there exists a suspicion of a pneumonic or pleuritic tendency, or when the affection of the mucous membrane continues with unusual severity, a blister to the chest has appeared in many instances to be followed by considerable benefit. the In attempting to allay irritation, the object in every instance is to mitigate the violence of the cough, and thereby to obviate the additional injury inflicted by it upon inflamed parts. But not only do the means for allaying irritation accomplish this, but by allowing a larger quantity of secretion to accumulate in the bronchial tubes during the intervals of coughing, it is expectorated with greater facility when the cough is repeated. Accordingly the remedies for allaying irritation will necessarily vary with the period of the disease. At first, the irritation depends upon the highly inflamed state of the mucous membrane, and the presence of its acrimonious secretion. The best means, therefore, for allaying irritation at this period will be those already pointed out as calculated to subdue inflammatory action; besides which, we can do little more than add a little mucilage and syrup to our diaphoretic mixture, or substitute for it, a mild demulcent, to which may be added some form of anodyne. A common demulcent is the oily emulsion, which may be made with half an ounce of ol. olivæ, rendered miscible with about seven ounces of water by means of half a drachm of liq. potas. carb., and to which may be added a little syrup of tolu, and to each dose of two tablespoonsful about 20 minims of tincture of hyoscyamus or a drachm of syrup of poppies. Instead of this form of demulcent, the spermaceti mixture is occasionally given; but by far the most elegant as well as the most grateful demulcent is the mist. amygdala, to each dose of which may be added either of the above anodynes, with or without five or six grains of nitre. As soon as the febrile and inflammatory symptoms have been subdued, when the skin becomes moist and the heat moderate, and even from the beginning in mild cases, the more powerful anodynes prepared from opium may be given. The pulv. ipecac. comp. in doses of five or six grains night and morning will often answer the purpose exceedingly well. If, however, there exist any doubt about the propriety of this more powerful opiate, a very excellent substitute will be found in four or five grains of extr. hyoscyami or extr. conii, with half a grain or a grain of ipecacuanha, two or three times a day. In other cases, three or four grains of the extr. papav. given with the ipecacuanha; or a drachm of tinct. camph. comp. with each dose of the saline or demulcent mixture, will be found of much service. In short, in proportion as the febrile and inflammatory symptoms are mild, the stronger opiates may be exhibited with greater freedom. The reputed expectorants are rarely admissible or beneficial in acute catarrh; it is in the more chronic forms of bronchial inflammation that they are found of service. The use of Mudge's inhaler, when not distressing to the patient, has sometimes afforded relief, and appeared to promote expectoration. It is only in the most severe forms of catarrh, and particularly when there is a marked tendency to pneumonia or pleurisy, that in addition to general and local depletion the free use of mercury may become necessary; it is in such cases, too, that digitalis often proves a valuable medicine. After an attack of catarrh, great precaution is necessary to avoid a relapse or return of the complaint. patient, therefore, should be directed to wear flannel next The his skin, to preserve his feet warm and dry, to avoid damp and especially night air, to shun sudden vicissitudes, and perhaps defend the chest by the additional covering of a plaster or a prepared hare-skin. ACUTE BRONCHITIS. In bronchitis, which is the most frequent of all catarrhal affections, and that which presents the greatest variety, the inflammation from the commencement is seated chiefly or exclusively in the bronchi and their ramifications. The acute form of it may or may not be preceded by the usual premonitory symptoms of a febrile disorder, and is commonly first announced by a feeling of rawness, roughness, or tickling about the throat, which excites a slight cough with little or no expectoration. As the disease advances, febrile symptoms of reaction more or less severe supervene, the skin becoming hot, sometimes dry, at other times moist, the tongue white and furred, with thirst, high-coloured urine, a frequent, full, and perhaps strong, but seldom a hard pulse: the local feeling of irritation appears to extend down the trachea and bronchi, aggravating the cough, and producing hurry of respiration, wheezing, and a sense of constriction, heat, and soreness within the chest. The expectoration now becomes more copious, and consists at first of a thin transparent mucus mixed with saliva, and in some rare instances faintly tinged with blood. So long in general as the expectoration preserves the pituitous character, the febrile symptoms are liable to be severe and the cough very distressing, occasioning not only an aggravation of the internal soreness, but flying pains or stitches apparently affecting the parietes of the chest, together with weariness, and some times even great pain and tenderness felt in the muscles, and especially in the abdominal muscles, where they are attached to the ribs. During the fits of coughing, the patient's face appears flushed, his eyes injected or suffused with tears, and he experiences a fulness, giddiness, or splitting pain in the head, and especially in the forehead. Commonly in a very few days, the sputa change their character, becoming whitish, more consistent, and viscid, but variable in quantity, and often expectorated with considerable difficulty; the general symptoms and soreness of the chest, though perhaps somewhat mitigated, still continue severe; the dyspnoea and wheezing are often very great, with a livid or dingy paleness of the face, livor of the lips, and occasionally a suffused or watery aspect of the eyes, and a peculiar shining moisture beneath the eyes and about the forehead. When such acute cases terminate favourably, the cough gets less violent and is less frequently repeated; the expectorated matter changes its character, becoming thicker and more friable, assumes a greenish or yellowish colour, and is rejected with greater freedom and facility; the febrile symptoms subside, the oppression of the chest and hurry of respiration are relieved, and the patient is restored to health probably in a week or ten days, or in a period varying from this to four or six weeks. When, on the contrary, the disease proves fatal, the obstruction in the bronchial tubes becomes so great, and the respiration so impeded, that the patient experiences a most distressing sense of oppression and threatening suffocation, his face gets livid, his lips purple, the repeated efforts to breathe exhaust his strength, he can no longer cough up the bronchial secretion, it rattles in the tubes, the pulse sinks, becoming small, frequent, and feeble, the extremities get cold, clammy sweats break forth, and the patient dies;-death in some instances being preceded for some hours by a state of asphyxia. The description given, may be regarded as that which is applicable to the most exquisite form of a first attack of acute bronchitis. In practice, we meet with almost infinite variety, both as it regards the acuteness of the inflammation and the extent of the bronchial membrane which it happens to involve; we observe a corresponding diversity in the general symptoms and in the quantity, quality, and successive changes which take place in the expectorated mucus; and we have each individual case more or less modified by the age and constitution of the patient. In a large majority of the instances even of a first attack, the general symptoms are moderate, and the dyspnoea and oppression within the chest such as to excite little or no apprehension. In such cases the matter expectorated does not by any means always present the character and successive changes which have been described; in some it is scanty, in others copious; in some the early secretion appears to be less irritating than usual; in others a partial change only from the thin and transparent, or viscid and transparent, to the thick and yellow takes place, whilst it not unfrequently happens that the secretion entirely ceases as the inflammation subsides without any material change in its character having been observed. In some persons, and especially those of a cold, lax, and leucophlegmatic temperament, acute bronchitis gives rise to symptoms differing very considerably from those described. The disease probably commences in the usual way, but instead of the bronchial secretion passing through the ordinary changes, it permanently continues thin, trans |