The practice of physick in seventeen several books wherein is plainly set forth the nature, cause, differences, and several sorts of signs : together with the cure of all diseases in the body of man / by Nicholas Culpeper ... Abdiah Cole ... and William Rowland ; being chiefly a translation of the works of that learned and renowned doctor, Lazarus Riverius ...

Chap. 3. Of Peripneumonia, or Inflamation of the Lungs.

PEripneumonia hath the same essence with a Pleurisie, and is distinguished only by the part affe∣cted, because that is the inflamation of the Lungs, and this of the Membrane that compasseth the Ribs. They differ somwhat in the matter, for a Pleurisie comes often of Choller, but a Perip∣neumonia of Flegm; although all humors (as we said of a Pleurisie) may produce this disease, I mean humors which are like blood, and make up the mass of it. For as thick humors do hardly pe∣netrate the thick Membrane called Pleura, but thin and Chollerick easily; so on the other side, thick flegmatick humors do easily go to the soft and thin substance of the Lungs, and stick close thereto; but thin and Chollerick humors do easily pass by. But this hindereth not, but the Chollerick blood may somtimes cause the Inflamation of the Lungs, as Hippocrates 1. de morbis, describeth the Ery∣sipelas, or Chollerick tumor of the Lungs, which comes from Chollerick blood thrown into the Lungs from the right Ventricle of the Heart by the Arterial Vein. But an oedematous Inflamation comes from flegmatick blood falling upon the Lungs by way of defluxion from the Head. But only excrementitious flegm, falling as a Catarrh from the Brain, can make a Peripneumonia, because it putrifieth in the Lungs, and attracteth blood, by the mixture whereof there is an Inflamation, and this often happeneth in old folk. Mesue saith that this Peripneumonia comes rather of Choller, be∣cause the Lungs are nourished with Chollerick blood which cometh in great plenty to them by the Arterial Vein. To whom we answer, that fresh, thin, and steeming blood made in the right Ventri∣cle of the Heart is carried into the Lungs, which by reason of its purity, is easily governed by Nature, and is sent by the Venal Artery to the left Ventricle of the Heart, and it seldom is altered from its Natural condition, which useth to make a Peripneumonia. But contrarily, a defluxion from the Head cutting through the large passages into the Bronchia of the Lungs, if it there putrifie, will draw blood unto it, and make a Peripneumonia.

This Peripneumonia is somtimes alone without another disease, somtimes it followeth other dis∣eases, as Squinzy or Pleurisie. Galen in Com. 11. Sect. 7. Aphor. teacheth that a Peripneumonia doth follow a Pleurisie two waies: Either when a Pleurisie is turned into a Peripneumonia, or when an inflamation of the Lungs followeth a Pleurisie. This transmutation is when the former disease ceaseth, and the other comes; but it comes upon it when it is white, the former remaineth.

Therefore the immediate internal cause of a Peripneumonia is blood, often flegmatick, seldom chollerick, and most seldom melanchollick, Which either comes from the whol body being pletho∣rick, or cachochymical, that is, full, or of evil habit; or from some part which is replete or di∣stempered.

The External Causes of Peripneumonia and Pleurisie are the same; namely whatsoever defluxi∣on can come to those parts: the chief whereof are: First great exercise and violent motion of the Body, especially after long rest, and high feeding. For then the humors abounding from high diet, and kept in by long rest, by exercise are dispersed, attenuated, and heated, and are after sent to the weaker parts, most fit to receive them, among which the Breast and Lungs are chief, because by strong exercise, there is caused great and often breathing, and so they become wearied, and the sub∣stance of the Lungs being soft and loose can easily receive the humors coming to them.

Secondly, Among the external Causes the cold and Northernly Air is reckoned, when it comes suddenly after a Southern and warm; for the pores are opened by warm Air, and the humors are more fluid, which by the cold Air coming after, are compressed, and the humors sent to the weak parts.

Lastly, From Hipp. lib. of Air, Places, and Waters, the drinking of standing Pools and Lakes, begets the Peripneumonia; for saith the Divine old man, we observe diseases of the Lungs to be most in Marshy Countries.

