7. They should not remain in Bed above seven, or eight Hours.

8. The Swelling of the Legs and Ancles, which happens to most Persons at

this time, is not dangerous, and generally disappears of itself; if they

live soberly and regularly, and take moderate Exercise.

9. It is not necessary, in this State, that they should go constantly

every Day to Stool; though they should not be without one above two or

three. If their Costiveness exceeds this Term, they should receive a

Glyster the third Day, and even sooner, if they are heated by it, if

they feel puffed up, are restless, and have any Pains in the Head.

10. Should they, after some time, still continue very weak; if their

Stomach is disordered; if they have, from time to time, a little

irregular Fever, they should take three Doses daily of the Prescription

No. 14. which fortifies the Digestions, recovers the strength, and

drives away the Fever.

11. They must by no means return to their Labour too soon. This

erroneous Habit daily prevents many Peasants from ever getting perfectly

well, and recovering their former Strength. From not having been able to

confine themselves to Repose and Indolence for some Days, they never

become as hearty hardy Workmen as they had been: and this premature

hasty Labour makes them lose in the Consequence, every following Week of

their Lives, more time than they ever gained, by their over-early

resuming of their Labour. I see every Day weakly Labourers, Vineroons,

and other Workmen, who date the Commencement of their Weakness from that

of some acute Disease, which, for want of proper Management through the

Term of their Recovery, was never perfectly cured. A Repose of seven or

eight Days, more than they allowed themselves, would have prevented all

these Infirmities; notwithstanding it is very difficult to make them

sensible of this. The Bulk, the Body of the People, in this and in many

other Cases, look no further than the present Day; and never extend

their Views to the following one. They are for making no Sacrifice to

Futurity; which nevertheless must be done, to render it favourable to

us.

__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 a few 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

Inclination to 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.

Sec. 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 called _petechial_ ones, but are

improperly termed the _pourpre_, 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.

Sec. 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 a _Tenesinus_, or straining to Stool, often termed a

_Needy_; 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.

Sec. 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 Water No. 2, the Almond Emulsion No. 4, or that of No. 7.

The Juices of the Plants, which enter into the last of these Drinks, are

excellent Remedies in this Case; as they 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 Glyster No. 5 must 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.

Sec. 50. When the Disease is circumstanced as described (Sec. 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 Fever is 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]

Sec. 51. In this, and in all other inflammatory Diseases, the Blood is in a

very thick viscid State: and almost immediately on its being drawn, a

white tough Skin, somewhat like Leather, is formed on its Top, which

most People have seen, and which is called the _pleuritic Crust_. It is

thought a promising Appearance, when at each Bleeding it seems less

hard, and less thick, than it was at the preceding ones: and this is

very generally true, if the Sick feels himself, at the same Time,

sensibly better: but whoever shall attend _solely_ to the Appearance of

the Blood, will find himself often deceived. It will happen, even in the

most violent Inflammation of the Breast, that this Crust is not formed,

which is supposed to be a very unpromising Sign. There are also, in this

Respect, many odd Appearances, which arise from the smallest

Circumstances; so that we must not regulate the Repetitions of our

bleeding, solely by this Crust: and in general we must not be over

credulous in supposing, that the Appearances in the Blood, received into

the Bason, can enable us to determine, with Certainty, of its real State

in the Body.

[20] We should however, with the greater Circumspection (of how much the

longer standing the Disease has been, and by how much the more

difficult the viscous Humours are to be melted down and dislodged)

attend to the Coction of the Matter of Expectoration; which Nature

does not often easily effect, and which she effects the more

imperfectly and slowly, the weaker he is. Her last Efforts have

often been attended with such high Paroxysms, as have imposed even

upon very competent Physicians, and have made them open a Vein a

few Hours before the Patients' Death, from their Pulses being

strong, hard and frequent. Excessive Weakness is the Sign, by which

we may discover such unavailing Efforts to be the last. _E. L._

Sec. 52. When the sick Person is in the Condition described (Sec. 47) the

Bleeding is not only unattended with Ease; but sometimes it is also

pernicious, by the sudden Weakness to which it reduces him. Generally in

such a Case all Medicines and Means are insignificant: and it is a very

bad Sign in this Disease, when this Discharge is not attended with Ease

and Benefit to the Sick; or when there are some Circumstances, which

oblige us to be sparing of it.

Sec. 53. The Patient's Legs should every Day, for one half Hour, be put

into a Bath of warm Water, wrapping him up closely; that the Cold may

not check that Perspiration, which the Bath promotes.

Sec. 54. Every two Hours he should take two Spoonfuls of the Mixture No. 8,

which promotes all the Discharges, and chiefly that of Expectoration.

Sec. 55. When the Oppression and Straitness are considerable, and the Cough

dry, the Patient may receive the Vapour of boiling Water, to which a

little Vinegar has been added. There are two ways of effecting this;

either by placing below his Face, after setting him up, a Vessel filled

with such boiling hot Water, and covering the Patient's Head and the

Vessel with a Linen Cloth, that may inclose the Steam; or else by

holding before his Mouth a Spunge dipped in the same boiling Liquor.

This last Method is the least effectual, but it fatigues the Patient

considerably less. When this bad Symptom is extremely pressing, Vinegar

alone should be used without Water; and the Vapour of it has often saved

Patients, who seemed to have one Foot in the Grave: but it should be

continued for several Hours.

Sec. 56. The outward Remedies directed in No. 9. are also applied with

Success to the Breast, and to the Throat.

Sec. 57. When the Fever is extremely high, the Sick should take every Hour,

a Spoonful of the Mixture No. 10. in a Cup of the Ptisan [21] but

without diminishing on this Account the usual Quantity of his other

Drinks, which may be taken immediately after it.

[21] The Use of Acids, in Inflammations of the Breast, requires no

little Consideration. Whenever the sick Person has an Aversion to

them; when the Tongue is moist, the Stomach is heavy and

disordered, and the Habit and Temperament of the Patient is mild

and soft; when the Cough is very sharp without great Thirst, we

ought to abstain from them. But when the Inflammation is joined to

a dry Tongue, to great Thirst, Heat and Fever, they are of great

Service. Slices of China Oranges sprinkled with Sugar may be given

first; a light Limonade may be allowed afterwards; and at last

small Doses of the Mixture, No. 10. if it becomes necessary. _E.

L._--I have chosen to retain this Note of the Editor of _Lyons_,

from having frequently seen the Inefficacy, and sometimes, I have

even thought, the ill Effects of Acids in Peripneumonies and

Pleurisies, in a Country far South of _Swisserland_; and where

these Diseases are very frequent, acute and fatal. On the other

hand I shall add the Substance of what Dr. _Tissot_ says on this

Head in a Note to his Table of Remedies, wherein he affirms, that

he has given in this Disease very large Doses of them, rising

gradually from small ones, and always with great Success;

intreating other Physicians to order this Acid (the Spirit of

Sulphur) in the same large Doses which he directs in this Chapter,

and assuring himself of their thanks, for its good

Consequences--Now the only ill Effect I can surmize here, from

shewing this Diversity of Opinion in these two learned Physicians,

and my own Doubts, is, that the Subjects of this Disease in Country

Places may prove somewhat confused and irresolute by it, in their

Conduct in such Cases. But as all of us certainly concur in the

great Intention of doing all possible Good, by the extensive

Publication of this Treatise, I shall take leave to observe that in

this Disease, and in Pleurisies, more solid Benefit has been

received in _Carolina_, _Virginia_, &c. from the Use of the

_Seneka_ Rattle-snake Root, than from any other Medicine whatever.

Bleeding indeed is necessarily premised to it; but it has often

saved the Necessity of many repeated Bleedings. This Medicine,

which is termed in Latin, the _Polygala Virginiana_, is certainly

rather of a saponaceous attenuating Quality, and betrays not any

Marks of Acidity, being rather moderately acrid. There will be

Occasion to mention it more particularly in the subsequent Chapter,

as such a Liberty can need no Apology to any philosophical

Physician. _K._

Sec. 58. As long as the Patient shall grow worse, or only continue equally

bad, the same Medicines are to be repeated. But if on the third Day

(tho' it rarely happens so soon) or fourth, or fifth, the Disease takes

a more favourable Turn; if the Exasperation returns with less Violence;

the Cough be less severe; the Matter coughed up less bloody: if

Respiration becomes easier; the Head be less affected; the Tongue not

quite so dry; if the high Colour of the Urine abates, and its Quantity

be increased, it may be sufficient then to keep the Patient carefully to

his Regimen, and to give him a Glyster every Evening. The Exasperation

that occurs the fourth Day is often the highest.

