AN EXPLANATION Of that PART of Dr. Boerhaave’s Aphorisms, Which treats of the PHTHISIS PULMONALIS, OR THE CONSUMPTION; Describing the RISE, PROGRESS and METHOD of CURE, peculiar to that Disorder. By CHRISTOPHER PACKE, M.B. LONDON: Printed by M. Cooper, for the Author 1754 TO THE READER THE following pages were origi- nally designed as a specimen of an intended supplement, to the English translation, of the two first volumes of Vann Swieten’s commentary, on Boer- haaves Aphorisms concerning the know- ledge and cure of Distempers; and the author had never heard of the publi- cation of a third Volume of that ex- cellent work till he had agreed with the printer, for the publishing this little commentary. The size of his intended performance therefore is now diminish- ed by one half, as there remains at pre- sent only a fourth part of the aphorisms unexplaned. As To the Reader. As an entire explanation of Boer- baaves Aphorisms, cannot but be very necessary to beginners in the Science of Medicine, it is hoped, that this intended performance will be well accepted, till its deficiencies are supplied by some more able hand. The proposals describing the conditions on which the intended supplement will be published, are to be seen at the end of this Commentary. An AN EXPLANATION OF Dr. Boerhaave’s Aphorisms. Phthisis. SECT. MCXCVI. IF the lungs should be so eroded by any ulcer, that a consumption of the whole ha- bit should be occasioned, the patient is said to be afflicted with the Phthisis Pul- monalis, or a Consumption as the English popu- larly call it. Before this disorder is more particularly consi- dered, it will be by no means improper to excite in the readers mind, a general idea of its phæno- mena, their causes and effects. The distemper arises from an exulceration of the substance of the lungs, affecting the veins, arteries and bronchial vessels. The pus absorbed from this ulcer into the blood, dissolves its whole mass by degrees into a putrescent liquamen, imparting at the same time an alcalescent acrimony to the fluids; On this single circumstance simply considered, de- B pends 2 Phthisis pends almost the whole assemblage of symptoms apparent in the disease. The blood through the ab- sorption of purulent matter, labours under a begin- ning and increasing cachochymy; its balsamic qua- lity decreases, then disappears; and as the distemper increases in violence, the fluids are so far from being nutrititious, that they become towards the end acrid and eroding; abrading every day more and more the solid parts of the body; whence the wasting and consumption. The blood being first spoiled by the ulcer, continually supplies it with fresh pus and this increase of pus, promotes the farther conta- mination of the fluids with an amazing swiftness, in so much that the disease is sometimes finished by the death of the patient in so short a time, that it loses almost the denomination of a chronic disorder. A young lady of about sixteen, died in less than a fortnight after the first spitting of purulent matter, notwithstanding great care taken on the first; appearance of the cough, with regard to her regimen in diet, her medicines, a perpetual blister to divert the matter from the lungs, riding on horseback and in a coach, and the constant use of asses milk. The lungs are full of cells and their substance is very soft; so that the matter is liable to lodge in them with great obstinacy, and a suppuration once begun, is easily communicated to their whole sub- stance, through the softness of its contexture. The number of cells for the reception and confinement of the matter, is probably the reason why consump- tive patients are often rendered miserable, by a con- stant tickling ineffectual cough, through the great difficulty of expectoration, and the endeavour of nature to dislodge the offending matter. There is also another calamity, which greatly contributes to render this evil so difficult of cure and quick in its progress, which is, that the lungs are furnished with a greater number of absorbent vessels, than any Pulmonalis. 3 any other of the viscera, if you except small guts with the bibulous orifices of their lacteal veins. The quantity of the absorbed matter and the progress of the bloods infection, will be in a direct ratio (ceteris paribus) of these absorbent vessels: So that in a pulmonary consumption the blood will be sooner spoiled, than in a consumption of the liver, spleen and other parts. The ulcers there- fore of this part are less likely to heal, as the sinuses will be more numerous, from the great number of cells and soft contexture peculiar to the lungs; and the matter will be rendered sooner purulent, from its great increase and obstinate con- finement. Also if some of the ulcers are healed, new ones are more likely to be formed. The con- stant motion of the part in respiration, and dis- traction of the fibres under a solution of conti- nuity still farther from each other, is also another reason, why these ulcers are so very difficult of con- solidation: This motion of the parts, occasioned by the ingress of the air in respiration, is very diffe- rent from that of the lungs and whole body together, in riding, failing or swinging; which is salutary, promotes expectoration, the transit of the blood and reunion of the ulcerated fibres; by this, the parts not being farther distracted from each other. If we observe a wound made in any muscular exter- nal part of the body, we find, that by the motion of that part in particular, the aperture will be- come larger and the cure impossible, till the divid- ed fibres are kept in contact, by rest and a proper situation of the part. SECT. MCXCVII THE origin of this ulcer is derived from any cause, which confines the blood within the lungs in such a manner, as to convert it into purulent matter. B2 In 4 Phthisis In confirmation of this (admirable and compre- hensive) definition we find, that inflammatory ob- structions of the lungs are often terminated in a- consumption; any schirrous tubercles may impede the passage of the blood, producing the same ef- fect; also coughs (or what we commonly call colds) long continued, are often productive of this evil; as by the violent and frequent agitation of the parts in coughing, a solution of continuity in the fi- bres may be effected, and the bloods passage through the lungs so impaired, as to produce pus from its Stagnation in them. SECT. MCXCVIII. THESE causes may be referred, first (A) to that particular temperament of the body, by which an haemoptoe is first occasioned, and after that, an ulcer in the eroded part. This consists in the tender frame of the arteriose vessels, and the impetus of the blood infected with acrimony of any sort. It is known by the appearance of the fine ves- sels, and of the whole body: A long neck, plane and narrow chest, depresson of the sca- pulae, the blood being very florid, thin, dissolute, acrid and hot. The colour of the body being white and fine red, the skin transparent, mind chearful and the genius quick. (B) In that weakness of the bowels, by which the aliments too tenacious in their own nature, beget obstruc- tions, putrefaction and acrimony then is pro- duced an exulceration of the vessels eroded by these evils; this is known by a small febricula, dry cough, increasing heat, redness of the lips, mouth and cheeks, increasing and arising after Pulmonalis. 5 after the entrance of fresh chyle into the blood, a propensity to sweat on sleeping, weakness and great panting on the least motion, (r) In that age when the vessels having arrived at their greatest bulk, resist any farther extension, while at the same time, the blood increases in quantity, acrimony and impetus therefore be- tween the sixteenth and thirty-sixth year. (A) In an hereditary disposition of the constitution, here consult what has been delivered at (24, 26, 29,38, 39, 40, 41, 44, 45, 48, 60, 61, 64, 69, 72, 82, 84, 86, 100, 106.) For these (sections) being compared with (1198 a. B. y. d.) explane, define and foretell the nature, causes and effects of a blood-spitting; the haemoptoe which is the effect of this con- slitution, is accelerated by the interruption of any habitual evacuation, especially of the san- guineous kind, as the haemorrhoids, menstrual or lochial flux, bleeding at the nose, habitual venae-section, and these especially in plethoric habits, or persons deprived of a limb. 2. Any great force brought on the lungs by cough- ing, shouting, running; great efforts of the strength, anger or any wound inflicted how- foever. 