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Cer. Physicians were called in. knowledged to each other, that The disorder was attributed to the it was impossible to say any thing gout; 'and remedies for the gout with certainty, either of the leat were accordingly prescribed. or the nature of the disease. Bye

Their attempts, however, were presumed, there was an abscess in to no purpose. The pains seemed the lungs; because he had obto assume a new force after the served the patient expectorate a use of these medicines, and fixed viscid matter after much agony. themselves more and more to Boerhaave, however, differed from the left side of the breast; so that him in opinion; because, exit was found impossible to remove cepting the fingular and urgent their seat. Blood-letting,' open- symptoms of pain, the marquis ing medicines, oil, opium, &c. was in other respects healthy, were all given, without affording He was then asked, what he any relief. To these pains, after thought of the nature of the difa certain time, there was added ease? It was not till after some another, and an infinitely more ex- considerable reflection that he cruciating one, which was felt answered, that he really did not immediately under the lefi breast, know what to think. He was and seemed, as the marquis ex- inclined, however, to be of opipressed himself, as if the inside of nion, he said, from the symphis breast was torn out by. viotoms, that the organs destined lence. Tormented himself to to dilate the breast, were unable this degree, and tormenting all to support the contractions eflen. about hiin, by his lamentable and tial to the action of each muscle ; incessant groans, he could find no and the parts of the breast which place or Gtuation that afforded required to be dilated, relisted to hin the least mitigation of his mi- this dilatation at each inspiration; sery. He usually fat upon his and that, from this arose the viobed, leaning a little forwards, lent pain, the difficulty in breathand reclining his elbows on his ing, and the sense of suffocation, thighs. In this situation he, The patient and his friends were now and then, at intervals, got a satisfied with this reflection, little reft, and slept a few mo- Boerhaave advised cataplasms to ments; but it was only to be wak- be frequently applied to the parts ed foon, and on a sudden, by a that are the most in motion in recruel exacerbation of the same re. fpiration; as the ribs, cartilages, lentless pain.

and iternum. He likewise pre. Such was the situation of the scribed emollient drinks, a sparmarquis when Boerhaave was ing diet, and the frequent inipia desired to visit him, with his phy. ration of the vapour of some foft. fician in ordinary, the same Dr. ening decoction. His prescription Bye, whom we have already men- was followed, and ihe patient tioned.

e found himself much relieved. His When Bye related to Boerhaave friends began to indulge hopes of all the particulars of the disease, his recovery. The pain never and the remedies that had been returned again with so much omployed to no purpose, they ac- violence as before, even till his death. How blind and preca- clyfter, occasionally thrown up, rious, favs Boerhaave, is the joy was now the only thing that gave of us mortals !

death

him any relief. The great stricAt length, the cough returned, ture of his breast persuaded him as it were, with new violence. that his disease was hypochondriaNothing could calm it but opium; cal; and that this sensation was but this calm was not of long du. the effect of natus. He was the ration : his expectoration was ex. more perfuaded of this, because ceedingly painful, and his refpi- his appetite was so keen that he ration fo difficult, that the patient would have eaten to excess, if his was obliged to throw his neck servants had not taken care to backwards, to raise his breast; prevent him. What he eat, sery. and, at the same time, to draw ed only to increase his pain. in his breath, with so frightful a About eight days before his noile, that it could be compared death, the hemorrhoids began to only to the cry of a bittern. Then return; and this gave himn great again, perhaps, for a few mo- spirits. He now began to have ments, the respiration would be hopes of being cured, and even more easy : but this relief was but reproached his physicians with trilling. He was obliged to be not having atteinpted to bring almost constantly seated upright, them back sooner. On the 7th of both night and day, with his neck July he voided, by the anus, 2 stretched out, and his head raised. confiderable quantity of blood, At the least change of poiture, which immediately coagulated. when he by chance slept for a The next morning the flux conmoment, he felt the moit horrid tinued, and in greater abundance. pain. If he attempted to lie The marquis was to enlivened at down on bis pillow, to repore him. this, that he attempted to make a self for an instant, his face be- few steps in his chamber, leaning came black; the veins of his upon his servants. The fame head fwclled, and his eyes day he had a most craving apseemed to be bursting from their petite, and eat of many different lockets. He appeared to draw things, , swallowing everything, his breath only from the bottom just then, without any fear of of his entrails. An hideous hol. fuffocation. He likewise supped low found seemed to be his only with the same good humour; rerelief. It he attempted to freak, joiced at being able to do what a few words usually revived all he had so long been incapable o!; his pain.