Sec. 59. This Distemper is most commonly terminated and carried off by

Expectoration, and often by Urine, which on the seventh, the ninth, or

the eleventh Day, and sometimes on the Days between them, begins to let

fall a plentiful Sediment, or Settling, of a pale red Colour, and

sometimes real _Pus_ or ripe Matter. These Discharges are succeeded by

Sweats, which are as serviceable then, as they were injurious at the

Beginning of the Disease.

Sec. 60. Some Hours before these Evacuations appear, there come on, and not

seldom, some very alarming Symptoms, such as great Anguish;

Palpitations, some Irregularity in the Pulse; an increased Oppression;

convulsive Motions (this being what is called the _Crisis_, the Height,

or Turn of the Distemper) but they are no ways dangerous, provided they

do not occasion any improper Treatment. These Symptoms depend on the

morbid and purulent Matter, which, being dislodged, circulates with the

Humours, and irritates different Parts, until the Discharge of it has

fairly begun; after which all such Symptoms disappear, and Sleep

generally ensues. However I cannot too strongly insist on the Necessity

of great Prudence in such Circumstances. Sometimes it is the Weakness of

the Patient, and at other times Convulsions, or some other Symptoms,

that terrify the By-standers. If, which is most generally the Case, the

absurd Practice of directing particular Remedies for such Accidents

takes place, such as spirituous Cordials, Venice Treacle, Confections,

Castor and Rue; the Consequence is, that Nature being disturbed in her

Operations, the _Crisis_ or Turn is not effected; the Matter which

should be discharged by Stool, by Urine, or by Sweat, is not discharged

out of the Body; but is thrown upon some internal or external part of

it. Should it be on some inward part, the Patient either dies at once;

or another Distemper succeeds, more troublesome and incurable than the

first. Should it be expelled to some outward part, the Danger indeed is

less; and as soon as ever such a Tumour appears, ripening Pultices

should be apply'd to bring it to a Head, after which it should

immediately be opened.

Sec. 61. In order to prevent such unhappy Consequences, great Care must be

taken, whenever such terrifying Symptoms come on, [about the Time of the

_Crisis_] to make no Change in the Diet, nor in the Treatment of the

Patient; except in giving him the loosening Glyster No. 5; and applying

every two Hours a Flannel, squeezed out of warm Water, which may cover

all the Belly, and in a Manner go round the Body behind the Reins. The

Quantity of his Drink may also be increased a little; and that of his

Nourishment lessened, as long as this high and violent State continues.

Sec. 62. I have not spoken of Vomits or Purges, as being directly contrary

to the Nature of this Disease. Anodynes, or Opiates, to procure Sleep

are also, in general, very improper. In a few Cases, however, they may

possibly be useful; but these Cases are so very difficult to be

sufficiently distinguished, that Opiates should never be admitted in

this Disease, without the Presence and Advice of a Physician. I have

seen many Patients, who have been thrown into an incurable Hectic, by

taking them improperly. When the Disease is not received in a mortal

Degree, nor has been injudiciously treated, and proceeds in a benign

regular Manner, the Patient may be called very well and safe by the

fourteenth Day; when he may, if he has an Appetite, be put upon the Diet

of People who are recovering. But if he still retains an Aversion to

Food; if his Mouth is foul and furred, and he is sensible of some

Heaviness in his Head, he should take the purging Potion No. 11.

Sec. 63. Bleedings from the Nose occur sometimes naturally in this Disease,

even after repeated Bleedings by Art; these are very benign and

favourable, and are commonly attended with more Ease and Relief than

artificial Bleedings. Such voluntary Discharges may sometimes be

expected, when the Patient is sensibly mended in many Respects after the

Use of the Lancet; and yet complains of a great Pain in his Head,

accompanied with quick sparkling Eyes, and a Redness of the Nose.

Nothing should be done to stop these voluntary Bleedings, since it would

be very dangerous: For when Nature has fulfilled her Intention by them,

they cease of themselves. At other times, but more rarely, the Distemper

is carried off by a natural Purging, attended with moderate Pain, and

the Discharge of bilious Matter.

Sec. 64. If the Expectoration, or hawking up of Matter, stops very

suddenly, and is not speedily attended with some other Evacuation; the

Oppression and Anguish of the Patient immediately return, and the Danger

is great and pressing. If the Distemper, at this Juncture, is not of

many Days standing; if the Patient is a strong Person; if he has not as

yet been plentifully bled; if there be still some Blood mixed with the

Humour he expectorates; or if the Pulse be strong and hard, he should be

bled immediately in the Arm; and constantly receive the Steam of hot

Water and Vinegar by the Mouth, and drink plentifully of the Ptisan No.

2, something hotter than ordinary. But if his Circumstances, after this

Suppression, are different from these just mentioned; instead of

bleeding him, two Blisters should be applied to the Legs; and he should

drink plentifully of the Ptisan No. 12.

The Causes which oftenest produce this Suppression of his Expectoration

are, 1, a sharp and sudden cold Air. 2, too hot a one. 3, over hot

Medicines. 4, excessive Sweating. 5, a Purge prematurely and

injudiciously timed. and 6, some immoderate Passion of the Mind.

Sec. 65. When the Sick has not been sufficiently bled, or not soon enough;

and even sometimes, which I have seen, when he has been greatly weakened

by excessive Bleeding; so that the Discharges by Stool, Urine,

Expectoration and Perspiration, have not been sufficiently made; when

these Discharges have been confused by some other Cause; or the Disease

has been injudiciously treated; then the Vessels that have been

inflamed, do not unload themselves of the Humours, which stuff up and

oppress them: but there happens in the Substance of the affected Lung,

the same Circumstance we see daily occur on the Surface of the Body. If

an inflammatory Tumour or Swelling does not disperse itself, and

disappears insensibly, it forms an Imposthume or Abscess. Thus exactly

also in the inflamed Lung, if the Inflammation is not dissipated, it

forms an Abscess, which, in that part, is called a _Vomica:_ and the

Matter of that Abscess, like the external ones, remains often long

inclosed in its Sac or Bag, without bursting open its Membrane or Case,

and discharging the Matter it contains.

Sec. 66. If the Inflammation was not very deeply seated in the inward

Substance of the diseased Lung; but was extended to its Surface, that

is, very near the Ribs, the Sac will burst on the Surface of the Lung;

and the Matter contained in it must be discharged into the Cavity, or

Hollowness of the Breast, between the Lung, the Ribs, and the Diaphragm

or Midriff, which is the Membrane that divides the Breast and the Belly.

But when the Inflammation is considerably deeper, the Imposthume bursts

withinside of the Lung itself. If its Orifice, or Opening is so small,

that but little can get out at once; if the Quantity of all the Matter

be inconsiderable, and the Patient is at the same Time pretty strong, he

coughs up the Matter, and is very sensibly relieved. But if this

_Vomica_ be large, or if its Orifice is wide, and it throws out a great

Quantity of Matter at once; or if the Patient is very weak, he dies the

Moment it bursts, and that sometimes when it is least expected. I have

seen one Patient so circumstanced expire, as he was conveying a Spoonful

of Soup to his Mouth; and another, while he was wiping his Nose. There

was no present Symptom in either of these Cases, whence a Physician

might suppose them likelier to die at that Instant, than for some Hours

before. The _Pus_, or Matter, is commonly discharged through the Mouth

after Death, and the Bodies very soon become putrified.

Sec. 67. We call that _Vomica_ which is not burst, an _occult_ or hidden,

and that which is, an evident or open one. It is of considerable

Importance to treat exactly and clearly of this Topic; as a great Number

of Country People die of these Imposthumes, even without a Suspicion of

the Cause of their Death. I had an Instance of it some Days since, in

the School-master of a Village. He had an occult and very considerable

_Vomica_ in the left Lung, which was the Consequence of an Inflammation

of the Breast, that had been treated improperly at the Beginning. He

seemed to me not likely to live twenty four Hours; and really died in

the Night, after inexpressible Anguish.

Sec. 68. Whatever Distemper is included within the Breast of a living

Patient, is neither an Object of the Sight or Touch whence these

_Vomicas_, these inward Tumours, are so often unknown, and indeed

unsuspected. The Evacuations that were necessary for the Cure, or

sometimes for the Prevention, of them, have not taken place, during the

first fourteen Days. At the End of this Term, the Patient, far from

being cured, is not very considerably relieved; but, on the contrary,

the Fever continues to be pretty high, with a Pulse continually quick;

in general soft and weak; though sometimes pretty hard, and often

fluctuating, or, as it were, waving. His Breathing is still difficult

and oppressed; with small cold Shudderings from Time to Time; an

Exasperation of the Fever; flushed Cheeks, dry Lips, and Thirst.

