Advice to the people in general, with regard to their health

by S. A. D. Tissot

§ 67. We call that Vomica which is not burst, an occult or hidden, and that which is, an evident or open one. It is of considerable Importance to treat exactly and clearly of this Topic; as a great Number of Country People die of these Imposthumes, even without a Suspicion of the Cause of their Death. I had an Instance of it some Days since, in the School-master of a Village. He had an occult and very considerable Vomica in the left Lung, which was the Consequence of an Inflammation of the Breast, that had been treated improperly at the Beginning. He seemed to me not likely to live twenty four Hours; and really died in the Night, after inexpressible Anguish.

§ 68. Whatever Distemper is included within the Breast of a living Patient, is neither an Object of the Sight or Touch whence these Vomicas, these inward Tumours, are so often unknown, and indeed unsuspected. The Evacuations that were necessary for the Cure, or sometimes for the Prevention, of them, have not taken place, during the first fourteen Days. At the End of this Term, the Patient, far from being cured, is not very considerably relieved; but, on the contrary, the Fever continues to be pretty high, with a Pulse continually quick; in general soft and weak; though sometimes pretty hard, and often fluctuating, or, as it were, waving. His Breathing is still difficult and oppressed; with small cold Shudderings from Time to Time; an Exasperation of the Fever; flushed Cheeks, dry Lips, and Thirst.

The Increase of these Symptoms declare, that Pus or Matter is thoroughly formed: the Cough then becomes more continual; being exasperated with the least Motion; or as soon as ever the Patient has taken any Nourishment. He can repose only on the Side affected. It often happens indeed, that he cannot lie down at all; but is obliged to be set up all Day; sometimes even without daring to lean a little upon his Loins, for fear of increasing the Cough and Oppression. He is unable to sleep; has a continual Fever, and his Pulse frequently intermits.

The Fever is not only heightened every Evening; but the smallest Quantity of Food, the gentlest Motion, a little Coughing, the lightest Agitation of the Mind, a little more than usual Heat in the Chamber, Soup either a little too strong, or a little too salt, increase the Quickness of his Pulse the Moment they occur, or are given. He is quite restless, has some short Attacks of the most terrible Anguish, accompanied and succeeded by Sweatings on his Breast, and from his whole Countenance. He sweats sometimes the whole Night; his Urine is reddish, now frothy, and at other times oily, as it were. Sudden Flushings, hot as Flames, rise into his whole Visage. The greater Number of the Sick are commonly sensible of a most disagreeable Taste in their Mouth; some of old strong Cheese; others of rotten Eggs; and others again of stinking Meat, and fall greatly away. The Thirst of some is unquenchable; their Mouths and Lips are parched; their Voice weak and hoarse; their Eyes hollow, with a kind of Wildness in their Looks. They have a general Disgust to all Food; and if they should ask for some particular Nourishment without seeing it, they reject it the Moment it is brought them; and their Strength at length seems wholly exhausted.

Besides these Symptoms, a little Inflation, or Bloatedness, as it were, is sometimes observed on the Breast, towards the Side affected; with an almost insensible Change of Colour. If the Vomica be situated at the Bottom of the affected Lobe of the Lungs, and in its internal Part, that is, nearly in the Middle of the Breast, some Puffiness or light Swelling may be perceived in some Bodies, by gently pressing the Pit of the Stomach; especially when the Patient coughs. In short, according to the Observations of a German Physician, if one strike the open Hand on the Breast, covered only with a Shirt, it retains in the Spot, which is directly opposite to the Vomica, a flat heavy Sound, as if one struck a Piece of Flesh; while in striking on the other Side it gives a clear loud Sound, as from a Drum. I still doubt however, whether this Observation will generally hold true; and it would be hazardous to affirm there is no Abscess in a Breast, which does not return this heavy Sound.

§ 69. When a Vomica is formed, as long as it is not emptied, all the Symptoms I have already enumerated increase, and the Vomica grows in Size: the whole Side of the Lung affected sometimes becomes a Bag or Sac of Matter. The sound Side is compressed; and the Patient dies after dreadful Anguish, with the Lung full of Pus, and without having ever brought up any.

To avoid such fatal Consequences, it is necessary to procure the Rupture and Discharge of this inward Abscess, as soon as we are certain of its Existence: And as it is safer it should break within the Lobe affected, from whence it may be discharged by hawking up; than that it should burst and void itself into the Cavity of the Breast, for Reasons I shall give hereafter, we must endeavour, that this Rupture may be effected within the internal Substance of the Lungs.

§ 70. The most effectual Methods to procure this are, 1. To make the Patient continually receive, by his Mouth, the Vapour of warm Water. 2. When by this Means that part of the Sac or Abscess is softened, where we could wish the Rupture of it to happen, the Patient is to swallow a large Quantity of the most emollient Liquid; such as Barley Water, Almond Milk, light Veal Broth, or Milk and Water. By this Means the Stomach is kept always full: so that the Resistance to the Lungs being considerable on that Side, the Abscess and its Contents will naturally be pressed towards the Side of the Wind-pipe, as it will meet with less Resistance there. This fulness of the Stomach will also incline the Patient to cough, which may concur to produce a good Event. Hence, 3, we should endeavour to make the Patient cough, by making him smell to some Vinegar, or even snuff up a little; or by injecting into his Throat, by the Means of a small Syringe or Pipe, such as Children make out of short Pieces of Elder-Boughs, a little Water or Vinegar. 4. He should be advised to bawl out aloud, to read loud, or to laugh heartily; all which Means contribute to burst open the Abscess, as well as those two following ones. 5. Let him take every two Hours a Soup-Ladle of the Potion [Nº. 8]. 6. He should be put into a Cart, or some other Carriage; but not before he has drank plentifully of such Liquors as I have just mentioned: after which the Shaking and Jolting in the Carriage have sometimes immediately procured that Rupture, or breaking of the Bag or Abscess, we wished for.

§ 71. Some Years since I saw a Country Maid Servant, who was left in a languishing Condition after an Inflammation of the Breast; without any Person's suspecting her Ailment. This Woman being put into a Cart, that was sent for a Load of Hay; one of the Wheels run violently against a Tree: she swooned away, and at the same Time brought up a great Quantity of digested Matter. She continued to bring up more; during which I was informed of her Case, and of the Accident, which effectually cured her.

A Swiss Officer, who served in Piedmont, had been in a languid State of Health for some Months; and returned home to set himself down as easily as he could, without conceiving any considerable Hopes of Recovery. Upon entering into his own Country, by the Way of Mount Bernard; and being obliged to go some Paces on Foot, he fell down; and remained in a Swoon above a Quarter of an Hour: during which Time he threw up a large Quantity of Matter, and found himself that very Moment very greatly relieved. I ordered him a proper Diet, and suitable Medicines: his Health became perfectly established; and the Preservation of his Life was principally owing to this lucky Fall.