CHAPTER X. ON PLEURISY
UNDER the ribs, the spine, and the internal part of the thorax
as far as the clavicles, there is stretched a thin strong membrane,
adhering to the bones, which is named
succingens.
When inflammation occurs in it, and there is heat with cough
and parti-coloured sputa, the affection is named Pleurisy. But
all these symptoms must harmonise and conspire together as
all springing from one cause; for such of them as occur separately
from different causes, even if they all occur together,
are not called pleurisy. It is accompanied by acute pain of
the clavicles; heat acrid;
decubitus on the inflamed side easy,
for thus the membrane (
pleura) remains in its proper seat,
but on the opposite side painful; for by its weight, the inflammation
and suspension of the membrane, the pain stretches to
all its adhesions at the shoulders and clavicles; and in certain
cases even to the back and shoulder blade; the ancients called
this affection Dorsal pleurisy. It is attended with dyspnœa, insomnolency,
anorexia, florid redness of the cheeks, dry cough,
difficult expectoration of phlegm, or bilious, or deeply tinged
with blood, or yellowish; and these symptoms observe no
order, but come and go irregularly; but, worst of all, if the
bloody sputa cease, and the patients become delirious; and
sometimes they become comatose, and in their somnolency
the mind wavers.
But if the disease take a bad turn, all the symptoms getting
worse, they die within the seventh day by falling into syncope;
or, if the commencement of the expectoration, and the
more intense symptoms occurred with the second hebdomad,
they die on the fourteenth day. It sometimes happens that
in the intermediate period there is a transference of all the
symptoms to the lungs; for the lung attracts to itself, being
both porous and hot, and being moved for the attraction of
the substances around, when the patient is suddenly suffocated
by metastasis of the affection. But if the patient pass this
period, and do not die within the twentieth day, he becomes
affected with empyema. These, then, are the symptoms if
the disease get into a bad state.
But if it take a favourable turn, there is a profuse hemorrhage
by the nostrils, when the disease is suddenly resolved;
then follow sleep and expectoration of phlegm, and afterwards
of thin, bilious matters; then of still thinner, and again of
bloody, thick, and flesh-like; and if, with the bloody, the bile
return, and with it the phlegm, the patient's convalescence is
secure; and these symptoms, if they should commence on the
third day, with an easy expectoration of smooth, consistent,
liquid, and (not) rounded sputa, the resolution takes place on
the seventh day, when, after bilious discharges from the
bowels, there is freedom of respiration, the mind settled, fever
diminishing, and return of appetite. But if these symptoms
commence with the second week, the resolution occurs on the
fourteenth day.
But if not so, it is converted into Empyema, as indicated
by rigors, pungent pains, the desire of sitting erect, and the
respiration becoming worse. It is then to be dreaded, lest,
the lungs suddenly attracting the pus, the patient should be
thereby suffocated, after having escaped the first and greater
evils. But if the abscess creep in between the ribs and separate
them, and point outwardly; or, if it burst into an intestine,
for the most part the patient recovers.
Among the seasons of the year winter most especially engenders
the disease; next, autumn; spring, less frequently;
but summer most rarely. With regard to age, old men are
most apt to suffer, and most readily escape from an attack;
for neither is there apt to be a great inflammation in an arid
frame; nor is there a metastasis to the lungs, for old age is
more frigid than any other age, and the respiration small, and
the attraction of all things deficient. Young men and adults
are not, indeed, very apt to suffer attacks; but neither, also, do
they readily recover, for from a slight cause they would not
experience even a slight attack of inflammation, and from
great attacks there is greater danger. Children are least of all
liable to pleurisy, and in their case it is less frequently fatal;
for their bodies are rare, secretions copious, perspiration and
exhalation abundant; hence neither is a great inflammation
formed. This is the felicity of their period of life in the
present affection.