The Increase of these Symptoms declare, that _Pus_ or Matter is

thoroughly formed: the Cough then becomes more continual; being

exasperated with the least Motion; or as soon as ever the Patient has

taken any Nourishment. He can repose only on the Side affected. It often

happens indeed, that he cannot lie down at all; but is obliged to be set

up all Day; sometimes even without daring to lean a little upon his

Loins, for fear of increasing the Cough and Oppression. He is unable to

sleep; has a continual Fever, and his Pulse frequently intermits.

The Fever is not only heightened every Evening; but the smallest

Quantity of Food, the gentlest Motion, a little Coughing, the lightest

Agitation of the Mind, a little more than usual Heat in the Chamber,

Soup either a little too strong, or a little too salt, increase the

Quickness of his Pulse the Moment they occur, or are given. He is quite

restless, has some short Attacks of the most terrible Anguish,

accompanied and succeeded by Sweatings on his Breast, and from his whole

Countenance. He sweats sometimes the whole Night; his Urine is reddish,

now frothy, and at other times oily, as it were. Sudden Flushings, hot

as Flames, rise into his whole Visage. The greater Number of the Sick

are commonly sensible of a most disagreeable Taste in their Mouth; some

of old strong Cheese; others of rotten Eggs; and others again of

stinking Meat, and fall greatly away. The Thirst of some is

unquenchable; their Mouths and Lips are parched; their Voice weak and

hoarse; their Eyes hollow, with a kind of Wildness in their Looks. They

have a general Disgust to all Food; and if they should ask for some

particular Nourishment without seeing it, they reject it the Moment it

is brought them; and their Strength at length seems wholly exhausted.

Besides these Symptoms, a little Inflation, or _Bloatedness_, as it

were, is sometimes observed on the Breast, towards the Side affected;

with an almost insensible Change of Colour. If the _Vomica_ be situated

at the Bottom of the affected Lobe of the Lungs, and in its internal

Part, that is, nearly in the Middle of the Breast, some _Puffiness_ or

light Swelling may be perceived in some Bodies, by gently pressing the

Pit of the Stomach; especially when the Patient coughs. In short,

according to the Observations of a German Physician, if one strike the

open Hand on the Breast, covered only with a Shirt, it retains in the

Spot, which is directly opposite to the _Vomica_, a flat heavy Sound, as

if one struck a Piece of Flesh; while in striking on the other Side it

gives a clear loud Sound, as from a Drum. I still doubt however, whether

this Observation will generally hold true; and it would be hazardous to

affirm there is no Abscess in a Breast, which does not return this heavy

Sound.

Sec. 69. When a _Vomica_ is formed, as long as it is not emptied, all the

Symptoms I have already enumerated increase, and the _Vomica_ grows in

Size: the whole Side of the Lung affected sometimes becomes a Bag or Sac

of Matter. The sound Side is compressed; and the Patient dies after

dreadful Anguish, with the Lung full of _Pus_, and without having ever

brought up any.

To avoid such fatal Consequences, it is necessary to procure the Rupture

and Discharge of this inward Abscess, as soon as we are certain of its

Existence: And as it is safer it should break within the Lobe affected,

from whence it may be discharged by hawking up; than that it should

burst and void itself into the Cavity of the Breast, for Reasons I shall

give hereafter, we must endeavour, that this Rupture may be effected

within the internal Substance of the Lungs.

Sec. 70. The most effectual Methods to procure this are, 1. To make the

Patient continually receive, by his Mouth, the Vapour of warm Water. 2.

When by this Means that part of the Sac or Abscess is softened, where we

could wish the Rupture of it to happen, the Patient is to swallow a

large Quantity of the most emollient Liquid; such as Barley Water,

Almond Milk, light Veal Broth, or Milk and Water. By this Means the

Stomach is kept always full: so that the Resistance to the Lungs being

considerable on that Side, the Abscess and its Contents will naturally

be pressed towards the Side of the Wind-pipe, as it will meet with less

Resistance there. This fulness of the Stomach will also incline the

Patient to cough, which may concur to produce a good Event. Hence, 3, we

should endeavour to make the Patient cough, by making him smell to some

Vinegar, or even snuff up a little; or by injecting into his Throat, by

the Means of a small Syringe or Pipe, such as Children make out of short

Pieces of Elder-Boughs, a little Water or Vinegar. 4. He should be

advised to bawl out aloud, to read loud, or to laugh heartily; all which

Means contribute to burst open the Abscess, as well as those two

following ones. 5. Let him take every two Hours a Soup-Ladle of the

Potion No. 8. 6. He should be put into a Cart, or some other Carriage;

but not before he has drank plentifully of such Liquors as I have just

mentioned: after which the Shaking and Jolting in the Carriage have

sometimes immediately procured that Rupture, or breaking of the Bag or

Abscess, we wished for.

Sec. 71. Some Years since I saw a Country Maid Servant, who was left in a

languishing Condition after an Inflammation of the Breast; without any

Person's suspecting her Ailment. This Woman being put into a Cart, that

was sent for a Load of Hay; one of the Wheels run violently against a

Tree: she swooned away, and at the same Time brought up a great Quantity

of digested Matter. She continued to bring up more; during which I was

informed of her Case, and of the Accident, which effectually cured her.

A _Swiss_ Officer, who served in _Piedmont_, had been in a languid State

of Health for some Months; and returned home to set himself down as

easily as he could, without conceiving any considerable Hopes of

Recovery. Upon entering into his own Country, by the Way of _Mount

Bernard_; and being obliged to go some Paces on Foot, he fell down; and

remained in a Swoon above a Quarter of an Hour: during which Time he

threw up a large Quantity of Matter, and found himself that very Moment

very greatly relieved. I ordered him a proper Diet, and suitable

Medicines: his Health became perfectly established; and the Preservation

of his Life was principally owing to this lucky Fall.

Many Persons afflicted with a _Vomica_, faint away the very Instant it

breaks. Some sharp Vinegar should be directly held to their Nose. This

small Assistance is generally sufficient, where the bursting of it is

not attended with such Appearances as shew it to be mortal, in which

Case every Application is insignificant.

Sec. 72. If the sick Person was not extremely weak before the Bursting of

the Abscess; if the Matter was white, and well conditioned; if the Fever

abates after it; if the Anguish, Oppression and Sweats terminate; if the

Cough is less violent; if the Patient is sensibly easier in his

Situation or Posture; if he recovers his Sleep and Appetite; if his

usual Strength returns; if the Quantity he expectorates, or brings up,

becomes daily and gradually less; and if his Urine is apparently better,

we may have Room to hope, that by the Assistance of these Remedies I

shall immediately direct, he may be radically, compleatly cured.

Sec. 73. But if on the contrary; when his Strength is exhausted before the

bursting of the Abscess; when the Matter is too thin and transparent,

brown, green, yellow, bloody and of an Offensive Smell; if the Pulse

continues quick and weak; if the Patient's Appetite, Strength and Sleep

do not improve, there remains no hope of a Cure, and the best Medicines

are ineffectual: Nevertheless we ought to make some Tryal of them.

Sec. 74. They consist of the following Medicines and Regulations. 1. Give

every four Hours a little Barley or Rice Cream. 2. If the Matter brought

up is thick and glewy, so that it is very difficult to be loosened and

discharged, give every two Hours a Soup-ladle of the Potion No. 8; and

between the giving these two, let the Patient take every half Hour a Cup

of the Drink No. 13. 3. When the Consistence of the Matter is such, that

there is no Occasion for these Medicines to promote the Discharge of it,

they must be omitted; tho' the same Sort and Quantity of Food are to be

continued; but with the Addition of an equal Quantity of Milk; or, which

would be still more beneficial, instead of this Mixture, we should give

an equal Quantity of sweet Milk, taken from a good Cow, which, in such a

Case, may compose the whole Nourishment of the Patient. 4. He should

take four Times a Day, beginning early in the Morning, and at the

Distance of two Hours, a Dose of the Powder No. 14, diluted in a little

Water, or made into a _Bolus_, or Morsel, with a little Syrup or Honey.

His common Drink should be Almond Emulsion, commonly called Almond Milk,

or Barley Water, or fresh Water with a fourth part Milk. 5. He should

air and exercise every Day on Horseback, or in a Carriage, according as

his Strength and his Circumstances will allow him. But of all Sorts of

Exercise, that upon a trotting Horse is, beyond all Comparison, the very

best, and the easiest to be procured by every Body; provided the Disease

be not too far advanced; since in such a Situation, any Exercise, that

was only a little violent, might prove pernicious.

