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disposition ; and in all cases where there is the appearance of a large effusion, or where the hæ. morrhagy frequently returns, the effusion is not only to be moderated, but to be entirely stopped, and the returns of it prevented by every means in our power. See 797, and following.
848. To stop an hæmoptysis, or prevent the re. turns of it, two medicines have been frequently employed; neither of which I can approve of. These are, chalybeates, and the Peruvian bark. As both of them contribute to increase the phlogistic diathesis of the system, they can hardly be safe in any case of active hæmorhagy, and I have frequently found them hurtful.
849, As the hæmoptysis which happens in consequence of predisposition, is always attended with a phlogistic diathesis ; and, as the bad consequences of the disease are especially to be apprehended from the continuance of that diathesis ; so this is to be industriously taken off by blood-letting, in greater or smaller quantity, and more or less frequently repeated, according as the symptoms shall direct. At the same time, cooling purgatives are to be employed, and every part of the antiphlogistic regimen is to be strictly enjoined. The refrigerants may also be administered; taking care, however, that the acids, and more especially the nitre, do not excite coughing,
850. From what was observed in 795, it will appear, that blistering upon the breast or back may be a remedy of hæmoptysis, when it is present ; and that issues in the same places may be useful in preventing the recurrence of it when it has ceased.
851. The avoiding of motion is generally a proper part of the antiphlogistic regimen; and, in the hæmoptysis, nothing is more necessary than avoiding bodily exercise : but some kinds of gestation, as sailing, and travelling in an easy carriage on smooth roads, have often proved a remedy.
852. Such is the treatment I can propose for. the hæmoptysis, considered merely as an hæmor. rhagy: but when, in spite of all our precautions, it continues to recur, it is often followed by an ul. ceration of the lungs, and a phthisis pulmonalis. This, therefore, I must now proceed to consider; but, as it arises also from other causes besides the hæmoptysis, it must be treated of with a more general view.
OF THE PHTHISIS PULMONALIS, OR CONSUMPTION OF
Of the Phænomena and Causes of the Phthisis Pul
monalis. 853. The Phthisis Pulmonalis I would define to be, an expectoration of pus, or purulent matter from the lungs, attended with a hectic fever.
As this is the principal species of phthisis, I shall frequently in this chapter employ the general term of Phthisis, though strictly meaning the phthisis pulmonalis.
854. I have met with some instances of an expectoration of purulent matter continuing for many years, accompanied with very few symptoms of hectic, and at least without any hectic exquisitely formed : but in none of these instances were the persons so entirely free from symptoms of hectic, as to form any exception to the general definition.
855. In every instance of an expectoration of pus, I presume there is an ulceration of the lungs. The fate Mr. de Haen is the only author that I know of who has advanced another opinion, and has supposed, that pus may be formed in the blood. vessels, and be from thence poured into the bronchiæ. Admitting his fact, I have attempted an ex. planation of the appearance of pus without ulcer. ation in 349: but, after all, I cannot help suspecting the accuracy of his observations; must entirely reject his explanation of them ; must however allow, that we still want facts to support the explanation I have offered ; and doubt much if it will apply to any case of phthisis. For these reasons I still conclude, agreeably to the faith of all other dissections, and the opinions of all physicians, that the symptoms mentioned in our definia tion, depend always upon an ulceration formed in the lungs.
856. It has sometimes happened, that a catarrh was attended with an expectoration of a matter so much resembling pus, that physicians have been often uncertain whether it was mucus or pus, and therefore whether the disease was a catarrh or a phthisis. It is often of consequence to determine these questions; and it appears to me that it may be generally done, with sufficient certainty, from the following considerations, of which each particular is not always singly decisive, but when they are taken together can hardly deceive us. 1, From the colour of the matter; as mucus is
naturally transparent, and pus always opaque. When mucus becomes opaque, as it sometimes does, it becomes white, yellow, or greenish; but the last-mentioned colour is hardly ever so remark. able in mucus as in pus.
2, From the consistence; as mucus is more viscid and coherent, and pus less so, and may be said to be more friable. When mucus is thrown into water, it is not readily diffused, but remains united in uniform and circular masses : but pus, in the same circumstances, though not readily dif. fused, does not remain so uniformly united, and by a little agitation, is broken into ragged fragments.
3, From the odour ; which is seldom perceived in mucus, but frequently in pus. It has been proposed to try the odour of the matter expectorated, by throwing it upon live coals : but in such a trial both mucus and pus give out a disagreeable smell, and it is not easy to distinguish between them.
4, From the specific gravity compared with water; and, indeed, it is usual for the mucus of the lungs to swim on the surface of the water, and for pus to sink in it. But in this we may sometimes be deceived; as pus which has entangled a great deal of air may swim, and mucus that is free from air may sink.
5, From the mixture which is discernible in the matter brought up; for if a yellow or greenish. matter appears surrounded with a quantity of transparent or less opaque and less coloured mat