The first Bleeding, especially if there has been a considerable Discharge, almost constantly abates the Stitch, and often entirely removes it: thoughit more commonly returns, after an Intermission of some Hours, either in the same Spot, or sometimes in another. This shifting of it is rather favourable, especially if the Pain, that was first felt under the Breast, shifts into the Shoulders, to the Back, the Shoulder-blade, or the Nape of the Neck.
When the Stitch is not at all abated, or only a little; or if, after having abated, it returns as violently as at first, and especially if it returns in the same Spot, and the Height of the other Symptoms continue, Bleeding must be repeated. But if a sensible Abatement of the Stitch continues; and if, though it returns, it should be in a smaller Degree, and by Intervals, or in these Places I have mentioned above; if the Quickness, or the Hardness of the Pulse, and all the other Symptoms are sensibly diminished, this repeated Bleeding may sometimes be omitted. Nevertheless, in a very strong Subject, it seems rather prudent not to omit it, since in such Circumstances it can do no Mischief; and a considerable Hazard may sometimes be incurred by the Omission. In very high and dangerous Pleurisies a frequent Repetition of bleeding is necessary; except some Impediment to it should arise from the particular Constitution of the Patient, or from his Age, or some other Circumstances.
If, from the Beginning of the Disease, the Pulse is but a little quicker and harder than in a healthy State; if it is not manifestly strong; if the Head-ach and the Stitch are so moderate asto prove supportable; if the Cough is not too violent; if there is no sensible Oppression or Straitness, and the Patient expectorate, or cough up, Bleeding may be omitted.
With Respect to the administering of other Remedies, the same Directions are to be exactly followed, which have been already given in the preceding Chapter, to which the Reader is referred from§ 53to66.
§ 96. When the Disease is not very acute and pressing, I have often cured it in a very few Days by a single Bleeding, and a large Quantity of a Tea or Infusion of Elder-flowers, sweetened with Honey. It is in some Cases of this kind, that we often find the WaterFaltrancsucceed, with the Addition of some Honey, and even of Oil: though the Drink I have just directed is considerably preferable. That Drink which is compounded of equal Quantities of Wine and Water, with the Addition of much Venice Treacle, annually destroys a great Number of People in the Country.
§ 97. In those dry Pleurisies, in which the Stitch, the Fever, and the Head-ach are strong and violent; and where the Pulse is very hard and very full, with an excessive Dryness of the Skin and of the Tongue, Bleeding should be frequently repeated, and at small Intervals from each other. This Method frequently cures the Disease effectually, without using any other Evacuation.
§ 98. The Pleurisy terminates, like any other inward Inflammation, either by some Evacuation; by an Abscess; in a Mortification; or in a Scirrhosity or hard Tumour; and it often leaves Adhesions in the Breast.
The Gangrene or Mortification sometimes appears on the third Day, without having been preceded by very vehement Pains. In such Cases the dead Body often looks very black, especially in the Parts near the Seat of the Disease: and in such the more superstitious ascribe it to some supernatural Cause; or draw some unhappy Presage from it, with Respect to those who are yet unattacked by it. This Appearance however is purely a natural Consequence, quite simple, and cannot be otherwise; and the hot Regimen and Medicines are the most prevailing Causes of it. I have seen it thus circumstanced in a Man in the Flower of his Age, who had taken Venice Treacle in Cherry Water, and the Ingredients ofFaltrancinfused in Wine.
§ 99.Vomicasare sometimes the Consequences of Pleurisies; but their particular Situation disposes them more to break22outwardly; which is the most frequent Cause of anEmpyema§ 84. “To prevent this, it is highly proper to apply, at the first Invasion of the Disease, to the Spot where the Pain chiefly rages, a small Plaister, which may exactly fit it; since if the Pleurisy should terminate in an Abscess or Imposthume,the purulent Matter will be determined to that Side.
“As soon then as it is foreseen that an Abscess is forming (see§ 68) we should erode, by a light Caustic, the Place where it is expected; and as soon as it is removed, Care should be taken to promote Suppuration there. By this Means we may entertain a reasonable Hope, that the Mass of Matter will incline its Course to that Spot, where it will meet with the least Resistance, and be discharged from thence. For this Heap of Matter is often accumulated between thePleura, and the Parts which adhere to it.”
This is the Advice of a very23great Physician; but I must inform the Reader, there are many Cases, in which it can be of no Service; neither ought it to be attempted, but by Persons of undoubted Abilities.
With Regard to the Scirrhosity, or Hardness, and to the Circumstances of Adhesions, I can add nothing to what I have said in§ 86and87.
§ 100. It has been observed that some Persons, who have been once attacked by this Disease, are often liable to Relapses of it, especially such as drink hard. I knew one Man, who reckoned up his Pleurisies by Dozens. A few Bleedings, at certain proper Intervals, might prevent these frequent Returns of it; which, joinedto their excessive Drinking, make them languid and stupid, in the very Flower of their Age. They generally fall into some Species of an Asthma, and from that into a Dropsy, which proves the melancholy, though not an improper, Conclusion of their Lives. Such as can confine themselves to some proper Precautions, may also prevent these frequent Returns of this Disease, even without bleeding; by a temperate Regimen; by abstaining from Time to Time, from eating Flesh and drinking Wine; at which Times they should drink Whey,or some of those Diet-DrinksNº. 1,2,4; and by bathing their Legs sometimes in warm Water; especially in those Seasons, when this Disease is the most likely to return.
§ 101. Two Medicines greatly esteemed in this Disease among the Peasantry, and even extolled by some Physicians, are the Blood of a wild He Goat, and the24Soot in an Egg. I do not contest the Cure or Recovery of many Persons, who have taken these Remedies; notwithstanding it is not less true, that both of them, as well as the Egg in which the Soot is taken, are dangerous: For which Reason it is prudent, at least, never to make use of them; as there is great Probability, they may do a little Mischief; and a Certainty that they can do no Good. TheGenipi, or25Wormwood of the Alps, has also acquired great Reputation in this Disease, and occasioned many Disputes between some very zealous Ecclesiastics, and a justly celebrated Physician. It seems not difficult however to ascertain the proper Use of it. This Plant is a powerful Bitter; it heats and excites Sweat: it seems clear, that, from such Consequences, it should never be employed in a Pleurisy, while the Vessels are full, the Pulse hard, the Fever high, and the Blood inflamed. In all such Circumstances it must aggravate the Disease; but towards the Conclusion of it, when the Vessels are considerably emptied, the Blood is diluted, and the Fever abated, it may then be recurred to; but with a constant Recollection that it is hot, and not to be employed without Reflection and Prudence.26