The predisposing and occasional causes are hereditary; original structure of the pneumonick organs; narrow thorax; plethora; suppression of habitual or natural evacuations, and cutaneous eruptions, as menses, piles, old ulcers, sweat of the feet; consequence of catarrh and colds, and sudden suppression of perspiration: serum, pituita in excess; cachexy; dregs of fever, small pox, measles, and pulmonick inflammation; pulmonick tubercles; spasmodic stricture of the diaphragm and bronchiæ; smoky rooms and houses, especially with wood fires; noxious mineral and metallic fumes, arsenical, nitrous, sulphureous, saturnine; smoky atmosphere of cities; pulverulent trades, as stonecutters, lapidaries, millers, flax-dressers, chimney-sweepers; fetid offensive smells; sudden changes of weather and winds from heavy to a light atmosphere, portending storms, and especially snow; easterly winds; fogs, with unsteadiness of weather and seasons; possibly some secret alterations in the electrick fluid, and affecting electrometers; warm and moist air; errors and intemperance in food and drink, and ingurgitation; violent motion and agitation of body and of mind; symptomatick in various diseases, as hystericks, hypochondriasm, gout, pectoral dropsy, empyema, polypi in the heart or aorta; wounds of the lungs; diseases of the liver and spleen.
Dyspnœa and Coughs
are symptoms of many diseases; and they are also primary, and very general maladies, especially in this island. It is true, we have here no compass to steer by: these are an exploded banditti; a sort of rebels to the symmetry of system, whose diagnosticks and therapeuticks are as yet slovenly and imperfectly noticed by medical authors. From the universal connection of the organs of respiration, their functions are more or less interrupted by and warped with other diseases and morbid symptoms. Many of the chronic impediments in breathing, and the broken-winded, may be called asthmatic excrescences, without its periodical paroxisms, exacerbations, and remissions; and without any rapid emaciation or hectick: they are spurious asthmas and chronic catarrhs. All the parts about the fauces and pharynx are crowded with mucous glands, from which, as in angina and catarrh, there is often a profuse secretion. Many persons advanced in life, and the aged, have a large discharge of mucus, variously, from the fauces, pharynx, larynx, lungs, stomach; all requiring frequent expectoration or hawking. The predisposing and occasional causes are many of those already enumerated under consumption and asthma. To these may be superadded cold pituitous temperament; air hot, cold, weighty, light, moist, impure, stagnant; changes and vicissitudes of the winds; cold moist climate and atmosphere, and especially in winter, autumn, and spring, and interchanges of the seasons; sudden vicissitudes, disorders and inconstancy of the surrounding elements; suppressed perspiration, and pulmonary exhalation; catarrhal defluxion on the lungs, larynx, fauces; mucus in excess, tenacious; faults in the mucus glands and ducts; trachea too sensible or irritable; calculi, chalky concretions, and inspissated mucus in the larynx; vascular or parenchymatous diseases of the lungs; original faults of the lungs, bronchiæ, larynx; wasted lungs; extravasated air; spasm of the respiratory muscles; flatulent farinaceous food, slimy food, and drink; weak or foul stomach, voraciousness; infants swallowing saliva; symptomatick in various diseases of the thorax, as consumption, asthma, empyema, polypus, aneurism, cum multis aliis: symptomatick in various diseases of the abdomen interrupting the play of the diaphragm; as full stomach, flatulence; pregnancy; dropsy; enlarged spleen or liver; tympany; nephritis; worms; injured abdominal muscles.
Catarrh,
colds, influenza, coryza, gravedo. In our irregular climate, during the annual revolution of the seasons, few escape slight catarrhs and colds, to which all ages are liable. That particular epidemick species of erratick catarrh, called Influenza, has sometimes spread suddenly over a kingdom, and some the greatest part of Europe. In no other epidemick do so few die in proportion to the number infected. Its continuance is generally short; and the little depredations committed during its itinerant incursions, are principally upon declining, consumptive, asthmatick, those of diseased lungs, worn out constitutions, and aged. In such forlorn complaints, catarrhal influenza has hastened the final dissolution sooner than it would otherwise have happened. In some, from neglect or irregularity, it has excited consumption, or pulmonick inflammation: in others, recovering from fevers, and convalescents of various descriptions, it has occasioned relapses. These observations are also applicable to simple catarrh skirmishing in less formidable inroads. Frequent relapses, from imprudence, in persons of phthisical or asthmatic constitutions, may expedite the inflammation of latent tubercles; or in aged persons subject to pituitous coughs, spurious peripneumony.
