Alabama state intelligencer., 1831-05-11

tant that an impression should be made at the com mencement on disease so rapid and dangerous in It's nature. have sometimes been under the neces- sity of employing the lancet daily, and sometimes twice day, in severe and obstinate cases of peu- rlsy before the disease was finally subdued; though the lniiammatory symptoms often yield to two or three eoplons bleedings. The next step is the ap- pcatlon of large blistering plaster to the affected slde The plaiser to be servceable should be large; ana nave frequently been astonished that physi- cians who were respected in their profession. have aiten so little studied the efficacy of this remedy as 10 trust 10 plaster not larger than the palm of the iianu' when one as large as page of fooscap writ lns paper shoud have been applied. Ihave many 'iie known the drawing of such blister act like enarln' Tn immediately subdung every symptom'of a,sease. Without waiting for the operation of the oiister however a brisk cathartic of calomel and Jaiap or caomel and caster oil should be exbibled
 u was 'ormerly apprehended that the operation of calnalucs was injurious, by diminishing expectora uoh' pu' 'ns opinion Is entirely erroneous. For as the cough is produced by the irritation of the lunes ana by the efiusion and collection of serops Gu;ds Tn them and this irritation and effusion are tbe TO- suits oi inflammation and fever so any means ms. sessing me power to subdue and moderate inAom matory action, must have beneficial effect in tb;s disease; and the power of cathartics in this wav is wen hhown to every practitioner This class of medicines like bleeding is more esnac;oIl,, ,,aoci during the first, or nfammaory stare Inf inc d.oasa ih the pneumonia disorders of this winter. I have noticed considerable disposition to affections rtbe h".iiniS 'ritli atrVabiOsNife ularrn0ea, the
 oeihs sometimes dscolored with blood merc t is necessary to allay and moderate the action of the ntestlnes, otherwise great debility is soon produced as answering this intention, teaspoonful of pare gorlc may be given from time to time. as occasion may require.
 have never had any, or'but little faith in emetcs in pneumonlc cases, although they have lately been exolled as almost specifically eiEcacous in pieuritic affections. Such. however, have not been tIeir of fecis within the sphere of my observation Ii is trne thai m cases owha are called bud colds not amount lng to pneumonia, where the lungs have. been con siderably oppressed with phlegm by assisting in the dlslodgement and expectoration of this, they have sometimes afforded. at least, agemporary relief; and as determining to the surface, and promoting persn ration' have occasionally proved permanently benc- hca: but the case is different in pleursy or violent pneumonia inflammation. Here remedies of preat CT efficacy are required and such as take off the mo- mentum oi blood to the infamed organs Among these the most powerful and the most suddenly eff cacious is bleeding. On this head I am fully war ranted to speak decidedly, having, in several n- stances seen the inecacy of the diluting, sweating emollent plan, consisting in the exhibition of hot herb teas warm pediluvians, warm applications and the usual daphoretcs, as Dover's powders, the diff ferent preparations of antmony, &c One good bleeding was worth more than all ; and without it they were, Tn the first stage, ,inert and unavailing
 have before observed that the pneumonia aiiec- tons ths season were of less infammatory charac ter than usual and 1t consequently became necessa " to employ the lancet with more limitation obsory- ing closely the change in the character of the dis ease from state of high excitement to that of de- bility and collapse
 The quantity of blood to be extracted at any time must necessarily vary according to circumstances and that not so much from the age and habit of the patient as from the effects of the operation Enough should be taken away to cause an evident chopqo in the state of the pulse, the skin, the feelings of the patient The pulse becoming softer and less strong the skn most, or the person complaining of sickness or faintness though in a recumbent posture. (the situation in which he shouldj always be bled are circumstances by which we are to be guided in de- terminmg the extent of the evacuation In order to produce these changes have, in former years fre- quently been under the necessity of withdrawing three pints, and two quarts of blood at single bleeding; in so so doing, have often had the satis- faction of seeing determination of the disease spee dily effected; when otherwise, from the tardy and timd use of the lancet, the disorder would probably have terminated in something like phthisis pulmo- nalis with copious expectoration of mucus, bloody and purulent matter, and frequent concentrations of fever, and night sweats
 In pneumonia or peripneumony, distinguished by the pain being less acute, and less fixed, and the pulse softer the indications and mode of treatment are the same as in pleurisy. There is an exception however, when the disease attacks persons of ad- vunced age, or of incorporate habits; in such state of collapse speedily succeeds the ebre excite ment which usherod in and attended the early stages of the dsease here the lancet should be used with out delay at the commencement of the disease; as q loss of time at this period, in the employment of en- ergetlc treatment, may be productive of fatal conse- quences The incorporate use of spurious lquors isvery aptto induce chronic weakness, subacute inflammation or obstruction of the lungs; which, for
 while, may excite but little attention or alarm, but which upon occasion of taking cold may be spec dily succeeded by fatal consequences. have found upon dissection after death, the lungs of an invete- rate dram drinker almost entirely destroyed; DOT ton of one 1obe only retaining any degree of sound ness, the remainder consisting of menbranous bag, filled with grumous corruption, the stench of wl,ich was insutferabe, and exceeded any thing had ever smelt In pneumonia, therefore, attacking persons of incorporate habits gangrene is more lia- ble to occur than in others; and may be known by the sudden cessation of pain, the patient when in- terrogated saying that he feels much better; but the change for the is too striking to lead per- son of any experience into mistake; the patients mind becomes wandering; frightfu and imaginary objects are constantly obtrudiug themselves upon his view he starts with horror and alright and cannot be persuaded that his fears and terrors unound- ed; his eye becomes vacant, and staring; his lips and countenance livd; his breath purid and oflen- sive and his pulse tremulous and weak When tho disease in such patients does not terminate in this manner the patient gradually sinks, perhaps collect ed or more frequently, with low muttering delirium and lethargc stupor; or is carried off by suffocaon, from an effllsion of blood mucus into the lungs and air cells and inability to expectorate throw off the matter by coughing.
 The pulse is not always criterion of the necessi- ty of blood letting Frequently, considerable local inflammation exists with rather weak and small pulse or one but little altered from its natural state. This is more especially the cases in peripneumony, or inflammation of the lungs. Here other symptoms and circumstances are to direct us in the employ ,ent of this rarnadu as nan and diicnx of hreath-