Sec. 75. The Multitude, who are generally illiterate, seldom consider any

thing as a Remedy, except they swallow it. They have but little

Confidence in _Regimen_, or any Assistance in the Way of Diet, and

consider Riding on Horseback as wholly useless to them. This is a

dangerous Mistake, of which I should be glad to undeceive them: since

this Assistance, which appears so insignificant to them, is probably the

most effectual of any: it is that in Fact, without which they can

scarcely expect a Cure, in the highest Degrees of this Disease: it is

that, which perhaps alone may recover them, provided they take no

improper Food. In brief it is considered, and with Reason, as the real

Specific for this Disease.

Sec. 76. The Influence of the Air is of more Importance in this Disorder,

than in any others; for which Reason great Care should be taken to

procure the best, in the Patient's Chamber. For this Purpose it should

often be ventilated, or have an Admission of fresh Air, and be sweetened

from Time to Time, tho' very lightly, with a little good Vinegar; and in

the Season it should be plentifully supplied with agreeable Herbs,

Flowers and Fruits. Should the Sick be unfortunately situated, and

confined in an unwholsome Air, there can be but little Prospect of

curing him, without altering it.

Sec. 77. Out of many Persons affected with these Disorders, some have been

cured by taking nothing whatsoever but Butter-milk; others by Melons and

Cucumbers only; and others again by Summer Fruits of every Sort.

Nevertheless, as such Cases are singular, and have been but few, I

advise the Patient to observe the Method I have directed here, as the

surest.

Sec. 78. It is sufficient if he have a Stool once in two, or even in three,

Days. Hence, there is no Reason for him, in this Case, to accustom

himself to Glysters: they might excite a Looseness, which may be very

dangerous.

Sec. 79. When the Discharge of the Matter from the Breast diminishes, and

the Patient is perceivably mended in every Respect, it is a Proof that

the Wound in the Abscess is deterged, or clean, and that it is disposed

to heal up gradually. If the Suppuration, or Discharge, continues in

great Quantity; if it seems but of an indifferent Consistence; if the

Fever returns every Evening, it may be apprehended, that the Wound,

instead of healing, may degenerate into an Ulcer, which must prove a

most embarrassing Consequence. Under such a Circumstance, the Patient

would fall into a confirmed Hectic, and die after some Months Sickness.

Sec. 80. I am not acquainted with any better Remedy, in such a dangerous

Case, than a Perseverance in these already directed, and especially in

moderate Exercise on Horseback. In some of them indeed Recourse may be

had to the sweet Vapours of some vulnerary Herbs in hot Water, with a

little Oil of Turpentine, as directed No. 15. I have seen them succeed;

but the safest Way is to consult a Physician, who may examine and

consider, if there is not some particular Circumstance combined with the

Disease, that proves an Obstacle to the Cure of it. If the Cough

prevents the Patient from Sleeping, he may take in the Evening two or

three Table Spoonfuls of the Prescription No. 16, in a Glass of Almond

Milk or Barley Water.

Sec. 81. The very same Causes which suddenly suppress the Expectoration, in

an Inflammation of the Breast, may also check the Expectoration from a

_Vomica_ already begun: in which Circumstance the Patient is speedily

afflicted with an Oppression and Anguish, a Fever and evident

Feebleness. We should immediately endeavour to remove this Stoppage, by

the Vapour of hot Water; by giving a Spoonful of the Mixture No. 3 every

Hour; by a large Quantity of the Ptisan No. 12, and by a proper Degree

of Motion or Exercise. As soon as ever the Expectoration returns, the

Fever and the other Symptoms disappear. I have seen this Suppression in

strong Habits quickly followed with an Inflammation about the Seat of

the _Vomica_, which has obliged me to bleed, after which the

Expectoration immediately returned.

Sec. 82. It happens sometimes, that the _Vomica_ is entirely cleansed; the

Expectoration is entirely finished, or drained off, the Patient seems

well, and thinks himself compleatly cured: but soon after, the

Uneasiness, Oppression, Cough and Fever are renewed, because the

Membrane or Bag of the _Vomica_ fills again: again it empties itself,

the Patient expectorates for some Days, and seems to recover. After some

Time however, the same Scene is repeated; and this Vicissitude, or

Succession, of moderate and of bad Health, often continues for some

Months and even some Years. This happens when the _Vomica_ is emptied,

and is gradually deterged; so that its Membranes, or Sides touch or

approach each other; but without cicatrizing or healing firmly; and then

there drops or leaks in very gradually fresh Matter. For a few Days this

seems no ways to incommode the Patient; but as soon as a certain

Quantity is accumulated, he is visited again with some of the former

Symptoms, 'till another Evacuation ensues. People thus circumstanced, in

this Disease, sometimes appear to enjoy a tolerable Share of Health. It

may be considered as a kind of internal Issue, which empties and

cleanses itself from Time to Time; pretty frequently in some

Constitutions, more slowly in others; and under which some may attain a

good middling Age. When it arrives however at a very considerable

Duration, it proves incurable. In its earliest State, it gives way

sometimes to a Milk-diet, to riding on Horseback; and to the Medicine

No. 14.

Sec. 83. Some may be surprized, that in treating of an Abscess of the

Lungs, and of the Hectic, which is a Consequence of it, I say nothing of

those Remedies, commonly termed _Balsamics_, and so frequently employed

in them, for Instance, Turpentines, Balsam of Peru, of Mecca,

Frankincense, Mastich, Myrrh, Storax and Balsam of Sulphur. I shall

however say briefly here (because it is equally my Design to destroy the

Prejudice of the People, in favour of improper Medicines, and to

establish the Reputation of good ones) that I never in such Cases made

use of these Medicines; because I am convinced, that their Operation is

generally hurtful in such Cases; because I see them daily productive of

real Mischief; that they protract the Cure, and often change a slight

Disorder into an incurable Disease. They are incapable of perfect

Digestion, they obstruct the finest Vessels of the Lungs, whose

Obstructions we should endeavour to remove; and evidently occasion,

except their Dose be extremely small, Heat and Oppression. I have very

often seen to a Demonstration, that Pills compounded of Myrrh,

Turpentine and Balsam of Peru, have, an Hour after they were swallowed,

occasioned a Tumult and Agitation in the Pulse, high Flushings, Thirst

and Oppression. In short it is demonstrable to every unprejudiced

Person, that these Remedies, as they have been called, are truly

prejudicial in this Case; and I heartily wish People may be disabused

with Respect to them, and that they may lose that Reputation so

unhappily ascribed to them.

I know that many Persons, very capable in other Respects, daily make use

of them in these Distempers: such however cannot fail of disusing them,

as soon as they shall have observed their Effects, abstracted from the

Virtues of the other Medicines to which they add them, and which

mitigate the Danger of them. I saw a Patient, whom a foreign Surgeon,

who lived at _Orbe_, attempted to cure of a Hectic with melted Bacon,

which aggravated the Disease. This Advice seemed, and certainly was,

absurd; nevertheless the Balsamics ordered in such Cases are probably

not more digestible than fat Bacon. The Powder No. 14 possesses whatever

these Balsamics pretend to: it is attended with none of the

Inconveniencies they produce; and has all the good Qualities ascribed to

them. Notwithstanding which, it must not be given while the Inflammation

exists; nor when it may revive again; and no other Aliment should be

mixed with the Milk.

The famous Medicine called the _Antihectic_, (_Antihecticum Poterii_)

has not, any more than these Balsamics, the Virtues ascribed to it in

such Cases. I very often give it in some obstinate Coughs to Infants

with their Milk, and then it is very useful: but I have seldom seen it

attended with considerable Effects in grown Persons; and in the present

Cases I should be fearful of its doing Mischief.

Sec. 84. If the _Vomica_, instead of breaking within the Substance of the

Lungs affected, should break without it, the Pus must be received into

the Cavity of the Breast. We know when that has happened, by the

Sensation or Feeling of the Patient; who perceives an uncommon, a

singular kind of Movement, pretty generally accompanied with a Fainting.

