PATHOLOGY. 
out material inconvenience to the patient; and no 
doubt increafed effufion fometimes occurs without any 
ill eifeft. The lungs, the pericardium, and heart, com¬ 
monly become involved in the morbid action, when death 
occurs in pleuritic complaints. 
The treatment of inflammation, whether feated in the 
pnrcnchymo r\f thp lunge tko iq uiml'a*® TIip 
remedy chiefly to be depended upon is blood-letting, 
freely and early employed. The quantity of blood drawn 
nuift of courfe be regulated by the violence of the dif- 
eafe, and the ftrength of the patient’s conftitution, and 
ought generally to be as large as this laft circumftance 
will allow. The remiflion of the pain and the relief of 
the refpiration, during the flowing of the blood, may 
limit the quantity to be then drawn; but, if thele fymp- 
toms of relief do not appear, the bleeding (hould be con¬ 
tinued until fome degree of licknefs and faintnefs, the 
figns of approaching fyncope, come on. This direction is 
as old as the writings of Hippocrates. It will often hap¬ 
pen, that one bleeding, however copious, will not prove 
a cure for the difeafe : for, although the pain and diffi- 
culty of breathing may be much relieved by the firft 
bleeding, thefe fymptoms very frequently recur after a 
(liort interval, and often with as much violence as before. 
In the event of fuch recurrence, the bleeding mull be 
repeated, even in the courfe of the fame day, and perhaps 
to the fame quantity as before. Sometimes the fecond 
bleeding may be larger than the firft. There are perfons 
who are conftitutionally liable to faint even upon a fmall 
bleeding; and, in fuch perfons, this may prevent the 
drawing of fo much blood at firft as a pneumonic in¬ 
flammation may require; but, as the fame perfons are 
frequently found to bear fubfequent bleedings better 
than the firft, thefe may be carried to the extent which 
the fymptoms of the difeafe feem to demand. For it is 
according to the ftate of the fymptoms, that the bleed¬ 
ings muft be determined to be repeated; and they will 
be more effe&ual, when employed in the courfe of the 
firft three days, than afterwards: but they are not to be 
omitted, although four or five days may have elapfed 
before the phyfician is called in ; nay, if there be a re¬ 
currence of the urgent fymptoms, as defcribed above, 
the bleeding fhould be repeated at any period of the dif¬ 
eafe, efpecially within the firft fortnight, and even after¬ 
wards, if a tendency to fuppuration be not evident, or 
if, after an apparent folution, the difeafe (hall have again 
returned. 
There is in peripneumony, as in fome other acute in¬ 
flammations, a ftate of pulfeoccafionally recurring, which, 
to an inexperienced praflitioner, appears to contra-indi¬ 
cate the ufe of the lancet; it is foft, and fmall, or what 
has been called an opprefled pulfe ; but it rifes, and be¬ 
comes fuller and larger, after blood-letting. Under fuch 
circumftances, the propriety of the blood-letting is to 
be determined by the urgency of the other fymptoms, 
efpecially of the difficulty of breathing. In a fimilar man¬ 
ner, a pulfe that is irregular, and beats with confiderable 
intermiflions, in peripneumony, will become regular 
after the relief of blood-letting; and fuch a ftate of pulfe, 
therefore, when the pneumonic fymptoms are urgent, is 
not to be confidered as contra-indicating, but as more 
ftrongly demanding, the ufe of the lancet. 
When a large quantity of blood has been taken from 
the arm, fome blood may be ftill taken locally, by means 
of cupping. This local blood-letting will be particu¬ 
larly proper, when the continuance or recurrence of 
pain, rather than the difficulty of breathing, becomes 
the urgent fymptom. After this, a large blilter (hould 
be applied over the thorax or fide, according to the feat 
of the pain, and the abftinent and cooling regimen rigo- 
roufly enforced. 
Some practitioners,apparentlylipon theoretical grounds, 
have objected to the ufe of purgatives , upon the fuppoii- 
tion that the evacuation which they occaiion may tend 
to fupprefs the expectoration ; but, in the vigour of the 
Vol. XIX. No. j 3 oo. 
