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

by S. A. D. Tissot

§ 81. The very same Causes which suddenly suppress the Expectoration, in an Inflammation of the Breast, may also check the Expectoration from a Vomica already begun: in which Circumstance the Patient is speedily afflicted with an Oppression and Anguish, a Fever and evident Feebleness. We should immediately endeavour to remove this Stoppage, by the Vapour of hot Water; by giving a Spoonful of the Mixture [Nº. 3] every Hour; by a large Quantity of the Ptisan [Nº. 12], and by a proper Degree of Motion or Exercise. As soon as ever the Expectoration returns, the Fever and the other Symptoms disappear. I have seen this Suppression in strong Habits quickly followed with an Inflammation about the Seat of the Vomica, which has obliged me to bleed, after which the Expectoration immediately returned.

§ 82. It happens sometimes, that the Vomica is entirely cleansed; the Expectoration is entirely finished, or drained off, the Patient seems well, and thinks himself compleatly cured: but soon after, the Uneasiness, Oppression, Cough and Fever are renewed, because the Membrane or Bag of the Vomica fills again: again it empties itself, the Patient expectorates for some Days, and seems to recover. After some Time however, the same Scene is repeated; and this Vicissitude, or Succession, of moderate and of bad Health, often continues for some Months and even some Years. This happens when the Vomica is emptied, and is gradually deterged; so that its Membranes, or Sides touch or approach each other; but without cicatrizing or healing firmly; and then there drops or leaks in very gradually fresh Matter. For a few Days this seems no ways to incommode the Patient; but as soon as a certain Quantity is accumulated, he is visited again with some of the former Symptoms, 'till another Evacuation ensues. People thus circumstanced, in this Disease, sometimes appear to enjoy a tolerable Share of Health. It may be considered as a kind of internal Issue, which empties and cleanses itself from Time to Time; pretty frequently in some Constitutions, more slowly in others; and under which some may attain a good middling Age. When it arrives however at a very considerable Duration, it proves incurable. In its earliest State, it gives way sometimes to a Milk-diet, to riding on Horseback; and to the Medicine [Nº. 14].

§ 83. Some may be surprized, that in treating of an Abscess of the Lungs, and of the Hectic, which is a Consequence of it, I say nothing of those Remedies, commonly termed Balsamics, and so frequently employed in them, for Instance, Turpentines, Balsam of Peru, of Mecca, Frankincense, Mastich, Myrrh, Storax and Balsam of Sulphur. I shall however say briefly here (because it is equally my Design to destroy the Prejudice of the People, in favour of improper Medicines, and to establish the Reputation of good ones) that I never in such Cases made use of these Medicines; because I am convinced, that their Operation is generally hurtful in such Cases; because I see them daily productive of real Mischief; that they protract the Cure, and often change a slight Disorder into an incurable Disease. They are incapable of perfect Digestion, they obstruct the finest Vessels of the Lungs, whose Obstructions we should endeavour to remove; and evidently occasion, except their Dose be extremely small, Heat and Oppression. I have very often seen to a Demonstration, that Pills compounded of Myrrh, Turpentine and Balsam of Peru, have, an Hour after they were swallowed, occasioned a Tumult and Agitation in the Pulse, high Flushings, Thirst and Oppression. In short it is demonstrable to every unprejudiced Person, that these Remedies, as they have been called, are truly prejudicial in this Case; and I heartily wish People may be disabused with Respect to them, and that they may lose that Reputation so unhappily ascribed to them.

I know that many Persons, very capable in other Respects, daily make use of them in these Distempers: such however cannot fail of disusing them, as soon as they shall have observed their Effects, abstracted from the Virtues of the other Medicines to which they add them, and which mitigate the Danger of them. I saw a Patient, whom a foreign Surgeon, who lived at Orbe, attempted to cure of a Hectic with melted Bacon, which aggravated the Disease. This Advice seemed, and certainly was, absurd; nevertheless the Balsamics ordered in such Cases are probably not more digestible than fat Bacon. The Powder [Nº. 14] possesses whatever these Balsamics pretend to: it is attended with none of the Inconveniencies they produce; and has all the good Qualities ascribed to them. Notwithstanding which, it must not be given while the Inflammation exists; nor when it may revive again; and no other Aliment should be mixed with the Milk.

