some simple vegetable tonic, as the common spiced bitters, quinine or salicine. In one very aggravated case, I used the vapor bath and an emetic, every other day, for ten days; and, for intermediate treatment, I gave an expectorant and tonic in connection. When I commenced the treatment of the patient, he expectorated from one to two pints of muco-purulent matter daily. At the expiration of ten days, the symptoms were greatly abated; and, by continuing the expectorant and tonic treatment alone for two weeks longer, he was restored to health, and has continued well to this day.

Local applications to the chest are sometimes serviceable. Wet cloths will absorb morbific matter; and, if there is any active inflammation, they will aid in allaying it. Occasionally, when the vital powers are not very active, I have found a decided benefit from the use of an irritating plaster, anteriorly, over the superior lobes of the lungs, or on the spine, over some of the last cervical and first dorsal vertebræ. For this purpose, Dr. Hill's irritating plaster may be employed; or one may be made by mingling pulverized podophyllum 'peltatum with common shoemaker's wax, Burgundy pitch or almost any adhesive material. This treatment is best suited to those lingering cases, which endanger the inducing of tuberculous disease, in these cases, too, inhaled vapor, properly medicated, as with rosin, ether, or the like, is sometimes of service.

In the second and the third forms of chronic bronchitis but little benefit is to be expected from medication. Of course, mild expectorant and some general constitutional treatment will be of some service. [In these cases the occasional use of emetics and the vapor bath, as Professor Newton has suggested, is the best course of treatment. Professor Gabbert, to these means adds the use of astringents, such as bayberry and hemlock. In the intervals between the administration of the emetics and baths, the compound lobelia pills should occasionally be given, in order to promote capillary action and favor expectoration. Tonics when used in conjunction with these pills will seldom excite febrile action. A nourishing yet unstimulating diet should be used, and the benefits of a pure dry atmosphere, and of gentle exercise, should be sought. C.]

SECTION IV.

BRONCHITIS OF CHILDREN.

The bronchitis of children is primary acute bronchitis modified by some peculiarities of constitution on the part of children. One modification is its decided tendency to be converted into lobular pneumonitis. Whether this tendency is to be ascribed to the delicate structure and comparative weakness of the air-cells in children, in connection with the strong respiratory action which takes place with them, or to the fact, that children do not, like adults, expectorate to relieve the air-passages, so that the smallest tubes and air-cells become specially oppressed, does not certainly appear. Another modification is the early period at which a copious secretion takes place, either preventing the existence, or causing the early disappearance of the dry rales, so that they do not fall under observation. On account of the amount of mucus which loads the tubes, the mucous and the sub-crepitant rales are abundant almost throughout the continuance of the disease. Percussion is generally normal, though sometimes a little dull, on account of the accumulation of mucus in the smaller tubes and an accompanying congestion of the blood-vessels in the lungs. Of course, there is a loose cough and some degree of dyspnea. There is often considerable constitutional disturbance, and not unfrequently cerebral symptoms. The whole face is sometimes flushed, and the color is a purplish red, on account of the blood's being imperfectly aerated.

The treatment of this form of bronchitis consists essentially in the use of emetics, expectorants, and diaphoretics. Emetics and nauseating expectorants are the more necessary, for the reason, that children do not voluntarily expectorate. With them, it is mainly during the process of vomiting, that the mucous secretions are ejected from the air-tubes. The antifebrile character of the treatment will, of course, be proportioned to the amount of febrile excitement; and, in general, regard must be had, according to circumstances, to the preservation of a healthy operation of the various functions.

[In treating the bronchitis of children, great care should be taken to produce a free cutaneous secretion. On account of the difficulty, always experienced by them in taking medicine, the use of external means becomes the more necessary. The warm bath, should, therefore, be frequently applied; and in its application these cautions should be observed:-To have the temperature of the room above 80°, to immediately wrap the child in warm flannels, without exposing its body to the contact of air, and thereby cause a chill, and to let it remain quiet in bed in order to promote perspiration. After a proper degree of strength is obtained to render reaction certain, the sponging of the chest in salt water a little below the temperature of the body, will fortify the system against a relapse. C.]

SECTION V.

EPIDEMIC BRONCHITIS.

