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the cough is always brought on, and there is a pain and ftrait- nefs in the breaft, that alfo declares the feat of the diforder to be in the lungs.
Atrophies are alfo much of the fame nature with a pbtbifis, dif- fering only in regard to the part they affect, and to the age of the patient. An atrophy is an injury of the glands of the me- fentery, pancreas, or liver, and is common to infants ; where- as thepbtbijis is a like difternperature of the lungs, and affects perfons nearer the time of their growing to man's eftate. A true pbtbifis is, however, to be carefully diftinguifhed from that marafmus which frequently affects old perfons : this arifes from many different caufes, but never from that of a pbtbifis^ or difternperature of the lungs. The vomica pulmonum is alfo by fome confounded with a pbtbifis, but improperly; for tho' thefe diftempcrs are nearly allied to one another, and often degenerate into each other, yet their origin is different. The pbtbifn takes its origin from an ulcer, properly fo called ; the vomica is an abfeefs, or impofThumation. The ulcer in a pbtbifn affects the humid parts of the lungs, where there is leaft blood ; the vomica, on the contrary, is always feated in thofe parts where there is moft abundance of blood : fin'ce it generally happens, that a vomica is a fliorter difeafe in its pe riod, and carries the patient off earlier; the pbtbifis does it more flowly and gradually. When a vomica, indeed, does not carry off the patient at firft, it ufually degenerates into a true phthijis ; and on the other hand, when the matter lodged in the lungs in a true pbtbifis is fo acrid as to corrode the vef- fels, then a vomica pulmonum often comes on in the courfe of that difeafe; but thefe are accidental degenerations of one difeafe into another, and tho' the firft cafe is frequent, the other is more rare.
Signs of a pbtbifis. This difeafe, when it begins flowly and gradually, has fcarce any figns at all by which it may be known: the utmoft fymptoms of it in this cafe, is a cough, which, tho' not violent, will not be cured. This cough, by degrees, increafes, and holds the patient always, in fpite of medicines: in fome cafes it is moderate, but in others it be comes in a little time very violent. This cough is in fome at- tended with a confiderable fpitting, in others with very little, and in fome' perfons, both at the beginning and end of" the diftemper, with no fpitting at all.
It is, however, a vulgar error to fuppofe every cough attended with fpitting to be a confumption, for very frequently the faults of the firft concoction will give origin to coughs more violantj, and attended with greater fpitting than thofe in a genuine pbtbifis. Hence, for the proper diftinguifhjng of a pbtbifis, many other fymptoms are neceffary : thefe are, that the patient be of an age fuited to this difeafe, in general, be- tween fifteen and thirty-five : the cough alfo, in a true pbtbifis, is continual, and always becomes much more violent on being cxpofed to the cold, as alfo on drawing the breath very deeply, ortaking the effluvia of airy acrid fubftances: when the mat- ter feems fetched up from very deep, and is ftreaked with blood, or is of an ill fmell, and approaching to the nature of matter ; this alfo denotes the cafe to be a true pbtbifis. This difeafe is always attended alfo with a decay of itrength, a fen- fation of a ftraitnefs in the breaft, a want of appetite, or a defire for nothing but cold foods and drinks. The fleep in this cafe alfo rather tires and weakens than refrefhes the pa- tient, and the mou-h is dry, the faltva glutinous, and the temper ufually peevifh, and affected flxongly at trifles ; the body alfo becomes extremely fenfible of all changes of the weather. If thefe fymptoms happen in a cafe where there is either an hereditary difpofition to a pbtbifis, or where there has been any prior injury done to the lungs, there is no room to doubt but that the cafe is a true confumption or pbtbifis. Thefe prior injuries of the lungs may be either from preced- ing difeafes, fuch as a fpitting of blood, a peripneumony, or the like ; or from external contufions or wounds of the breaft ; or finally, from frequently being among the vapours of cor- rofive medicines : and when thefe are attended with a hectic, or Iofs of flefh in the whole body, and particularly in the face, there is not the leaft room to doubt but that the cafe is a dan- gerous pbtbifis. The fpitting of purulent matter is one of the moft certain figns of a perfect pbtbifis, but it is not an univerfal one; for there are fome cafes in which the bronchia and mem- braneous portions of the lungs only are affected, in which a pbtbifis may arrive at its greateft degree without any fuch fpit- ing. It is alfo to be obferved, that the common thick, ycllow- ifh, or grccnifh matter, which is frequently voided in large quantities in Ample coughs, is not to be confounded with the purulent matter voided in a continued pbtbifis. The urine of people in this difeafe is ufually very like that of perfons in health, except that it retains its froth longer ; this, however, is no certain fymptom of the difeafe, for it fre- quently happens in cafes of fimple colds, in people of phleg- matic habits.
Jf a vomica pulmonum comes on from a pbtbifis, the fever, which was before a flow one, aflumes the appearance of an acute one ; and the pain that attends the cough becomes more violent, and refpiration more difficult ; finally, colliquative fweats, and diarrhoeas, are very fatal fymptoms, ufually appear- ing towards the laft fiages.
