CHAPTER VI.

OF THE PLEURISY.

THE true pleurisy is an inflammation of that membrane called the pleura, which lines the inside of the breast. It is distinguished into the moist and dry. In the former, the patient spits freely; in the latter, little or none at all. There is likewise a species of this disease, which is called the spurious or bastard pleurisy, in which the pain is more external, and chiefly affects the muscles between the ribs. The pleurisy prevails among labouring people, especially such as work without doors, and are of a sanguine constitution. It is most frequent in the spring season.

CAUSES.—The pleurisy may be occasioned by whatever obstructs the perspiration; as cold northerly winds, drinking cold liquors when the body his hot, sleeping without doors on the damp ground, wet clothes, plunging the body into cold water, or exposing it to the cold air when covered with sweat, &c. It may likewise be occasioned by drinking strong liquors; by the stoppage of usual evacuation; as old ulcers, issues, sweating of the feet or hands, &c.; the sudden striking in of any eruption, as the itch, the measles, or the smallpox. Those who have been accustomed to bleed at a certain season of the year, are apt, if they neglect it, to be seized with a pleurisy. Keeping the body too warm by means of fire, clothes, &c. renders it more liable to this disease. A pleurisy may likewise be occasioned by violent exercise, as running, wrestling, leaping, or by supporting great weight, blows on the breast, &c. A bad conformation of the body renders persons more liable to this disease, as a narrow chest, a straitness of the arteries of the pleura, &c.

SYMPTOMS.—This, like most other fevers, generally begins with chilliness and shivering, which are followed by heat, thirst, and restlessness. To these succeed a violent pricking pain in one of the sides among the ribs. Sometimes the pain extends towards the back-bone, sometimes towards the fore part of the breast, and at other times towards the shoulder-blades. The pain is generally most violent when the patient draws in his breath.

The pulse in this disease is commonly quick and hard, the urine high coloured, and if blood be let, it is covered with a tough crust, or buffy coat. The patient’s spittle is at first thin, but afterwards it becomes grosser, and is often streaked with blood.

REGIMEN.—Nature generally endeavours to carry off this disease by a critical discharge of blood from some part of the body, by expectoration, sweat, loose stools, thick urine, or the like. We ought therefore to second her intentions by lessening the force of the circulation, relaxing the vessels, diluting the humours, and promoting expectoration.

For these purposes, the diet, as in the former disease, ought to be cool, slender, and diluting. The patient must avoid all food that is viscid, hard of digestion, or that affords much nourishment; as flesh, butter, cheese, eggs, milk, and also every thing that is of a heating nature. His drink may be whey, or an infusion of pectoral and balsamic vegetables.

Barley-water, with a little honey or jelly of currants mixed with it, is likewise a very proper drink in this disease. It is made by boiling an ounce of pearl-barley in three English pints of water to two, which must afterwards be strained. The decoction of figs, raisins, barley, &c. recommended in the preceding disease, is here likewise very proper. These and other diluting liquors are not to be drank in large quantities at a time; but the patient ought to keep continually supping them, so as to render his mouth and throat always moist. All his food and drink should be taken a little warm.

The patient should be kept quiet, cool, and every way easy, as directed under the foregoing disease. His feet and hands ought daily to be bathed in lukewarm water; and he may sometimes sit up in bed for a short space, in order to relieve his head.

MEDICINE.—Almost every person knows, when a fever is attended with a violent pain in the side, and a quick hard pulse, that bleeding is necessary. When these symptoms come on, the sooner this operation is performed the better; and the quantity at first must be pretty large, provided the patient be able to bear it. A large quantity of blood let at once, in the beginning of a pleurisy, has a much better effect than repeated small bleedings. A man may lose twelve or fourteen ounces of blood as soon as it is certainly known that he is seized with a pleurisy. For a younger person, or one of a delicate constitution, the quantity must be less.

If after the first bleeding, the stitch, with the other violent symptoms, should still continue, it will be necessary, at the distance of twelve or eighteen hours, to let eight or nine ounces more. If the symptoms do not then abate, and the blood shows a strong buffy coat, a third or even a fourth bleeding may be requisite. If the pain of the side abate, the pulse become softer, or the patient begin to spit freely, bleeding ought not to be repeated. This operation is seldom necessary after the third or fourth day of the fever, and ought not then to be performed unless in the most urgent circumstances.