3. By a diet of the acrid, saline or aromatic kind, drink of the same nature and manner of life. By any disease whereby the quantity, acrimony, velocity, rarefaction and heat of the blood is increased; whence it so often happens in acute fevers, the plague, small- pox and scurvy. Christopher Bennet in his Vestibulum ad Thea- trum Tabidorum, imparts many useful observati- B3 ons 6 Phthisis ons on this distemper, and the method of treat- ing patients in all stages of the disorder. The rea- der must frequently exclude his theory, but may draw many useful conclusions, according to a just ra- tionale of medicine, from the recital of matter of fact in his histories of cases: However, his theory and method of cure is frequently more just, than could have been expected from the times he lived in. By the title of his book, he seems to have designed a larger work on the same subject, and this treatise on- ly as a preparation to his grand design; but be that as it will, the book here mentioned is the only one of the kind wrote by him. It is observed by physicians both antient and mo- dern, that a spitting of blood usually foretells an exulceration of the lungs; and the consequence is without doubt extremely natural; but yet we see ma- ny persons subject to this disorder, who nevertheless live many years free from a consumption; and die at last of mere old age or some other distemper. But it concerns all who are subject to an haemootoe, to take early care in the use of the nonnaturals and the administration of remedies, to prevent its attack when absent, and remove its symptoms when pre- sent. The tender frame, &c. The phthisis is most frequent in young persons, as their vessels are most lax; to these it more particularly happens, if at the same time their humours are acrid and thin. The fluids are also more moveable in young persons, than in those of a more advanced age. This tendency or temperament may be known by the eye and touch: the flesh feels soft, and the skin is thin, so that the colour of the blood is easily discerned through it, and appears florid in the cheeks and lips, on the lead; increase of the circulation. Long neck. The preternatural length of the aspera-arteria, renders the inspiration and expiration more difficult, a greater force being required, to draw Pulmonalis 7 draw in and expel the air through this long tube. The air therefore acts with greater violence on the lungs; for as it requires this nisus to facilitate its passage, it enters the bronchial vessels with greater velocity and quantity of motion, which cannot but be of bad consequences to lungs of a tender tex- ture. The extraordinary length of the aspera-ar- teria, also subjects the patient to frequent coughs from the more copious secretion and greater quantity of mucus, in a long than a short wind-pipe. Plane and narrow chest. A straitness in the ca- vity of the thorax gives rise also to a consumption very frequently, and that of the worst sort; it be- ing in this case a distemper, arising from the bad conformation of the solid parts; which admits of no cure but a palliative it being impossible to al- ter the shape of bones and relieve effectually, lungs labouring under great pressure and ressistance to their free motion, from the narrowness and intropres- sure of the sternum and dorsal vertebrae; the circu- lation of the fluids and ingress of the air is greatly impeded by this misfortune in the conformation. Depression of the scapulae. A straitness on the shoulders and depression of the scapule is word; of all, and a most alarming symptom in a consump- tive patient, as at this place the lungs are more par- ticularly and immediately affected. The skin white. The fine colour of the skin, mentioned by our author as a sign of a consump- tive tendency, denotes a transparency of the fluids, tenuity of the vessels and laxity of the fibres; which is accompanied by a weak constitution of the whole body in general, and of the lungs in particular. This weakness in the whole system of fibres, great- ly diminishes the energy of the vascular tunics, and assimilation of the chyle consequent on their acti- on. The acrimony therefore which the blood ac- quires when remaining some time in the body, is not sufficiently obtunded by the admission of new B4 salutary 8 Phthisis salutary chyle, properly extracted from the food, temperated and attenuated by the bland and sapona- ceous juices, sent by nature into the alimentary canal. For though the food be ever so well chosen and chylisication perfect, yet in the condition of the vascular coats here supposed, the chyle cannot be entirely mixed with the blood, thus renewing its sa- lutary and benign qualities. A morbid laxity of the pulmonary fibres in particular, will certainly produce a depraved disposition in the fluids, as the sanguisication is more especially performed in the vends constituted of these fibres. The blood there- fore by these means, may be endued with all the evils mentioned in the Aphorism, and become slo- rid, thin, dissolute, acrid and hot. Mind chearful. It has been observed by most medical writers, that almost all persons of a con- sumptive habit, are blessed with a lively imagina- tion and chearful temper; but whether this tempe- rament of the body affects the mind, or the mind the temperament, favours too much of a metaphy- sical disquisition to be considered in this place. B In that weakness of the bowels. Weakness of the bowels renders the chylification imperfect, con- sequently if the aliment is of too tenacious a tex- ture, a depraved chyle enters the blood, crudi- ties arise and obstructions may be formed; which are more likely to fall on the lungs, as here nature endeavours greatly, to assimilate the chyle which abounds with tenacious crudities, and is with difficulty driven through the pulmonary vessels; a frequent respiration then will be present, and all the train of symptoms liable to follow. Through this weakness of the abdominal viscera or intestinal tube, the faeces are not driven with sufficient force to their place of exit; acrimony is generated from their remora in the body and putrescency consequent on stagnation: this acrid putreseent disposition thus conciliated to the humours, may affect the lungs and Pulmonalis. 9 and erode their vessels, producing ulcers, con- sumption and death. In this state of the viscera, a strict regimen in diet should be observed; and therefore we see the necessity, of confining young persons to aliment of a mild nature, easy of di- gestion in the prime viae and assimilation in the vessels. Hippocrates says that the firmness of texture in the aliment, should be in proportion to the age, labour and exercise, lest the blood suffers by a de- praved chyle. A small Fever. If a person is afflicted with a small fever and difficulty of breathing, particular- ly after meals, we may pronounce him affected with weak lungs, and that the chyle is not easily trans- mitted through them. This heat and quick respi- ration (caused by the increased quantity of the blood, from the addition of new chyle in proportion to the food received,) is not usually perceived till an hour or two after the time of eating, as the chyli- fication then proceeds swistly and the blood receives its supply. Though in some who are troubled greatly with wind after eating, the distension of the stomach immediately occasions a great sense of ful- ness, and uneasiness in breathing. A person in this case appears weak and his fit in tender and flaccid : And though he is easy and seems in health at any distance of time from meals, yet on the least un- usual motion, his pulse and respiration are greatly increased; he labours also under inexpressible un- easiness and anxiety at the heart: this symptom de- notes that the solids and fluids are not in æquilibrium. The heart vibrates and palpitates, being greatly oppressed in transmitting the blood, accumulated in it, by the augmented impetus and improper exercise; as also in impelling the fluids overwhelming the lungs, through the pulmonary arteries; the air then is called in to its assistance, and a quick respiration or panting is remarkable. In this condition of the habit we see, that the blood is driven with great difficulty 10 Phthisis difficulty through the lungs, and except timely and prudent advice be followed, and the symptoms hap- pily alleviated, an obstruction will soon be formed, as the blood will (in all probability) cease to be entirely transmitted through the pulmonary vessels. Dry Cough. This obstruction once formed, produces a dry cough, from the endeavours of na- ture to dislodge the offending matter; the cough is at first dry, as a rupture of the obstructed vessels is not at first effected. By the weakness of the vis- cera (considered under this