having, for some time before, not Boerhaave remarked, with aito- even dared to take any folid nouniliment, that in the midst of this rifliment, without danger of imdeplorable itate, the polle was mediate fuffocation. still regular; nor did it begin to On the 9th of July, however, fall or vary, or become inicrmit. Dr. Buc found him again in bed, tent, till a few days before bis after palling a molt painful night. death. The marquis dragged on He seemed to be in the agonics of this unhappy life till the oth oï 'death. His face and neck were July, Al the leaft return of the considerably swelled; his face was pain, his face became black. A of a dark complexion, and his

bres

eyes seemed as if starting from his fistants, that they were going to head. He was able, however, to discover the cause. relate what had happened in the On opening the breast, there night. He mentioned the danger im nediaiclv spouted out a stream' he had been in of fuffocation, of limpid, yellow, infipid water. and desired to be let blood. The Boerhaave reflected a moment on physician refused this. You are what this walor might be, and determined then that I shall pe- whether it was not a dropsy of the riflı, said the marquis. You breast which had suffocated the would not surely wish, faid Bye, patient, after causing so many ills. that I fould hasten your death? It continued to flow during the While he was speaking these diffection, but in less quantity. words the fuffocation increased; The breast feeined to be filled with his face became quite black: he water, on looking into it, through attempted to bid adieu to the mar- this narrow opening. Boerhaave chionets, who was by the bed- introduced his finger into it, and fide; and then, vielding to his found the right lobe in its place, lait efforts to breathe, bowed but adhering to the pleura. He dow: his head and expired. ? went no farther on that lide, but

Byeimmediately informed Boer- opened the left cavity of the breast, beave of this event, to whom he and found there no water : but the had every day communicated the whole lobe, from the top to the botstate of the patient, Boerhaave tom, was adhering to the pleura. came to him; and they were per- He then carefully laid this part of mitted to open the body.

the thorax open; taking care not Boerhaave, before ihis opera- to disorder any part of its contents. tion, was willing to reflect on all The moment he had accomplished the circumstances of the disease, this, he saw that, from the neck to see whether he could not fore- to the diaphragin, the whole of tell what he Mould discover on the cavity was filled with a white diffection; and thus say what fubstance, of a sound appearance, part was diseased. But this great except that, in the middle of its man candidly owns, that he was surface, there was a little tumour, unable to determine anything which included a fluid, of a milky before hand; and he requests the colour, but not purulent. This reader to judge for himself, from substance was pretty hard and unithe circumstances he has related, form, through the whole of its of what might be the effential surface. Boerhaave kas stupified causes of the marquis's death, at the fight of this fingular phebefore he goes any farther. nomenon. This substance was

The body was, externally, of a much more considerable in the very healthy appeara!Ice; and, not- left than in the right lide of the withstanding the marquis's long heart; and even entirely filled it. abitinence and extreme fuffer- This was the reason why the lobe. ings, he was by no means eina- of the lungs was pretid to close ciated. The abdomen only was to the pleura on that fide, that a little livelled. This tension neither air nor blood could perendered Boerhaave very attentive: netrate it any longer. Tive first be even ventured to say to the afa seat of the disoruer had, there.

fore,

· fore, probably, been in the left light in proportion to its fize,

cavity, under the scapula ; and some idea may be formed of its hence the pain the patient com- excessive bulk. The whole of plained of at the beginning

this substance was as white as This excrescence --had indeed snow. Here and there appeared extended to the right side of the a milky Guid, on cutting into it. breast; but still it was not so No veels, however, were to be considerable there as not to leave perceived in it, excepting those some room for the admission of to which it was attached: Ex. air, and for some degree of action cept the skin, that enclosed the to the lobe on that ride, in refpi- whole, there was 110 appearance of ration. The great veffels how- any cauls, or cavities, or mem. ever, and even the heart itself, braue within. If any portion of with its pericardium, were pushed this substance was rubbed between somewhat out of their places. The the fingers, it melted like fat 'oil. respiration could, therefore, only It was, therefore, in Boerhaave's take place in this lower part of opinion, the true featoma. the right cavity of the ihorax, The displacement of all the because this excresence being at thoracic viscera was altogether the top of the breast, where it is fingular. This fubftance had puth. narrowest 'in the human subject, ed the diaphragm downwards; and the lungs were presed down to this had occafioned the tumefac. wards the inferior part of the ca- tion of the lower belly, which vity, where the breast becomes Boerhaave noticed at the first somewhat wider. This, therefore, as á fingular appearance. The