The blood may be many ways attenuated without bleeding. There are likewise many things that may be done to ease the pain of the side without the operation, as fomenting, blistering, &c. Fomentations may be made by boiling a handful of flowers of elder, camomile, and common mallows, or any other soft vegetables, in a proper quantity of water. The herbs may be either put into a flannel bag, and applied warm to the side, or flannels may be dipped in the decoction, afterwards wrung out, and applied to the part affected with as much warmth as the patient can easily bear. As the clothes grow cool, they must be changed, and great care taken that the patient do not catch cold. A bladder may be filled with warm milk and water, and may be applied to the side, if the above method of fomenting be found inconvenient. Fomentations not only ease the pain, but relax the vessels, and prevent the stagnation of the blood and other humours. The side may likewise be frequently rubbed with a little of the volatile liniment.

Topical bleeding has often a very good effect in this disease. It may either be performed by applying a number of leeches to the part affected, or by cupping, which is both a more certain and expeditious method than the other.

Leaves of various plants might likewise be applied to the patient’s side with advantage. I have often seen great benefit from young cabbage-leaves applied warm to the side in a pleurisy. These not only relax the parts, but likewise draw off a little moisture, and may prevent the necessity of blistering plasters; which, however, when other things fail, must be applied.

If the stitch continue after repeated bleedings, fomentation, &c. a blistering plaster must be applied over the part affected, and suffered to remain for two days. This not only procures a discharge from the side, but takes off the spasm, and by that means assists in removing the cause of the disease. To prevent a strangury when the blistering plaster is on, the patient may drink freely of the Arabic emulsion.

If the patient is costive, a glister of thin water-gruel, or barley-water, in which a handful of mallows, or any other emollient vegetable has been boiled, may be daily administered. This will not only empty the bowels, but have the effect of a warm fomentation applied to the inferior viscera, which will help to make a derivation from the breast.

The expectoration may be promoted by sharp, oily, and mucilaginous medicines. For this purpose, an ounce of the oxymel, or the vinegar of squills, may be added to six ounces of the pectoral decoction, and two table spoonsful of it taken every two hours.

Should the squill disagree with the stomach, the oily emulsion may be administered, or, in place of it, two ounces of the oil of sweet almonds, or oil of olives, and two ounces of the Syrup of violets, may be mixed with as much sugar-candy powdered as will make an electuary of the consistence of honey. The patient may take a tea-spoonful of this frequently, when the cough is troublesome. Should oily medicines prove nauseous, which is sometimes the case, two table spoonsful of the solution of gum ammoniac in barley-water may be given three or four times a day.

If the patient does not perspire, but has a burning heat upon his skin, and passes very little water, some small doses of purified nitre and camphire will be of use. Two drachms of the former may be rubbed with five or six grains of the latter in a mortar, and the whole divided into six doses, one of which may be taken five or six hours, in a little of the patient’s ordinary drink.

We shall only mention one medicine more, which some reckon almost a specific in the pleurisy, viz. the decoction of the Seneca rattle-snake root. After bleeding, and other evacuations have been premised, the patient may take two, three, or four table-spoonsful of this decoction, according as his stomach will bear it, three or four times a day. If it should occasion vomitting, two or three ounces of simple cinnamon-water may be mixed with the quantity of decoction here directed, or it may be taken in smaller doses. As this medicine promotes perspiration and urine, and likewise keeps the body easy, it may be of some service in a pleurisy, or any other inflammation of the breast.

No one will imagine that these medicines are all to be used at the same time. We have mentioned different things, on purpose that people may have it in their power to choose; and likewise, that when one cannot be obtained, they may make use of another. Different medicines are no doubt necessary in the different periods of a disorder; and where one fails of success, or disagrees with the patient, it will be proper to try another.

What is called the crisis, or height of the fever, is sometimes attended with very alarming symptoms, as difficulty of breathing, an irregular pulse, convulsive motions, &c. These are apt to frighten the attendants, and induce them to do improper things, as bleeding the patient, giving him strong stimulating medicines, or the like. But they are only the struggles of Nature to overcome the disease, in which she ought to be assisted by plenty of diluting drink, which is then peculiarly necessary. If the patient’s strength, however, be much exhausted by the disease, it will be necessary at this time to support him with frequent small draughts of wine-whey, negus, or the like.

When the pain and fever are gone, it will be proper, after the patient has recovered sufficient strength, to give him some gentle purges, as those directed towards the end of an acute continual fever. He ought likewise to use a light diet of easy digestion, and his drink should be butter-milk, whey, and other things of a cleansing nature.