On the Causes and Symptoms of Acute Diseases (1.10)

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.