Part 10

Sec. 71. Some Years since I saw a Country Maid Servant, who was left in a languishing Condition after an Inflammation of the Breast; without any Person's suspecting her Ailment. This Woman being put into a Cart, that was sent for a Load of Hay; one of the Wheels run violently against a Tree: she swooned away, and at the same Time brought up a great Quantity of digested Matter. She continued to bring up more; during which I was informed of her Case, and of the Accident, which effectually cured her.

A Swiss Officer, who served in Piedmont, had been in a languid State of Health for some Months; and returned home to set himself down as easily as he could, without conceiving any considerable Hopes of Recovery. Upon entering into his own Country, by the Way of Mount Bernard; and being obliged to go some Paces on Foot, he fell down; and remained in a Swoon above a Quarter of an Hour: during which Time he threw up a large Quantity of Matter, and found himself that very Moment very greatly relieved. I ordered him a proper Diet, and suitable Medicines: his Health became perfectly established; and the Preservation of his Life was principally owing to this lucky Fall.

Many Persons afflicted with a Vomica, faint away the very Instant it breaks. Some sharp Vinegar should be directly held to their Nose. This small Assistance is generally sufficient, where the bursting of it is not attended with such Appearances as shew it to be mortal, in which Case every Application is insignificant.

Sec. 72. If the sick Person was not extremely weak before the Bursting of the Abscess; if the Matter was white, and well conditioned; if the Fever abates after it; if the Anguish, Oppression and Sweats terminate; if the Cough is less violent; if the Patient is sensibly easier in his Situation or Posture; if he recovers his Sleep and Appetite; if his usual Strength returns; if the Quantity he expectorates, or brings up, becomes daily and gradually less; and if his Urine is apparently better, we may have Room to hope, that by the Assistance of these Remedies I shall immediately direct, he may be radically, compleatly cured.

Sec. 73. But if on the contrary; when his Strength is exhausted before the bursting of the Abscess; when the Matter is too thin and transparent, brown, green, yellow, bloody and of an Offensive Smell; if the Pulse continues quick and weak; if the Patient's Appetite, Strength and Sleep do not improve, there remains no hope of a Cure, and the best Medicines are ineffectual: Nevertheless we ought to make some Tryal of them.

Sec. 74. They consist of the following Medicines and Regulations. 1. Give every four Hours a little Barley or Rice Cream. 2. If the Matter brought up is thick and glewy, so that it is very difficult to be loosened and discharged, give every two Hours a Soup-ladle of the Potion No. 8; and between the giving these two, let the Patient take every half Hour a Cup of the Drink No. 13. 3. When the Consistence of the Matter is such, that there is no Occasion for these Medicines to promote the Discharge of it, they must be omitted; tho' the same Sort and Quantity of Food are to be continued; but with the Addition of an equal Quantity of Milk; or, which would be still more beneficial, instead of this Mixture, we should give an equal Quantity of sweet Milk, taken from a good Cow, which, in such a Case, may compose the whole Nourishment of the Patient. 4. He should take four Times a Day, beginning early in the Morning, and at the Distance of two Hours, a Dose of the Powder No. 14, diluted in a little Water, or made into a Bolus, or Morsel, with a little Syrup or Honey. His common Drink should be Almond Emulsion, commonly called Almond Milk, or Barley Water, or fresh Water with a fourth part Milk. 5. He should air and exercise every Day on Horseback, or in a Carriage, according as his Strength and his Circumstances will allow him. But of all Sorts of Exercise, that upon a trotting Horse is, beyond all Comparison, the very best, and the easiest to be procured by every Body; provided the Disease be not too far advanced; since in such a Situation, any Exercise, that was only a little violent, might prove pernicious.

Sec. 75. The Multitude, who are generally illiterate, seldom consider any thing as a Remedy, except they swallow it. They have but little Confidence in Regimen, or any Assistance in the Way of Diet, and consider Riding on Horseback as wholly useless to them. This is a dangerous Mistake, of which I should be glad to undeceive them: since this Assistance, which appears so insignificant to them, is probably the most effectual of any: it is that in Fact, without which they can scarcely expect a Cure, in the highest Degrees of this Disease: it is that, which perhaps alone may recover them, provided they take no improper Food. In brief it is considered, and with Reason, as the real Specific for this Disease.

