[7]. Peripneumonia superficialis. The superficial or spurious peripneumony consists in an inflammation of the membrane, which lines the bronchia, and bears the same analogy to the true peripneumony, as the inflammations of other membranes do to that of the parenchyma, or substantial parts of the viscus, which they surround. It affects elderly people, and frequently occasions their death; and exists at the end of the true peripneumony, or along with it; when the lancet has not been used sufficiently to cure by reabsorbing the inflamed parts, or what is termed by resolution.
M. M. Diluents, mucilage, antimonials, warmish air constantly changed, venesection once, perhaps twice, if the pulse will bear it. Oily volatile draughts. Balsams? Neutral salts increase the tendency to cough. Blisters in succession about the chest. Warm bath. Mild purgatives. Very weak chicken broth without salt in it. Boiled onions. One grain of calomel every night for a week. From five drops to ten of tincture of opium at six every night, when the patient becomes weak. Digitalis? See Class [II. 1. 6. 7].
[8]. Pertussis. Tussis convulsiva. Chin-cough resembles peripneumonia superficialis in its consisting in an inflammation of the membrane which lines the air-vessels of the lungs; but differs in the circumstance of its being contagious; and is on that account of very long duration; as the whole of the lungs are probably not infected at the same time, but the contagious inflammation continues gradually to creep on the membrane. It may in this respect be compared to the ulcers in the pulmonary consumption; but it differs in this, that in chin-cough some branches of the bronchia heal, as others become inflamed.
This complaint is not usually classed amongst febrile disorders, but a sensitive fever may generally be perceived to attend it during some part of the day, especially in weak patients. And a peripneumony very frequently supervenes, and destroys great numbers of children, except the lancet or four or six leeches be immediately and repeatedly used. When the child has permanent difficulty of breathing, which continues between the coughing fits: unless blood be taken from it, it dies in two, three, or four days of the inflammation of the lungs. During this permanent difficulty of breathing the hooping-cough abates, or quite ceases, and returns again after once or twice bleeding; which is then a good symptom, as the child now possessing the power to cough shews the difficulty of breathing to be abated. I dwell longer upon this, because many lose their lives from the difficulty there is in bleeding young children; where the apothecary is old or clumsy, or is not furnished with a very sharp and fine-pointed lancet. In this distressing situation the application of four leeches to one of the child's legs, the wounds made by which should continue to bleed an hour or two, is a succedaneum; and saves the patient, if repeated once or twice according to the difficulty of the respiration.
The chin-cough seems to resemble the gonorrhœa venerea in several circumstances. They are both received by infection, are both diseases of the mucous membrane, are both generally cured in four or six weeks without medicine. If ulcers in the cellular membrane under the mucous membrane occur, they are of a phagedenic kind, and destroy the patient in both diseases, if no medicine be administered.
Hence the cure should be similar in both these diseases; first general evacuations and diluents, then, after a week or two, I have believed the following pills of great advantage. The dose for a child of about three years old was one sixth part of a grain of calomel, one sixth part of a grain of opium, and two grains of rhubarb, to be taken twice a day.
The opium promotes absorption from the mucous membrane, and hence contributes to heal it. The mercury prevents ulcers from being formed under the mucous membrane, or cures them, as in the lues venerea; and the rhubarb is necessary to keep the bowels open.
M. M. Antimonial vomits frequently repeated. Mild cathartics. Cool air. Tincture of cantharides, or repeated blisters; afterwards opiates in small doses, and the bark. Warm bath frequently used. The steam of warm water with a little vinegar in it may be inhaled twice a day. Could the breathing of carbonic acid gas mixed with atmospheric air be of service? Copious venesection, when a difficulty of breathing continues between the fits of coughing; otherwise the cough and the expectoration cease, and the patient is destroyed. Ulcers of the lungs sometimes supervene, and the phthisis pulmonalis in a few weeks terminates in death. Where the cough continues after some weeks without much of the hooping, and a sensitive fever daily supervenes, so as to resemble hectic fever from ulcers of the lungs; change of air for a week or fortnight acts as a charm, and restores the patient beyond the hopes of the physician.
Young children should lie with their heads and shoulders raised; and should be constantly watched day and night; that when the cough occurs, they may be held up easily, so as to stand upon their feet bending a little forwards; or nicely supported in that posture which they seem to put themselves into. A bow of whalebone, about the size of the bow of a key, is very useful to extract the phlegm out of the mouths of infants at the time of their coughing; as an handkerchief, if applied at the time of their quick inspirations after long holding their breath, is dangerous, and may suffocate the patient in an instant, as I believe has sometimes happened.
[9]. Variola discreta. The small-pox is well divided by Sydenham into distinct and confluent. The former consists of distinct pustules, which appear on the fourth day of the fever, are circumscribed and turgid; the fever ceasing when the eruption is complete. Head-ach, pain in the loins, vomiting frequently, and convulsive fits sometimes, precede the eruption.