242 
PATHOLOGY 
by the application of a great number of leeches to the 
edges of the lower jaw and to the fides of the neck, 
carefully avoiding the trachea, are the firft means to be 
ufed. The knowledge of the powerful efficacy which 
mercury poflefles of checking in fome cafes the deposi¬ 
tion of coagulating lymph (though we cannot explain 
its modus operandi), furnilhes us with another remedy 
of fcarcely lefs importance. Calomel may be given in 
dofes of four or five grains every hour, combined with 
jullfo much opium as will prevent it from pafling off by 
the bowels. Thefe dofes are applied to children of three 
or four years of age ; they may be greatly increafed when 
required. Along with thefe meafures the common means 
of counter-irritation may be _advantageoufly ufed, as 
for inftance the hot-bath and buffering remote parts. 
Blifters on the neck feem to 11s to be attended with very 
bad effedts in the early period of the difeafe. 
When fuffocation is threatened, or perhaps in fome 
remarkable cafes after it has occurred, we may perform 
the operation of tracheotomy. 
6 . Emprefma pneumonitis, (Pneumonia perineumo- 
nia, Cull.) Peripneumony, or inflammation of the lungs : 
obtufe pain in the cheft ; conftant difficulty of refpira- 
tion, alleviated by an eredt pofition ; tumid purple face 
or lips ; cough, generally moift, often bloody ; pulfe 
ufually foft. Dr. Good makes three varieties of Pneu¬ 
monitis. 
a. Pn. vera: the fever a cauma; pain fevere, little 
expedtoration in the beginning. 
£. Pn. maligna : fever a fynochus or typhus. The de¬ 
bility fo extreme from an early ftage of the difeafe, that 
the pulfe ceafes on the preflure of the finger; and the 
vafcular action is too weak to accomplifli expedtoration. 
Often epidemic. 
y. Pn. notha : great fecretion and expedtoration, with 
a mild cauma. Probably in many inftances a catarrhal 
affedtion : chiefly occurring in advanced life, or in thofe 
who have weakened their conftitutions by exceffes. 
We Shall treat the firft two varieties together, as the 
latter appears to be merely a confequence of the former, 
and to Stand to it in the fame relation as typhus does to 
inflammatory fever ; i. e. merely as the effedt of previous 
inflammatory action. The third variety, which is pro¬ 
perly bronchitis, is referred to Catarrhus. 
Inflammation of the parenchyma of the lungs, to 
which for the prefent we confirm our attention, is Seldom 
a folitary affection, the pleura being in general affedted 
along with it: and it is occasionally accompanied with 
catarrhus. 
Pneumonitis comes on with an obtufe pain in the cheft 
or fide, great difficulty of breathing, particularly in a 
recumbent pofition, or when lying on the fide affedted,) 
together with a cough, drynefs of the Skin, heat, anxiety, 
and thirft. At the firft commencement of the difeafe the 
pull'e is ufually full, Strong, hard, and frequent; but in 
a more advanced ftage it is commonly weak, foft, and 
often irregular. In the beginning, the cough is frequent¬ 
ly dry and without expedtoration ; but in fome cafes it 
is moift even from the firft, and the matter fpit up is va¬ 
rious both in colour and confiftence, and is often Streaked 
with blood. The countenance is generally flufhed; the 
noftrils are much dilated before each refpiration ; the 
patient ufually breathes with the diaphragm principally, 
but not So exclufively as in Pleuritis. In the more Se¬ 
vere Pneumonites, the difficulty of breathing, at all times 
the molt dangerous fymptom, becomes increafed, and is 
often attended with more or lefs general, deep, livid, or 
even dark, fuffufion of the countenance, with fome de¬ 
gree of tumidity, but little heat. There is alfo great 
anxiety in the expreflion. The noftrils are widely dila¬ 
ted, and Sharply deprefled above their lobes, juft before 
and during infpiration. The patient is often obliged to 
fit up in bed. There are vertigo and pain of the head. 
