Pleurisy, properly so called, is an inflammation of the membrane which
lines the ribs, and is attended with difficulty of breathing, cough,
continual fever, and pain shooting to the clavicle and hypochondrium.
You may distinguish pleurisy from inflammation of the liver (for in it
there are all these symptoms), by the pain in pleurisy being pungent, and
the cough being sometimes without expectoration (when it indicates that
the disease is not yet concocted), and sometimes with expectoration, the
appearance of which indicates the nature of the humour that occasions the
complaint; for it is red and tinged with blood when a fulness of blood is
the cause; yellow and palish when caused by yellow bile; white and frothy
when from phlegm; and blackish when from the melancholic humour. And the
pulse is hard and serrated. But, in inflammation of the liver, the pain
is not pungent, nor is the pulse so hard; and the cough throughout is dry
and without expectoration, and the face appears paler. Pleurisies from
inflammation of the external muscles (which are not, properly speaking,
pleurisies) are not accompanied with cough and expectoration, nor is
the pulse hard; and if one touch the part affected with his hand, the
patients feel pain; and if not resolved, the swelling is converted into
pus, which may be evacuated externally by an incision; whereas pleurisy
from inflammation of the membrane which lines the chest has not this
termination; for if it do not discharge the empyema either internally or
externally, it terminates in peripneumonia.
_The cure._ If the pain shoot to the clavicle, we must straightway open
a vein; or if to the hypochondrium, we must purge downwards. Physicians
of late, in all cases, have recourse to venesection, apprehending,
I suppose, the disturbance occasioned by purging. When the strength
prevents us from having recourse to either of these remedies, we must use
stimulant clysters; and if the pain is moderate, after the clyster we
may give honied water, and the juice of ptisan and of chondrus. When the
affection is on the decline, we may add to the juices leeks or calamint,
and the patient may get the seeds of pennyroyal and nettle, with honey,
as a linctus. When the pains are violent after the evacuation, they
must be soothed by the application of hot wool, or of sulphurated wool;
or by fomentations of millet and flour in a bag, or by means of hot
water or oil in a bladder. Unwashed wool may be applied with oil; and
wine, containing an admixture of sea-water, or salt, may be added to
it. Or we may apply a cataplasm, formed of the medicine from seeds,
with the decoction of chamomile and marshmallows, or of dried figs,
iris, wormwood, and some honey, with oil of nard. About the fourth day
give spoon-meats for food, with some honey; but after the seventh day
we are to give a linctus of almonds and nettle-seeds, triturated in
honey, or the linctus of butter and honey pounded together. And we are
to use the hypoglottis (electuary) of boiled honey. And we must apply
to the affected parts the fetid epitheme—that from sweet marjoram, and
the rue-plaster. The bulbi, applied with axunge, are often an effectual
remedy, and they may also be administered in a clyster with butter
and turpentine. Among the most powerful remedies is the linctus from
pine-nuts and bitter almonds, linseed, pitch-fruit, and starch, in equal
parts, with honey. When they are troubled with insomnolency, it will be
proper to give a linctus of poppy-heads; and we may use the antidote
called athanasia, and those prepared for this purpose. When the disease
remains after the fourteenth day, we must cup them, and keep them upon a
spare diet; and then, when the disease is on the decline, we may make
them take the bath (but avoiding the cold), and allow them to use a more
nutritious diet. If the inflammation of the pleura be not resolved, but
appear to be converted into pus, we must have recourse to the remedies
formerly mentioned.
_For pains of the sides without fever._ Pains of the sides without
fever are cured by bdellium and costus, mixed with the ashes of burnt
cabbage-leaves and tallow: for this remedy is powerfully discutient.
* * * * *
COMMENTARY. See Hippocrates (de Morbis, ii; de Rat. Vict. in Acut.);
Galen (de Med. sec. loc. vii, et alibi); Celsus (iv, 6); Aretæus (Morb.
Acut. i, 10; Curat. Morb. Acut. i, 10); Aëtius (viii, 76); Psellus (Op.
Medicum); Alexander (vi, 1); Oribasius (Synops. ix, 7, 8); Actuarius
(Meth. Med. iv, 4); Nonnus (129); Cælius Aurelianus (Morb. Acut. ii,
13); Octavius Horatianus (ii, 4); Marcellus (de Medicam. 24); Serapion
(ii, 21); Mesue (de Ægrit. Pect. 7); Avicenna (iii, 10, 4); Alsaharavius
(Pract. xii, 8); Avenzoar (i, 16, 4); Haly Abbas (Theor. ix, 21; Pract.
vi, 13); Rhases (Divis. 54; Contin. x.)
Hippocrates gives brief descriptions of pleurisy, and recommends nearly
the same treatment that is now practised, namely, bleeding ad deliquium
animi, purging, diluent drinks, and fomentations to the side by means
of sponges squeezed out of hot water, or of bags filled with salts and
millet, or the like. He says, those who have neither been bled nor purged
die on the seventh day, either with delirium, or with orthopnœa and a
râle. One of his aphorisms is, that pneumonia supervening upon pleurisy
is dangerous. (vii, 11.) He was acquainted with pulmonary adhesions, as
is remarked by his devoted admirer Laennec.