Sec. 76. The Influence of the Air is of more Importance in this Disorder, than in any others; for which Reason great Care should be taken to procure the best, in the Patient's Chamber. For this Purpose it should often be ventilated, or have an Admission of fresh Air, and be sweetened from Time to Time, tho' very lightly, with a little good Vinegar; and in the Season it should be plentifully supplied with agreeable Herbs, Flowers and Fruits. Should the Sick be unfortunately situated, and confined in an unwholsome Air, there can be but little Prospect of curing him, without altering it.

Sec. 77. Out of many Persons affected with these Disorders, some have been cured by taking nothing whatsoever but Butter-milk; others by Melons and Cucumbers only; and others again by Summer Fruits of every Sort. Nevertheless, as such Cases are singular, and have been but few, I advise the Patient to observe the Method I have directed here, as the surest.

Sec. 78. It is sufficient if he have a Stool once in two, or even in three, Days. Hence, there is no Reason for him, in this Case, to accustom himself to Glysters: they might excite a Looseness, which may be very dangerous.

Sec. 79. When the Discharge of the Matter from the Breast diminishes, and the Patient is perceivably mended in every Respect, it is a Proof that the Wound in the Abscess is deterged, or clean, and that it is disposed to heal up gradually. If the Suppuration, or Discharge, continues in great Quantity; if it seems but of an indifferent Consistence; if the Fever returns every Evening, it may be apprehended, that the Wound, instead of healing, may degenerate into an Ulcer, which must prove a most embarrassing Consequence. Under such a Circumstance, the Patient would fall into a confirmed Hectic, and die after some Months Sickness.

Sec. 80. I am not acquainted with any better Remedy, in such a dangerous Case, than a Perseverance in these already directed, and especially in moderate Exercise on Horseback. In some of them indeed Recourse may be had to the sweet Vapours of some vulnerary Herbs in hot Water, with a little Oil of Turpentine, as directed No. 15. I have seen them succeed; but the safest Way is to consult a Physician, who may examine and consider, if there is not some particular Circumstance combined with the Disease, that proves an Obstacle to the Cure of it. If the Cough prevents the Patient from Sleeping, he may take in the Evening two or three Table Spoonfuls of the Prescription No. 16, in a Glass of Almond Milk or Barley Water.

Sec. 81. The very same Causes which suddenly suppress the Expectoration, in an Inflammation of the Breast, may also check the Expectoration from a Vomica already begun: in which Circumstance the Patient is speedily afflicted with an Oppression and Anguish, a Fever and evident Feebleness. We should immediately endeavour to remove this Stoppage, by the Vapour of hot Water; by giving a Spoonful of the Mixture No. 3 every Hour; by a large Quantity of the Ptisan No. 12, and by a proper Degree of Motion or Exercise. As soon as ever the Expectoration returns, the Fever and the other Symptoms disappear. I have seen this Suppression in strong Habits quickly followed with an Inflammation about the Seat of the Vomica, which has obliged me to bleed, after which the Expectoration immediately returned.

Sec. 82. It happens sometimes, that the Vomica is entirely cleansed; the Expectoration is entirely finished, or drained off, the Patient seems well, and thinks himself compleatly cured: but soon after, the Uneasiness, Oppression, Cough and Fever are renewed, because the Membrane or Bag of the Vomica fills again: again it empties itself, the Patient expectorates for some Days, and seems to recover. After some Time however, the same Scene is repeated; and this Vicissitude, or Succession, of moderate and of bad Health, often continues for some Months and even some Years. This happens when the Vomica is emptied, and is gradually deterged; so that its Membranes, or Sides touch or approach each other; but without cicatrizing or healing firmly; and then there drops or leaks in very gradually fresh Matter. For a few Days this seems no ways to incommode the Patient; but as soon as a certain Quantity is accumulated, he is visited again with some of the former Symptoms, 'till another Evacuation ensues. People thus circumstanced, in this Disease, sometimes appear to enjoy a tolerable Share of Health. It may be considered as a kind of internal Issue, which empties and cleanses itself from Time to Time; pretty frequently in some Constitutions, more slowly in others; and under which some may attain a good middling Age. When it arrives however at a very considerable Duration, it proves incurable. In its earliest State, it gives way sometimes to a Milk-diet, to riding on Horseback; and to the Medicine No. 14.