The refpiration is attended with great labour, oppreflion, 
and generally with a rattling noife : on infpiration, the 
bottom part of the fternum is often drawn forcibly and 
quickly towards the fpine, the upper ribs raifed, and the 
abdomen protruded ; on expiration, thefe movements 
are reverfed. Sometimes the pomum adami defcends on 
infpiration ; fometimes the Shoulders are much elevated. 
Speaking is very difficult. The cough occurs in painful 
oppreSfive fits, and raifes various expedtoration; this is 
however generally copious and mucous, fometimes 
tinged with blood. The hands are cool, and livid, and 
the pulfe frequent. 
If the adtual inflammation or engorgement of the 
lungs does not caufe death, a favourable termination is 
effedted by the occurrence of copious fecretion, both 
from the nervous lining and the ferous investment of the 
lungs; though it muft be confeffed that inflammation of 
the lungs often fubfides by mere refolution, where bleed¬ 
ing is actually employed. And moreover the establish¬ 
ment of each of thefe Secretions, when in excefs, pro¬ 
duces other and fatal difeafes, as empyema and chronic 
catarrh. Another termination of Pneumonitis, is fup- 
puration of its fubftance, or Apoftema vomica. 
Before we fpeak of the treatment of pneumonitis, we 
Shall detail thefymptoms of the next fpecies. 
7. Emprefma pleuritis, or pleurify : acute pain in the 
cheft; increal'ed during infpiration; difficulty of lying 
on one fide; hard pulfe; Short dittrefling cough. Dr. 
Good gives three varieties. 
cl. PI. vera: fever a cauma ; pain felt chiefly on one 
fide. The inflammation, in this cafe, commences in that 
fide of the membrane which lines the ribs; though of¬ 
ten communicated to the contiguous portion which co¬ 
vers the lungs. 
G. PI. mediaftina : heavy pain in the middle of the 
fternum, defcending towards its enfiform cartilage 5 with 
great anxiety. 
y. PI. diaphragmatic.!: painful conftridtion around 
the prsecordia ; Small, quick, and laborious, breathing. 
Pleurify comes on with an acute pain in the fide, which 
is much increafed by making a full infpiration, and is ac¬ 
companied by flushing in the face, increafed heat over 
the whole body, rigors, difficulty of lying on the fide 
affedted, together with a cough and naul'ea; and the 
pull’e is hard, Strong, and frequent, and vibrates under 
the finger when prelfed upon, not unlike the tenfe firing 
of a mufical instrument. The blood exhibits the thick 
fizy or huffy coat on its furface in a high degree. 
We lee in this complaint an expreffion of Suffering on 
the countenance, and a State of general contraction of 
the features. The noSlrils are acute and drawn a little 
upwards, and are furrounded by a ring of a pearly white. 
They are moved rapidly by the alternate adts of refpira¬ 
tion, being dilated quickly j uft before each inspiration. 
There is often a circumfcribed or partial flufli of the 
cheeks, which generally terminates abruptly, efpecially 
towards the note. The patient cannot, in general, lie 
on the pained fide or part; and he choofes a particular 
pofition, which is preferved unchanged ; any motion o"f 
the body Seems to aggravate the pain of the cheft. The 
relpiration is frequent, quick, and Short, and often per¬ 
formed exclufively by the diaphragm, the chef being motion- 
lej's. If a deep infpiration be attempted, it induces Sharp 
pain, and is, with the calling out from this pain, imme¬ 
diately checked and fupprefled by the patient. The 
cough is alfo checked, and is, at firSf, fhort and dry, and 
attended with Sharp pain. The patient fpeaks in a low 
tone, and in Short Sentences. The pulfe is rather fre¬ 
quent and (harp, fometimes lefs affedied than might be 
expedted. The pain is Situated in various parts of the 
cheft ; generally on one fide, or under the fternum ; 
fometimes under the fcapula, or at the back. 
Pleuritis terminates fatally by implicating in in¬ 
flammatory adtion the vifcera it invests, by fpreading to 
other ferous membranes, or by effufion, adhefion, See. 
the confequence of inflammation when it attacks ferous 
membranes. Adhefions are very frequently formed with¬ 
out 
