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but upon his back only; when he cannot breathe with tolerable ease, except the trunk of his bodybe erect; when, even in this posture, the breathing is very difficult, and attended with a tumescence and flushing of the face, together with par- . tial sweats about the head and neck, and ah irregular pulse; these circumstances mark the difficulty of breathing in progressive degrees, and consequently, in proportion, the danger of the disease. A frequent violent cough, aggravating the pain, is always the symptom of an obstinate disease.
As I apprehend that the disease is hardly ever resolved, without some expectoration, so a drycough must be always an unfavourable symptom.
As the expectoration formerly described marks that the disease is proceeding to a resolution; so an expectoration which has not the conditions there mentioned, must denote at least a doubtful state of the disease; but the marks taken from the colour of the matter are for the most part fallacious. An acute pain, very much interrupting inspiration, is always the mark of a violent disease; though not of one more dangerous than an obtuse pain, attended with very difficult respiration.
When the pains, which at first had affected one side only, have afterwards spread into the other; or when, leaving the side first affected, they entirely pass into the other, these are always marks of an increasing, arid therefore of a dangerous disease.
85$. Whm the t&minafioh of this diseasS p*bveS Fatal, ft is oil bhe dr other of the day*s bt iKe ft?st -week, from the third to the seventh. This 5s the most common case; hut, in a few instances', 3ekth has happened at a later period of the disease.
When the disease is violent, but admitting of resolution, this also happens frequently in the coiirse of the first wgek; btitj in a more moderate stjtte 6f the disease, the resolution is often delayed to the second week.
The disease, on sortie of the days" from the third to the seventh, generally suffers a remission; which, however, may be often fallacious, as the disease does sometimes f eturn again with as much violence as before, and then with great danger.
Sometimes the disease disappears on the second or third day, while an erysipelas makes its appearance oh some e■xfehi^l part; and, if this continue fixed, the pneumonic inftlnimafidh does hot recur.
354. trteUhlpnla, like biher inflammations, bf?eh ends in suppuration dr gahgrehe.
355. When a pneumonia, with symptoms nei-fkter very Violent Jior vefy slight, has continued , for many days, it is to be feared it will end in a suppuration. This, however, is not to be determined precisely by the number of days: for, not only after the fourth, but even after the tenth day, there have been examples of a pneumonia ending by a resolution; and, if the disease has suffered some intermission, and again recurred, there may be instances of a resolution happening at a much later period from the beginning of the disease, than that just now mentioned.
356. But, if a moderate disease, in spite of proper remedies employed, be protracted to the fourteenth day without any considerable remission, a suppuration is pretty certainly to be expected; and it will be still more certain, if no signs of resolution have appeared, or if an expectoration which had appeared shall have again ceased, and the difficulty of breathing has continued or increased, while the other symptoms .have rather abated.
357. That in a pneumonia, the effusion is made, which may lay the foundation of a suppuration, we conclude from the difficulty of breathing becoming greater when the patient is in a horizontal posture, or when he can lie more easily upon the affected side.
358. That, in such cases, a suppuration has actually begun, may be concluded from the par tient's being frequently affected with slight cold shiverings, and with a sense of cold felt sometimes in one, and sometimes in another part of the body. We form the same conclusion also from the state of the pulse, which is commonly less frequent and softer, but sometimes quicker and fuller, than before,
359. That a suppuration is already formed, maybe inferred from there being a considerable remission of the pain which had before subsisted, while, alongst with this, the cough, and especially the dyspnoea, continue, and are rather augmented. At the same time, the frequency of the pulse is rather increased; the feverish state suffers considerable exacerbations every evening, and by degrees a hectic, in all its circumstances, comes to be formed.
S60. The termination of pneumonia by gangrene, is much more rare than has been imagined; and, when it does occur, it is usually joined with the termination by effusion (346); and the symptoms of the one are hardly to be distinguished from those of the other.
361. The cure of pneumonic inflammation must proceed upon the general plan (264); but the importance of the part affected, and the danger to which jt is e$poge4, require that the remedies be |ully, as well as early? eniplpyed.
362. Tl}e remedy chiefly to he depended- upon, is that of bleeding at the suii*; whjcb. will he perr formed with mPst advantage in the arm of the sip^e affected, but may be d?ne in either arm, as may be most convenient for the patient qr the surgeon. The quantity drawn must be suited to the violence of the disease, and tQ the vigour of the patient; and generally ought tq be as large as. thw Ia^jt circumstance will allow. The remission of pain, and (he relief of respiration, during the flowing of die blood, may limit the quantity to be then drawn j but, if these symptoms of relief do not appear, the bleeding should be continued till the symptoms of a banning syncope come on. It is sejdpm, that ope pleeding, however large* will prqve a cure of this disease; and although the pain and difficulty of breathing may be much relieved by the first bleeding, these symptom^ commonly, and after no long interval, rec.u.r; often with as much violence as befqre. Jn the event of such recurrence, the bleeding is to be repeated, even in the course of u>e sam§ day, and perhaps to ti}e same quantity as before.
Sometimes the second bleeding may be larger than the first, There are persons, who by their constitution, are ready to faint even upon a small bk?4J9§ > %\dt W sH?h persons, tfp> may prevent