The Oppression and Anguish cease at once; the Fever abates; the Cough

however commonly continues, tho' with less Violence, and without any

Expectoration. But this seeming Amendment is of a short Duration, since

from the daily Augmentation of the Matter, and its becoming more acrid

or sharp, the Lungs become oppressed, irritated and eroded. The

Difficulty of Breathing, Heat, Thirst, Wakefulness, Distaste, and

Deafness, return, with many other Symptoms unnecessary to be enumerated,

and especially with frequent Sinkings and Weakness. The Patient should

be confined to his _Regimen_, to retard the Increase of the Disease as

much as possible; notwithstanding no other effectual Remedy remains,

except that of opening the Breast between two of the Ribs, to discharge

the Matter, and to stop the Disorder it occasions. This is called the

Operation for the _Empyema_. I shall not describe it here, as it should

not be undertaken but by Persons of Capacity and Experience, for whom

this Treatise was not intended. I would only observe, it is less painful

than terrifying; and that if it is delayed too long, it proves useless,

and the Patient dies miserably.

Sec. 85. We may daily see external Inflammations turn gangrenous, or

mortify. The same Thing occurs in the Lungs, when the Fever is

excessive, the Inflammation either in its own Nature, extremely violent,

or raised to such a Height by hot Medicines. Intolerable Anguish,

extreme Weakness, frequent Faintings, Coldness of the Extremities, a

livid and foetid thin Humour brought up instead of concocted Spitting,

and sometimes blackish Stripes on the Breast, sufficiently distinguish

this miserable State. I have smelt in one Case of this Kind, where the

Patient had been attacked with this Disease (after a forced March on

Foot, having taken some Wine with Spices to force a Sweat) his Breath so

horribly stinking, that his Wife had many Sinkings from attending him.

When I saw him, I could discern neither Pulse nor Intellect, and ordered

him nothing. He died an Hour afterwards, about the Beginning of the

third Hour.

Sec. 86. An Inflammation may also become hard, when it forms what we call a

_Scirrhus_, which is a very hard Tumour, indolent, or unpainful. This is

known to occur, when the disease has not terminated in any of those

Manners I have represented; and where, tho' the Fever and the other

Symptoms disappear, the Respiration, or Breathing, remains always a

little oppressed; the Patient still retains a troublesome Sensation in

one Side of his Breast; and has from Time to Time a dry Cough, which

increases after Exercise, and after eating. This Malady is but seldom

cured; though some Persons attacked with it last many Years, without any

other considerable Complaint. They should avoid all Occasions of

over-heating themselves; which might readily produce a new Inflammation

about this Tumour, the Consequences of which would be highly dangerous.

Sec. 87. The best Remedies against this Disorder, and from which I have

seen some good Effects, are the medicated Whey No. 17, and the Pills No.

18. The Patient may take twenty Pills, and a Pint and a half of the Whey

every Morning for a long Continuance; and receive inwardly, now and

then, the Vapour of hot Water.

Sec. 88. Each Lung, in a perfect State of Health, touches the _Pleura_, the

Membrane, that lines the Inside of the Breast; though it is not

connected to it. But it often happens, after an Inflammation of the

Breast, after the Pleurisy, and in some other Cases, that these two

Parts adhere closely to each other, and are never afterwards separated.

However this is scarcely to be considered as a Disease; and remains

commonly unknown, as the Health is not impaired by it, and nothing is

ever prescribed to remove it. Nevertheless I have seen a few Cases, in

which this Adhesion was manifestly prejudicial.

__Chapter V.__

_Of the Pleurisy._

__Sect.__ 89.

The Pleurisy, which is chiefly known by these four Symptoms, a strong

Fever, a Difficulty of Breathing, a Cough, and an acute Pain about the

Breast; the Pleurisy, I say, is not a different Malady from the

Peripneumony, or Inflammation of the Breast, the Subject of the

preceding Chapter; so that I have very little to say of it,

particularly, or apart.

Sec. 90. The Cause of this Disease then is exactly the same with that of

the former, that is, an Inflammation of the Lungs; but an Inflammation,

that seems rather a little more external. The only considerable

Difference in the Symptoms is, that the Pleurisy is accompanied with a

most acute Pain under the Ribs, and which is commonly termed a _Stitch_.

This Pain is felt indifferently over every Part of the Breast; though

more commonly about the Sides, under the more fleshy Parts of the

Breast, and oftenest on the right Side. The Pain is greatly increased

whenever the Patient coughs or draws in the Air in breathing; and hence

a Fear of increasing it, by making some Patients forbear to cough or

respire, as much as they possibly can; and that aggravates the Disease,

by stopping the Course of the Blood in the Lungs, which are soon

overcharged with it. Hence the Inflammation of this Bowel becomes

general; the Blood mounts up to the Head; the Countenance looks deeply

red, or as it were livid; the Patient becomes nearly suffocated, and

falls into the State described Sec. 47.

Sometimes the Pain is so extremely violent, that if the Cough is very

urgent at the same Time, and the Sick cannot suppress or restrain it,

they are seized with Convulsions, of which I have seen many Instances,

but these occur almost always to Women; though they are much less

subject than Men to this Disease, and indeed to all inflammatory ones.

It may be proper however to observe here, that if Women should be

attacked with it, during their monthly Discharges, that Circumstance

should not prevent the repeated and necessary Bleedings, nor occasion

any Alteration in the Treatment of the Disease. And hence it appears,

that the Pleurisy is really an Inflammation of the Lungs, accompanied

with acute Pain.

Sec. 91. I am sensible that sometimes an Inflammation of the Lungs is

communicated also to that Membrane, which lines the Inside of the

Breast; and which is called the _Pleura_; and from thence to the

Muscles, the fleshy Parts, over and between the Ribs. This however is

not very frequently the Case.

Sec. 92. Spring is commonly the Season most productive of Pleurisies: in

general there are few in Summer: notwithstanding that in the Year 1762,

there were a great many during the hottest Season, which then was

excessively so. The Disease usually begins with a violent Shivering,

succeeded by considerable Heat, with a Cough, an Oppression, and

sometimes with a sensible Straitning, or Contraction, as it were, all

over the Breast; and also with a Head-ach, a Redness of the Cheeks, and

with Reachings to vomit. The Stitch does not always happen at the very

first Onset; often not 'till after several Hours from the first

Complaint; sometimes not before the second, or even the third Day.

Sometimes the Patient feels two Stitches, in different Parts of the

Side; though it seldom happens that they are equally sharp, and the

lightest soon ceases. Sometimes also the Stitch shifts its Place, which

promises well, if the Part first attacked by it continues perfectly free

from Pain: but it has a bad Appearance, if, while the first is present,

another also supervenes, and both continue. The Pulse is usually very

hard in this Distemper; but in the dreadful Cases described Sec. 47 and 90,

it becomes soft and small. There often occur at, or very quickly after,

the Invasion, such an Expectoration, or hawking up, as happens in an

Inflammation of the Breast; at other Times there is not the least

Appearance of it, whence such are named dry Pleurisies, which happen

pretty often. Sometimes the Sick cough but little, or not at all. They

often lie more at Ease upon the Side affected, than on the sound one.

The Progress of this Disease advances exactly like that described in the

preceding Chapter: for how can they differ considerably? and the

Treatment of both is the same. Large Haemorrhages, or Bleedings from the

Nose, frequently happen, to the great Relief of the Patient; but

sometimes such Discharges consist of a kind of corrupted Blood, when the

Patient is very ill, and these portend Death.

Sec. 93. This Distemper is often produced by drinking cold Water, while a

Person is hot; from which Cause it is sometimes so violent, as to kill

the Patient in three Hours. A young Man was found dead at the Side of

the Spring, from which he had quenched his Thirst: neither indeed is it

uncommon for Pleurisies to prove mortal within three Days.

Sometimes the Stitch disappears, whence the Patient complains less; but

at the same Time his Countenance changes; he grows pale and sad; his

Eyes look dull and heavy, and his Pulse grows feeble. This signifies a

Translation of the Disease to the Brain, a Case which is almost

constantly fatal.

There is no Disease in which the critical Symptoms are more violent, and

more strongly marked, than in this. It is proper this should be known,

as it may prevent or lessen our excessive Terror. A perfect Cure

supervenes sometimes, at the very Moment when Death was expected.

Sec. 94. This Malady is one of the most common and the most destroying

kind, as well from its own violent Nature, as through the pernicious

Treatment of it in Country Places. That Prejudice, which insists on

curing all Diseases by Sweating, entirely regulates their Conduct in

treating a Pleurisy; and as soon as a Person is afflicted with a Stitch,

all the hot Medicines are immediately set to Work. This mortal Error

destroys more People than Gunpowder; and it is by so much the more

hurtful, as the Distemper is of the most violent kind; and because, as

there is commonly not a Moment to be lost, the whole depends on the

Method immediately recurred to.

