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The disease has often the appearance only of a more violent catarrh, and after the employment of some remedies, is entirely relieved by a free and copious expectoration. In other cases, however, the feverish and catarrhal symptoms are at first very moderate, and even slight; but after a few days these symptoms suddenly become considerable, and put an end to the patient's life, when the indications of danger were before very little evident.
380. From the different circumstances in which this disease appears, the pathology of it is diffiT cult. It is certainly often no other at first than a catarrhal affection, which, in elderly persons, is frequently attended with a large afflux of mucus to the lungs; and it was on this footing, that Sydenham considered it as only differing in degree from his Febris Hyemalis. A catarrh, however, is strictly an affection of the mucous membrane and follicles of the bronchise alone: but it may readily have, and frequently has, a degree of pneumonic Inflammation joined to it; and in that case may prove more properly the peculiar disease we treat of here. But, further, as pneumonic inflammation very often produces an effusion of serum into the bronchiae (348), so this, in elderly persons, may occur in consequence of a slight degree of inflammation; and, when it does happen, will give the exquisite and fatal cases of the peripneumonia notha.
381. After this attempt to establish the pathology, the method of cure in the different circumstances of the disease will not be difficult.
In case the fever, catarrhal and pneumonic symptoms are immediately considerable, a bloodletting will certainly be proper and necessary: but, where these symptoms are moderate, a blood-letting will hardly be requisite; and, when an effusion is to be feared, the repetition of blood-letting may prove extremely hurtful.
In all cases, the remedies chiefly to be depended upon are vomiting and blistering. Full vomiting may be frequently repeated; and nauseating doses ought to be constantly employed.
Purging may perhaps be useful; but, as it is seldom so in pneumonic affections, nothing but gentle laxatives are here necessary.
In all the circumstances of this disease, the antiphlogistic regimen is proper: cold is to be guarded against; but much external heat is to be as carefully avoided.
382. If a person sweats easily, and it can be brought out by the use of mild tepid liquors only, the practice may in such persons be tried. See Jkiorgagni De Scd. et Caus. Epist. xiii, Art. 4.
383. I might here, perhaps, give a separate section on the Carditis and Pericarditis, or the inflammations of the heart and pericardium; but they hardly require a particular consideration. An acute inflammation of the pericardium is almost always a part of the same pneumonic affection I have been treating of; and is not always distinguished by any different symptoms; or, if it be, does not require any different treatment. The same may be said of an acute inflammation of the heart itself; and, when it happens that the one or other is discovered by the symptoms of palpitation or syncope, no more will be implied than that the remedies of pneumonic inflammation should be employed with greater diligence.
From dissections, which shew the heart and pericardium affected with erosions, ulcerations, and abscesses, we discover, that these parts had been before affected with inflammation; and that, in cases where no symptoms of pneumonic inflammation had appeared: it may therefore be .alleged, that those inflammations of the heart and pericardium should be considered as diseases independent of the pneumonic. This indeed is just: but the history of such cases proves, that those inflammations had been of a chronic kind, and hardly discovering themselves by any peculiar symptoms; or, if attended with symptoms marking an affection of the heart, these were, however, such as have been known frequently to arise from other calces than inflammation. There is, therefore, upon the whole, no room for our treating more particularly of the inflammation of the heart or pericardium.
OF THE GASTRITIS, OR INFLAMMATION OF THE
384. Among the inflammations of the abdominal region, 1 have given a place in our nosology to the Peritonitis; comprehending under that title, not only the inflammations affecting the peritonaeum lining the cavity of the abdomen, but also those affecting the extensions of this membrane in the omentum and mesentery. It is not, however, proposed to treat of them here, because it is very difficult to say by what symptoms they are always to be known; and farther, because, when known, they do not require any remedies beside those of inflammation in general. I proceed, therefore, to treat of those inflammations which, affecting viscera of peculiar functions, both give occasion to peculiar symptoms, and require some peculiarities in the method of cure: and I shall begin with the inflammation of the stomach.
385. The inflammation of the stomach is of two kinds, Phlegmonic, or Erythematio* The first may be seated in what is called the nervous coat of the stomach, or in the peritoneum investing it. The second is always seated in the villous coat and cellular texture immediately subjacent.
386. The phlegmonic inflammation of the stomach, or what has been commonly treated of under the title of Gastritis, is known by an acute pain in some part of the region of the stomach, attended with pyrexia, with frequent vomiting, especially upon occasion of any thing being taken down into the stomach, and frequently with hickup. The pulse is commonly small and hard; and there is a greater loss of strength in all the functions of the body, than in the case of almost any other inflammation.
387. This inflammation may be produced by various causes, as, by external contusion; byacrids of various kinds taken into the stomach ; frequently by very cold drink taken into it while the body is very warm; and sometimes by ovef-distention, from the having taken in a large quantity of food of difficult digestion. All these may be considered as external causes; but the disease sometimes
* This is a new term; but whoever considers what is said in 274, will, L expect, perceive the propriety, and even the necess'tv of it.