Also the Signs of a Peripnumonia do agree with the signs of a Pleurisie. Two are the same, as a sharp Feaver, and a Cough; which somtimes is dry, somtimes moist, or with more Flegmatick spittle coloured with Choller or Blood; and in the progress of time, the spittle becomes Mattery when the matter of the Disease grows ripe, and concocted by heat, which somtimes comes to pass when the substance of the Lungs is not hurt; for if they ulcerate, a Consumption wil sollow.

So we may observe, That in sore Eyes that are Mattery, the humors are converted into Matter when the substance of the Eye is neither suppurated, nor ulcerated.

The other signs differ in respect of the part affected; the difficulty of Breathing is greater than in a Pleurisie by reason of the narrowness of the part inflamed, so that the Patient seems to be choaked and cannot breath but with the head upright: For the part cannot be compressed by reason of the extention and repletion, nor be more dilated, although it be much dilated, yet it takes in but little Air, therefore the respiration is quick and often, with snorting: This is augmented by a Feaver by which the breath is hotter, and the desire of cold air is greater.

The Pulse is great, faint, and soft by reason of Flegm and the looseness of the Lungs: yet there is some hardness by the Choller and blood: it is unequal from the compression of the Artery neer the Heart, and in thick Humors most: Somtimes it is intermitting, watery, vermicular, when the Lungs are rotten by too much moisture.

There is a heavy pain that reacheth from the Breast to the Back, somtimes it is between the Shoul∣ders, and somtimes under one only Shoulder, and from thence communicated to the Throat and Pap: Especially in a Cough, somtimes they feel no pain til they begin to Cough: somtimes there is also a pricking pain in the side when it is joyned with a Pleurisie as it often happeneth: Although the Membrane that covers the Lungs be of the same nature with the Pleura, as Galen taught 4. de loc. affect. cap. 5. Yet there is not so great pain in a Peripneumonia as in a Pleurisie, for two Differences which are laid down by Galen in the place afore-cited.

The First is, Because the Nerves that go to the Membrane of the Lungs, are few and very little; but they which go to the Pleura, are many and great.

Th Other is, Because the Breast consists of Bones and Flesh, which wil not be stretched, from whence the pain is greater.

But the Lungs are soft and yeilding, and therefore their pain is less.

There is Redness in the Cheeks, by reason of the hot vapors which fly into the head and carrying with them the thinner blood. And this Colour is most in the Cheeks, because their skin is thinnest.

There are besides these signs, Heaviness, Weakness, and a Tossing, with great sense of Heat in the whol Body.

The Tongue is Yellow, and then it groweth Red; a great thirst, swelling of the Eyes, and of the veins of the Temples.

There is a Delirium, or Doting, when it comes from Choller; and a Coma, when it comes from Flegm.

If the Disease comes of Chollerick blood, the spittle wil be yellow, the heat and thirst greater, more difficulty of breathing with less Heaviness; the air breathed forth is more hot: the Feaver is very violent, the Pulse swift, the Delirium great, the Water thin, yellow and cleer, the age, time of the year, the Country, and Diet before, do al attest for Choller.

If Flegm (which is most ordinary) produce the Disease, the spittle wil be white, viscous, and froathy; the Feaver, burning of the Breast, thirst, and driness of the tongue, wil be less: the weight of the Brea•••• greater; the Pulse slower, and softer; the Age, old; Habit of body, time of the Yeer, and the Country, are cold and moist.

If the Disease come from pure Blood, the Spittle wil be Red; the Urin Red and Thick; the Face more Red; the Veins of the Temples more swoln; with heaviness and distention of the whol body; and other things that declare abundance of blood.

Lastly, If Melancholly blood be the Cause, the Spittle wil be black or blewish; the Tongue black, from the beginning dry and rough; there wil be also heaviness and great sighing between brea∣thing; and al the signs of Melancholly predominating in the whol body.

The Prognostick of this Disease is thus to be made.