Sec. 95. The proper Manner of treating this Disease, is exactly the same in

all Respects, with that of the Peripneumony; because, I again affirm, it

is the very same Disease. Hence the Bleedings, the softening and

diluting Drinks, the Steams, the Glysters, the Potion No. 8, and the

emollient Poultices are the real Remedies. These last perhaps are still

more effectual in the Pleurisy; and therefore they should be continually

applied over the very Stitch.

The first Bleeding, especially if there has been a considerable

Discharge, almost constantly abates the Stitch, and often entirely

removes it: though it more commonly returns, after an Intermission of

some Hours, either in the same Spot, or sometimes in another. This

shifting of it is rather favourable, especially if the Pain, that was

first felt under the Breast, shifts into the Shoulders, to the Back, the

Shoulder-blade, or the Nape of the Neck.

When the Stitch is not at all abated, or only a little; or if, after

having abated, it returns as violently as at first, and especially if it

returns in the same Spot, and the Height of the other Symptoms continue,

Bleeding must be repeated. But if a sensible Abatement of the Stitch

continues; and if, though it returns, it should be in a smaller Degree,

and by Intervals, or in these Places I have mentioned above; if the

Quickness, or the Hardness of the Pulse, and all the other Symptoms are

sensibly diminished, this repeated Bleeding may sometimes be omitted.

Nevertheless, in a very strong Subject, it seems rather prudent not to

omit it, since in such Circumstances it can do no Mischief; and a

considerable Hazard may sometimes be incurred by the Omission. In very

high and dangerous Pleurisies a frequent Repetition of bleeding is

necessary; except some Impediment to it should arise from the particular

Constitution of the Patient, or from his Age, or some other

Circumstances.

If, from the Beginning of the Disease, the Pulse is but a little quicker

and harder than in a healthy State; if it is not manifestly strong; if

the Head-ach and the Stitch are so moderate as to prove supportable; if

the Cough is not too violent; if there is no sensible Oppression or

Straitness, and the Patient expectorate, or cough up, Bleeding may be

omitted.

With Respect to the administering of other Remedies, the same Directions

are to be exactly followed, which have been already given in the

preceding Chapter, to which the Reader is referred from Sec. 53 to 66.

Sec. 96. When the Disease is not very acute and pressing, I have often

cured it in a very few Days by a single Bleeding, and a large Quantity

of a Tea or Infusion of Elder-flowers, sweetened with Honey. It is in

some Cases of this kind, that we often find the Water _Faltranc_

succeed, with the Addition of some Honey, and even of Oil: though the

Drink I have just directed is considerably preferable. That Drink which

is compounded of equal Quantities of Wine and Water, with the Addition

of much Venice Treacle, annually destroys a great Number of People in

the Country.

Sec. 97. In those dry Pleurisies, in which the Stitch, the Fever, and the

Head-ach are strong and violent; and where the Pulse is very hard and

very full, with an excessive Dryness of the Skin and of the Tongue,

Bleeding should be frequently repeated, and at small Intervals from each

other. This Method frequently cures the Disease effectually, without

using any other Evacuation.

Sec. 98. The Pleurisy terminates, like any other inward Inflammation,

either by some Evacuation; by an Abscess; in a Mortification; or in a

Scirrhosity or hard Tumour; and it often leaves Adhesions in the Breast.

The Gangrene or Mortification sometimes appears on the third Day,

without having been preceded by very vehement Pains. In such Cases the

dead Body often looks very black, especially in the Parts near the Seat

of the Disease: and in such the more superstitious ascribe it to some

supernatural Cause; or draw some unhappy Presage from it, with Respect

to those who are yet unattacked by it. This Appearance however is purely

a natural Consequence, quite simple, and cannot be otherwise; and the

hot Regimen and Medicines are the most prevailing Causes of it. I have

seen it thus circumstanced in a Man in the Flower of his Age, who had

taken Venice Treacle in Cherry Water, and the Ingredients of _Faltranc_

infused in Wine.

Sec. 99. _Vomicas_ are sometimes the Consequences of Pleurisies; but their

particular Situation disposes them more to break [22] outwardly; which

is the most frequent Cause of an _Empyema_ Sec. 84. "To prevent this, it is

highly proper to apply, at the first Invasion of the Disease, to the

Spot where the Pain chiefly rages, a small Plaister, which may exactly

fit it; since if the Pleurisy should terminate in an Abscess or

Imposthume, the purulent Matter will be determined to that Side.

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

Substance of the Lungs.

"As soon then as it is foreseen that an Abscess is forming (see Sec. 68) we

should erode, by a light Caustic, the Place where it is expected; and as

soon as it is removed, Care should be taken to promote Suppuration

there. By this Means we may entertain a reasonable Hope, that the Mass

of Matter will incline its Course to that Spot, where it will meet with

the least Resistance, and be discharged from thence. For this Heap of

Matter is often accumulated between the _Pleura_, and the Parts which

adhere to it."

This is the Advice of a very [23] great Physician; but I must inform the

Reader, there are many Cases, in which it can be of no Service; neither

ought it to be attempted, but by Persons of undoubted Abilities.

[23] This is, undoubtedly, Baron _Van Swieten_, with whom he had

premised, he agreed considerably, in all the Diseases they had both

treated of. _K._

With Regard to the Scirrhosity, or Hardness, and to the Circumstances of

Adhesions, I can add nothing to what I have said in Sec. 86 and 87.

Sec. 100. It has been observed that some Persons, who have been once

attacked by this Disease, are often liable to Relapses of it, especially

such as drink hard. I knew one Man, who reckoned up his Pleurisies by

Dozens. A few Bleedings, at certain proper Intervals, might prevent

these frequent Returns of it; which, joined to their excessive Drinking,

make them languid and stupid, in the very Flower of their Age. They

generally fall into some Species of an Asthma, and from that into a

Dropsy, which proves the melancholy, though not an improper, Conclusion

of their Lives. Such as can confine themselves to some proper

Precautions, may also prevent these frequent Returns of this Disease,

even without bleeding; by a temperate Regimen; by abstaining from Time

to Time, from eating Flesh and drinking Wine; at which Times they should

drink Whey, or some of those Diet-Drinks No. 1, 2, 4; and by bathing

their Legs sometimes in warm Water; especially in those Seasons, when

this Disease is the most likely to return.

Sec. 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 the [24] Soot 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. The _Genipi_,

or [25] Wormwood 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]

[24] This, with great Probability, means that small black Substance

often visible in a rotten Egg, which is undoubtedly of a violent,

or even poisonous Quality. Dr. _Tissot_ terms it expressly--_la

suie dans un Oeuf_. K.

[25] Dr. _Lewis_, who has not taken Notice of this Species of Wormwood

in his Improvement of _Quincy's_ Dispensatory, has mentioned it in

his late _Materia Medica_. K.

[26] This being a proper Place for directing the Seneka Rattle Snake

Root, I shall observe, that the best Way of exhibiting it is in

Decoction, by gradually simmering and boiling two Ounces of it in

gross Powder, in two Pints and a half of Water, to a Pint and a

quarter; and then giving three Spoonfuls of it to a grown Person,

every six Hours. If the Stitch should continue, or return, after

taking it, Bleeding, which should be premised to it, must be

occasionally repeated; though it seldom proves necessary, after a

few Doses of it. It greatly promotes Expectoration, keeps the Body

gently open, and sometimes operates by Urine and by Sweat; very

seldom proving at all emetic in Decoction. The Regimen of Drinks

directed here in Pleurisies are to be given as usual. Dr.

_Tennant_, the Introducer of this valuable Medicine, confided

solely in it, in Bastard Peripneumonies, without Bleeding,

Blistering, or any other Medicines. _K._

__Chapter VI.__

_Of the Diseases of the Throat._

__Sect.__ 102.

The Throat is subject to many Diseases: One of the most frequent and the

most dangerous, is that Inflammation of it, commonly termed a Quinsey.

This in Effect is a Distemper of the same Nature with an Inflammation of

the Breast; but as it occurs in a different Part, the Symptoms, of

Course, are very different. They also vary, not a very little, according

to the different Parts of the Throat which are inflamed.

Sec. 103. The general Symptoms of an Inflammation of the Throat are, the

Shivering, the subsequent Heat, the Fever, the Head-ach, red

high-coloured Urine, a considerable Difficulty, and sometimes even an

Impossibility, of swallowing any thing whatever. But if the nearer Parts

to the _Glottis_, that is, of the Entrance into the Windpipe, or Conduit

through which we breathe, are attacked, Breathing becomes excessively

difficult; the Patient is sensible of extreme Anguish, and great

Approaches to Suffocation; the Disease is then extended to the

_Glottis_, to the Body of the Wind-pipe, and even to the Substance of

the Lungs, whence it becomes speedily fatal.

