Chapter XX.

Chapter XX.Of spurious, or false Inflammations of the Breast, and of spurious, bilious, Pleurisies.Sect.285.The Inflammation of the Breast and that Pleurisy, which is calledbilious, are the same Disease. It is properly a putrid Fever, attended with an Infarction or Stuffing of the Lungs, though without Pain; in which Circumstance it is called a putrid or bilious Peripneumony: but when attended with a Pain of the Side, a Stitch, it is called a spurious or bastard Pleurisy.§ 286. The Signs which distinguish these Diseases from the inflammatory ones of the same Name, described Chap. IV and V, are a less hard and less strong, but a quicker Pulse, though unaccompanied with the same Symptoms which constitute the inflammatory ones (See§ 47and90). The Mouth is foul, and has a Sensation of Bitterness; the Patient is infested with a sharp and dry Heat; he has a Feeling of Heaviness and Anxiety all about his Stomach, with Loathings: he is less flushed and red in these, than in the inflammatory Diseases, but rather a little yellow. He has a dejected wan Look; his Urineresembles that in putrid Fevers, and not that of inflammatory ones; and he has very often a small bilious Looseness, which is extremely offensive. The Skin is commonly very dry in this Disease; the Humour spit up is less thick, less reddish, and rather more yellow than in the inflammatory Diseases of the same Names.§ 287. They must be treated after the manner of putrid Fevers, as in§ 241. Supposing some little Degree of Inflammation to be combined with the Disease, it may be removed by a single Bleeding. After this the Patient is to drink Barley WaterNº. 3, to make Use of Glysters; and as soon as all Symptoms of any Inflammation wholly disappear, he is to take the vomiting and purging DraughtNº. 34. But the utmost Caution must be taken not to give it, before every Appearance of any Inflammation is totally removed; as giving it sooner would be certain Death to the Sick: and it is dreadful but to think of agitating, by a Vomit, Lungs that are inflamed, and overloaded with Blood, whose Vessels burst and discharge themselves, only from the Force of Expectoration. After an Interval of some Days, he may be purged again with the MedicineNº. 23. The PrescriptionNº. 25succeeds also very well as a Vomit. If the Fever is violent, he must drink plentifully of the PotionNº. 10.Blisters to the Legs are very serviceable, when the Load and Oppression are not considerably abated after general Evacuations.§ 288. The false Inflammation of the Breast is an Overfulness or Obstruction in the Lungs, accompanied with a Fever; and it is caused by extremely thick and tenacious Humours; and not by a really inflammatory Blood, or by any putrid or bilious Humour.§ 289. This Distemper happens more frequently in the Spring, than in any other Season. Old Men, puny, ill-constitutioned Children, languid Women, feeble young Men, and particularly such as have worn their Constitutions out by drinking, are the Subjects most frequently attacked by it; especially if they have used but little Exercise throughout the Winter: if they have fed on viscid, mealy and fat Aliments, as Pastry, Chesnuts, thick Milk or Pap, and Cheese. All their Humours have contracted a thick glutinous Quality; they are circulated with Difficulty, and when Heat or Exercise in the Spring increases their Motion at once, the Humours, already stuffing up the Lungs, still more augment that Plenitude, whence these vital Organs are fatally extended, and the Patient dies.§ 290. This Distemper is known to exist,1, By the previous Existence of the Causes already mentioned.2, By the Symptoms which precede and usher it in. For Example, the Patient many Days before-hand has a slight Cough; a small Oppression when he moves about; a little Restlessness, and is sometimes a little choleric or fretful. His Countenance is higher coloured than in Health;he has a Propensity to sleep, but attended with Confusion and without Refreshment, and has sometimes an extraordinary Appetite.3, When this State has continued for some Days, there comes on a cold Shivering, though more considerable for its Duration than its Violence; it is succeeded by a moderate Degree of Heat, but that attended with much Inquietude and Oppression. The sick Person cannot confine himself to the Bed; but walks to and fro in his Chamber, and is greatly dejected. The Pulse is weak and pretty quick; the Urine is sometimes but little changed from that in Health; at other Times it is discharged but in a small Quantity, and is higher coloured: he coughs but moderately, and does not expectorate, or cough up, but with Difficulty. The Visage becomes very red, and even almost livid; he can neither keep awake, nor sleep well; he raves for some Moments, and then his Head grows clear again. Sometimes it happens, especially to Persons of advanced Age, that this State suddenly terminates in a mortal Swoon or Fainting: at other Times and in other Cases, the Oppression and Anguish increase; the Patient cannot breathe but when sitting up, and that with great Difficulty and Agony: the Brain is utterly disturbed and embarrassed; this State lasts for some Hours, and then terminates of a sudden.