The symptoms of pulmonick inflammation are fever, darting pungent pain fixed like a dagger in some part of the chest, the side, breast, or back; and sometimes shooting to the scapula and clavicle: sometimes the pain is more dull and obtuse; and its situation oftenest in the side, about the middle of the ribs, between the sternum and spine; and commonly confined to one lobe. At the invasion there is shivering, restlessness, anxiety, succeeded by heat: hot accelerated laborious respiration; load and oppression at the breast; urgent, short, and painful cough; and very early in the disease more or less expectoration, streaked with blood; the pain is exasperated by inspiration and coughing, and mostly fixed, but sometimes veering or shifting: the pulse quick, full, hard, and tense, like a stretched chord; the blood drawn forms a buffy tenacious crust on the coagulum; the urine is of a florid colour: from the violence of pain, patients are often unable to lay on either side, but compelled to recline half-erect on their backs: when the inflammation is violent, or both pulmonick lobes assailed, there is inexpressible anxiety and struggle in respiration, florid countenance, prominent eyes; with other symptoms of obstructed circulation, and return of blood from the head, and menacing suffocation. In the advanced or dangerous stage of the disease, the pulse is weak, soft, and irregular. Sometimes there is nausea of the stomach; and sometimes delirium.
The termination of pulmonick inflammation is by resolution, by suppuration, by gangrene, by fatal effusion of blood, or exudation of coagulable lymph into the cellular texture. Favourable symptoms are, as in anginous excreation, facility in expectoration, without much exertion or coughing, copious, of due consistence, a little yellow, white, thick, slightly streaked with blood; the sooner this is concocted and excreted, the sooner is the crisis; less urgent and painful cough; freer breathing; abatement in the heat of the body and velocity of the pulse; general perspiration; deposition of sediment in the urine; nasal hemorrhage; dispersion of the pain, hitherto fixed in the thorax, about the shoulders, back, or arms; erysipelas in some external part; pustular eruption about the breast, neck, and scapulæ; abscesses in different parts. A crisis, when favourable, always ensues within seven, or at the utmost fourteen days; and after such crisis, expectoration may continue copious several days.
Inauspicious symptoms are, the respiration struggling and laborious in the extreme; dry pertinacious cough; no expectoration, or with difficulty; suppressed expectoration; obtuse pain, with difficult respiration; frequent violent cough exasperating the pain; the pain changing from one side into the other; the pulmonick lobes in both sides inflamed; the breathing intolerable and suffocating, except in an erect posture, and even then with laborious anxiety; the face turgid and florid, or pale, with features of consternation; violent headach; delirium; remission succeeded by relapse; excessive sweats; dry skin; weak, soft, and irregular pulse; sudden cessation of pain; grumous livid expectoration; rattling noise in the thorax, as if plugged up by phlegm; dejected countenance, squalid sunk eyes; great prostration of strength; cold clammy partial sweats; limpid urine; florid blood coughed up, or white and glutinous matter resembling the branches of blood-vessels. Effusion of blood, and exudation of coagulable lymph into the pulmonary cellular texture, bronchial vesicles and air-pipes, is more frequently than gangrene, the cause of suffocation and death. The occurrence of either is seldom later than fourteen days. There is also great danger of pulmonick inflammation, persevering beyond seven or, at the utmost, fourteen days, and without any considerable remission or signs of resolution, terminating in suppuration; of which the diagnosticks are hereafter marked. Authors have likewise described a malignant peripneumony, which seems to be a complication of the preceding deleterious symptoms, and of putrid fever.
There is, however, a species of pulmonick affliction, the specifick diagnosticks of which it would be unpardonable to omit; because it has often and fatally been either confounded with, and treated as genuine pulmonick inflammation, or slighted as a catarrh. This is named Peripneumonia Notha; whose symptoms, at the onset, are ambiguous. It is most frequent in persons old, phlegmatick, fat, weak, emaciated, subject to catarrh, addicted to fermented and spirituous liquors; and in foggy weather and rainy winters. It appears in the same seasons with genuine pulmonick inflammation, and with catarrh; that is, in spring and autumn; and frequently under the veil of a violent catarrh. The fever and heat are inconsiderable; the pulse not hard nor tense; but there is straitness and difficulty of breathing, and load at the breast, with anxiety and gasping for breath; urgent violent cough, with some expectoration, and sometimes exciting vomiting; giddiness of the head; rending headach; sometimes drowsiness. It is sometimes suddenly and unexpectedly aggravated, and suffocates the patient.