A Peripneumonia is more dangerous than a Pleurisie; and for the most part deadly by reason of the necessity of respiration, and the neerness of the Heart.

Celsus saith, That this kind of Disease hath more Danger than Pain; and for the most part Killeth.

But strength of Body, less vehemency of Symptomes, yellow Spittle, not mixed with much Blood, raised in the beginning; a great flux of blood at the Nose in the Critical day; or a flux of the Belly which is Chollerick and froathy; or a flux of the Hemorrhoids or Terms, do shew some hope of recovery.

Imposthumes about the Ears, or inferior parts, being well suppurated and kept open, do foretel re∣covery, as Hipp. in proga.

If a Peripneumonia be turned into a Pleurisie, it is good, and though it seldom happen, as Galen teacheth, Comment. Aphor. 11. Sect. 7. because there is a going from a Disease more dangerous, to one less dangerous. And this transmutation is known by a pricking pain of the side coming thereup∣on, and by abating the shortness of breath.

But the vehemency of the Disease and symptomes do declare a dangerous and deadly Peripneumo∣nia, as want of spittle, continual watching, a Delirium or Coma, coldness of the extream parts, snor∣ting with great difficulty of breathing, blewness and crookedness of the nails.

Moreover, A Peripneumoma coming upon a Pleurisie is most dangerous, as Hippocrates tea∣cheth, Aph. 11. Sect. 7. because the translation of a humor from an ignoble part, to a more noble, is evil; and the strength being spent by the disease foregoing, can endure the force of a new, and wor••e.

When the urine is thick in the beginning of the Disease, and after before the fourth day it becomes thin, death is at hand. Hipp. in Coacis.

The Cure of the Peripneumonia is very like that of the Pleurisie, and there must be first bleeding as much as the strength will permit, once or twice in a day till the disease abate: for since the Lungs are then full of blood, and draw much from the heart, which is inflamed, you need not fear to let blood thrice, four, five, or six times.

But if a Peripneumonia follow a Squinzy, or Pleurisie, you may let blood more warily because the strength is abated by the former Disease.

You must let blood from the Basilica Vein of both arms, if the whol Lungs be equally affected, or from either, on that side the pain is, or on which the Patient sets more weight, or from which he supposeth he raiseth most spittle.

You must bleed women in this disease, first in the Ancle Vein, and after within six hours in the Arm; except it be so desperate that you are constrained at the first to bleed in the Arm. In which case, all the time you bleed, and a little before, you must apply Cupping-glasses to the Thighs.

But after, if the strength will not permit further phlebotomy, you must apply Cupping-glasses to the Shoulders and ••ack, both dry, and with Scarrification, as much as the Patient can suffer.

Also Emollient and loosening Clysters are good revulsives; but you must not use too strong pur∣ging Medicines therein, lest you bring a flux of the Belly, which is most dangerous in this Disease.

If a crude flegmatick humor coming from the head cause this disease, or nourish it, a Vesicatory laid to the hinder part of the Head, doth very much good.

In the mean while use the Juleps and Emulsons prescribed in the Cure of a Pleurisie. Anoint the breast with Oyl of Violets, sweet Almonds, or with fresh Butter, or the like, or with this Lini∣ment:

Take of Oyl of Violets, and Water Lillies, of each one ounce and an half; fresh Butter and Mu∣cilage of Fleabane seeds, of each one ounce: Oyl of Roses half an ounce: the Troches of Camphire one dram. Make a Liniment. Or,

Take of Oyl of Violets three ounces: the Oyl of Pompion seeds, and Breast-milk, of each one ounce: fresh Butter one ounce and an half: Mix them and make a Liniment.

You may provoke spitting with Syrup of Violets and Ju••ubes, and the rest, prescribed in the Cure of a Pleurine. As the Lohochs and Compositions there mentioned, given with this Caution, In a thin matter give things that thicken, and in a thick matter give things that attenuate.

Let his ordinary drink be Barley Water, with Liquoris, as in a Pleurisie.

Purging is not good in this Disease, except in the declining of it, and you must make choyce of such things then, as were prescribed in the Cure of a Pleurisie.