head,) and the conse- quent acrimony and putrescency of the feces, may be induced such an erosive quality on the whole mass, as greatly to endanger the cohesion of the fibres, constituting the obstructed vessels. An haemoptoe or spitting of purulent or sanious mat- ter, will then be present, according to the violence or duration of the obstruction. If these symptoms appear, you may fear the approach of a consump- tion; and if the other circumstances are present with them, you may be under great apprehensions for the welfare of your patient, the texture of the fi- bres and bad conformation of the solids, conspir- ing in the same end with this dreadful disorder. Propensity to sweat. Profuse sweats breaking out in the night-time and after sleeping, denote both a great laxity in the fibres and dissolved crasis of the blood: the nocturnal sweats being more profuse, as each of these united circumstances is greater. r. In that age when, &c. Our author here thinks, the chief danger of a consumption to be be- tween the sixteenth and thirty-sixth year; after the fibres have arrived at their greatest degree of exten- sion. Some cease to grow at sixteen, others not till after twenty. The fibres have not acquired their full solidity, density and vigour till after the thir- tieth year, which age is generally allowed to be the prime or acme of the human constitution; the author here delivers thirty-six years, as the longest time Pulmonalis. 11 time possible for the fibres to continue their exten- sion, or rather that if a person lives six years after the full increase of his stamina free from any con- sumptive taint, he may relinquish all apprehension of the disorder. However, a late case proves this as well as all other general rules, liable to particular exceptions. A woman about sixty years of age, afflicted with a consumption and exulceration of the lungs, applied for help; a purulent spitting by her own account had appeared, soon after fire perceived herself out of order; she was now extremely weak and short breathed. By the assistance of a perpetual blister, mild pectorals and balsamic diluents, the spitting grew better coloured and the cough less troublesome, ail the symptoms common to the disease were also much alleviated, but being unable to confine her- self to a proper diet, and having a violent craving after every thing she saw swallowed by the people about her, whether beef, spirituous liquors, &c. She perhaps prevented a cure, or at least greatly in- creased the violence of the evil by her own obsti- nate folly. She continued in this way near half a year, at which time she was stronger and better, than when she first desired assistance, though much worse than when a fortnight had elapsed after the application of the blister; for no longer was fire careful! in ob- serving her regimen and medicines. Her cough, spitting and hectic fever, were now greatly in- creased, and all the symptoms proceeded with great rapidity, to effect her final dissolution in about a month. There is however this conclusion to be drawn from her case, that though it is possible for persons advanced in age to prove consumptive, yet, on account of the greater strength and solidity na- tural to their fibres, the distemper neither proceeds so fast, nor is so difficult of cure. When the full increase of stature is obtained, the fibres have but just undergone their greatest extension and 12 Phthisis and remain in a relaxed and weak state, till they have been strengthened by proper nutriment, from aliment capable of an easy and perfect assimilation. In process of time, the fibres acquire strength and vigour sufficient to digest a more tenacious diet and sustain labour, both which might have op- pressed the lungs, if used immediately after the full increase of stature. The pulmonary vessels at that time, not being able to support the impetus of the blood augmented suddenly or unequally. This weakness (if proper care be taken) is remedied by time. Persons of a full age and robust habit, are not so subject to haemoptoes, or haemorrhages of any kind, as young people, and those of a deli- cate system of vessels, which yeild more easily to the impetus of the fluids impinging on their sides. A. An Haereditary Disposition to this paticu- lar disease, is often a miserable legacy from the parent to the child. The hereditary labes is com- municated either in the temperament of the hu- mors or conformation of the solids. Particular fa- milies are often seen consumptive on this account. The bad conformation of the solid parts, is most commonly the cause of an hereditary consumption; this kind is most difficult of even palliation, the cure being impossible. When it proceeds from a bad temperament of body which becomes haereditary, and entails this disorder on posterity, the cure is not so difficult, as the temperament of the humors may be greatly changed by regimen, medicines, and a prudent use of the nonnaturals; whereas an amend- ment of the deformed solid parts is not to be hoped for. This as well as other diseases, which become sometimes haereditary, has been known to afflict the grandson and not the son. It may seem strange that the haereditary cause appearing in the father should lay dormant in the son, and yet be by him. communicated to the grandson ; but however un- accountable this may be thought, it may certainly happen Pulmonalis. 13 happen and be rationally accounted for. Let us suppose a bad conformation of the thorax hereditary in a family, and one of this family afflicted with a phthisis on that account; his son fearful of the consequences attending such an haereditary misfor- tune, is regular, temperate and rides constantly, thus hoping to escape the impending evil. If he succeeds in his purpose and lives till after thirty in this prudent method, his lungs will have acquired such strength and firmness, that his death may be at laid effected by old age or some other disorder. Although the son may have escaped the haereditary disease himself, yet the bad conformation natural to the family may be communicated to his offspring, and in the grand-son produce the family disorder, by means of an intemperate life, imprudent pro- phylaxis or occurrences both inevitable and blame- less. Here consult What has been delivered at the places cited. The diseases of the solid simple fibre (24.) may produce this disorder, from too great weakness affecting the lungs with difficulty of breath- ing, cough, and the subsequent symptoms; the fibres are liable to break from their excessive debi- lity, whence the event. (26.) The acid habit (60.) also generates a weak fibre and may produce the consequences related (64.) A bad nutriment may also cause this distemper (48.) The glutinous ten- dency of the humors (69.) may also be a cause of obstructions in the lungs and a subsequent Phthisis. All the causes of putrescency may occasion a con- sumption, from the alcaline tendency (76.) whence erosion of the lungs (86.) from the acrimony of the humors. The increased motion of the blood may produce a consumption, whether the fibre be too rigid or too lax; if too lax, the vessels in the lungs may be ruptured and extravasation with exulceration ensue: This may be the case in consumptions arising from crying, 14 Phthisis crying, singing, shouting, &c. If the fibres are too rigid, an increase in the moment of the blood may bring on a pleurisy, peripneumony, inflam- mations of the mediastinum, diaphragm, &.c. Whence suppuration of the lungs and incurable phthisis. Other inflammations occasioned by the too great moment of the blood, accompanied with rigi- dity of the fibre, and producing great suppurations, may cause this evil from resorption of purulent mat- ter into the mass of blood. The diseases of a Plethora (106.) may also the origin of this malady, as they will produce ob- structions with theirs. 1. A retention of any usual excretion, es- pecially of the sanguineous kind, and in plethoric habits, will produce many of the consequences al- ready described. An interruption of the menstrual flux in women, and of the hæmorrhoids in men, increases the quantity and moment of the blood; whence extravasation and suppuration may afflict the lungs. Persons after the loss of a limb are very apt to become plethoric; for as there is in this case less demand for nutriment, and that often without any diminution in the appetite, a disease from fulness may be the consequence; this is most likely to hap- pen to soldiers and sailors, who often lose their limbs by accidents, being themselves in perfect health, so that their appetites and juices are quite natural. The disorder from retention of the necessary evacu- ations, are most likely to produce hæmoptoes or rupture of the vessels in the spring season; for at this time, the vessels are naturally distended by the in- fluence of the season of the year, any retention therefore and congestion of humors, happening at this juncture, will greatly augment the dilatation of the vessels, and by that means may produce a dis- ruption of the fibres. To obstructed virgins this often happens in the spring especially, for on the retention of the menstrual-flux, a difficulty of breath- ing Pulmonalis. 