243 
patient and of the difeafe, fuch an apprehenfion is abfo- 
lutely groundlefs. On the contrary, the free evacuation 
of the bowels, by cooling purgatives, conduces, like 
the blood-letting, to diminifli the local and general in¬ 
flammatory aCtion. In the turgid and loaded ftate of the 
lungs, the (training of vomiting is likely to be productive 
nf rntfrhief, and cart anfwer no ufeful pa. rl ''' r ° .■ pbr» 
practice of exhibiting naujealing medicines is highly 
proper. Of thefe, antimony and ipecacuanha, combined 
with digitalis, are the nioft common. The laft medicine 
is alfo ufed with advantage in the earlielt ftages of the 
difeafe, to reprefs the frequency of the pulfe. 
Though it has not been our cultom, in the compila¬ 
tion of this article, to enter particularly into necrotomy, 
becaufe we wifhed to be the more full on the aCtions and 
diforders which lead to fatal difeafes, rather than to detail 
irremediable conditions; yet we cannot avoid tranfcri- 
bing from the judicious Laennec, his account of the ap¬ 
pearance on difleCtion which the inflamed pleura exhibits. 
The minutiae of pathological anatomy are fufficiently 
important in regard to the obfcure difeafes of the cheft, 
to warrant this deviation from the general tenor of our 
labours. 
The anatomical chara&er of acute pleurify, like that 
of the inflammation of all ferous membranes, is rednefs 
of the part affeCted. This rednefs is in fome fort punc¬ 
tuated, and looks as if one had traced with a pencil upon 
the pleura an infinity of fmall bloody fpots of very irre¬ 
gular figure, and very clofe to one another. Thefe red 
points occupy the whole thicknefs of the membrane, and 
leave fmall intermediate portions retaining the natural 
white colour. This punctuated appearance is unquef- 
tionably a character of the inflammation, and not at all 
attributable, as fome have fuppofed, to the partial difap- 
pearance of the rednefs after death. Befides this parti¬ 
cular rednefs, and even in thofe inftances where it is very 
inconfiderable, we always find the fuperficial blood-vef- 
fels of the pleura redder, more diftinCt, and more diften- 
ded, than in the natural ftate. 
M. Laennec never could clearly make out a diftinCt 
thickening of the pleura in thefe cafes. Such fuppofed 
thickening, he thinks, has been either an extenfive con¬ 
geries of miliary tubercles on the outer or inner furface 
of the pleura ; or a cartilaginous incruftation on the 
parts covered by it; or, laftly, falfe membranes, more or 
lefs denfe, adherent to its internal furface. 
Inflammation of the pleura is always accompanied by 
an extravafation on its internal furface, and which may 
be confidered as the fpecies of fuppuration proper to fe¬ 
rous membranes. This extravafation appears to com¬ 
mence with the inflammation itfelf. It confifts of two very 
different matters. The one, of a firmer femi-concrete 
confidence, is ufually tecmeAfuIfe membrane, orcoagulable 
lymph; the other, very thin and watery, is called, ferojity, 
or fero-purulent effufion. Both of thefe exhibit great va¬ 
riation of character. The falfe membrane confifts of a 
yellowilh-white, opake, dr femi-tranfparent, matter, va¬ 
rying from the confidence of thick pus to that of boiled 
white of egg, or of the buffy coat of the blood. This, 
fubftance forms a complete incruftation (where the in¬ 
flammation is general) over the pleuracoftalis and pleura- 
pulmonalis. Thefe two (fleets of pleura are fometimes 
united by bands of the fame membrane, extending from 
the one to the other, through the ferous fluid effuled into 
the cavity. Thefe membranous exudations vary in thick¬ 
nefs, from half a line to two lines ; fometimes exhibiting 
a kind of reticulated ftruCture ; at others, appearing 
ftudded or granulated with fmall irregular tubercles. 
Thefe membranes are fometimes detached and found 
floating in the ferofity. Th e ferous effufion is commonly 
of a lemon, or light-yellow, colour, t ran ('parent or (light¬ 
ly flocculent, refembling unftrained whey ; an effufion 
common to all the ferous menjbranes in the body. In 
fome cafes, this effufion is of a very deep tawny colour,, 
ruddy, and evidently mixed with blood ; fometimes, in- 
3 R deedj 
