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that ufually attended with a fpitting of coloured matter, often ftreaked with blood ; but the fpurious often has no cough at all attending it ; or if it has, there is no difference feen in the matter voided by fpitting. The true has always an acute continuous fever, which attacks the patient at firft with a fhivering ; the fpurious either has no fever at all with it, or it is at the utmoft a flight and irregular one. The true difeafes do not terminate in lefs than feven days; the others much fooner. The true ufually attack young people; the fpurious are common to young and old. The difference between the true and fpurious difeafes, are deter- mined by the obfervation of thefe fymptoms ; but it yet re- mains to diftinguifh juftly the true difeafes from one another. This is done by the following obfervations : T\i& pleurify is a very rare difeafe; and the peripneumony a verv common one ; but this is exactly contrary to the com- mon opinion, from thefe difeafes being too generally con- founded with, and miftaken for one another. In a peripneumony^ a fpitting of blood ufually happens about the clofe of the fecond day : this is a primary fymptom in a peripneumony, but is ufually erroneoufly attributed to a pleurify, tho' reafon Chews how eafily fuch a fpitting may happen from an inflammation of the lungs ; and it is very different to con- ceive how it fhould happen fo readily from an inflammation of a part fo remote from having any communication with* the organs of expectoration as the pleura. In the peripn:umtmy y the pain extends itfelf farther, affecting the whole breaft, whereas in the pleurify it is rather fixed to the right fide, and felt a little below the breaff . Thefe are the fymptoms by which thefe difeafes are difUnguiihed from one another, and the ufe of the diftinction is principally this, that in the plenrify the application of external remedies often is of great fervice, whereas it is of no effect in the other cafe, tho' the miftake is of no great confequence in this refpe£t as the applications in the peripneumony can do no harm : but in an unhappy termination of thefe difeafes by fuppuration, the diftinction becomes of fome confequence ; fince in the pleurify the matter may be evacuated by a paracentefls, or the letting in a canula; which In the peripneumony can by no means be done, unlefs in fuch an accidental cafe that the di- feafe terminates in an external vomica pulmonnm : then indeed the matter being difcharged from the abfeefs into the cavity of the thorax, may be let out in the fame manner as in the fup- purated pleurify ; but this is a cafe that does not occur in an age, The ufual opinion of medical writers, in regard to this cafe, is, that the peripneumony is always a diforder affecting only the external furfaceof the lungs ; and they obferve, that even its name exprefles this, the fignification of it being a diftem- perature fpreading round about the lungs : this, however, is not agreeable to obfervation or experience; for in diffections of bodies that have died of this difeafe, the very internal part of the lungs is always found affected ; and indeed if the fur- face only were fo, it is not eafy to conceive how the fpitting of blood fhould come on fo foon as the fecond day,
Signs of thefe difeafes. Thefe are in general common to both, and are the following : A vertiginous diforder of the head ufually precedes all the other fymptoms ; this is fucceeded by a fhivering and chillnefs all over the body; this increafes-by degrees, and ufually brings on with it cardialgias, naufeas, and anxieties : after tliis there comes on a very remarkable heat, with very intenfe thtrft, and a violent pain in the head ; this is accompany ed with a ftraitnefs of the breaft, and dif- ficulty of refpirat'ion; and the patient feels a violent and fe- vere pain in the breaff: and this becomes continual, and is always greatly exafperated by the cough that attends the dif- eafe. The urine in the firft days is red, and after a few days more it becomes turbid, when it has Hood to be cold ; and finally depofits a thick pale-red fediment. The peculiar fymp- toms of each difeafe are already enumerated.
Per fans fubjeSt to them. Thefe are difeafes not equally common to all ages, but they principally affect young people : they are moft frequent in the beginning of the fpring feafon, and raoft- \y affect fuch as are of a fanguine plethoric habit. Perfons who have been fubject to bleeding at the nofe, but have been for fome time free from returns of them, often fall into thefe difeafes ; and in general men are much more fubject to them than women.
Caufes of them. Thefe difeafes are brought on by any thing that gives a violent commotion to the blood, fuch as immo- derate exercife, the abufe of fpiritous liquors, and violent fits of anger. The fuddenly cooling the body when very hot, has alfo often occafioned them, by fhutting the pores and for- cing the blood inwards. The neglect of habitual bleedings may alfo occafion them ; and they have been fometimes oc- cafioned by blows, or other external injuries on the breaft, and by the endeavouring to lift great weights.
Prognoftia in them. All inflammatory fevers are dangerous ; but the pleuriy and peripneumony, when they attack young per- fons, or fuch as are under thirty years of age, are attended with the leaft danger of any, provided that they are properly treated : when they affect perfons advanced in years, they ufually prove very dangerous, in fpite of all the care and caution that they can be treated with. Suppl. Vol. II.