15 ing and spitting of blood is very common, which if not remedied in time, may become the origin of an incurable phthisis. However an hæmoptoe of this kind is not usually esteemed so dangerous, as those incident to men, to whom it may happen from many causes at this time. In women often is seen at the monthly period, a blood-spitting in place of the menses. 2. Any great force brought on the lungs, may occasion a comsumption. By the inflation of mu- sical wind instruments, singing and shouting long continued, the glottis is kept continually strait, and the free passage of the air to and from the lungs prevented; if this is too often repeated, obstruc- tion and disruption of the pulmonary vessels may ensue. Of any exercise which requires a violent and frequent respiration, this disorder may be the con- sequence. If a weak youth plays or runs immo- derately, the moment of the blood in the lungs will be too much increased and an hæmoptoe occasi- oned. Excessive feasting is dangerous for the same reason, as the lungs are greatly employed in assi- milating the chyle. The pulmonary canals are in the last instance oppressed with new chyle, and if weak, may undergo a disunion of their fibres and extravasation of the fluids. 3.By a diet of the acrid, saline and aromatic kind. All gluttons expose themselves to great danger of a consumption, as they not only devour a great quantity of food, but also delight in savoury sauces, or an acrid quality of their ingesta; some also at meals, swallow a glass of wine between every mouthful, which with the flesh-meat we English usually feed upon, conspires greatly in producing all these evils already so often described, the lungs not being able to sustain so great an increase of im- petus in their fluids. By any disease whereby, &c. All the distempers which from a rarefaction and increased heat of the blood 16 Phthisis blood generate acrimony in the body, produce this disease; which is one reason why the plague, small- pox and fevers of all kinds, so often terminate in the phthisis. There is also another circumstance attending acute disorders, which may produce a consumption, (viz.) the great debility and uni- versal laxity of the fibres, which these evils (espe- cially if tedious or violent) leave on their depar- ture. The scurvy may produce a consumption, both from the fever which it excites in many, and the acrimony of the humors with which it always is united. SECT MCXCIX. HENCE (1198) it arises with a gentle pain, moderate heat and confined op- pression perceived in the thorax; the blood flows out for the most part florid, scarlet, fro- thy, with a noise of the lungs, with the fibres, membranes, arteries, veins and bronchial ves- sels; with a soft, small, fluttering pulse; pant- ing; a salt taste having been before perceived in the mouth. An hæmoptoe may be foretold, if the patient cannot sleep in quiet, tosses about in bed with in- explicable inquietude, straitness in the chest and dif- ficulty of breathing. Before the blood-spitting these symptoms attend, from the too great distension of the pulmonary vessels. A light cough first ap- pears chiefly in the morning, because, by the su- pine posture and rest of the body in the night-time, any matter offending the lungs, has had time and opportunity to accumulate itself. The cough is fol- lowed with a spitting of phlegm streaked with blood at first, afterwards it appears frothy and of a scarlet, florid colour; the admistion of the air with the blood and Pulmonalis 17 and expectorated phlegm being the reason of this its colour and appearance. Blood might be spit out of the mouth, and proceed horn the sauces, but this might be effected without a cough, and if oc- casioned by the draining of those parts in violent coughing, might then be distinguished by a flight inflammation and foreness of the part: A quinzy may also produce a blood-spitting, and then the place of extravasation is evident enough. Blood can never be brought up from the Lungs without a cough, and a hæmoptoe of this kind is known by the preceding dyspnea, soft pulse and particular scarlet colour of the extravasated matter. Noise of the lungs. A noise or rattling in the throat during respiration, is one of the latter signs, proceeding from a copious extravasation of matter into the bronchial vessels. The expectoration of sibrils and membranous fragments with the spittle, is also one of the last and alarming symptoms, as it denotes a great disruption of fibres and destruction of substance. The quantity of blood spit out, is greater or less, according to the size of the vend bunt and danger of the patient; the ruptured vessel in some is so large, chat the patient is in danger of immediate suffocation by the quantity of extravasated liquor. All obstructions of the lungs, are attended with a soft, small pulse, for when the respiration is impair- ed, the impetus is diminished of the blood too long detained in the lungs. The pulse is also quick, from the impeded passage thro’ the lungs and frequent contraction of the heart consequent on any conside- rable obstruction; a quick respiration or panting is called in now by nature, to facilitate the blood’s passage thro’ the pulmonary vessels; and as no great quantity, can pass into the aorta at a single contrac- tion of the heart, the pulse continues soft, frequent, and small. A salt taste in the mouth, is occasioned by the acrimony abounding in the fluids. C SEC Phthisis 18 SECT. MCC. The cure is effected (1), by a copious vene-section every third day to the fourth time, (or repeated) till the inflammatory crust entirely disappears. 2. By refrigerating, incras- sating, stiptic and demulcent medicines, used a long time and united with mild balsamics. 3. By the fix nonnaturals so conducted, as to be most opposite to the causes mentioned (1198); and chiefly by continually persevering in the mildest diet and manner of life, to which pur- pose a milk-diet is the best adapted. 4. By correcting the specific nature of the cause or par- ticular disorder. Stiptic remedies are improper; the impetus and quantity of the blood is first to be diminished, in proportion to the size of the vessel burst, and force of the circulation; by this, the moment of the blood is moderated, and the quantity of liquor extrava- sated into the lungs, proportionally diminished. It is of little signification to bleed in small quantity; let the orifice be large and fifteen or twenty ounces lost. This method must be understood to respect the beginning of the disorder, or first appearance of the hæmoptoe, when the patient is full of flesh and fluids; for when the ulcer is form’d and pus gene- rated, all vene-section is exceeding prejudicial, ex- cept in particular circumstances, hereaster to be treat- ed of. The blood-spitting will in great probability be happily removed, if skillful and timely advice be followed. It is of little moment to direct which vein shou’d be opened in particular, for revulsion is here impossible as the blood of the whole body passes thro’ the lungs; the diminution of the quantity op- pressing Pulmonalis. 19 pressing the vessels is the efficacious circumstance. Ligatures applied to the arm and thighs, compress the veins (which in general are more superficial than the arteries) and retard the blood returning to the heart: The oppression therefore on the heart and lungs will be less, as the quantity of fluids so detain’d in the limbs is greater. But, as this comprestion long continu'd on one particular limb, might bring on a mortification from the impeded circulation thro' it, so, on the first appearance of stagnation and great uneasiness in the part bound, let another limb be tied in the same manner, and the former loos’d. In all hæmorrhages from the bursting of one large ar- tery or many small ones, ligatures shou’d be always ready. 