Aretæus, with his usual accuracy, gives a most complete description of
all the symptoms of pleurisy, but, as it is not much different from
our author’s, we shall not enter far upon a detail of it. He states
distinctly that the disease is an inflammation of the membrane which
lines the chest. The sputa are pituitous, bilious, or deeply saturated
with blood, or yellowish. He remarks, by the way, that pleurisy is
sometimes a sporadic disease, and sometimes epidemical. His directions
about the application of the common remedies are dictated by his usual
excellent judgment. On the necessity of early and repeated venesection
he insists strongly, but recommends it not to be carried the length of
producing deliquium animi, as the fluids will thereby be determined
inwardly. Archigenes (ap. Aëtium) and other ancient authorities joined
him in this rule of practice, although in opposition to Hippocrates. He
approves of cupping the side, but not until after the seventh day, and
directs us to apply to the scarifications salts or nitre. His internal
remedies consist of demulcents, diluents, and narcotics, varied according
to circumstances. He forbids the use of cold drink and cold air. Celsus
also cautions against cold, and directs sinapisms to the chest. His
general treatment is nothing different from that of Hippocrates.
Galen treats of pleurisy cursorily in many parts of his works, but, as
he follows entirely the views of Hippocrates, we need not enter into a
detail of his practice. We may mention, however, that the worst character
of the pulse, according to him, is when it is hard, small, and very
frequent. (Diff. Puls. iv, 5.)
Aëtius gives an interesting account of a species of pleurisy arising
from indigestion or crudities of the stomach. In this case he forbids
venesection, and recommends clysters and calefacient applications.
Alexander gives very minute directions how to distinguish pleurisy
from hepatitis. He remarks that, in the latter disease, the patient is
yellowish: in the former the pulse is hard and serrated. When the pain
is not violent, he recommends us to trust to cupping, which he says was
a popular remedy in Armenia. He disapproves in general of opiates. When
the discharges from the bowels are bilious, he directs purging with
scammony, black hellebore, and the like. According to Actuarius, the
urine in pleurisy is first reddish, and afterwards becomes red and of a
dark wine colour. (De Urinis, vii, 9.) The sputa, he says, in pleurisy
and pneumonia, is of a whitish and bloody colour. (De Diagnos. i, 16.)
Psellus cautions us not to confound pleurisy with abscess of the side.
In the latter case, he remarks, there is no cough, and pain is felt upon
pressure. He appears to copy from Paulus.
There is nothing particularly original in the accounts given of it
by Oribasius, Nonnus, Octavius, and Marcellus. We shall, therefore,
proceed to explain the views of the Methodists. The remedies recommended
by Cælius Aurelianus are, upon the whole, nearly the same as those
directed by the other sects, but he attaches much importance to his own
method of applying them. In illustration of his principles, we shall
mention a few of his strictures upon the practice of the others. He
condemns Hippocrates for carrying venesection the length of producing
deliquium animi, which he pronounces to be a very pernicious practice.
Indiscriminate purging, he thinks, increases irritation. He disapproves
of abstinence for seven days, as enjoined by the father of medicine.
Diocles he blames for enjoining the same rules with regard to bleeding
and purging, and for allowing cold food in summer. Praxagoras he strongly
and properly condemns for giving pepper or southernwood in mulse; and
also for recommending the warm bath, and fomentations to the side,
which he justly remarks will only occasion cold to the patient; and for
prohibiting venesection, when the disease is occasioned by cold, and the
patient is old and weak. He finds fault with Asclepiades for saying that
venesection is not proper in certain countries, as at Rome and Athens,
whereas Cælius properly maintains that venesection is everywhere proper.
It is worthy of remark, by the way, that prejudices against bleeding
prevailed in Rome when Galen wrote, and to a certain extent do so still.
Cælius also justly condemns his too free allowance of mulse, or wine and
honey. He blames Themison for using acrid applications to the chest. Of
his strictures on the treatment of Heraclides, the most just are his
condemnation of the practice of giving mulse with rue, and garlic with
vinegar, to remove the nausea; and of his direction to bleed only on the
second day after two or three clysters had been given.
Of the practice of the Arabians little need be said, as their views of
treatment are entirely conformable to those of the Greeks. Avicenna’s
directions are most minute, and would furnish an excellent guide to
practice. He forbids cold things, and approves of cupping and sinapisms
only when the disease does not yield to the ordinary treatment. When
insomnolency continues long, he permits to give the syrup of poppies.
Convalescents are directed to avoid saltish and sharp things, repletion,
the sun, wind, smoke, loud talking, and the like. Serapion, on the fourth
day, adds liquorice to the decoction of barley. Mesue and Avicenna agree
in opinion, that fomentations to the side do no good unless in slight
cases, and when applied early. Mesue forbids cupping until the seventh
day; and, when the stomach and bowels are loaded, he opens the bowels
before bleeding. Haly Abbas directs bleeding from the arm opposite
the side affected, at first; but, if the disease is protracted, from
the arm of the same side. He recommends gentle laxatives, and, after
bleeding and purging, warm applications to the side, such as a bladder
half filled with hot water. He also speaks of cupping, and of stimulant
plasters, sinapisms, and such like. He says, when the body is cleansed,
and the disease matured, the patient is to be put into a tepid bath. This
practice may deserve consideration.
It is worthy of remark that the Arabians in general bleed from the arm of
the opposite side. The Greek and Latin authorities are divided in opinion
upon this rule of practice. Hippocrates, Galen, and Celsus recommend us
to bleed from the arm of the affected side; but Aretæus, Aëtius, and
Cælius Aurelianus, from the opposite. Galen, in one place, mentions that
he had abstracted blood in a case of pleurisy by opening one of the
arteries of the hand.