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be very effectual; and some of them, being acrid stimulant substances, cannot be very safe.
The gums usually employed seem too heating: squills seem to be less so; but they are not very powerful, and sometimes inconvenient, by the constant nausea they induce.
The volatile alkali may be of service as an expectorant ; but it should be reserved for an advanced state of the disease.
Mucilaginous and oily demulcents appear to be useful, by allaying that acrimony of the mucus which occasions too frequent coughing ; and which coughing prevents the stagnation and thickening of the mucus, and thereby its becoming mild.
The receiving into the lungs the steams of warm water impregnated with vinegar, has often proved useful in promoting expectoration.
But of all other remedies, the most powerful for this purpose are antimonial medicines, given in nauseating doses, as in 179. Of these, however, I have not found the kermcs mineral more efficacious than emetic tartar, or antimonial wine; and the dose of the kermes is much more uncertain than that of the others.
374. Though a spontaneous sweating often proves the crisis of this disease, it ought not to be excited by art, unless with much caution. At least, I have not yet found it either so effectual or safe, as some writers have alleged. "When, after some remission of the symptoms, spontaneous sweats of a proper kind arise, they may be encouraged; but it ought to be without much heat, and without stimulant medicines. If, however, the sweats be partial and clammy only, and a great difficulty of breathing still remain, it will be very dangerous to encourage them.
375. Physicians have differed much in opinion with regard to the use of opiates in pneumonic inflammation. To me it appears, that, in the beginning of the disease, and before bleeding and blistering have produced some remission of the pain and of the difficulty of breathing, opiates have a very bad effect, by their increasing the difficulty of breathing, and other inflammatory symptoms. But in a more advanced state of the disease, when the difficulty of breathing has abated, and when the urgent symptom is a cough, proving the chief cause of ths continuance of the pain, and of the want of sleep, opiates may be employed with great advantage and safety. The interruption of the expectoration, which they seem to occasion, is for a short time only; and they seem often to promote it, as they occasion a stagnation of what was by frequent coughing dissipated insensibly, and therefore give the appearance of what physicians have called Concocted Matter.
OF THE PERIPNEUMONIA NOTHA, Or BASTARD PEBIP, NEVMONY.
876. A Disease under this name is mentioned in some medical writings of the sixteenth century; but it is very doubtful if the name was then applied to the same disease to which we now apply it. It appears to me, that unless some of the cases described under the title of Catarrhus suffocativus be supposed to have been of the kind I am now to treat of, there was no description of this disease given before that by Sydenham, under the title I have employed here.
377. After Sydenham, Boerhaave was the first who in a system took notice of it as a distinct disease; and he has described it in his aphorisms, although with some circumstances different from those in the description of Sydenham. Of late, Mr. Lieutaud has with great confidence asserted, that Sydenham and Boerhaave had, under the same title, described different diseases; and that, perhaps, neither of them had, on this subject, delivered any thing but hypothesis.
378. Notwithstanding this bold assertion, I am humbly of opinion, and the Baron Van Sweiten seems to have been of the same, that Sydenham and Boerhaave did describe, under the same title, one and the same disease. Nay, I am further of opinion, that the disease described by Mr. Lieutaud himself is not essentially different from that described by both the other authors. Nor will the doubts of the very learned but modest Morgagni, on this subject disturb us, if we consider that, while very few describers of diseases either have it in their power, or have been sufficiently attentive in distinguishing between the essential and accidental symptoms of disease; so, in a disease which may have not only different, but a greater number of symptoms, in one person than it has in another, we need not wonder, that the descriptions of the same disease by different persons should come out in some respects different. I shall, however, enter no further into this controversy, but endeavour to describe the disease as it has appeared to myself; and, as I judge, in the essential symptoms, much the same as it has appeared to all the other authors mentioned.
S79. This disease appears at the same seasons that other pneumonic and catarrhal affections commonly do; that is, in autumn and in spring. Like these diseases also, it is seemingly occasioned by sudden changes of the weather from heat to cold. It appears also, during the prevalence of contagious catarrh; and it is frequently under the form of the peripneumonia notha, that these catarrhs prove fatal to elderly persons.
This disease attapks most commonly persons somewhat advanced in life, especially those of a full phlegmatic habit; those who have before been frequently liable to catarrhal affections; and those, who have been much addicted to the large use of fermented and spiritous liquors.
The disease commonly comes on with the same symptoms as other febrile diseases; that is, with alternate chills and heats j and the symptoms of pyrexia are sometimes sufficiently evident; but in most cases these are very moderate, and in some hardly at all appear. With the first attack of the disease, a cough comes on, usually accompanied with some expectoration; and in many cases, there is a frequent throwing up of a considerable quantity of a viscid opaque mucus. The cough often becomes frequent and violent; is sometimes accompanied with a rending headach; and as in other eases of cough, a vomiting is sometimes excited by it. The face is sometimes flushed; and some giddiness or drowsiness often attends the disease. A difficulty of breathing, with a sense of oppression, or straitening in the chest, with some obscure pains there, and a sense of lassitude over the whole body, very constantly attend this disease. The blood drawn in this disease shews a buffy surface, as in other inflammatory affections.