medicines are seldom of benefit in it, unless combined with opium. The balsams and terebinthinates; the sulphate of iron or zinc, with myrrh, or the compound galbanum pill; and either of these, with camphor or opium, are often of service. Although astringents and inhalations may be required, yet we should be cautious in using them when the disease has been of very long continuance, particularly in persons advanced in age, or when there is any irregularity of the action of the heart, or physical signs of obstructive or other organic change of this organ complicated with it; inasmuch as the arrest of an habitual discharge will, in such circumstances, risk the supervention of effusion in the cavities of the thorax. It will be more judicious in these cases to confide in preparations of iron, in the decoction of senega, or other suitable expectorants; in purgatives combined with bitter tonics; in diuretics, and in diaphoretics, so as to moderate the discharge, and to prevent its increase or its exhausting effects upon the system. At the same time the vital energies should be promoted by the preparations of iron or cinchona or quinine, or by tonics given with alkaline carbonates; by a light nutritious diet, moderate exercise, and change of air, with the sulphureous, chalybeate, and tonic mineral waters. In other cases, where the age of the patient, the regular or healthy state of the heart's action, the absence of leucophlegmasia, and the circumstances of the case altogether are such as to preclude dread of the consequences of sup

pressing this discharge, cold-sponging the surface of the body by the nitro-hydrochloric lotion, &c. and the liniments already noticed, with the internal use of more astringent tonics, particularly the sulphate of zinc or of quinine, in addition to the means already recommended, may also be prescribed.

iii. DILATATION OF THE BRONCHI (§ 68).

132. A. This alteration has been viewed as a consequence of, or an attendant upon, the more chronic cases of bronchitis, or of whooping-cough complicated with bronchitis. ROTIKANSKI has considered the dilatation to be caused by bronchitis of the terminal branches of the air-tubes, producing first obstruction of them and finally obliteration, dilatation following as a consequence. He takes into account the collapse of the air-cells of the portion of lung supplied by the obliterated capillary bronchi; and the space thus given to the bronchus by the collapsed and atrophied portion of lung, he believes to be the cause of dilatation. LAENNEC considered that the dilatation was the primary lesion and the condensation of the lungs parenchyma was consequent upon it. Dr. CORRIGAN, however, believes the disease to be analogous to scirrhus of the liver, and calls it therefore, scirrhus of the lungs. He supposes that the atrophy and obliteration of the pulmonary tissue is the primitive affection, and the dilatation a secondary result or consequence of this; arising not only from an

M

attempt to fill up the space

left vacant in the contracting lung, by the forcible expansion of the bronchi, during the act of inspiration, but also by the mechanical dragging apart of the walls of the tubes from the shrinking of the pulmonary tissue itself. Bronchial dilatation, when considerable, owing to the collapse and atrophy of large portions of the lungs which attend it, causes more or less obstruction of the circulation through the lungs, consecutive active dilatation of the right ventricle, congestion of the venous system, and cyanosis by interrupting the changes of the blood in the lungs. The permeable portions of this organ are excessively developed, and their action being increased, bronchial and pulmonary hæmorrhage sometimes supervenes. Bronchial dilatations when slight, or not very extensive, are not easily detected, and even when very great, they may be mistaken for tubercular cavities owing to the physical signs, to the emaciation, dyspnoea, cough, and expectoration attending them. The marked cachexia, the partial cyanosis, and lividity of the countenance, lips, and extremities, the distended state of the veins, anasarca, &c., often indicate more extreme dilatation. The state of the expectoration is also important, for besides being puriform and copious, it is often fœtid-a diagnostic symptom of this alteration, without which M. Louis, and other pathologists who have devoted much attention to pulmonary diseases, have sometimes failed of distinguishing it from phthisis.

133. B. The TREATMENT of this alteration is nearly the same as that which has been recommended in the more chronic states of bronchitis. The means which are especially indicated consist of the inhalation of balsamic and terebinthinate fumes; of those of creosote, chlorine, iodine, &c. (§ 111 et seq.); the internal use of balsams, tonics, and bitters, particularly the sulphates of quinine, or of zinc, or iron; and preparations of cinchona or steel; with the use of the liniments already noticed; or the nitro-hydrochloric acid lotion on the chest. The chlorate of potash, alkaline carbonates, tonic infusions or decoctions, the compound cascarilla mixture, &c., are indicated in this form of the disease. An open state of the bowels, an occasional cathartic, nutritious diet, and change of air, are also evidently required. In other respects, the treatment already detailed (§ 96 et seq.) may be followed; or modified according to the peculiarities of the case.

iv. ULCERATION OF THE BRONCHI (§§ 56, 57).

134. A. This is another alteration which is produced by, or is attendant on, the advanced stages of chronic bronchitis; most frequently, however, when complicated with tubercular phthisis. It is often met with, particularly after bronchitis occasioned by the mechanical irritation of mineral, vegetable, or animal molecules. The existence of ulceration, when seated in the bronchi, is not indicated by any sign in addition to those which

accompany the most chronic states of bronchitis, or tubercular disease, when it arises from, or is complicated with, this change. When affecting the LARYNX or TRACHEA, (see Part II.), it may frequently be suspected, or occasionally prognosticated. I have readily recognised it before death when occurring in the trachea; but have surmised it merely when existing near the bifurcation of the large bronchi, and then rather by the history of the case and the character of the expectoration than by any precise symptom or sign.

135. B. The TREATMENT of this lesion, even could its existence be ascertained during life, cannot be different from that required in some other states of chronic bronchitis. That ulceration may take place in the bronchi and heal, as evinced by the appearance of cicatrices, has been ascertained by LAENNEC and other pathologists. In addition to the means of cure already adduced, the establishment of local drains or derivatives of the most active kind is obviously required. Blisters and issues applied to a distant part have not been found of use by LAENNEC. When the latter are large and effective they may prove of more service. M. LAENNEC prefers the repeated application of small moxas, as near the seat of disease as possible, and the preservation of absolute rest and silence. The inhalation of anodyne, balsamic, and terebinthinate fumes may likewise be tried; and the terebinthinate embrocation be assiduously applied to different regions of the chest in suc