3. By refrigerating, incrassating, &c. The medicines shou’d be of a cooling nature, and such as conspire to assuage the increased moment of the fluids; for in general, wherever an hæmorrhage appears, is present also too great an impetus in the circulation. Farinaceous emulsions and mild decoc- tions, are medicines well adapted to answer this third intention. Incrassants are particularly usefui, in hæmoptoes proceeding from a thin, erosive quality in the blood; the broken crasis of which may be thus mended, and the haemorrhage stopt. Mild gelatinous substances, as harts-horn or calves-foot geliy are remedies of this class; the arable emulsion is also an excellent demulcent and incrassant. By these means a mild lentor is conciliated to the blood, which in general is to be attempted, as the greatest part of (if not all hæmoptoics, are afflicted with a thin broken crasis of the fluids. Stiptics are violent medicines, which ought not to be administer’d, the mild gellies being in this case, the most salutary as- tringents. The property of those medicines ranked under the class of stiptics, is, to coagulate the hu- mors and constringe the vessels: But as stiptics act chiefly by constriction, an inflammation of the lungs C2 may 20 Phthisis may succeed the stopping of the hæmorrhage by their use: Obstruction and inflammation being most like- ly to form and suppuration attend, around parts previously wounded. Stiptic remedies therefore should never be exhibited, except in cases of great extremity, or before many repetitions of phleboto- my. A mild milk-diet must be strictly observed, to prevent all tumult in the circulation. 4. By correcting the specific nature of the cause. We are here directed, to examine carefully into the circumstances attending the patient, before he was affected with any disorder in the lungs; by this means will be known, whether the hæmoptoe was produced by the retention of any habitual eva- cuation, as of the hæmorrhoids in men, or the men- strua in women; and the patient is to be treated ac- cordingly. It is doubtful whether any great advan- tage will accrue from such an enquiry; for tho’ we find the hæmoptoe evidently proceed from the re- tention of the menses, we cannot give an emenago- gic or stimulating medicine, for fear of increasing the moment of the blood and quantity of the hæ- morrhage. However, this enquiry ought to be made, as it may assist us in forming a just prognosis of the event; for if we succeed in stopping an hae- moptoe, arising from obstruction of the menstrua, and find afterwards the menses appear, we may hope effectually to cure the patient. SECT. MCCI. WHEN once this has happen’d and is Reliev ’d (1200), phlebotomy is to be administer ’d every six months for some years, by degrees diminishing the quantity. On the first appearance of the hæmoptoe’s being stopped, the patient shou’d begin to life a moderate exercise Pulmonalis. 21 exercise, to strengthen the fibres of his lungs and prevent a plethoric tendency in the habit. For this reason, the venae-section shou’d be repeated every six months at least (tho’ no signs of the hæmoptoe appear), and left off entirely, by a gradual diminu- tion in the quantity. SECT. MCCII BUT if on account of the redundancy of the evil, (1198) improper application of stiptics, or neglect of the true method of cure (1200), after the blood-spitting should arise, a dif- ficulty of breathing, continually increasing, vague horror, heat and redness of the cheeks, dry cough, hectic fever, greater thirst, weakness and a sense of weight in the thorax, it signifies, that the wound of the hæmoptoe has changed the matter already collected about its lips, and under the crust of dried blood, into pus; that the collection has become a concealed vomica, which when it breaks becomes an open ulcer of the lungs. The use of a stiptic remedy in this disorder, is certainly much to be condemned; but there are cir- cumstances which require its exhibition: Let us sup- pose a physician called to an hæmoptoe so violent, that vaene-section, ligatures, refrigerating medicines, and every judicious application, avail nothing; what must he do? The hæmoptoe still continues, and the quantity of blood extravasated into the lungs, may soon be so great, that suffocation and immediate death may impend. The physician therefore must endeavour to procure relief, by some powerful stip- tic at all events; sixty or seventy drops of the tinc- tura saturnina must be given in cold water. The hæmorrhage may very probably be thus stopped, C3 tho’ 22 Phthisis tho’ the patient may in propess of time, proceed regularly thro’ all the stages of a consumption. This tincture is a fine medicine, cooling and contracting the blood; but its use is never to be advised in a hæmoptoe, except in some such desperate case, as is here supposed. If you can avert the immediate a- cute danger, by no other means than that of the disorders palling into a chronic evil, you are to bring on the lingering illness, and prolong life as much as is in your power. For however dreadful the pros- pect may be, there is still a possibility of the patient’s recovery. In such a case therefore and no other, are astringents to be used, and not even then, ’till all other approved remedies have been tried in vain. The balsamic electuary of the pharmacopæia pau- perum of the college at Edinburgh, is excellent in any extravasation or ulceration of the lungs, being a mild detergent and balsamic. Persons of this con- stitution are apt to spit blood, on speaking loud and violent exercise, especially in a cold air; for in this case the perspiration is diminished at the same time in which the motion of the blood is increased, which cannot but be very pernicious. When an hæmoptoe is present, the patient shou’d be kept very quiet, in a chamber warmed by a moderate fire, that the per- spiration and equable motion may be properly pre- served; every thing increasing the impetus of the fluids, is pernicious. The most light and insipid aliment must be observed, easy of admistion with the blood and without stimulus; fresh milk or that made sower by art, is a very proper aliment, as it is without stimulus, and has been previously concoct- ed, in the vessels of the animal from which it is ta- ken. If a more solid aliment is receiv’d, the lungs are oppressed with difficulty in breathing, to the continuance of the disorder if present, and renewal of the haemoptoe if absent. The food should be given in a small quantity, and often repeated. The first hæmoptoe may be in all probability relieved, without Pulmonalis. 23 without any bad consequence by an early admini- stration of the means related; and the physician has nothing to fear, if his patient after the disappearing of the hæmoptoe, is free from fever, oppression of the breath or cough. But if the patient should be- come plethoric, by not observing a proper diet, or if imprudent advice has been followed, there is great reason to fear the disruption of a larger vessel, and stagnation of the extravasated liquor, in the cellular substance of the lungs. He then complains of a difficulty in breathing, pants, shivers, with a dry cough perpetually irritating. These symptoms denote, a collection of the extravasated liquors in the lungs, and beginning suppuration. The dys- pne arises from a compression of the bronchial ves- sels by the stagnating matter, which is at last con- verted into a putrid liquamen: Then arises the hec- tic fever, the paroxysms of which appear in the evening. Great flushings in the face, and redness of the lips and cheeks, appear in the afternoon, as the patient will generally dine with the family. If a consumptive person eats a plentiful meal, his sto- mach will be greatly distended, thro’ the eruption of the air contained in the food, and excessive laxity of his fibres; the blood-vessels therefore, which convey the blood to the inferior parts of the body, will be morbidly compressed by this preternatural size of the stomach; consequently the blood will be detained too long in the superior parts, and produce pain in the head, tumid appearance in the face, with redness of the lips and cheeks. This inconvenience might be prevented, by exhibiting the food in small quantities often repeated. The evening exacerba- tions cannot be prevented entirely, as they are owing to the course of nature, and absence of the day ; however they may be moderated, by using the fluids prescribed, particularly at that time. Sec- C4 Phthisis 24 SECT. MCCIII. 2° THlS collection of matter, may arise from a peripneumony terminated in an apos- tem, (832. to 843. 867) besides the causes mentioned (1198); it is known by the same signs (832. 843. 