Catarrhal symptoms are increased secretion of mucus, from the membrane of the nose, fauces, and bronchiæ, with slight fever. It generally begins with some difficulty of breathing through the nose; dull pain and weight in the forehead; oppression in moving the eyes; distillation from the nose, sometimes from the eyes, of a thin fluid, often acrid, and exciting frequent sneezing; lassitude and languor of the body and spirits; sometimes shivering and heat, and increased sensibility to cold air; hoarseness, soreness of the trachea and fauces, with some difficulty of breathing, frequent cough and irritation at the glottis, at first dry; sometimes slight inflammation or angina, and pains resembling rheumatic about the neck and head. In some, the appetite is impaired, but not considerably; but in all the smell and taste. By degrees, the cough and sternutation are accompanied with a copious excretion of mucus, progressively incrassating, with less laborious efforts of coughing and hawking. Some catarrhs or colds, affect principally the membrane of the nose, and the different sinusses or cavities communicating with that emunctory; wherein stagnating mucus becomes more tenacious: others are lower situated in the fauces, pharynx, and trachea. Catarrh seldom continues beyond a few days, or weeks: that from contagion is more febrile and chronic. The predisposing and occasional causes are, cutaneous perspiration and pulmonary exhalation suddenly checked; cold moist atmosphere; sudden atmospheric changes; cold habitations and beds; wet feet; head or breast exposed or naked, thin ragged clothing; excessive effeminacy and warm rooms; epidemick state of the air.
Hooping Cough,
chincough, tussis convulsiva, epidemick, and contagious: is generally prevalent in infancy and adolescence, and but once in life: adults are rarely afflicted with it; and it is not confined to any particular season of the year. In the London registers, hooping cough and cough are confounded, and conjointly make no inconsiderable augmentation to the funerals. By the records of Dr. Armstrong in the dispensary of infant poor, of 732 cases of hooping cough, only 25 died; that is, about 3½ per cent. or 1 of 33. But this is too favourable a representation as a general scale of mortality. Its beginning resembles a slight catarrh continuing some days, or one, two, and three weeks before the formation and maturity of the convulsive paroxisms. These consist of many successive expiratory motions, so as to exhaust the lungs of air, succeeded by a full inspiration and pulmonick gulp, which rushing thro’ the glottis, makes a particular loud hooping sound. The duration of these pneumonick convulsive paroxisms, is from one to several minutes, in which the child’s face is turgid with blood, tears trickle down the cheeks, and it seems almost in the agony of suffocation and strangling. At the termination of each paroxism there is usually some mucus expectoration and excreation: this, at the beginning, is thin and not considerable; but by degrees increases in quantity and tenacity; and frequently at the same time, the contents of the stomach are evacuated. The pneumonick convulsions vary in their recurrence: they often return, frequently in the course of twenty-four hours, especially during the night: and thus may continue to persecute from one to three months, and sometimes a much longer space. Throughout, the senses are not injured; nor in the beginning the appetite; and in the intervals, children return to their amusements as if nothing had happened.
The younger the child there is more danger; as also in those born of phthisical or asthmatic parents, or in a state of debility, when seized with the hooping cough. When it begins in the form of catarrh, and is attended with fever, difficulty of breathing, and little expectoration, it may prove fatal in the early immature stages, unless the convulsive cough supervenes, and with copious expectoration. After some continuance of the disease, fever, with nocturnal exacerbation and difficult respiration, sometimes occur, and always with danger. Some fall down in the paroxisms; others have convulsions: violent paroxisms of coughing have excited epilepsy, apoplexy, or suffocation; but fever, dyspnœa, and pulmonic inflammation are to be most dreaded. With moderate expectoration the paroxisms are neither frequent nor violent: but expectoration in either extremes of scantiness or excess are both unpropitious, more especially with dyspnœa. Paroxisms terminated by vomiting, and succeeded by craving for food, are favourable omens; and recovery may be predicted by longer intervals from coughing, and shorter paroxisms; by restitution of natural appetite and respiration, of tranquil sleep, of fecal excretion, by evanescence of fever, and recruit of strength. The predisposing and occasional causes are, a certain epidemick state of the air or specifick contagion, the nature of which, and in truth of the disease beyond empirical observation, are as yet very imperfectly understood.