iron, especially the sulphate with the compound galbanum pill, or the other preparations with myrrh, balsams, and the medicines already noticed, are chiefly indicated. These, aided by gentle aperients, conjoined with tonics, by a mild digestible diet and restoratives, by attention to the states of the urinary and intestinal excretions, and by residence in a dry, temperate, and pure air, are the chief means of alleviating this complication, which rarely admits of complete cure. treatment of other complications of chronic bronchitis will readily suggest itself from what I have already advanced.

The

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CHAP. VIII.

PRACTICAL REMARKS ON REMEDIES RECOMMENDED FOR ACUTE, SUB-ACUTE, AND CHRONIC BRONCHITIS.

104. IT cannot be overlooked, that the terms acute, sub-acute, and chronic, as well as sthenic and asthenic, active and passive, severe and mild, so generally and necessarily used in our descriptions of disease, are merely conventional; that sthenic and acute conditions of vital force and vascular action insensibly pass into asthenic and chronic, and that active and severe, silently lapse into mild or passive, according to vital and vascular states, and to diathesis and temperament, habit of body and age. These several conditions are manifested by disease, not only in different persons, but also by the same person in different periods of the malady. And, whilst these terms indicate merely the extreme degrees of the scale of vital force and vascular action, it should also be recollected, that the intermediate grades are more or less numerous, and that these, as well as the more extreme, require due recognition. Upon the ability, the acumen of the physician, to estimate these aright, an ability derived from close observation and experience, the safety of the

patient mainly depends. It is impossible for us to measure or to weigh these various and evervarying conditions otherwise than by the use of these terms, than which we have none more precise to employ; and although the observing and experienced physician, while duly appreciating these, is also guided by still nicer or more precise distinctions, and by numerous minute modifications and circumstances, which hardly admit of description, and which can only be acquired in the course of practice, yet those now enumerated should be used in such a way as will mark both grades and amounts, and with as much precision as possible.

105. A. Vascular depletion in acute bronchitis, as well as in various other diseases, has been almost altogether relinquished for more than thirty years. For many years previous to 1830, and more especially during the first quarter of the present century, blood-letting was remarkably abused, as to both its quantity and repetitions. I had numerous opportunities of observing this, as regarded the diseases of intertropical as well as of temperate countries. In the first Part of my "Dictionary of Practical Medicine," published in 1832, as well as in subsequent Parts, I endeavoured to combat this abuse, and to show that, whilst some cases, even of the same disease, owing to different grades and states of vital force, to diathesis, to habit of body and to endemic or epidemic influence, admitted of, and were benefited

by, general or local blood-letting, and other antiphlogistic remedies, other cases required very different or even quite opposite means of cure. Since then, medical practice has run on to the opposite extreme, until vascular depletions, almost in every disease, have been disused by those who ought to be able to judge as to the propriety of having recourse to them. That they have not been so generally tolerated during the last twentyfive or thirty years, or borne to nearly the same amount where they were required as before this period, are admitted facts, and that the same stationary constitution or influence still continues, cannot be controverted. But reprobation of vascular depletions has been carried too far, until the opinion of those who are incapable of forming an opinion respecting the practice, has become so strong in opposition to it, that many are prevented from having recourse to it, in any way or amount, where it is manifestly required; and cases are occasionally observed, in which, at an early stage, inordinate vascular action, excited vital force, or vascular congestion or oppletion, might have been relieved by a moderate, or even a small and cautious depletion, more especially when resulting from impeded or interrupted exhalation, secretion, and excretion, as so frequently observed in the early course of many diseases. Therefore, although it may be conceded that many persons were subjected to vascular depletions where none were required, and others experienced an unnecessary

repetition of the practice,—that blood-letting was often excessively prescribed, as to amount and repetition, during the first quarter of this century, -and admitting that the stationary constitution or influence of that period warranted the practice of large vascular depletions, and that diseases required a recourse to them, yet it does not follow that the present stationary or prevailing constitution should either preclude a cautious recourse to depletions, or prevent all diseases, or all cases of the same disease, from being benefited by them when judiciously prescribed. It ought not to be overlooked, that the causes of disease in most cases act upon the living economy by impeding or interrupting the functions of exhalation, secretion, and excretion; and that in proportion to the amount of such interruption will the vascular system be overloaded, congested, and the blood even contaminated, owing to the overloaded state of this system, and to the irritation caused by the blood-contamination, increased vascular action, or re-action, or congestion, results which a moderate blood-letting may be reasonably expected to relieve, and thereby to admit of more rapid and more certain effects from remedies internally and externally prescribed,— especially if judiciously selected and congruously combined. To decide when vascular depletion ought or ought not to be employed, and to determine what cases, or even - what stage of disease should or should not be depleted, is the duty of the physician; and he