867.) SECT. MCCIV. AN empyema also (1185.) may corrode, dissolve and consume the lungs, so that the same distemper may arise, as if they had been consumed by their proper ulcer. (1188. No. 4.) It is known by the symptoms there delivered. Where it is taken notice of in its proper place. SECT. MCCV. FROM whence it is evident, what are the in diagnostic signs of an ulcer of the lungs, though concealed. How different its causes, kinds, and how various the phthisis. Wandering horrors, difficulty in breathing, tick- ling and dry cough, are signs of a beginning con- sumption. The ulcer is known to be confirmed, and the pus to have acquired a degree of acrimony, beyond that of laudable pus, by the thirst, hectic fever and increased malignity of all the other symp- toms. Its difference and causes will be evident to all, who underhand and recollect the preceding doc- trines. SECT Pulmonalis. 25 SECT. MCCVI. THESE effects of an ulcer already formed in the lungs but concealed, called a vo- mica, are commonly to be observed; the acri- mony, quantity and putrescency of the pus in- creasing every day, the dilatation of the mem- brane containing it, its corrosion, maceration, the conversion of the blood and bronchial vessels into pus; the purulent consumption of the whole lungs, or one of its lobes; a cough without in- termission, either dry, or producing by expec- toration, nothing but parts abraded by the agi- tation of the cough; the conversion of the blood flowing to the ulcer, into pus, propagation of the vomica, and its rupture into the tubes of the larynx; a suffocating secretion of pus for some time, or else continually forced up with cough- ing, in great quantity, sinking in water, sweet, fat, fetid, white, red, yellow, livid, cineritious, strigmentous, placed on burning coals emitting the stinking smell of burnt flesh; rupture of the vomica into the cavity of the thorax, whence the most difficult respiration, and appearances of an empyema (1188 N° 4). Then the worst respiration, consumption of all the blood and chyle into pus, lost preparation of nutritious juice, an entire wasting of all the solids, hectic fever, with a small and languid pulse, violent heat of the superiour parts slushing in the cheeks and hippocratic face, inexpressible anxiety espe- cially in the evening, great third, profuse sweats in the night, red pustules, inflation of the hands and feet from the part affected, great weak- 26 Ththisis weakness, hoarse voice, falling of the hair, itch- ing over the whole body, with watry pustules; yellow, stinking, purulent, cadaverous, frequent, weakening diarrhea with a tenesmus in suppressi- on of the spitting, death. Whence these rules may be deduced. Pus generates pus, macerates, erodes and con- verts all the contiguous vessels into its own nature, whence the continual propagation of the evil. It seldom happens that both the lobes of the lungs are at the same time afflicted with a vomica. The cough now produces nothing. The lungs are irritated to frequent and ineffectual contractions without any expectoration of the offending matter, which is con- tained in a cyst not yet supposed to be broken. The pus contained in the vomica macerates and erodes the fibres of the lungs, effecting a disruption of the vessels; it then becomes an open abscess, the pus is propelled thro the aspera arteria, and a ruptur’d vo- mica is known to be present by the conspiring symp- toms. There have been instances of persons suffo- cated by the rupture of a vomica, tho’ this is a rare case, proceeding from the great quantity and im- pacted consistence of the pus. If you throw some of this purulent spitting into a vessel of water, it sinks to the bottom, and is thus distinguished from com- mon phlegm or mucus, which is specificaliy lighter than water. There is now to be perceived a stink- ing breath, the spitting thrown on live coals, stinks like roasting flesh burnt at the fire, from the fetid oil common to both expelled by the fire. The pus is ejected by the mouth from the cavity of the tho- rax, a terrible putrefaction spreads itself in the lungs, and thus is destroyed a viscus, the assistance of which is particularly required in sanguification; on this account the nutrition of the body begins to languish on the first confirmation of the disorder. The assi- milation Pulmonalis. 27 milation of the aliment into good juices decreases as the evil spreads; till at last it is next to nothing: before the nutrition is entirely destroyed the patient dies by the cessation of respiration through loss of substance in the fibres of the lungs. The purulent spitting seldom or never cures the patient by eva- cuating the pus; as expectoration is a most preca- rious evacuation, and the least suppression of it ren- ders the matter sanious, and increases the evil by the erosion of new fibres. The sweats proceed from the dissolved crasis of the blood and laxity of the cutaneous fibres; the pustules are produced by the acrimony and extravasation of the fluids; and the hairs fall off, from the deficient nutrition of the body; through this impaired nutrition, the patient becomes lean, exhibiting the bones almost naked. A colliquative diarrhea occasioned by the acrimony of the putrescent humors, now comes on, so that at this time, the shadow of human nature remains only. This flux of the belly, is an effort of nature, to dis- charge the acrid matter redundant in the body; it may be considered therefore, both as salutary and pernicious; it is salutary, as it expells a great quan- tity of acrid matter thro’ the anus, and is esteemed pernicious, as it greatly debilitates, and stops ex- pectoration; so that the patient is in danger of being suffocated, by the quantity of purulent and sanious matter oppressing the lungs. The colliquative di- arrhea with a suppression of the spitting, usually closes the dreadful scene. The rules to be deduced from these doctrines, are recounted in the succeeding, sections. SECT. MCCVII 1° AN hereditary phthisis is the worst of all, and not to be cured, except by prevent- ing the hæmoptoe. 2. A ph- 28 Phthisis 2. A phthisis from an hæmoptoe brought on by external violence, without any internal pre- existing fault, is (other circumstances supposed equal) the mildest. 3. The phthisis, in which the vomica sud- denly bursts, white, equal, concocted pus is easily ejected, answering to the size of the ulcer, without thirst, with digestion, secretion and good excretion, may be healed though with diffi- culty. 4. A phthisis from an empyema, is incurable. 5. Heavy, solid, stinking, sweet spitting with the last signs, (1206) are without hopes. 1. An hereditary consumption cannot be cured, on account of the bad conformation its most frequent cause; or the fixed temperament of a fatal tendency; but it may be prevented, by the proper administra- tion of the six non-naturals. This has been suffi- dently considered in the comment on the ( 1198) section. 2. A phthisis, from an hæmoptoe produced by external violence, is certainly the lead dange- rous, as there is no hereditary labes, bad conforma- tion, or procatarctic cause previously existing in the blood. But this must be understood to respect a phthisis, in which the proper means have not been made use of, to cure the first extravasation, for if the hæmorrhage or hæmoptoe which must first be present, arising from the immoderate exercise, fall or any other external violence, cannot be entirely relieved, by the use of proper remedies, there is still less hopes of curing the evil farther advanced, and now become a phthisis. 3. The phthisis in which is suddenly broken, &c. If an abscess of the lungs, proceeding from the causes mentioned, (1193) should suppurate and discharge Puimonalis. 29 discharge by expectoration, a good laudable pus, within one or two days after the signs of suppura- tion, the patient may recover, if proper care be ta- ken. Absence of thirst after the evacuation, signi- fies, that the patient is free from a putrid fever, consequently that the vomica is thoroughly cleansed. If the matter ejected is in proportion to the size of the abscess, there will be less fear of new erosions, from the acrimony of stagnating pus remaining in the lungs; but we cannot judge with any great ex- actness, of the size of the abscess formed, and the quantity contained in it, which ought to be expel- led; the only probable method of estimating this quantity, is, to compare the violence of the prece- ding symptoms, shortness of breath, degree of fever, or oppression on the breast. There is good reason to hope for the patient’s recovery, if all the symptoms are remarkably relieved, and continue to diminish, after the discharge of matter. A free respiration is a most promising sign. 4. A consumption from an empyema is esteemed fatal, from the quantity of pus, and great improba- bility of its being sufficiently evacuated. 