§ 291. This is a very dangerous Distemper; because, in the first Place, it chiefly attacks those Persons whose Temperament and Constitutionare deprived of the ordinary Resources for Health and Recovery: in the second Place, because it is of a precipitate Nature, the Patient sometimes dying on the third Day, and but seldom surviving the seventh; while the Cause of it requires a more considerable Term for its Removal or Mitigation. Besides which, if some Indications present for the Employment of a Remedy, there are frequently others which forbid it; and all that seems to be done is, as follows;1, If the Patient has still a pretty good Share of Health; if he is not of too advanced an Age; if the Pulse has a perceivable Hardness, and yet at the same Time some Strength; if the Weather is dry, and the Wind blows from the North, he should be bled once, to a moderate Quantity. But if the greater Part of these Circumstances are wanting, Bleeding would be very prejudicial. Were we obliged to establish some general and positive Rule in this Case, it were better to exclude Bleeding, than to admit it.2, The Stomach and the Bowels should be unloaded from their viscid glutinous Contents; and the Medicines which succeed the best in this Respect areNº. 35, when the Symptoms shew there is a great Necessity for vomiting, and there is no Inflammation; or the PrescriptionNº. 25, which after vomiting, purges by Stool, promotes Urine, breaks down and divides the viscid Humours that occasion the Disease, and increase Perspiration. When we are afraid of hazarding the Agitation of a Vomit and its Consequences,the Potion,Nº. 11may be given; but we must be very cautious, in Regard to old Men, even with this; as such may expire during the Operation of it.3, They should, from the Beginning of the Disease, drink plentifully of the PtisanNº. 26, which is the best Drink in this Disease; or that ofNº. 12, adding half a Dram of Nitre to every Pint of it.4, A Cup of the MixtureNº. 8must be taken every two Hours.5. Blisters are to be applied to the Insides of the Legs.When the Case is verydoubtfuland perplexing, it were best to confine ourselves to the three last-mentioned Remedies, which have often been successful in severe Degrees of this Disease; and which can occasion no ill Consequence.§ 292. When this Malady invades old People, though they partly recover, they never recover perfectly, entirely, from it: and if due Precaution is not taken, they are very liable to fall into a Dropsy of the Breast after it.§ 293. The spurious or false Pleurisy is a Distemper that does not affect the Lungs, but only the Teguments, the Skin, and the Muscles which cover the Ribs. It is the Effect of a rheumatic Humour thrown upon these Parts, in which, as it produces very sharp Pains resembling that which is called aStitch, it has from this Circumstance, been termed a Pleurisy.It is generally supposed by the meer Multitude, and even by some of a different Rank, that a false Pleurisy is more dangerous than a genuine, a true one; but this is a Mistake. It is often ushered in by a Shivering, and almost ever attended with a little Fever, a small Cough, and a slight Difficulty of breathing; which, as well as the Cough, is occasioned from the Circumstance of a Patient's (who feels Pain in Respiration, or Breathing) checking Breathing as much as he can; this accumulates a little too much Blood in the Lungs; but yet he has no Anguish, nor the other Symptoms of acute true Pleurisies. In some Patients this Pain is extended, almost over the whole Breast, and to the Nape of the Neck. The sick Person cannot repose himself on the Side affected.This Disorder is not more dangerous than a Rheumatism, except in two Cases; 1, When the Pain is so very severe, that the Patient strongly endeavours not to breathe at all, which brings on a great Infarction or Stoppage in the Lungs. 2, When this Humour, like any other rheumatic one, is transferred to some internal Part.§ 294. It must be treated exactly like a Rheumatism. See§ 168and169.After bleeding once or more, a Blister applied to the affected Part is often attended with a very good Effect: This being indeed the Kind of73Pleurisy, in which it particularly agrees.§ 295. This Malady sometimes gives Way to the first Bleeding; often terminating on the third, fourth or fifth Day, by a very plentiful Sweat, and rarely lasting beyond the seventh. Sometimes it attacks a Person very suddenly, after a Stoppage of Perspiration; and then, if at once before the Fever commences, and has had Time to inflame the Blood, the Patient takes someFaltrank, it effects a speedy Cure by restoring Perspiration. They are such Cases as these, or that mentioned§ 96, which have given this Composition the Reputation it has obtained in this Disease: a Reputation nevertheless, which has every Year proved tragical in its Consequences to many Peasants, who being deceived by some misleading Resemblances in this Distemper, have rashly and ignorantly made Use of it in true inflammatory Pleurisies.****

Of spurious, or false Inflammations of the Breast, and of spurious, bilious, Pleurisies.