The predisposing and occasional causes of pulmonick inflammation are, epidemick state of the air; sudden vicissitudes of the seasons and weather from heat to cold; sudden suppression of perspiration, or of pulmonary exhalation; inspiration of cold air; sudden exposure to keen cold air, especially after breathing in a warm room, or drinking warm liquors; cold liquors drank when the body is heated; intemperance and sottishness, particularly in spirituous liquors; dry cold winds; strong muscular exercise, or manual labour; repulsion of cutaneous eruption, febrile or chronic; exsiccation of old ulcers; suppression of habitual evacuation and eruption; translation to and deposition of morbid matter on the lungs; consequence and dregs of small pox and measles; symptomatick from some other diseases.
Inflammations of the heart, mediastinum, and diaphragm, as solitary, are very rare diseases. The symptoms of Carditis are severe fever; pain and anxiety in the region of the heart; difficulty of breathing; cough; irregular pulse; palpitation, syncope. Inflammation of the diaphragm, paraphrenitis: the symptoms are, acute fever, intense pain in the breast darting to the back, and increased by inspiration, coughing and sneezing, and by natural exertion at stool and urine; restlessness, anxiety, dry cough, quick convulsive breathing; sneezing, hiccup, nausea, vomiting; compulsive painful grin on the countenance, delirium. When it occurs, it is generally complicated with inflammation of the adjacent organs, in either the thorax or the abdomen. As the heart is the main spring of the blood’s circulation, and the diaphragm the principal agent in respiration, it is evident that inflammation in either must be extremely dangerous.
Inflammation of the Liver,
hepatitis, acute and chronic. Both species are much more frequent in tropical climates and warm regions, than in northern and cold; and more so in the former during the hottest seasons of the year. The sensibility of the liver being dull, its inflammation is less painful than that of any other viscus. The symptoms are, fever, pain in the right side under the false ribs, and felt at the corresponding clavicle, scapula, and hand; sensation of heat and heaviness in the hepatick region; difficulty of breathing, more especially when the inflammation invests the superior convex part of the liver; there is often dry cough; nausea, bilious vomiting, and diarrhœa; the urine of a fiery or saffron-colour; and generally, but not always, the eyes, countenance, and skin more or less of a jaundice tinge; the pulse not remarkably disturbed; but thirst. Sometimes hepatick inflammation is entangled with that of some contiguous organs of the lungs or abdomen, and with their respective features. The acute hepatitis, but not the chronic, is usually terminated in a few days, at the utmost fourteen or twenty-one, by discussion, suppuration, or gangrene. Critical resolution may be variously accompanied with bilious diarrhœa and urine, nasal or hemorrhoidal hemorrhage, copious bilious sweats. Suppuration is not an unfrequent termination: after which many survive, but with difficult and slow recovery. The purulency may be expurgated by absorption, by the biliary ducts, by erosion of the abdominal muscles, or by an artificial opening when the abscess is perceptible externally; and sometimes it erodes the diaphragm and lungs.
The predisposing and occasional causes are, burning climates; acrid viscid bile; the blood tenacious and glutinous in consistence; calculi, steatome, worms in the biliary ducts; bilious vomiting; sudden refrigeration of the body when heated, and obstructed perspiration; thirst, and not sufficient dilution of the blood; intoxication and abuse of spirituous liquors; poisons; external injuries; violent exercise; passions of mind; inveterate hypochondriasm; translation of purulent matter to the liver; symptomatick.
Inflammation of the Spleen is a rare occurrence: schirrus of that organ is far more frequent. The Peritonitis is also an uncommon inflammatory vagrant: it will be revived hereafter under Puerperal Fever.