Peripneumonia is an inflammation of the lungs, supervening, for the
most part, upon violent catarrhs, cynanche, asthma, pleurisies, or
other complaints, but being sometimes the original affection. It is
accompanied with difficulty of breathing, an acute fever of the ardent
type, weight and tightness of the chest, a râle, a seizure of the face
with great fulness, the morbific matter being determined upwards like
fire. Wherefore the cheeks appear red, the eyes swelled, with falling
down of the eyebrows, and the cornea appears somewhat glossy. When the
symptoms incline to a more ardent type, it is to be apprehended that the
inflammation is of an erysipelatous nature. When the disease originates
from the conversion of other diseases into this, we must not have
recourse to venesection, more especially if the diseases be of a chronic
nature, and if blood had been previously let. But, in the remissions,
clysters are to be injected into the bowels, which are moved with
difficulty; or, when nothing contra-indicates, large cupping-instruments
with scarifications may be frequently applied to the breast and sides.
But if the peripneumonia was the original affection, and the strength
permit, we must open a vein; or if not, we may cup, proportioning the
evacuation of blood to the powers of the patient. Let draughts of the
juice of ptisan, or of chondrus with honey, be taken, or from bitter
almonds with semilago, or chondrus having some sweet potion mixed with
it, such as hydromel, apomel, or hydrorosatum. Fresh butter to the extent
of three spoonfuls is also proper. The patient must also drink the
propoma of the decoction of figs with hyssop, or of iris boiled in honied
water, or of powdered iris, to the amount of two spoonfuls sprinkled upon
honied water. This also evacuates downwards. To keep up the strength,
he should be made to drink frequently of honied water alone, and with
pine-nuts, and the seed of cucumbers. And cupping-instruments and the
cerate of privet, having some iris sprinkled upon it; or the cerate of
the oil of rue and dried iris; or that made of wax, and rosin, marrow,
butter, hyssop, dried iris, and nard ointment, may be applied to the
whole chest and sides.
* * * * *
COMMENTARY. The reader is referred to the authorities on pleurisy, as
most of them treat of both diseases together.
Hippocrates recommends bleeding, purging, and attenuant drinks as his
general plan of treatment. If the appendix to his treatise on the Regimen
in Acute Diseases be genuine he approved of carrying venesection the
length of inducing deliquium.
Aretæus gives a minute and faithful account of the disease, but his
description is too long for our limits. He remarks that as the lungs have
but small nerves, there is little pain unless the investing membrane be
affected. He states that when the suppuration takes place, a metastasis
of the matter to the bladder or belly sometimes occurs and relieves
the patient, whereas, if it be determined to the lungs, it is apt to
terminate in phthisis. He gives excellent directions for the application
of his remedies, which are the same as those now in use, namely, copious
bleeding (but so as to avoid deliquium), purging, attenuant and diluent
drinks, rubefacients, containing mustard, to the chest, alkaline
substances, such as soda, given in the decoction of hyssop; and when the
fever has subsided he allows wine devoid of astringency.
Aëtius makes the same remark as Aretæus respecting the metastasis of the
matter. His account of the disease is excellent, but like our author’s.
Celsus properly states that the danger is greater than the pain.
His account of the treatment is too long for our limits, but is well
deserving of attention.
According to Actuarius, in hot affections of the lungs the urine is first
a bright yellow, but if the disease gain ground, and dyspnœa and thirst
supervene, the urine becomes red and of a dark wine colour. (De Urinis,
vii, 5.)
As the Arabians treat the disease like the Greeks, it is unnecessary to
say much of their practice. Haly Abbas describes the disease as a hot
inflammation of the lungs, for which he recommends bleeding, cooling and
diluent draughts, containing linseed, fenugreek, barley, oil of almonds,
liquorice, &c.
Rhases describes a species of pneumonia, requiring the use of tonics,
analeptics, and wine. He relates the case of a patient who, he affirms,
would infallibly have sunk under this disease, if he had not resisted
the advice of the other medical attendants, who prescribed the
anti-inflammatory treatment and laxatives.
Although our business be with facts and opinions, and not with words,
we are confident we shall be excused in giving here a short verbal
disquisition on one of the terms which occur in this Section, we mean
ῥωγμὸς, translated by us _rále_. It occurs again at Book Sixth, Sect.
XXXIII, in the description of _laryngotomy_, and in Aretæus’s description
of asthma (Morb. Chron. i, 11.) Cælius Aurelianus thus defines the term:
“gutturis stridor quem Græci _rhogmon_ vocant.” (Morb. Acut. ii, 10.) In
the Latin translations of the Arabians it is made _oregmon_. See Rhases
(Div. i, 5.) About the terms used by Hippocrates in describing _ráles_
there is some difficulty, owing to the differences of the readings. Thus
in the appendix to the work on Regimen in Acute Diseases we read ῥωγμὴ
in some MSS., and ῥωχμὴ in others. See Littré (Hipp. t. ii, 464.) In
other places he uses ῥέγξις. (Ibid. 262.) In Psellus we read ῥεγμός. (Op.
Med. l. 230.) These, as far as we know, are the only terms used by the
ancients for the noisy sounds of the respiration in the throat and chest.
Ῥόγχος, in Latin rhonchus, we believe, always signifies _snoring_.