Sect.285.

The Inflammation of the Breast and that Pleurisy, which is calledbilious, are the same Disease. It is properly a putrid Fever, attended with an Infarction or Stuffing of the Lungs, though without Pain; in which Circumstance it is called a putrid or bilious Peripneumony: but when attended with a Pain of the Side, a Stitch, it is called a spurious or bastard Pleurisy.

§ 286. The Signs which distinguish these Diseases from the inflammatory ones of the same Name, described Chap. IV and V, are a less hard and less strong, but a quicker Pulse, though unaccompanied with the same Symptoms which constitute the inflammatory ones (See§ 47and90). The Mouth is foul, and has a Sensation of Bitterness; the Patient is infested with a sharp and dry Heat; he has a Feeling of Heaviness and Anxiety all about his Stomach, with Loathings: he is less flushed and red in these, than in the inflammatory Diseases, but rather a little yellow. He has a dejected wan Look; his Urineresembles that in putrid Fevers, and not that of inflammatory ones; and he has very often a small bilious Looseness, which is extremely offensive. The Skin is commonly very dry in this Disease; the Humour spit up is less thick, less reddish, and rather more yellow than in the inflammatory Diseases of the same Names.

§ 287. They must be treated after the manner of putrid Fevers, as in§ 241. Supposing some little Degree of Inflammation to be combined with the Disease, it may be removed by a single Bleeding. After this the Patient is to drink Barley WaterNº. 3, to make Use of Glysters; and as soon as all Symptoms of any Inflammation wholly disappear, he is to take the vomiting and purging DraughtNº. 34. But the utmost Caution must be taken not to give it, before every Appearance of any Inflammation is totally removed; as giving it sooner would be certain Death to the Sick: and it is dreadful but to think of agitating, by a Vomit, Lungs that are inflamed, and overloaded with Blood, whose Vessels burst and discharge themselves, only from the Force of Expectoration. After an Interval of some Days, he may be purged again with the MedicineNº. 23. The PrescriptionNº. 25succeeds also very well as a Vomit. If the Fever is violent, he must drink plentifully of the PotionNº. 10.

Blisters to the Legs are very serviceable, when the Load and Oppression are not considerably abated after general Evacuations.

§ 288. The false Inflammation of the Breast is an Overfulness or Obstruction in the Lungs, accompanied with a Fever; and it is caused by extremely thick and tenacious Humours; and not by a really inflammatory Blood, or by any putrid or bilious Humour.

§ 289. This Distemper happens more frequently in the Spring, than in any other Season. Old Men, puny, ill-constitutioned Children, languid Women, feeble young Men, and particularly such as have worn their Constitutions out by drinking, are the Subjects most frequently attacked by it; especially if they have used but little Exercise throughout the Winter: if they have fed on viscid, mealy and fat Aliments, as Pastry, Chesnuts, thick Milk or Pap, and Cheese. All their Humours have contracted a thick glutinous Quality; they are circulated with Difficulty, and when Heat or Exercise in the Spring increases their Motion at once, the Humours, already stuffing up the Lungs, still more augment that Plenitude, whence these vital Organs are fatally extended, and the Patient dies.

§ 290. This Distemper is known to exist,

1, By the previous Existence of the Causes already mentioned.

2, By the Symptoms which precede and usher it in. For Example, the Patient many Days before-hand has a slight Cough; a small Oppression when he moves about; a little Restlessness, and is sometimes a little choleric or fretful. His Countenance is higher coloured than in Health;he has a Propensity to sleep, but attended with Confusion and without Refreshment, and has sometimes an extraordinary Appetite.

3, When this State has continued for some Days, there comes on a cold Shivering, though more considerable for its Duration than its Violence; it is succeeded by a moderate Degree of Heat, but that attended with much Inquietude and Oppression. The sick Person cannot confine himself to the Bed; but walks to and fro in his Chamber, and is greatly dejected. The Pulse is weak and pretty quick; the Urine is sometimes but little changed from that in Health; at other Times it is discharged but in a small Quantity, and is higher coloured: he coughs but moderately, and does not expectorate, or cough up, but with Difficulty. The Visage becomes very red, and even almost livid; he can neither keep awake, nor sleep well; he raves for some Moments, and then his Head grows clear again. Sometimes it happens, especially to Persons of advanced Age, that this State suddenly terminates in a mortal Swoon or Fainting: at other Times and in other Cases, the Oppression and Anguish increase; the Patient cannot breathe but when sitting up, and that with great Difficulty and Agony: the Brain is utterly disturbed and embarrassed; this State lasts for some Hours, and then terminates of a sudden.