The Inflammation of the other Parts is attended with less Danger; and

this Danger becomes still less, as the Disease is more extended to the

outward and superficial Parts. When the Inflammation is general, and

seizes all the internal Parts of the Throat, and particularly the

Tonsils or Almonds, as they are called, the _Uvula_, or Process of the

Palate, and the _Basis_, or remotest deepest Part of the Tongue, it is

one of the most dangerous and dreadful Maladies. The Face is then

swelled up and inflamed; the whole Inside of the Throat is in the same

Condition; the Patient can get nothing down; he breathes with a Pain and

Anguish, which concur, with a Stuffing or Obstruction in his Brains, to

throw him into a kind of furious _Delirium_, or Raving. His Tongue is

bloated up, and is extended out of his Mouth; his Nostrils are dilated,

as tho' it were to assist him in his Breathing; the whole Neck, even to

the Beginning of the Breast, is excessively tumified or swelled up; the

Pulse is very quick, very weak, and often intermits; the miserable

Patient is deprived of all his Strength, and commonly dies the second or

third Day. Very fortunately this Kind, or Degree of it, which I have

often seen in _Languedoc_, happens very rarely in _Swisserland_, where

the Disease is less violent; and where I have only seen People die of

it, in Consequence of its being perniciously treated; or by Reason of

some accidental Circumstances, which were foreign to the Disease itself.

Of the Multitude of Patients I have attended in this Disorder, I have

known but one to fail under it, whose Case I shall mention towards the

Close of this Chapter.

Sec. 104. Sometimes the Disease shifts from the internal to the external

Parts: the Skin of the Neck and Breast grows very red, and becomes

painful, but the Patient finds himself better.

At other Times the Disorder quits the Throat; but is transferred to the

Brain, or upon the Lungs. Both these Translations of it are mortal, when

the best Advice and Assistance cannot be immediately procured; and it

must be acknowledged, that even the best are often ineffectual.

Sec. 105. The most usual kind of this Disease is that which affects only

the Tonsils (the Almonds) and the Palate; or rather its Process,

_commonly called_ the Palate. It generally first invades one of the

Tonsils, which becomes enlarged, red and painful, and does not allow the

afflicted to swallow, but with great Pain. Sometimes the Disorder is

confined to one Side; but most commonly it is extended to the _Uvula_,

(the Palate) from whence it is extended to the other Tonsil. If it be of

a mild kind, the Tonsil first affected is generally better, when the

second is attacked. Whenever they are both affected at once, the Pain

and the Anguish of the Patient are very considerable; he cannot swallow,

but with great Difficulty and Complaint; and the Torment of this is so

vehement, that I have seen Women affected with Convulsions, as often as

they endeavoured to swallow their Spittle, or any other Liquid. They

continue, even for several Hours sometimes, unable to take any thing

whatever; all the upper inward Part of the Mouth, the Bottom of the

Palate, and the descending Part of the Tongue become lightly red, or

inflamed.

A considerable Proportion of Persons under this Disease swallow Liquids

more difficultly than Solids; by Reason that Liquids require a greater

Action of some Part of the Muscles, in order to their being properly

directed into their Conduit or Chanel. The Deglutition (the Swallowing)

of the Spittle is attended with still more Uneasiness than that of other

Liquids, because it is a little more thick and viscid, and flows down

with less Ease. This Difficulty of swallowing, joined to the Quantity

thence accumulated, produces that almost continual hawking up, which

oppresses some Patients so much the more, as the Inside of their Cheeks,

their whole Tongue, and their Lips are often galled, and even flead as

it were. This also prevents their Sleeping, which however seems no

considerable Evil; Sleep being _sometimes_ but of little Service in

Diseases attended with a Fever; and I have often seen those, who thought

their Throats almost entirely well in the Evening, and yet found them

very bad after some Hours Sleep.

The Fever, in this Species of the Disease, is sometimes, very high; and

the Shivering often endures for many Hours. It is succeeded by

considerable Heat, and a violent Head-ach, which yet is sometimes

attended with a Drowsiness. The Fever is commonly pretty high in the

Evening, though sometimes but inconsiderable, and by the Morning perhaps

there is none at all.

A light Invasion of this Disease of the Throat often precedes the

Shivering; though most commonly it does not become manifest 'till after

it, and at the same Time when the Heat comes on.

The Neck is sometimes a little inflated, or puffed up; and many of the

Sick complain of a pretty smart Pain in the Ear of that Side, which is

most affected. I have but very seldom observed that they had it in both.

Sec. 106. The Inflammation either disappears by Degrees, or an Abscess is

formed in the Part which was chiefly affected. It has never happened, at

least within my Knowledge, that this Sort of the Disease, prudently

treated, has ever terminated either in a Mortification, or a Scirrhus:

but I have been a Witness to either of these supervening, when Sweating

was extorted in the Beginning of it, by hot Medicines.

It is also very rare to meet with those highly dangerous Translations of

this Disease upon the Lungs, such as are described in that Species of it

from Sec. 103, 104. It is true indeed it does not occur more frequently,

even in that Species, whenever the Disease is thrown out upon the more

external Parts.

Sec. 107. The Treatment of the Quinsey, as well as of all other

inflammatory Diseases, is the same with that of an Inflammation of the

Breast.

The Sick is immediately to be put upon a Regimen; and in that Sort

described Sec. 103, Bleeding must be repeated four or five Times within a

few Hours; and sometimes there is a Necessity to recur still oftner to

it. When it assaults the Patient in the most vehement Degree, all

Medicines, all Means, are very generally ineffectual; they should be

tried however. We should give as much as can be taken of the Drinks No.

2 and 4. But as the Quantity they are able to swallow is often very

inconsiderable; the Glyster No. 5 should be repeated every three Hours;

and their Legs should be put into a Bath of warm Water, thrice a Day.

Sec. 108. Cupping Glasses, with Scarification, applied about the Neck,

after bleeding twice or thrice, have often been experienced to be highly

useful. In the most desperate Cases, when the Neck is excessively

swelled, one or two deep Incisions made with a Razor, on this external

Tumour, have sometimes saved a Patient's Life.

Sec. 109. In that kind, and those Circumstances, of this Disease described

Sec. 105 we must have very frequent Recourse to Bleeding; and it should

never be omitted, when the Pulse is very perceivably hard and full. It

is of the utmost Consequence to do it instantaneously; since it is the

only Means to prevent the Abscess, which forms very readily, if Bleeding

has been neglected, only for a few Hours. Sometimes it is necessary to

repeat it a second Time, but very rarely a third.

This Disease is frequently so gentle and mild, as to be cured without

Bleeding, by the Means of much good Management. But as many as are not

Masters of their own Time, nor in such an easy Situation, as to be

properly attended, ought, without the least Hesitation, to be bled

directly, which is sometimes sufficient to remove the Complaint;

especially if, after Bleeding, the Patient drinks plentifully of the

Ptisan No. 2.

In this light Degree of the Disease, it may suffice to bathe the Legs,

and to receive a Glyster, once a Day each; the first to be used in the

Morning, and the last in the Evening. Besides the general Remedies

against Inflammations, a few particular ones, calculated precisely for

this Disease, may be applied in each kind or Degree of it. The best are,

first the emollient Poultices, No. 9, laid over the whole Neck. [27]

Some have highly extolled the Application of Swallows Nests in this

Disease; and though I make no Objection to it, I think it certainly less

efficacious than any of those which I direct.

[27] The _English_ avail themselves considerably, in this Disease, of a

Mixture of equal Parts of Sallad Oil, and Spirit of Sal Ammoniac;

or of Oil and Spirit of Hartshorn, as a Liniment and Application

round the Neck. This Remedy corresponds with many Indications; and

deserves, perhaps, the first Place amongst local Applications

against the inflammatory Quinsey. _E. L._

2. Of the Gargarisms (No. 19) a great Variety may be prepared, of pretty

much the same Properties, and of equal Efficacy. Those I direct here are

what have succeeded best with me and they are very simple. [28]

[28] Dr. _Pringle_ is apprehensive of some ill Effects from Acids in

Gargarisms [_which is probably from their supposed repelling

Property_] and prefers a Decoction of Figs in Milk and Water, to

which he adds a small Quantity of Spirit of Sal Ammoniac. _E. L._

3. The Steam of hot Water, as directed Sec. 55, should be repeated five or

six Times a Day; a Poultice should be constantly kept on, and often

renewed; and the Patient should often gargle.

