INFLAMMATIONS. 65 



tion 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 dissi- 

 pated insensibly, and therefore give the appearance of what phy- 

 cians have called Concocted Matter. 



" I have in the Synopsis set down the peripneumonia and the 

 pleuritis complicated with an intermittent or continued fever: 

 this is a subject which has been hitherto unnoticed in our system* 

 but it certainly deserved particular consideration. 



" In cases of the Tertiana pleuritica, it is a frequent occur- 

 rence, that a topical inflammation attends the paroxysm only of an 

 intermittent fever, when there will be no difficulty in the treat- 

 ment of the case ; but the case which certainly has confounded 

 practitioners, and may do so again, is that of remittents, where 

 neither the fever nor the pleuritic symptoms were ever entirely 

 absent. The question will be, whether such a case is to be 

 treated as a pleurisy or as an intermittent. From most practi- 

 tioners it appears that the treatment ought to be of a mixed kind. 

 Lautter, at the first appearance, proceeded to bleeding ; but 

 he came to find that it was not necessary, but that the bark was 

 necessary, and given with perfect success, the pleuritic symp- 

 toms disappearing with those of the intermittent fever. The 

 application of this will be easy. More or less bleeding may be 

 necessary according to the violence of the inflammatory symp- 

 toms, but the cure of the fever may be trusted entirely to the 

 bark. 



" Having observed this complication with regard to intermit- 

 tents, we say that pneumonic inflammation may also be connect- 

 ed with a synochus or typhus : it is always combined with a 

 synocha, which is there considered as symptomatic ; but the con- 

 tinued fever of which I speak here, as synochus or typhus, I 

 must suppose to be a fever depending upon contagion, and not 

 symptomatic of the pleuritic affection. This case has occurred, 

 but has been noticed as yet only by Sauvages in consequence o 

 his nosological inquiries. I cannot enter into a particular criti- 

 cism of the species set down by Sauvages, but I would give the ge- 

 neral idea, that these complications are purely and entirely acci- 

 dental: We have, in winter almost every day, instances of contagi- 



VOL. II. E 



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