explains the extraordinary efforts pericardium being united to the ., made by the patient, to draw his diaphraghm, had followed it, and,

breath from this lower part; the of course, removed from its nalu. bronchiæ being comprefied above ral situation. This was followed by this substance. Hence, too, by a depression of the great vefleis. the hollowness of his voice. Be. We have already seen the state of fides all this, the right lobe was the lungs. found adhering to the pleura, only Here then was a new example at the upper part of the breaft, of human misery. A mild, unétu. About the middle, it was seen als ous, an innocent humour, occatached to this tumour; so that fioned, by its abundance, a finhere was another hindrance to the gular difease, and death; and action of this lobe.

This, from iis fixing itself in too Boerhaave attempted to separate great a quantity on parls which the whole of this substance from can in no degree be compressed the other parts, to which it was without danger. We learn from attached. It was impossible to this, therefore, that, in extraorditake it out at once and entire, nary diseases, we may reasonably on account of the pericardium, fuppofc some hidden and unknown lungs, and great restels. He ex- caure, which anatomy alone can tracted it, however, in the best be likely to explain. manner he was able, and found It were to be withed, says Boerthe weight of it to be fix pounds haave, that the experienced phy. and three quarters. As it was lician might be able to discover

the

the source of a similar complaint, saying that a steatoma, cannot be from his first seeing the patient; derived from the cure, or the fupand that he might then be able pression of the hemorrhoids ; that to prevent this fat from spreading, he had cured them neither by so as to form so destructive a mais; caustic nor by any other external we might then hope to be able application, but by mild, emolto prevent the disorders it occa. liept, and detersive remedies; and fions; becaule it is impossible to 'that no figos of plethora had been resolve or diffipate a steatoma perceived when the hemorrboidal that is once formed, unless its flux began to diminish. In short, situation should admit of manual says he, with his usual candour Operation.

and dignity of mind, let every one Boerhaave 'confesses, that he judge freely and sincerely for knew no medicine that would himself; I have described the diso prevent a beginning steatoma from ease, such as I saw it. enlarging; and that which is not The physician, therefore, as well to be done externally, must be as the inathematician, has fulfillless possible within. Every time, ed his duty, when he has proved therefore, says he, that I hear that a difficulty is, in every tense great talkers. vaunting their re- and point of view, inexplicable. inedies for this purpose, I will to He who proves a difeale to be see them cure schirrous tumours, impenetrable, and of course inoccult and ulcerated cancers, me- curable, deserves as much of our liceris; steatoma, &c. by certain esteem as he who points out the means, and thus give us a proof seat of a disease, and the method of their art. As for my part, I of curing it. have observed that all prudent and experienced physicians alo lowed their insufficiency on these Account of Mount Vefuvius in the occasions, though they did it with rear 1777. From Travels into the regret.

Two Sicilies, by Henry Swina It would seem as it Boerhaave burne, Esq. might meet with some reproaches, - for his method of treating the THE unavoidable hurry upon Marquis before this complaint. T our arrival, prevented me

Nothing could be more grate. from visiting Vesuvius while the ful to the ignorant and illiberal, eruption continued. As soon as men of little minds, and of a nar- I was at liberty, I hired a hackney row way of thinking, than an op- two-wheeled chaise, called a Caportunity of censuring so great a leslo ; which is no more than a genius as Boerhaave. There are, very unealy triangular feat, gilt even now, persons of this difpofi. and bedanbed with gaudy colours, tion, who, in reading this narra- fixed upon an axletree, and drawn tive, will perhaps be led to afcribe by a fingle horse. Some of these the disorder of the Marquis to the horses fell very dear, and go at a suppreffion of the hemorrhoids. prodigious rate, always in a high But the great Boerhaave has re- trot. The driver stands behind, plied to these frivolous judges, by and with the whip and voice din VOL. XXV.

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