GEN. VII. SPEC. VI. 6 E. Bronch lemmitis chronica. Chronic croup: or Bronchial polypus. of a white pappy mucus as thick as cream. I observed one, about the size of a quill, which was tubular. It seemed to consist of a few lamellæ only." In connexion with the plan of treatment already pointed out, it is highly probable that much benefit might, in this chronic form of bronchlemmitis, be derived from the use Treatment, of mercury and fox-glove. And as a natural cure was obtained by a metastasis, or a morbid action excited in a remote organ, we have a strong invitation to follow in a like path; and should endeavour to obtain a like beneficial result by the use of setons or caustics. GEN. VII. SPEC. VII. Synonyms. SPECIES VII. EMPRESMA PNEUMONITIS. Peripneumony. INFLAMMATION OF THE LUNGS; OBTUSE PAIN IN THE INFLAMMATION of the lungs has been described under so many names that it is scarcely worth while to give a list of them. The most common perhaps is peripneumonia, for which pneumonitis, employed first, I believe, by Bourgard in his Dissertation, published in 1754, is here substituted merely on account of the regularity of its termination. The disease, as above characterized, is traced under the three following varieties: a Vera. True Peripneumony. Fever a cauma; pain severe, little expectoration in the beginning. The FIRST of these varieties, or TRUE PERIPNEUMONY, is, perhaps, the most common, and has been more generally treated of than the rest. pleuritis. characters. Dr. Cullen has united inflammation of the paren- United by chyma of the lungs, which is here alone contemplated, Cullen with with inflammation of their membranes; as believing that we have no means of ascertaining a difference from the course or concomitancy of the symptoms, and in this view of the disease he has been followed by Professor Frank, who however retains the term pleuritis, but limits it to what has occasionally been called bastard pleurisy*. It may be observed, however, that in pleurisy Distinctive the face is comparatively but little flushed, and far less tumid; that the pulse is harder; the cough less violent, and, from the beginning to the end, without expectoration; the seat of pain also is here fixed: while in peripneumony, it shifts not only to different parts of the same side, but often from the one side to the other; and, when the lower part of the right lung is affected, is communicated to the liver, occasioning an uneasiness in the right hypochondrium, and accompanied with a yellow and copious expectoration. It is most commonly the case, Yet somehowever, that some degree of pleurisy accompanies pneumonitis from continuous sympathy t; but then it is not idiopathic pleurisy, nor strictly possessed of its symptoms. Percussion, if skilfully managed, will often ascer * De Cur. Hom. Morb. Epit. Tom. II. § 185. 8vo. Mannh. 1792. + Morgagn. De Sed. et Caus. Morb. Ep. Art. 13, 14. 37. times found concurrent. GEN. VII, SPEC. VII. tain the particular part in which the inflammation is E. Pneu seated, but the stethoscope will prove a still better diamonitis vera. gnostic; for the use of which the reader is referred to the True peritreatment of PHTHISIS in the ensuing volume. pneumony. More easily able than inflammation of the brain and its membranes. And why. Inflammation of the substance of the lungs bears distinguish nearly the same relation to pleurisy or inflammation of the membrane that lines it, as profound or parenchymatous cephalitis bears to meningic. The two former, however, are somewhat more distinct and less liable to run into each other than the two latter, because one half the pleura, from its duplicature, is more remotely situated from the lungs and less connected with them. And I have hence followed the ordinary division, and treated of pneumonitis and pleuritis as distinct species, rather than varieties of one common species, which is the view taken of meningic and profound cephalitis. In both sets of disease, however, the membranous is the more acute affection, evinces more violent and painful symptoms, and runs through its course more rapidly. And hence, in pneumonitis, as in deep-seated phrensy, the pulse is sometimes soft*, the fever small†, and the progress protracted occasionally to twenty days or more ‡. Analogy between cephalitis and the diseases in question Causes. The causes of true peripneumony are those of inflammation in general; particularly excessive exertion of the lungs, or cold, applied when the system is generally heated, to the skin, mouth, or stomach. It attacks the robust and plethoric more frequently than the spare and delicate; and appears most frequently in cold weather, or sudden changes from hot to cold. Repelled eruptions have probably sometimes proved a cause; and noxious exhalations certainly. To the last we may refer the frequency of this disease in the outskirts of Mount Vesuvius, as remarked by Vivenzi§; and on this account it is