Sec. 83. Some may be surprized, that in treating of an Abscess of the Lungs, and of the Hectic, which is a Consequence of it, I say nothing of those Remedies, commonly termed Balsamics, and so frequently employed in them, for Instance, Turpentines, Balsam of Peru, of Mecca, Frankincense, Mastich, Myrrh, Storax and Balsam of Sulphur. I shall however say briefly here (because it is equally my Design to destroy the Prejudice of the People, in favour of improper Medicines, and to establish the Reputation of good ones) that I never in such Cases made use of these Medicines; because I am convinced, that their Operation is generally hurtful in such Cases; because I see them daily productive of real Mischief; that they protract the Cure, and often change a slight Disorder into an incurable Disease. They are incapable of perfect Digestion, they obstruct the finest Vessels of the Lungs, whose Obstructions we should endeavour to remove; and evidently occasion, except their Dose be extremely small, Heat and Oppression. I have very often seen to a Demonstration, that Pills compounded of Myrrh, Turpentine and Balsam of Peru, have, an Hour after they were swallowed, occasioned a Tumult and Agitation in the Pulse, high Flushings, Thirst and Oppression. In short it is demonstrable to every unprejudiced Person, that these Remedies, as they have been called, are truly prejudicial in this Case; and I heartily wish People may be disabused with Respect to them, and that they may lose that Reputation so unhappily ascribed to them.

I know that many Persons, very capable in other Respects, daily make use of them in these Distempers: such however cannot fail of disusing them, as soon as they shall have observed their Effects, abstracted from the Virtues of the other Medicines to which they add them, and which mitigate the Danger of them. I saw a Patient, whom a foreign Surgeon, who lived at Orbe, attempted to cure of a Hectic with melted Bacon, which aggravated the Disease. This Advice seemed, and certainly was, absurd; nevertheless the Balsamics ordered in such Cases are probably not more digestible than fat Bacon. The Powder No. 14 possesses whatever these Balsamics pretend to: it is attended with none of the Inconveniencies they produce; and has all the good Qualities ascribed to them. Notwithstanding which, it must not be given while the Inflammation exists; nor when it may revive again; and no other Aliment should be mixed with the Milk.

The famous Medicine called the Antihectic, (Antihecticum Poterii) has not, any more than these Balsamics, the Virtues ascribed to it in such Cases. I very often give it in some obstinate Coughs to Infants with their Milk, and then it is very useful: but I have seldom seen it attended with considerable Effects in grown Persons; and in the present Cases I should be fearful of its doing Mischief.

Sec. 84. If the Vomica, instead of breaking within the Substance of the Lungs affected, should break without it, the Pus must be received into the Cavity of the Breast. We know when that has happened, by the Sensation or Feeling of the Patient; who perceives an uncommon, a singular kind of Movement, pretty generally accompanied with a Fainting. The Oppression and Anguish cease at once; the Fever abates; the Cough however commonly continues, tho' with less Violence, and without any Expectoration. But this seeming Amendment is of a short Duration, since from the daily Augmentation of the Matter, and its becoming more acrid or sharp, the Lungs become oppressed, irritated and eroded. The Difficulty of Breathing, Heat, Thirst, Wakefulness, Distaste, and Deafness, return, with many other Symptoms unnecessary to be enumerated, and especially with frequent Sinkings and Weakness. The Patient should be confined to his Regimen, to retard the Increase of the Disease as much as possible; notwithstanding no other effectual Remedy remains, except that of opening the Breast between two of the Ribs, to discharge the Matter, and to stop the Disorder it occasions. This is called the Operation for the Empyema. I shall not describe it here, as it should not be undertaken but by Persons of Capacity and Experience, for whom this Treatise was not intended. I would only observe, it is less painful than terrifying; and that if it is delayed too long, it proves useless, and the Patient dies miserably.