PLE
When they have been treated in a judicious manner, they ufually go off on the feventh, or at the utmoft the eleventh day in copious fweats, which come on of themfelves; after; this enfis, the pulfein a very little time returns to its natural ft.te, the violent heat goes off, and the ftrengt , appetite, and fleep, return. When they go beyond the days of their crifes, which is often the cafe in old people, they then be- come very dangerous. If the urine is obferved to be turbid before the fourth day, and afterwards depofits a fediment, and the reft remain clear at the top, there is great hope that the difeafe will terminate happily, on the critical day, by a fweat. When a yeilowifh matter is thrown up by cough- ing, and is neither very vifcid nor frothy, and particularly when in a peripneumony it is ftreaked with blood, there is great reafon to expect that the difeafe will go happily off: but. on the contrary, when the patient cannot fpit at all, and the urine continues crude, there is great reafon to fear the difeafe will have a fatal period.
Finally, when a difcuflion and refolution of the ftafis cannot be effected by nature, or obtained by art, a corruption and fuppuration follows, and often an ulcerous difpofition of the lungs, or true phthifis is the confequence. Method of cure. The bowels are to be kept gently lax, during the whole courfe of the difeafe; but no irritating medicines muft by any means be given to promote this. When there is a remarkable plethora with a narrownefs of the breaft, and a fenfible fluffing up of the lungs, then bleeding is necefiary 5 but a fmall quantity only fhould be taken away, and the fame repeated the next day or oftener, if the fame fymptoms con- tinue to require it: always after bleeding the patient muft take fome gently diaphoretic medicines, and drink plentifully of warm and weak liquors. In the ufual and more common cafes, bleeding is not ncceffary in thefe difeafes, tho' fo great- ly recommended by fome. Every day before noon it is pro- per to give two dofes of the mixtura fimplex, or fome other fuch temperate diaphoretic, with large draughts of warm li- quors ; and in the afternoons the ahtifebrific powders of nitre,' diaphoretic antimony, crabs eyes fated with lemon juice mould be given ; and emulfions are alfo very proper, made of fweet almonds and barley water, or of the feeds of carduus marise. When thefe medicines have been given for fome days, if the pain continues ftill violent, the tincture of cafcarilla muft be taken ; and in cafes of the pleurify.. cloths four or more times doubled and wetted in camphorated fpirit of wine, are to be applied to the part. Plafters may alfo be applied occauonally, but they muft not be fuffered to remain on too long, left they ftop refpiration ; an equal regimen and perfect quietnefs is to' be obferved during the whole time of the difeafe; but par- ticularly on the critical days, on which nature muft be by no means ruffled or difturbed.
Authors differ greatly in their opinions about bleeding in this? difeafe: fome judge it abfolutely necefiary in all cafes; and others wholly reject it in all. Etmuller obferved, that bleed- ing in thefe difeafes always gave the ftafis a tendency to fup- puration ; others are of opinion, that it is to be done, or omitted, according to the peculiar indications in the cafe; and fome throw afide all the diflblvent and difcuttent medi- cines, and rely on the volatile fairs alone for the promoting fweats, and accomplifhing the cure by that means alone, only obferving, that if the difeafe will not yield to thefe, bleeding is to be added.
But rhe more rational practice feerns to determine, that it is a rafh attempt to endeavour to difcufs a ftafis already formed by hot medicines, which expand the blood, and feem calcu- lated only to add to it ; and that the natural ftate of the di- feafe does not indicate bleeding, tho* the urgency of certain fymptoms, fuch as ftraitnefs of the breaft and infarctions of the lungs, in perfons of plethoric habits, may render it ne- cefiary and beneficial.
Perfons of very plethoric habits, who have died of thefe dif- tempers, on diffection, have been found to have one fide of the lungs fo fluffed up with blood, that it would fink in wa- ter ; and unqueftionably in fuch cafes bleeding is neceffary. Sydenham's method of curing by large and often repeated bleedings, and the ufe of gentle expectorants, is found very dan- gerous in its effects, and feems the only reproachable thing in the works of that excellent writer. And tho' Riverius gives an inftance of a perfon cured of a pleurify in a few hours, by bleeding alone, the account docs not feem wholly to be depended upon ; for fome circumftances in the relation feem to fhew, that the difeafe was not properly either a pleurify, or a peripneumony, but an inflammation of the liver or fto- mach. Some people recommend the flowers of the common red poppies in thefe cafes, as a fpecific remedy; but Etmuller allows them no fuch quality, but fays they act in this cafe merely as a gentle opiate and anodyne ; a fort of medicines ' very dangerous in thefe cafes.
The feeds of carduus maria;, or the milk thiftle, are alfo by fome recommended as fpecifics: it is very evident that they mitigate the pain ; but the fever will always continue to its regular period on the feventh day.
Expectorating medicines, in general, are of no ufe in thefe
cafes, only if the fpitting of a bloody matter do not fucceed
a Q_q fuiBcient-
