with the addition of a little pulverized capsicum baccatum. Beach's common purgative or anti-bilious powder is also very good. This may be given in decoction or in a semi-liquid extract.

But the two principal things to be done, are to produce perspiration and to excite a free expectoration.-To accomplish the former, the vapor bath or the pack sheet may be resorted to, if the case is severe enough to call for it; but, in ordinary cases, the vegetable composition, and the common diaphoretic and anti-febrile powders are fully sufficient. I prefer in combination, the diaphoretic and the antifebrile powders, the formulas of which are given in this work. Let the common dose be given every four hours, or from four to six times a day. [I usually find it more convenient, and more agreeable to the patient, to take a pill of extract of lobelia, instead of the anti-febrile powders, once in four hours, alternatively with some diaphoretic powder. Or, if it is desirable to give the medicine in powder, the extract may be triturated with loaf sugar, and given in that form. The free use of gum acacia and licorice water will be found serviceable. Dr. Gabbert uses but little expectorant medicine in this disease, but depends almost wholly for the cure upon emetics and nauAfter the fever is subdued he uses quinine freely. C.]

seants.

As an expectorant, nothing excels the compound syrup of sanguinaria and lobelia. It may be given in doses of from half a dram to a dram, every two hours; or be alternated with the dose of diaphoretic and anti-febrile powder, and be given every four hours. In a majority of cases, the compound syrup mentioned above, given every two or three hours, in doses as large as can be borne without emesis or essential nausea, will effect a cure, in a short time.

SECTION II.

SECONDARY ACUTE BRONCHITIS.

Ordinarily acute bronchitis, as we find it, is a primary or idiopathic affection; and this, as we have seen, may be complicated with some other disease, arising either from the same or from a different cause. Secondary acute bronchitis, however, is an acute

inflammation of the mucous membrane of the bronchi, induced by the existence of some other disease, which has previously set in and which still continues. This other disease may be an acute affection as typhoid fever, measles, or almost any one of the exanthematous diseases; or it may be a chronic affection as emphysema, phthisis, or even some cardiac affection. Even chronic bronchitis may assist in giving a new development to the acute disease, which thereby becomes secondary to the chronic. Generally, in this latter class of cases, the dyspnoea, and distress are much more severe than in the primary form of the disease; and, in some cases, the vital powers may be so much embarrassed as to render the prognosis unfavorable.

The treatment of secondary acute bronchitis is essentially what is adopted in the primary disease, as the indications of cure are essentially the same. Expectorants and diaphoretics are the leading remedies. Emetics, laxatives, and diffusible stimulants may sometimes be required. Sinapisms and other stimulants, applied externally, particularly upon the anterior portion of the thorax, sometimes aid considerably in effecting the cure. Cold wet cloths, especially, are of great service."

SECTION III.

CHRONIC BRONCHITIS.

In strictness, chronic bronchitis is nothing more than a continuation and modification of the acute disease; or the former may be said to have its origin in the latter.

PATHOLOGY.-When inflammation is not soon resolved, generally ulceration supervenes. This is a breaking down of tissue, and a manifestation of that imperfect character of the reparative process, which is attended with suppuration. In the case of the mucous membrane of the bronchi, when this change takes place and continues for some length of time, acute bronchitis is said to be converted into chronic. Seldom, if ever, does the ulceration. extend to the minute ramifications of the tubes; but it affects mainly the larger bronchi, in connexion with the trachea and the

parts still higher. It seems inclined to seize first, on the follicles; but those most fully developed and best fitted to receive inflammation, are situated in the larger passages. From these follicles, the ulceration sometimes extends, with an irregular outline, and involves the membrane immediately around.

Such being the anatomical character of chronic bronchitis, it, of course, is incapable of being divided into stages.

Ordinarily, the preceding acute disease is, for a time, very manifest. Sometimes, however, the symptoms of chronic bronchitis develop themselves gradually, so that its origin is not generally referred to the acute disease. In this case, inflammatory action. has previously been going on, slowly and almost imperceptibly, but yet so as to bring about the same results as when it has been more rapid. This clandestine progress of the disease is confined almost exclusively to persons in advanced life. In middle age, in a form at all marked, it is very rare; and, in children, it is unknown.