Sec. 85. We may daily see external Inflammations turn gangrenous, or mortify. The same Thing occurs in the Lungs, when the Fever is excessive, the Inflammation either in its own Nature, extremely violent, or raised to such a Height by hot Medicines. Intolerable Anguish, extreme Weakness, frequent Faintings, Coldness of the Extremities, a livid and foetid thin Humour brought up instead of concocted Spitting, and sometimes blackish Stripes on the Breast, sufficiently distinguish this miserable State. I have smelt in one Case of this Kind, where the Patient had been attacked with this Disease (after a forced March on Foot, having taken some Wine with Spices to force a Sweat) his Breath so horribly stinking, that his Wife had many Sinkings from attending him. When I saw him, I could discern neither Pulse nor Intellect, and ordered him nothing. He died an Hour afterwards, about the Beginning of the third Hour.

Sec. 86. An Inflammation may also become hard, when it forms what we call a Scirrhus, which is a very hard Tumour, indolent, or unpainful. This is known to occur, when the disease has not terminated in any of those Manners I have represented; and where, tho' the Fever and the other Symptoms disappear, the Respiration, or Breathing, remains always a little oppressed; the Patient still retains a troublesome Sensation in one Side of his Breast; and has from Time to Time a dry Cough, which increases after Exercise, and after eating. This Malady is but seldom cured; though some Persons attacked with it last many Years, without any other considerable Complaint. They should avoid all Occasions of over-heating themselves; which might readily produce a new Inflammation about this Tumour, the Consequences of which would be highly dangerous.

Sec. 87. The best Remedies against this Disorder, and from which I have seen some good Effects, are the medicated Whey No. 17, and the Pills No. 18. The Patient may take twenty Pills, and a Pint and a half of the Whey every Morning for a long Continuance; and receive inwardly, now and then, the Vapour of hot Water.

Sec. 88. Each Lung, in a perfect State of Health, touches the Pleura, the Membrane, that lines the Inside of the Breast; though it is not connected to it. But it often happens, after an Inflammation of the Breast, after the Pleurisy, and in some other Cases, that these two Parts adhere closely to each other, and are never afterwards separated. However this is scarcely to be considered as a Disease; and remains commonly unknown, as the Health is not impaired by it, and nothing is ever prescribed to remove it. Nevertheless I have seen a few Cases, in which this Adhesion was manifestly prejudicial.

_Chapter V._

Of the Pleurisy.

_Sect._ 89.

The Pleurisy, which is chiefly known by these four Symptoms, a strong Fever, a Difficulty of Breathing, a Cough, and an acute Pain about the Breast; the Pleurisy, I say, is not a different Malady from the Peripneumony, or Inflammation of the Breast, the Subject of the preceding Chapter; so that I have very little to say of it, particularly, or apart.

Sec. 90. The Cause of this Disease then is exactly the same with that of the former, that is, an Inflammation of the Lungs; but an Inflammation, that seems rather a little more external. The only considerable Difference in the Symptoms is, that the Pleurisy is accompanied with a most acute Pain under the Ribs, and which is commonly termed a Stitch. This Pain is felt indifferently over every Part of the Breast; though more commonly about the Sides, under the more fleshy Parts of the Breast, and oftenest on the right Side. The Pain is greatly increased whenever the Patient coughs or draws in the Air in breathing; and hence a Fear of increasing it, by making some Patients forbear to cough or respire, as much as they possibly can; and that aggravates the Disease, by stopping the Course of the Blood in the Lungs, which are soon overcharged with it. Hence the Inflammation of this Bowel becomes general; the Blood mounts up to the Head; the Countenance looks deeply red, or as it were livid; the Patient becomes nearly suffocated, and falls into the State described Sec. 47.

Sometimes the Pain is so extremely violent, that if the Cough is very urgent at the same Time, and the Sick cannot suppress or restrain it, they are seized with Convulsions, of which I have seen many Instances, but these occur almost always to Women; though they are much less subject than Men to this Disease, and indeed to all inflammatory ones. It may be proper however to observe here, that if Women should be attacked with it, during their monthly Discharges, that Circumstance should not prevent the repeated and necessary Bleedings, nor occasion any Alteration in the Treatment of the Disease. And hence it appears, that the Pleurisy is really an Inflammation of the Lungs, accompanied with acute Pain.