Ptrfms fubjetl to a Phthisis. Thefe are principally young
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people of a plcftoric habit, accuftomed to perfeel health, and of florid conftitutions, particularly fuch as live idle lives. 1 hole who labour hard, or are of a fcorbutic or phlegmatic habit, are more than all others free from this difeafe. Perfons who are lubjca to haemorrhages of any kind, or to violent pains in the head, and thofe who find their breath very fhort after a little exercife, and particularly fuch as have had at any time fpitings of blood, are moft fubjecft to this diftemper ; as thofe, on the contrary, who are fubjea to cattarrhal deduc- tions, to fimple coughs, or to diarrhoeas, or cutaneous erup- tions, or external ulcers, are ufually free from it. Women in general are much more expofed to phthifes than men ; and that for this plain reafon : the fuppreffion of any habitual hse- morrhage, endangers the patient as to this difeafe ; and women are well known to be more fubjea to evacuations of blood than men ; and alfo to the fuppreffions of thofe evacuations. Old people are very feldom found to have phthifes, unlefs they anfe from violent external injuries ; and very young perfons are as feldom liable to them, unlefs from fuppreffions of large and habitual hxmorrhages by the nofe.
Caufes ,f a Phthisis. The remote caufe of this difeafe, is a plethoric habit; the proximate caufe is a congeftion of florid, rarely of ferous blood, in the breaft. The occalional, or ac- cidental caufes, are either external injuries from blows, falls, or bruifes on the breaft, a violent cough in the autumn, at which feafon the air is pecujiarly bad for all perfons inclined to z pbtbifis; the abufe of fpirituous liquors, the immoderate ufe of venery, the receiving the fumes of corrofive medicines, and finally, the improper cure of other difeafes, particularly the fuppreffing of fevers and hxmorrhages by aftringents, without any previous cautions. An hereditary difpofition is alfo frequently in fault; the cough which attends this difeafe is only an effort of nature, to break through the congeftion in the firft ftages, and in the latter, to throw up the matter oc- cafioned by it.
Pr-gnofics in it. A true pbtbifis, even in its beginning, is a dangerous difeafe, and admits but of a very dubious progno- ftic ; but when in an advanced ftate, it is always fatal. The reafon of this is evident, becaufe there are in this cafe real ul- cers in the lungs, and we well know that no ulcer can be cured till it is firft perfeflly cleanfed, and that is not eafy in an internal part ; and after this, the healing up of a wound in the lungs is fcarce to be expeBed, as thofe parts are continually difturbed by the very drawing in and voiding the breath, and greatly more fo by the cough. There have been, however, inftances of cures in the beginning of a phthifis, in which there have been evident proofs of a reftitution and cicatriza- tion of the parts.
People of a dry habit are much fooner carried off by it than thofe of a moift one ; as are alfo thofe of a bride difpofition, than thofe of a more languid temper ; and finally, younger perfons ufually die fooner in it, than thofe who are' more ad- vanced in years. Women, as they are more fubjea to a phthifis than men, fo they are more eafify cured. This diftemper is often brought upon them merely from a fuppreffion of" the menfes, and in that cafe it is often cured only by regularly bringing them again to their proper periods. The heaic fe- ver in thefe cafes is what haftens the death of the patient ; fo that the lefs of that fever the patient has, the longer he lives under it.
When the fpitting of true purulent matter is come on, and is attended with colliquative fweats and a diarrhoea, there is no farther hope for the patient ; and in genera], what is reported of the curing of confumptions, is founded on errors, and other cafes have been miftaken for it. A catarrhal cough be- come habitual, and attended with a voiding of a thick, pulpy, greenifh matter, is often miftaken for a confumption : as is alfo a flow fever, attended with copious fweats, and an exte- nuation of the body ; or a recent heaic, arifing from a con- tinued flow fever ; or a merely afthmatic diforder of the breaft ; or finally, a hasmoptvfis has been miftaken for a pbtbifis. In all the cafes faid to have been phthifes, and perfeaiy cured, ei- ther one of thefe has been the cafe, or the mere ftrength of nature, affifted by happy circumftances in the conftitution, not to be expeaed from one perfon in a thoufand, have carried the patient through it.
Method of Cure. The general method in a genuine phthifis, is to refpea firft the refolving, abftergifig, and difcufling the ul- cerous matter in the lungs ; and after this to attempt the clean- fing and healing of the ulcers; afterwards to reftore the ftrength by analeptics, and to give the weakened parts their due tone again : and during this, the feveral fymptoms, fuch as the cough, fever, C3V. are to be palliated as much as may be.
To this end, in the beginning of the courfe, gentle laxatives are by all means to be given ; fuch as fmall dofes of rhubarb, with manna, tamarinds, and the like : and in fubjeas abound- ing with bad humors, jalap, fena, and, in fome cafes, even mercurius dulcis are found neceffary ; but this laft medicine is only to be given with the utmoft caution, for fear of a falivation. After a few dofes of the laxatives, the re- folvent, abftergent, and difcutient medicines are to be given for feveral weeks together ; fuch are, decoaions of pimper- nel!, elecampane, fiorentine, iris, birth-wort, and frcfli arum- root,