There are some Persons, besides Children, who cannot gargle themselves:

and in fact the Pain occasioned by it makes it the more difficult. In

such a Case, instead of gargling, the same Gargarism (No. 19) may be

injected with a small Syringe. The Injection reaches further than

Gargling, and often causes the Patient to hawk up a considerable

Quantity of glarey Matter (which has grown still thicker towards the

Bottom of the Throat) to his sensible Relief. This Injection should be

often repeated. The little hollowed Pipes of Elder Wood, which all the

Children in the Country can make, may be conveniently employed for this

Purpose. The Patient should breathe out, rather than inspire, during the

Injection.

Sec. 110. Whenever the Disease terminates without Suppuration, the Fever,

the Head-ach, the Heat in the Throat, and the Pain in swallowing, begin

to abate from the fourth Day, some times from the third, often only from

the fifth; and from such Period that Abatement increases at a great

Rate; so that at the End of two, three, or four Days, on the sixth,

seventh, or eighth, the Patient is entirely well. Some few however

continue to feel a light Degree of Pain, and that only on one Side, four

or five Days longer, but without a Fever, or any considerable

Uneasiness.

Sec. 111. Sometimes the Fever and the other Symptoms abate, after the

Bleeding and other Remedies; without any subsequent Amendment in the

Throat, or any Signs of Suppuration. In such Cases we must chiefly

persist in the Gargarisms and the Steams; and where an experienced and

dexterous Surgeon can be procured, it were proper he should scarify the

inflamed Tonsils. These discharge, in such Cases, a moderate Quantity of

Blood; and this Evacuation relieves, very readily, as many as make use

of it.

Sec. 112. If the Inflammation is no ways disposed to disperse, so that an

Abscess is forming, which almost ever happens, if it has not been

obviated at the Invasion of the Disease; then the Symptoms attending the

Fever continue, though raging a little less after the fourth Day: the

Throat continues red, but of a less florid and lively Redness: a Pain

also continues, though less acute, accompanied sometimes with

Pulsations, and at other Times intirely without any; of which it is

proper to take Notice: the Pulse commonly grows a little softer; and on

the fifth or sixth Day, and sometimes sooner, the Abscess is ready to

break. This may be discovered by the Appearance of a small white and

soft Tumour, when the Mouth is open, which commonly appears about the

Centre or Middle of the Inflammation. It bursts of itself; or, should it

not, it must be opened. This is effected by strongly securing a Lancet

to one End of a small Stick or Handle, and enveloping, or wrapping up

the whole Blade of it, except the Point and the Length of one fourth or

a third of an Inch, in some Folds of soft Linnen; after which the

Abscess is pierced with the Point of this Lancet. The Instant it is

opened, the Mouth is filled with the Discharge of a Quantity of _Pus_,

of the most intolerable Savour and Smell. The Patient should gargle

himself after the Discharge of it with the detersive, or cleansing

Gargarism No. 19. It is surprising sometimes to see the Quantity of

Matter discharged from this Imposthumation. In general there is but one;

though sometimes I have seen two of them.

Sec. 113. It happens, and not seldom, that the Matter is not collected

exactly in the Place, where the Inflammation appeared, but in some less

exposed and less visible Place: whence a Facility of swallowing is

almost entirely restored; the Fever abates; the Patient sleeps; he

imagines he is cured, and that no Inconvenience remains, but such as

ordinarily occurs in the earliest Stage of Recovery. A Person who is

neither a Physician, nor a Surgeon, may easily deceive himself, when in

this State. But the following Signs may enable him to discover that

there is an Abscess, viz. A certain Inquietude and general Uneasiness; a

Pain throughout the Mouth; some Shiverings from Time to Time; frequently

sharp, but short and transient, Heat: a Pulse moderately soft, but not

in a natural State; a Sensation of Thickness and Heaviness in the

Tongue; small white Eruptions on the Gums, on the Inside of the Cheek,

on the Inside and Outside of the Lips, and a disagreeable Taste and

Odour.

Sec. 114. In such Cases Milk or warm Water should frequently be retained in

the Mouth; the Vapour of hot Water should be conveyed into it; and

emollient Cataplasms may be applied about the Neck. All these Means

concur to the softening and breaking of the Abscess. The Finger may also

be introduced to feel for its Situation; and when discovered, the

Surgeon may easily open it. I happened once to break one under my

Finger, without having made the least Effort to do it. Warm Water may be

injected pretty forcibly, either by the Mouth or the Nostrils: this

sometimes occasions a kind of Cough, or certain Efforts which tend to

break it. I have seen this happen even from laughing. As to the rest,

the Patient should not be too anxious or uneasy about the Event. I never

saw a single Instance of a Person's dying of a Quinsey of this kind,

after the Suppuration is truly effected; neither has it happened perhaps

after the Time it is forming for Suppuration.

Sec. 115. The glairy Matter with which the Throat is over-charged, and the

very Inflammation of that Part, which, from its Irritation, produces the

same Effect, as the Introduction of a Finger into it, occasions some

Patients to complain of incessant Propensities to vomit. We must be upon

our Guard here, and not suppose that this Heart-Sickness, as some have

called it, results from a Disorder of, or a Load within, the Stomach,

and that it requires a Vomit for its Removal. The giving one here would

often prove a very unfortunate Mistake. It might, in a high

Inflammation, further aggravate it; or we might be obliged (even during

the Operation of the Vomit) to bleed, in order to lessen the Violence of

the Inflammation. Such Imprudence with its bad Consequences, often

leaves the Patient, even after the Disease is cured, in a State of

Languor and Weakness for a considerable Time. Nevertheless, there are

some particular Disorders of the Throat, attended with a Fever, in which

a Vomit may be prudently given. But this can only be, when there is no

Inflammation, or after it is dispersed; and there still remains some

putrid Matter in the first Passages. Of such Cases I shall speak

hereafter. [29]

[29] In Diseases of the Throat, which have been preceded by such

Excesses in Food or strong Drink, as occur too often in many

Countries, when the Patient has very strong Reachings to vomit, and

the Tongue is moist at the same Time; we should not hesitate, after

appeasing the first Symptoms of the Inflammation [by sufficient

Bleedings, &c.] to assist the Efforts of Nature, and to give a

small Dose of Tartar emetic, dissolved in some Spoonfuls of Water.

This Remedy in this Case, promotes the Dispersion of the

Inflammation, beyond any other. _E. L._

Sec. 116. We often see in _Swisserland_ a Disorder different from these of

the Throat, of which we have just treated; though, like these, attended

with a Difficulty of swallowing. It is termed in French the _Oreillons_,

and often the _Ourles_, or swelled Ears. It is an Overfulness and

Obstruction of those Glands and their Tubes, which are to furnish the

_Saliva_ or Spittle; and particularly of the two large Glands which lie

between the Ear and the Jaw; which are called the _Parotides_; and of

two under the Jaw, called the _Maxillares_. All these being considerably

swelled in this Disease, do not only produce a great Difficulty of

swallowing; but also prevent the Mouth from opening; as an Attempt to do

it is attended with violent Pain. Young Children are much more liable to

this Disease than grown Persons. Being seldom attended with a Fever,

there is no Occasion for Medicines: It is sufficient to defend the Parts

affected from the external Air; to apply some proper Poultice over them;

to lessen the Quantity of their Food considerably, denying them Flesh

and Wine; but indulging them plentifully in some light warm Liquid, to

dilute their Humours and restore Perspiration. I cured myself of this

Disorder in 1754, by drinking nothing, for four Days, but Balm Tea, to

which I added one fourth part Milk, and a little Bread. The same

_Regimen_ has often cured me of other light Complaints of the Throat.

Sec. 117. In the Spring of 1761, there were an astonishing Number of

Persons attacked with Disorders of the Throat, of two different Kinds.

Some of them were seized with that common Sort which I have already

described. Without adding any thing more particularly, in Respect to

this Species, it happened frequently to grown Persons, who were

perfectly cured by the Method already recited. The other Species, on

which I shall be more particular in this Place (because I know they have

abounded in some Villages, and were very fatal) invaded Adults, or grown

Persons also, but especially Children, from the Age of one Year, and

even under that, to the Age of twelve or thirteen.

The first Symptoms were the same with those of the common Quinsey, such

as the Shivering, the ensuing Heat or Fever, Dejection, and a Complaint

of the Throat: but the following Symptoms distinguished these from the

common inflammatory Quinseys.