The historian Sallust uses the word tabes as synonymous with contagium, in the following sentence: “Tanta vis morbi, uti tabes, plerosque civium animos invaserat.” (Catalin. 36.) Livy does the same in several places. (See ii, 23.)
SECT. XXXIII.—ON PLEURISY.
Pleurisy, properly so called, is an inflammation of the membrane which lines the ribs, and is attended with difficulty of breathing, cough, continual fever, and pain shooting to the clavicle and hypochondrium. You may distinguish pleurisy from inflammation of the liver (for in it there are all these symptoms), by the pain in pleurisy being pungent, and the cough being sometimes without expectoration (when it indicates that the disease is not yet concocted), and sometimes with expectoration, the appearance of which indicates the nature of the humour that occasions the complaint; for it is red and tinged with blood when a fulness of blood is the cause; yellow and palish when caused by yellow bile; white and frothy when from phlegm; and blackish when from the melancholic humour. And the pulse is hard and serrated. But, in inflammation of the liver, the pain is not pungent, nor is the pulse so hard; and the cough throughout is dry and without expectoration, and the face appears paler. Pleurisies from inflammation of the external muscles (which are not, properly speaking, pleurisies) are not accompanied with cough and expectoration, nor is the pulse hard; and if one touch the part affected with his hand, the patients feel pain; and if not resolved, the swelling is converted into pus, which may be evacuated externally by an incision; whereas pleurisy from inflammation of the membrane which lines the chest has not this termination; for if it do not discharge the empyema either internally or externally, it terminates in peripneumonia.
The cure. If the pain shoot to the clavicle, we must straightway open a vein; or if to the hypochondrium, we must purge downwards. Physicians of late, in all cases, have recourse to venesection, apprehending, I suppose, the disturbance occasioned by purging. When the strength prevents us from having recourse to either of these remedies, we must use stimulant clysters; and if the pain is moderate, after the clyster we may give honied water, and the juice of ptisan and of chondrus. When the affection is on the decline, we may add to the juices leeks or calamint, and the patient may get the seeds of pennyroyal and nettle, with honey, as a linctus. When the pains are violent after the evacuation, they must be soothed by the application of hot wool, or of sulphurated wool; or by fomentations of millet and flour in a bag, or by means of hot water or oil in a bladder. Unwashed wool may be applied with oil; and wine, containing an admixture of sea-water, or salt, may be added to it. Or we may apply a cataplasm, formed of the medicine from seeds, with the decoction of chamomile and marshmallows, or of dried figs, iris, wormwood, and some honey, with oil of nard. About the fourth day give spoon-meats for food, with some honey; but after the seventh day we are to give a linctus of almonds and nettle-seeds, triturated in honey, or the linctus of butter and honey pounded together. And we are to use the hypoglottis (electuary) of boiled honey. And we must apply to the affected parts the fetid epitheme—that from sweet marjoram, and the rue-plaster. The bulbi, applied with axunge, are often an effectual remedy, and they may also be administered in a clyster with butter and turpentine. Among the most powerful remedies is the linctus from pine-nuts and bitter almonds, linseed, pitch-fruit, and starch, in equal parts, with honey. When they are troubled with insomnolency, it will be proper to give a linctus of poppy-heads; and we may use the antidote called athanasia, and those prepared for this purpose. When the disease remains after the fourteenth day, we must cup them, and keep them upon a spare diet; and then, when the disease is on the decline, we may make them take the bath (but avoiding the cold), and allow them to use a more nutritious diet. If the inflammation of the pleura be not resolved, but appear to be converted into pus, we must have recourse to the remedies formerly mentioned.
For pains of the sides without fever. Pains of the sides without fever are cured by bdellium and costus, mixed with the ashes of burnt cabbage-leaves and tallow: for this remedy is powerfully discutient.
Commentary. See Hippocrates (de Morbis, ii; de Rat. Vict. in Acut.); Galen (de Med. sec. loc. vii, et alibi); Celsus (iv, 6); Aretæus (Morb. Acut. i, 10; Curat. Morb. Acut. i, 10); Aëtius (viii, 76); Psellus (Op. Medicum); Alexander (vi, 1); Oribasius (Synops. ix, 7, 8); Actuarius (Meth. Med. iv, 4); Nonnus (129); Cælius Aurelianus (Morb. Acut. ii, 13); Octavius Horatianus (ii, 4); Marcellus (de Medicam. 24); Serapion (ii, 21); Mesue (de Ægrit. Pect. 7); Avicenna (iii, 10, 4); Alsaharavius (Pract. xii, 8); Avenzoar (i, 16, 4); Haly Abbas (Theor. ix, 21; Pract. vi, 13); Rhases (Divis. 54; Contin. x.)
Hippocrates gives brief descriptions of pleurisy, and recommends nearly the same treatment that is now practised, namely, bleeding ad deliquium animi, purging, diluent drinks, and fomentations to the side by means of sponges squeezed out of hot water, or of bags filled with salts and millet, or the like. He says, those who have neither been bled nor purged die on the seventh day, either with delirium, or with orthopnœa and a râle. One of his aphorisms is, that pneumonia supervening upon pleurisy is dangerous. (vii, 11.) He was acquainted with pulmonary adhesions, as is remarked by his devoted admirer Laennec.
Aretæus, with his usual accuracy, gives a most complete description of all the symptoms of pleurisy, but, as it is not much different from our author’s, we shall not enter far upon a detail of it. He states distinctly that the disease is an inflammation of the membrane which lines the chest. The sputa are pituitous, bilious, or deeply saturated with blood, or yellowish. He remarks, by the way, that pleurisy is sometimes a sporadic disease, and sometimes epidemical. His directions about the application of the common remedies are dictated by his usual excellent judgment. On the necessity of early and repeated venesection he insists strongly, but recommends it not to be carried the length of producing deliquium animi, as the fluids will thereby be determined inwardly. Archigenes (ap. Aëtium) and other ancient authorities joined him in this rule of practice, although in opposition to Hippocrates. He approves of cupping the side, but not until after the seventh day, and directs us to apply to the scarifications salts or nitre. His internal remedies consist of demulcents, diluents, and narcotics, varied according to circumstances. He forbids the use of cold drink and cold air. Celsus also cautions against cold, and directs sinapisms to the chest. His general treatment is nothing different from that of Hippocrates.
Galen treats of pleurisy cursorily in many parts of his works, but, as he follows entirely the views of Hippocrates, we need not enter into a detail of his practice. We may mention, however, that the worst character of the pulse, according to him, is when it is hard, small, and very frequent. (Diff. Puls. iv, 5.)
Aëtius gives an interesting account of a species of pleurisy arising from indigestion or crudities of the stomach. In this case he forbids venesection, and recommends clysters and calefacient applications.