Epidemic bronchitis, commonly called influenza, is primary acute bronchitis, attended with febrile symptoms of decidedly greater intensity than accompany the ordinary form of the disease. The physical signs, in one case, do not differ essentially from those in the other. The character of the cough and the degree of the dyspnea, in the two cases, are essentially the same; but in influenza an epidemic and irritative influence is felt, the nature of which is much like that which produces common continued fever. Of course, while these are the special signs of acute bronchitis, they are also, to some extent, the general signs of continued fever.

The treatment superadds to that which is proper for the simple disease, a measure of those more decidedly antifebrile means. which are adapted to ordinary cases of fever. As far, too, as the liver, the stomach, and other abdominal organs become implicated, they require attention in kind much the same as is demanded by continued fever. Epidemic bronchitis, however, is seldom a very grave disease. The prognosis is almost always favorable.

SECTION VI.

BRONCHITIS OF OLD PEOPLE.

The bronchitis of old people is only chronic bronchitis, in an asthenic form, in consequence of the diminution of vital influence on the part of those who are the subjects of it. It has received various designations. It has sometimes been called catarrhus senilis-the catarrh of old people; but the term catarrh, from Kara, "down," and pew, "I flow," ought to be limited, in its application, to inflammatory affections of the nares, fauces, &c., and not to be extended to those of the bronchi, from which the discharge is upward to the throat and mouth. Again, it has been called peripneumonia notha — bastard or spurious peripnuemonia. Peripneumonia is a compound word from Tεpi, about, and vεμv, a lung. Notha, from voda, signifies bastard or spurious. When the nosological classification of diseases prevailed, and their pathology was not much understood, the term was understood to signify a collection of symptoms much like the following:-difficulty of breathing, oppression at the chest, obscure pains, a cough, and an expectoration Of course, these symptoms might vary considerably in the degree of their severity, and yet be understood to characterize one disease.

The bronchitis of old people, properly so called, is usually attended with a considerable amount of mucous or muco-purulent discharge, and not unfrequently with passive congestion of the pulmonary blood vessels. When the inflammation mainly attacks the smaller tubes, it is said to stimulate pneumonitis; but the truth probably is, that, when there are symptoms decidedly like those of pueumonitis, the parenchyma of the lungs is not only congested, but measurably involved in inflammation, properly so called. This, of course, as vitality with the aged is more or less reduced, depresses the system and produces considerable constitutional disturbance. The aged, too, are very subject to a degree of emphysema; and when this complicates. bronchitis, it aggravates the symptoms. To crown all, the patient may take cold, and superadd new inflammation or acute

bronchitis to the chronic; and then, of necessity, the symptoms will be severe.

In some cases there takes place, in the bronchitis of old people, a kind of semi-fibrinous secretion, of the same nature as that which takes place in the trachea, and sometimes in the bronchi, in the bronchitis of children. It is somewhat like the hyaline secretion of inflamed serous membranes, but it is only imperfectly, if, indeed, it can be said to be at all, organized. Such a secretion blocks up the tubes, and prevents the passage of air to the air-cells. It, consequently, produces great dyspnoea, or even orthopnæa, and much general prostration of the system. When this secretion exists, it may be detected in the sputa.

The treatment, in this form of disease, is essentially like that in chronic bronchitis generally; but the asthenic condition of the patient requires that stimulating tonics, especially those of the vegetable kind, be, to a greater or less extent, combined with the emetics, expectorants, and diaphoretics employed. The polygala senega is a good remedy, as it combines expectorant with stimulating tonic properties. As a rapidly diffusible stimulant, too, the carbonate of ammonia is good, to sustain the vital powers. Sinipisms, or other external stimulants, will sometimes assist in allaying the inflammation and arousing a healthy action; and sometimes properly medicated vapors may be of service. In general, however, the compound sirup of lobelia and sanguinaria in connection with vegetable composition, spiced bitters, capsicum baccatum, &c.,—constitutional conditions being attended to—will be all that is necessary.

SECTION VII.

GENERAL REMARKS.

Bronchitis, either as an acute or as a chronic disease, is occasionally dependent on some peculiar diathesis, or the introduction of some specific virus into the system. Thus, a person of a scrofulous habit is, on that account, the more liable to have chronic inflammation of the bronchial, in connection with the same kind of inflammation of the superior portion of the respira