5. Heavy, solid spitting with a diarrhaea, is a most fatal symptom; the disorder is at this time near its final period. SECT. MCCVIII. AFTER the vomica is formed in the lungs, the medical indication directs, to bring it to maturation and disruption ; which is effected by a milk diet, the motion of riding, warm va- pors and expectorating medicines, when it is burst, 1. To fortify the blood against the purulent infection. 2. To 30 Phthisis 2. To evacuate the ulcer of all its pus, as soon as possible, cleanse the lips, aud unite the fibres. 3. To administer that kind of aliment, which, requires the least force to impell it thro’, and as- similate it in the lungs, but yet, such as is most apt to nourish, and least conducive, to the forma- tion of pus. An inflammation of the lungs, if not seasonably discussed, naturally produces a vomica, and on the rupture of the membranes enclosing this vomica, a phthisis pulmonalis is confirmed. A milk-diet therefore must be used, when we perceive a vomica formed; milk promotes the maturation and rupture of the abscess, as it is of an emollient or relaxing nature: It is the most likely of any food in this case, to produce a laudable suppuration, and prevent the matter from becoming famous or ichorose; for it supplies the blood, with parts of a mild and aces- cent disposition. The sooner the membranes encio- sing the vomica break, and the abscess becomes an open ulcer, the better is it for the patient, for the longer the contents of the vomica remain enclosed within their cyst, the greater will be the quantity and acrimony of the pus formed; whereas, if a disrup- tion and evacuation of the membranes, is effected soon after the pus is generated, the less acrid and copious will be the matter of the vomica, and a suf- ficient evacuation, with a perfect: consolidation of the ulcer, will more probably ensue. By the concussion of the lungs in riding, a dis- ruption of the containing membranes may be obtained. These intentions are also assisted by an inspiration of the warm vapour arising from emol- lient decoctions, which relaxes the fibres, lubricates the lungs and aspera-arteria; they may be kept con- tinually steaming in vessels placed near the patient, or taken in at the mouth by means of a funnel. This Pulmonalis. 31 This warm vapor may be esteemed one of the most effectual remedies used in a phthisis, as it acts im- mediately on the parts affectted. As soon as the vo- mica is burst, we must endeavour. 1. To fortify the blood against the purulent infection, from the absorption of the virulent mat- ter, which may remain in the vomica; antiseptics are now to be administered. 2. To evacuate the ulcer. The lungs are of a very fungous nature and full of cells, wherefore sinuses are liable to form, and the matter stagnating in these cavities, is very obnoxious to resorption. We are to endeavour at the entire evacuation of the pus, and prevent as much as possible the generation of new. The emollient vapour is also very service- able in this intention, promoting greatly the free expectoration of the pus; a mild acid should now be added to the decoction made use of, which will mo- derate the putrescent quality of the pus formed, and restrain in some measure its tendency to increase the ulcer may be greatly cleansed, and its consoli- dation promoted by the use of this excellent remedy. 3. To administer that kind of aliment, &c. The diet now used should be gratefully acid, easy of digestion in the viae, and that which requires the lead; force of concoction, for its assimilation into blood when received into the circulation. The medicines proper at this time, are compounded by a judicious union of antiseptics, expectorators and mild balsamics. The patient is also to be purged with caution, after the first rupture of the vomica, to determine part of the absorbed matter to the anus. Glauber’s with Polychrest salt, decoction of tama- rinds with senna, and Sydenham’s purging draught, are here excellent in their kind. Except the most accurate regimen of diet be instituted and observed, medicines will be prescribed to very little purpose. The food should have been previously concocted when 32 Phthisis when taken by a phthisical person, otherwise his weak vessels will be unable to convert it into good chyle. The same food which in an healthy person produces good chyle, is perfectly concocted in the vessels, and supplies the blood with an addition of its own healthy nature, becomes pernicious to a con- sumptive person, by the admistion of the morbid fluids already in the body ; care therefore should be taken, to render the food of such a nature, as to correct (as much as is possible) the unhappy tendency of the diseased humors. Milk and broths are pro- per in this case, as they have been both already con- cocted; the one in the vessels of an animal naturally, and the other by an artificial extraction and prepa- ration of the nutrititious parts. To broth should be added a small quantity of some mild and grateful acid to correct the alcalescent tendency of this ani- mal diet. SECT. MCCIX. THE first indication is sufficiently answer- ed, by the help of medicines gratefully acid and saline, the vulnerary herbs and mild balsamics, used long, in great quantities and in many forms. The acid and saline medicines are antiseptic, assua- ging the putrescent infection of the blood. The vulnerary herbs in decoctions, and mild balsamics in any convenient form, are proper. The herbs and balsamics here used, must be those which are without stimulus, and excite no heat or tumult in the body, for such a quality in them, would destroy their other- wise salutary effects; the heat of the body being al- ready too great, according to the degree of putrid fever present. The Arabic emulsion is a fine balsa- mic of this class. The common esculent herbs as lettuce, Pulmonalis. 33 lettuce, spinach, &c. should be constantly and pru- dently mixt with the diet. The balsamic medicines are here directed to be used in many forms, as one may be better adapted to the particular constitution of the patient than another, and that the most useful may be found. But if the form at first prescribed agrees well, and contains a medicine effectually answering the indication present, its alteration is not to be advised. A proper decoc- tion, the arabic emulsion and balsam of Locatelli, may be used separately or together, for a considera- ble time, and a change of them is entirely needless; it being a practice very disagreeable to physician, patient and apothecary, to make frequent alterations in the medicines ordered. It may here be remarked, that nothing more effectually discovers the ignorance of the prescriber, than such an unsettled method of proceeding: Indeed if new and contrary indications frequently arise, such a proceeding is unavoidable, but in a chronic disorder, this is seldom or never seen. SECT. MCCX. THE other (indication) is answered, by liquid, diuretic medicines, exciting the cough, external and internal; by constant mo- tion, riding and sending the patient into the country; also by the help of balsamic abster- gents, internal and external, and by consolida- ting with healing paregorics. This indication requires the evacuation of the pus and consolidation of the ulcer; the pus is evacuated by coughing; this is promoted by the lac ammonia- cum, acetum fcilliticum decoction of marrubium album, tussilago and other medicines which enter the smallest vessels, The lac ammoniacum is a warm D medi- 34 Phthisis medicine and excites the cough; therefore at the time that this is used, the patient should drink plen- tifully of some balsamic and mild decoction, which renders the matter fluxile, and enters the smallest vessels; otherwise, when the cough is excited, no- thing will be brought up, consequently, much trou- ble is brought on the patient to little purpose, the lungs are still farther abraded and the ulcer increa- sed, by the unnecessary and ineffectual distraction of the fibres. By the prudent use of these medicines, thus conspiring in the chief intention, the cough, which is the effort of nature to relieve the lungs, will be promoted, and rendered effectual in discharg- ing the offending matter; the great advantage of this end if happily accomplished need not be farther insisted on. By constant motion, &c. The best internal medicaments may be of no use, except a constant, regular and well-chosen gymnastic physic is obser- ved. Few phthisical persons recover that live in ci- ties, the sulphureous steams from the smoak of coal- fires constringe the lungs and prohibit expectoration. Let the afflicted person seek the country and ride on horseback; this is the most effectual of all remedies in cleansing the lungs. While the patient is carried on horse-back the matter is moved in the lungs by the gentle agitation, an easy cough is excited attend- ed with a free expectoration; the shortness of breath is never so troublesome at this time. The gentle motion of vection assisted by the use of diluent, balsamic expectorants, cannot but be of great service; and though the physician advising this prudent method, may not succeed in his most sanguine wishes, of re- storing health and new vigour to his patient, yet he cannot fail of receiving the satisfaction, which a pal- liation of the symptoms, prolongation of life, and rendering the disease left terrible and painful, must necessarily produce. After exercise let the patient sleep if inclined to it. It must also be considered that Pulmonalis. 