The famous Medicine called the Antihectic, (Antihecticum Poterii) has not, any more than these Balsamics, the Virtues ascribed to it in such Cases. I very often give it in some obstinate Coughs to Infants with their Milk, and then it is very useful: but I have seldom seen it attended with considerable Effects in grown Persons; and in the present Cases I should be fearful of its doing Mischief.

§ 84. If the Vomica, instead of breaking within the Substance of the Lungs affected, should break without it, the Pus must be received into the Cavity of the Breast. We know when that has happened, by the Sensation or Feeling of the Patient; who perceives an uncommon, a singular kind of Movement, pretty generally accompanied with a Fainting. The Oppression and Anguish cease at once; the Fever abates; the Cough however commonly continues, tho' with less Violence, and without any Expectoration. But this seeming Amendment is of a short Duration, since from the daily Augmentation of the Matter, and its becoming more acrid or sharp, the Lungs become oppressed, irritated and eroded. The Difficulty of Breathing, Heat, Thirst, Wakefulness, Distaste, and Deafness, return, with many other Symptoms unnecessary to be enumerated, and especially with frequent Sinkings and Weakness. The Patient should be confined to his Regimen, to retard the Increase of the Disease as much as possible; notwithstanding no other effectual Remedy remains, except that of opening the Breast between two of the Ribs, to discharge the Matter, and to stop the Disorder it occasions. This is called the Operation for the Empyema. I shall not describe it here, as it should not be undertaken but by Persons of Capacity and Experience, for whom this Treatise was not intended. I would only observe, it is less painful than terrifying; and that if it is delayed too long, it proves useless, and the Patient dies miserably.

§ 85. We may daily see external Inflammations turn gangrenous, or mortify. The same Thing occurs in the Lungs, when the Fever is excessive, the Inflammation either in its own Nature, extremely violent, or raised to such a Height by hot Medicines. Intolerable Anguish, extreme Weakness, frequent Faintings, Coldness of the Extremities, a livid and fœtid thin Humour brought up instead of concocted Spitting, and sometimes blackish Stripes on the Breast, sufficiently distinguish this miserable State. I have smelt in one Case of this Kind, where the Patient had been attacked with this Disease (after a forced March on Foot, having taken some Wine with Spices to force a Sweat) his Breath so horribly stinking, that his Wife had many Sinkings from attending him. When I saw him, I could discern neither Pulse nor Intellect, and ordered him nothing. He died an Hour afterwards, about the Beginning of the third Hour.

§ 86. An Inflammation may also become hard, when it forms what we call a Scirrhus, which is a very hard Tumour, indolent, or unpainful. This is known to occur, when the disease has not terminated in any of those Manners I have represented; and where, tho' the Fever and the other Symptoms disappear, the Respiration, or Breathing, remains always a little oppressed; the Patient still retains a troublesome Sensation in one Side of his Breast; and has from Time to Time a dry Cough, which increases after Exercise, and after eating. This Malady is but seldom cured; though some Persons attacked with it last many Years, without any other considerable Complaint. They should avoid all Occasions of over-heating themselves; which might readily produce a new Inflammation about this Tumour, the Consequences of which would be highly dangerous.

§ 87. The best Remedies against this Disorder, and from which I have seen some good Effects, are the medicated Whey [Nº. 17], and the Pills [Nº. 18]. The Patient may take twenty Pills, and a Pint and a half of the Whey every Morning for a long Continuance; and receive inwardly, now and then, the Vapour of hot Water.

§ 88. Each Lung, in a perfect State of Health, touches the Pleura, the Membrane, that lines the Inside of the Breast; though it is not connected to it. But it often happens, after an Inflammation of the Breast, after the Pleurisy, and in some other Cases, that these two Parts adhere closely to each other, and are never afterwards separated. However this is scarcely to be considered as a Disease; and remains commonly unknown, as the Health is not impaired by it, and nothing is ever prescribed to remove it. Nevertheless I have seen a few Cases, in which this Adhesion was manifestly prejudicial.