DIAGNOSIS.In chronic bronchitis, the sputa and the cough vary considerably according to incidental circumstances. Generally, the sputa consist mainly of thick, whitish or yellowish mucus ; but this is often mixed with purulent matter, the result of suppuration and ulceration. Sometimes, however, the matter expectorated is thin, glairy, and semi-transparent. The existence of this form of the sputa is indicative of a complex anatomical condition, and not one of mere chronic bronchitis. The air-cells are somewhat dilated, constituting a degree of emphysema; and this gives rise to the peculiarity of secretion. Sometimes, the expectoration is almost wanting. This condition is produced by such a thickening of the mucous membrane as prevents its discharging its proper office, that of secretion; consistently with this condition the air-cells may be somewhat dilated.

The cough in chronic bronchitis is generally loud and hard. In the second condition named, it is generally harder than in the first; but, in both, it is somewhat loose. In the third condition, the cough is dry and short, but still it is comparatively strong.

The constitutional excitement in chronic bronchitis is never great, and is generally very slight. In the first variety specified,

when there is a considerable discharge of mucus and pus, the febrile symptoms are sometimes quite decided.

As physical signs, we have, in the first variety, the mucous and the sub-crepitant rales, produced by the muco-purulent matter in the larger and the medium-sized bronchi. The respiration is sometimes quite strong, but oftener feeble. Percussion is normal.

This form of bronchitis is distinguished from phthisis, to which it has some resemblance in symptoms,-mainly by the absence of dullness or percussion at the summit of the lungs, and of bronchial respiration at the same part, cavernous respiration, and other signs of the latter affection. It is apt, however, to terminate in phthisis, by preparing the way for the introduction of the latter disease.

The second variety generally comes on gradually, not being preceded by any marked degree of the acute affection; but, when fully developed, it is manifested by the existence of different rales, in different parts of the thorax, at the same time. We sometimes hear the sonorous, the sibilant, the mucous and the sub-crepitant, simultaneously. Laennec called this music, "cantus omnium avium," the song of all the birds." Generally, the tubes of medium size are more affected than the larger; and hence the sibilant and the sub-crepitant rather have the predominance over the sonorous and the mucous. We may hear, at one time, a portion of these rales, and not the whole. For instance, before there is much secretion, inflammation having quietly progressed to a certain extent, we may hear the sonorous and the sibilant, which sometimes rule; also, a sound intermediate between these two, or a compound rale; and afterwards, we may have the humid, that is, the mucous and the sub-crepitant, which, also may in character, approach each other. But the disease may have advanced farther in one portion of the tubes than in another,—the secretion having taken place freely in one, while another is still turgid and dry; and this condition may be such as to give rise to the simultaneous existence of the dry and one of the humid rales,—as the sibilant and the sub-crepitant, when the affection is upon the medium sized bronchi, or the sonorous and the mucous, when the larger tubes are the seat of the disease.

In this form of the disease, there is commonly some dyspnoea.

If there is, to any extent, an emphysematous condition of the aircells, it will be somewhat severe, considerably simulating asthma. So, too, when the thickening of the tubes essentially obstructs the passage of air through them, the resemblance to asthma will be even greater. Percussion is normal.

In the third variety, the respiration is usually feeble. The sibilant and the sonorous rales are heard, whenever the thickening of the tubes is sufficient to produce them. In other cases, they are wanting. Percussion is normal throughout the thorax; or, not · unfrequently, unnaturally resonant, on account of the existing emphysema. Sometimes one of the adventitious sounds, the emphysematous crackle, is heard, in consequence of the rustling of the air-cells against one another or against the pleura.

On the whole, the varieties in the symptomatology of chronic bronchitis are due, partly to incidental matters and different stages of the disease, and partly to its complication with another affection.

PROGNOSIS. In the first form of chronic bronchitis, the chances for entire recovery, under proper treatment, are good. With improper treatment, it may prove fatal. In the other forms, the disease may be expected to continue, with temporary abatements in the symptoms, while life lasts. Unless, however, it becomes complicated with other serious affections, it is not apt to bring life to a hasty termination.

TREATMENT. In the first variety, the indications to be fulfilled are quite similar to those of the acute disease. In severe cases, I have found great benefit from the repeated use of vapor baths and emetics. They equalize the circulation, and induce a healthy action on the surface. This necessarily diminishes the irritation and represses the morbid action of the lungs. At the same time, however, expectorants to promote a healthy action of the secreting follicles of the bronchi, are of great service; and nothing serves the purpose better than the compound sirup of sanguinaria and lobelia. Of course, the alvine discharges and all the secretions should be kept free.

But notwithstanding the liability to febrile excitement in this form of disease, the constitution often needs sustaining with