35 that though the cough is in itself salutary, and the only means whereby the lungs can throw off the op- pressing matter, yet, if it is constant and violent, the fibres are still more broken, and the strength of the patient greatly exhausted by it. The syrup of poppies is in this case very proper, to procure sleep and quiet the cough. This syrup rather promotes expectoration than prevents it, and is therefore pre- ferable in this case to the tinctura thebaica, which with the other anodynes in general, are thought to suppress expectoration. This mild and anodyne sy- rup, excites neither fever nor thirst, and may be ta- ken every night on going to bed, as deep is very necessary to persons in this disorder. SECT. MCCXI. THE third indication is provided for by the use of ptisans, broth and milk. This section needs no explanation; for as we have already considered the medicines proper for the pa- tient, the regimen must have been considered also; for the regimen and medicines are so closely united in this disorder, that when the one is perfectly described the other cannot be omitted. SECT. MCCXII. THE palliative cure of this disease, respects chiefly the cough, anxieties and diarrhaea. The cough is very painfull to the sick; but as this is a motion excited by nature to very salutary pur- poses, how can we attempt to stop it, and listen to the earned intreaties of the patient; the noxious cause of the disorder cannot be expelled without it, It may be moderated by mild paregorics, which is D2 necessary 36 Phthisis necessary when, the cough is violent and dry. The remedies so frequently seen on apothecaries files, in- tended for the relief of persons in this disorder, marked Linctus for the cough, oily mixture for the cough, are prescribed in vain, as the lungs are them- selves unfound. These medicines may be of some service, to a cough proceeding from a common de- fluxion of the mucaginous glands, but in this case, they are so far from relieving the patient, or pallia- ting the symptoms, that they increase the somes of the disorder. For all oils or fatty substances, (viz.) ol. amyg. dulc. sperma ceti, &c. which are general- ly the basis of those medicines, turn rancid in the primae via; and if carried into the lacteals, co-op- perate with the purulent, alealescent disposition of the humors. Antiseptics are therefore advised to very little purpose, if the patient is continually licking in rancidity and putrefaction, though it be off a bacu- lum liquoritiæ. If a linctus must be prescribed, let it be the following or of the like nature. Rx Syrup. Balsamic. § fs ________ex Althae. ________e fucco limonum aa § ifs These ingredients, on the natural dissolution of the constituent parts and reparation of the principles from each other, consequent on the action of the stomach and intestines, do not tend to putresaction, but con- spire in the principal intentions here delivered. The sugar and vegetable parts tend to fermentation, and are therefore acid and antiseptic, the syrups of al- thaea and tolu compose a mild balsamic; the syrup of lemons is antiseptic, and corrects the cloying quality of the sugar in the syrups. The violence and frequency of the cough, is in proportion to the quantity and confinement of the matter oppressing the lungs. The only effectual method of moderating or flopping the cough, is to paliiate Pulmonalis 37 palliate or cure the disease. By a convulsive motion of the abdominal muscles, the cough is excited, and the matter offending the lungs expelled; we know that opium is very effectual in assuaging convulsions, but as the unhappy cause remains in the pulmonary vessels, the abdominal muscles will notwithstanding its use, be stimulated to new contractions, which compress the lungs and excite the cough. Great anxieties also asslict the patient, towards the end of the disease, from the humors accumulated in, and difficult circulation through the lungs. Then often follows a suppression of expectoration, and altho’ the vessels are so destitute of their due proportion of blood, it is now necessary to diminish the present afflux of humors to the pulmonary vessels, which would be immediate death; to this end venae-section must be administered, though it debilitates, and at- tenuates still farther the dissolved crasis of the blood. If expectorators could be depended on alone in im- minent danger, their use alone would be more ad- viseable in this case. Let the patient take in a warm vapor at the mouth, which is one of the most effectual expectorators, being not only a palliative of the cough and present exigency of the symptoms, but contri- buting also to remove the fomes of the disorder; it mixes with the pus in the lungs, renders it less acrid, fluxile and moveable by the cough, and is more effi- cacious than any internal medicine, as it acts imme- diately on the part affected. The colliquative sweats, which appear towards the end of the distemper, are attended with excessive weakness, and are generally accompanied with a di- arrhea, tormina of the bowels and tenesmus; these symptoms proceed from the dissolved crasis of the blood, and great acrimony of the humours vellica- ting the intestinal tunics and muscles of the anus, so that a perpetual stimulus to dejection is excited. Astringents are improper in this case as they suppress expectoration, and tho’ the diarrhea is very exhaust- ing, 38 Phthisis ing, yet a retention of this purulent matter is still more prejudicial. Opiates of the stronger kind are better calculated to relieve the diarrhea, and obtund the acrimony of the matter vellicating the intestines; but these also stop expectoration; in which case the diarrhea may again return, and prove more violent than before, as nature will then endeavour to elimi- nate the offending matter in greater quantity by the anus. But the milder opiates, such as syrup of pop- pies, decoction of poppy-heads, &c. may safely be used as they relieve the diarrhea without suppressing the expectoration. SECT. MCCXIII. THESE symptoms are relieved by a pros- per diet (1211), and the cautious exhi- bition of opiates and warm liquids. The decoction of poppy-heads seems to be the best opiate in this last intention, as it abounds with a warm diluting liquid, besides its paregoric qua- lity, warm diluents being great correctors of acrimo- ny. When the distemper is thus far advanced, and this inveterate diarrhea present, a suppression of the spitting will succeed, in spite of the most assiduous and prudent assistance. All remedies at this time prove ineffectual, and the patient’s final dissolution soon closes the dismal scene. PRO- PROPOSALS FOR PRINTING by SUBSCRIPTION A SUPPLEMENT TO Van Swieten's COMMENTARY ON Boerbaave’s Aphorisms on the Know- ledge and Cure of Distempers. THIS Work will be contained in two Vo- lumes Octavo, which will be published in the space of one year from the present time. The price to Subscribers of the two Volumes, few’d, is 10 s. 6d. five Shillings of which is to be paid at the time of sub- scribing, and the remainder at the delivery of the books This performance was originally intended, as a sup- plement to the English translation of the two first vo- lumes of Van Swieten's commentary, and to have be- gun with the first aphorism concerning the Pleurisy; but as the publication of a third volume by that ex- cellent author, has rendered one half of this intended commentary needless, the Supplement will now be- gin at the first aphorism concerning the Phthisis Pul- monalis. And as without doubt a translation of this new volume will soon be published, this Supplement may be considered as a continuation of such transla- tion when made public. It is therefore requested as a favour, of all who intend to encourage this performance, to send their names to the author, or his booksellers. Subscriptions are taken in by Mess. 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