PREFACE.

THE etiology and pathological semeiology of diseases of the chest having been thoroughly examined and elucidated by so many profound observers, it may seem proper to apologize for entertaining the subject anew, and, especially, for instituting an inquiry into a disease so common as bronchial catarrh, and which generally occurs in so mild a form, that there is a proneness to regard it as far simpler and better understood than almost any other affection.

Trusting, however, that a mere gleaner may be permitted in a field from which the rich harvest has already been gathered, the following observations are advanced, with the assurance that, had they possessed an interest barely scientific in its character, the time and attention of the reader would have been spared, and that they are only brought forward now because it is believed that they involve truths of immense importance in a practical and therapeutic point of view.

A knowledge, moreover, of fibrous bronchitis serves to explain several points in thoracic pathology, which hitherto, involved in much obscurity, have led to controversy between the best observers.

FIBROUS OR RHEUMATIC BRONCHITIS

AND

RHEUMATIC PNEUMONIA.1

THE leading object of this volume is to point out, as clearly as possible, the distinctive characters of fibrous or rheumatic inflammation of the bronchial tubes, and at the same time to show the differential diagnosis between it and ordinary catarrh; the word rheumatic has therefore been affixed to the term bronchitis, for the purpose of showing at the outset that it is intended to treat of a distinct affection, which, for want of proper anatomical accuracy as to its true seat, has been most singularly confounded with inflammation of the mucous membrane of the bronchi.

The next object is to show that there exists a form of pneumonia wihch is never idiopathic, but occurs as a

1 The reader has a right to know that this Dissertation comes before him under the cloud of being a rejected address, it having already been subjected to the consideration of the Committee of the American Medical Association on Voluntary Communications, for 1853. If, however, the author's observations, shall be verified by others, they must prove valuable to the profession, since they not only point out a disease never before described, and show the differential diagnosis between it and other affections with which it may be confounded, but serve, at the same time, to explain many minor points of pathology.

secondary lesion, and is always symptomatic of, and directly dependent on, pre-existing fibrous bronchitis. It is farther intended to point out the relations which the foregoing pathological conditions bear to general rheumatism and to rheumatic endocarditis, and to show that ordinary pneumonia, simple mucous catarrh, and fibrous bronchitis, with rheumatic pneumonia, often happen in the same lung as distinct, but still contemporaneous and concurrent, affections, and that where this is the case, therapeutic attention to the rheumatic element is often of vital importance to the safety of the patient.

According to the present arrangement, all medical writers admit the undisputed existence of three idiopathic or symptomatic affections of the lungs-pleuritis, pneumonia, and pulmonary catarrh or bronchitis. Now, the word pleuritis has direct reference to the anatomical seat of the inflammation. The term pneumonia is less expressive; for how comprehensive is the definition of this disease, "inflammatory engorgement of some portion of the pulmonary parenchyma." The word bronchitis, and its definition, "inflammation of the mucous membrane of the bronchial tubes," would be equally significant, and just as expressive as the foregoing, provided the air-tubes were composed of nothing but a mucous membrane; but every one knows that between this mucous membrane and the parenchyma of the lungs are the bronchial tubes proper, composed entirely, with the exception of some few muscular filaments, of fibrous tissue and cartilaginous rings.

It is of disease seated in this fibro-cartilaginous tissue, or the bronchial tubes proper, and not of inflammation of their investing mucous membrane, or ordinary catarrh, that this paper proposes to treat.

Not very many years ago, all forms of inflammation