§ 291. This is a very dangerous Distemper; because, in the first Place, it chiefly attacks those Persons whose Temperament and Constitutionare deprived of the ordinary Resources for Health and Recovery: in the second Place, because it is of a precipitate Nature, the Patient sometimes dying on the third Day, and but seldom surviving the seventh; while the Cause of it requires a more considerable Term for its Removal or Mitigation. Besides which, if some Indications present for the Employment of a Remedy, there are frequently others which forbid it; and all that seems to be done is, as follows;

1, If the Patient has still a pretty good Share of Health; if he is not of too advanced an Age; if the Pulse has a perceivable Hardness, and yet at the same Time some Strength; if the Weather is dry, and the Wind blows from the North, he should be bled once, to a moderate Quantity. But if the greater Part of these Circumstances are wanting, Bleeding would be very prejudicial. Were we obliged to establish some general and positive Rule in this Case, it were better to exclude Bleeding, than to admit it.

2, The Stomach and the Bowels should be unloaded from their viscid glutinous Contents; and the Medicines which succeed the best in this Respect areNº. 35, when the Symptoms shew there is a great Necessity for vomiting, and there is no Inflammation; or the PrescriptionNº. 25, which after vomiting, purges by Stool, promotes Urine, breaks down and divides the viscid Humours that occasion the Disease, and increase Perspiration. When we are afraid of hazarding the Agitation of a Vomit and its Consequences,the Potion,Nº. 11may be given; but we must be very cautious, in Regard to old Men, even with this; as such may expire during the Operation of it.

3, They should, from the Beginning of the Disease, drink plentifully of the PtisanNº. 26, which is the best Drink in this Disease; or that ofNº. 12, adding half a Dram of Nitre to every Pint of it.

4, A Cup of the MixtureNº. 8must be taken every two Hours.

5. Blisters are to be applied to the Insides of the Legs.

When the Case is verydoubtfuland perplexing, it were best to confine ourselves to the three last-mentioned Remedies, which have often been successful in severe Degrees of this Disease; and which can occasion no ill Consequence.

§ 292. When this Malady invades old People, though they partly recover, they never recover perfectly, entirely, from it: and if due Precaution is not taken, they are very liable to fall into a Dropsy of the Breast after it.

§ 293. The spurious or false Pleurisy is a Distemper that does not affect the Lungs, but only the Teguments, the Skin, and the Muscles which cover the Ribs. It is the Effect of a rheumatic Humour thrown upon these Parts, in which, as it produces very sharp Pains resembling that which is called aStitch, it has from this Circumstance, been termed a Pleurisy.

It is generally supposed by the meer Multitude, and even by some of a different Rank, that a false Pleurisy is more dangerous than a genuine, a true one; but this is a Mistake. It is often ushered in by a Shivering, and almost ever attended with a little Fever, a small Cough, and a slight Difficulty of breathing; which, as well as the Cough, is occasioned from the Circumstance of a Patient's (who feels Pain in Respiration, or Breathing) checking Breathing as much as he can; this accumulates a little too much Blood in the Lungs; but yet he has no Anguish, nor the other Symptoms of acute true Pleurisies. In some Patients this Pain is extended, almost over the whole Breast, and to the Nape of the Neck. The sick Person cannot repose himself on the Side affected.

This Disorder is not more dangerous than a Rheumatism, except in two Cases; 1, When the Pain is so very severe, that the Patient strongly endeavours not to breathe at all, which brings on a great Infarction or Stoppage in the Lungs. 2, When this Humour, like any other rheumatic one, is transferred to some internal Part.

§ 294. It must be treated exactly like a Rheumatism. See§ 168and169.

After bleeding once or more, a Blister applied to the affected Part is often attended with a very good Effect: This being indeed the Kind of73Pleurisy, in which it particularly agrees.

§ 295. This Malady sometimes gives Way to the first Bleeding; often terminating on the third, fourth or fifth Day, by a very plentiful Sweat, and rarely lasting beyond the seventh. Sometimes it attacks a Person very suddenly, after a Stoppage of Perspiration; and then, if at once before the Fever commences, and has had Time to inflame the Blood, the Patient takes someFaltrank, it effects a speedy Cure by restoring Perspiration. They are such Cases as these, or that mentioned§ 96, which have given this Composition the Reputation it has obtained in this Disease: a Reputation nevertheless, which has every Year proved tragical in its Consequences to many Peasants, who being deceived by some misleading Resemblances in this Distemper, have rashly and ignorantly made Use of it in true inflammatory Pleurisies.

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