described by Baronius || and Bovillet, as endemic. De Caballis, Phænom, Med. † Cleghorn, p. 262. Stoll, Rat. Med. Part II. p. 376, Act. Nat. Cur. Vol. v. Obs. 124. § Epist. ad Haller. iv. | Pleuropneumoniâ ann. 1633, Flaminiam infestante. Fidi, 1536. GEN. VII. SPEC. VII. & E. Pneu monitis vera. True peripneumony. Professor Frank observes that it is occasionally the result of worms or saburra in the stomach or intestines. The first symptoms also are those of inflammation in general; but there is usually more shivering, or cold fit, and the hot stage is proportionally violent; the head Description, aches considerably, and the urine is high-coloured. The pain in the chest is rarely felt in any oppressive degree till these symptoms have continued for a day or two: though sometimes it is coetaneous. It is chiefly felt in a recumbent position, and more on one side than on the other. The cough is short, peculiarly distressing, and obstinate, the expectoration small, viscid, and discoloured, and sometimes little in quantity. The pulse is variable, in some cases hard and strong, in some soft or oppressed; but, with the advance of the disease, it becomes feeble, sometimes fluttering. Delirium is an occasional accompaniment, and is a highly dangerous symptom, except where it alternates with the pneumonic symptoms, in which case it augurs well. In favourable terminations the violence of the disease diminishes on or before the seventh day if it increase beyond this, it commonly proves fatal. tions of pneumonitis. most favour times adhe Peripneumony, like other inflammations, terminates Terminain effusion, suppuration, or gangrene; and it has also a termination peculiar to itself, which is that of hemorrhage from an increased vis à tergo. The most salutary mode is effusion, for the vessels hereby become relieved, Effusion the and the secernents immediately add to the relief by com- able. mencing an increased action, and consequently an increased discharge of mucus. In consequence of effu- Yet somesion, however, we occasionally find adhesions take place between the lungs and the pleura; and sometimes a collection of water in different parts of the chest; and not unfrequently a flow of blood, apparently from the mouths of the exhalants without any rupture of vessels, giving a bloody tinge to the sputum. This last has been often Bloody regarded as an alarming symptom, but the alarm is al- sputum not together unfounded, for it generally affords considerable dangerous. relief. Indeed an hemorrhage itself from the lungs has sions follow. Sometimes dropsy of the chest. necessarily a E. Pneu pneumony. GEN. VII. not always been attended with fatal consequences: it SPEC. VII. has occasionally proved critical, and carried off the dismonitis vera. ease in a few days: though a hemorrhage from the nose, True perino unusual attendant, is far preferable, as producing a like benefit with less risk. If the inflammation run into suppuration, the change is generally indicated by shiverings, with a remission of pain, and sometimes perspiration where there has been none before. If gangrene ensue, the pulse sinks, the debility rapidly increases, and the eyes are fixed with a ghastly stare. Treatment. and most The best, the easiest, and even the natural cure of Expectora peripneumony is expectoration; which, hence, ought to tion the best be excited, and encouraged by all the means in our natural cure. power. It forms the optima crisis of Stoll, though, as he Bleeding ac- adds, a crisis too rarely obtained*. Bleeding, by giving cording to some degree of freedom to the distended capillaries, afthe general habit and fords one mean of accomplishing this object; but if the constitution. patient's strength be considerably reduced, the strength In some cases very copious. of the capillaries will be reduced also, and they will be too debilitated for the increased action. It is, hence, necessary to measure the general habit and constitution of the patient, as also the situation in which he resides; for if he be in an open and mountainous region, and addicted to the pursuits of a country life, he will bear bleeding far more readily and freely than if he be the inhabitant of a crowded city, or accustomed to a sedentary life. In this case the bleeding should be prompt and copious, at least to eighteen or twenty ounces, and repeated twelve hours after if necessary; and as the disease occurs chiefly in robust constitutions, it is rarely that venesection can be dispensed with. The chief evil is that the fever is apt, at times, to run into a typhous form, and Sometimes assume the second of the varieties before us. And hence, local only. where there is any doubt upon the subject, local bleeding, is to be preferred, whether by leeches or cupping-glasses, repeated according as the evacuation appears to be deLaxatives manded. Laxatives and refrigerants are next employed and refrige rants. Rat. Med. 111. 53. |