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to the particular form it assumed, confounded with common catarrh, with pneumonia, under the appellation of peripneumonia notha, and with other diseases of the lungs and air-passages, more especially tubercular consumption, dyspnoea, &c. Dr. YOUNG seems to have viewed it as a modification or extension of inflammation of the trachea, or even as synonymous with that disease, probably from their occasional complication, or succession to each other. J. P. FRANK appears to have been among the first who directed attention to the frequency and importance of inflammation of the bronchial surface. Cum vero,' he observes, 'profundius per tracheam penetrat, ac in bronchia descendit inflammatio; tunc in primo casu tracheitidis speciem, in altero peripneumoniæ imaginem refert, in qua ultima vix non constantem internorum bronchiorum phlogosin in centenis cadaveribus deteximus.' (Interp. Clin. p. 110.) 'Rectam habebis febrium catarrhalium saltem fortiorem ideam, si eas pro inflammatione bronchiorum, sive pro bronchitide consideres.' (De Cur. Hom. Morb. p. i. t. i. c. vi.). BROUSSAIS also noticed the frequency and importance of inflammation of the mucous surface of the bronchi (Hist. des Phlegemas. Chron. t. i. p. 75. Paris, 1800). But it is chiefly to the writings of BADHAM, BROUSSAIS, HASTINGS, LAENNEC, VIL. LERMÉ, ALCOCK, ANDRAL, and CHOMEL, that we are indebted for our knowledge of it as a specific disease.

2. Bronchitis commences variously, and assumes different forms and states, according to the intensity of the exciting causes, the severity of the attack, and the constitution of the patient. I shall consider it chiefly with reference to its activity and duration, to the states of vital energy and the age of the patient, to its forms and complications, and to its results. Its general prevalence, severity, and not infrequent fatality, require for it a more particular notice than it has received, even recently, from several systematic writers. This will appear somewhat singular, when I state that I know of no disease that is more frequent, or productive of a greater number of deaths, in children than it, in its different states and complications. BRONCHITIS assumes different grades of severity, and a modified type, according to the habit of body and vital energy of the patient, and the extent to which the inflammatory action advances along the bronchial tubes. It presents itself in practice, as a primary disease, in three forms: 1st, Common catarrhal bronchitis, in which only the mucous membrane of the large bronchi and trachea are affected by the specific and often infectious inflammatory irritation constituting catarrh: 2nd, Sthenic or true bronchitis, in which the inflammatory action is more acutely marked, is of a more phlogistic description, probably from its further extension along the bronchi, and from both the mucous and the submucous tissue of the tubes being affected; and, 3rd,

Asthenic bronchitis, where, owing to weak vital energy, the inflammatory irritation assumes a lower and more asthenic grade, and extends still more generally, or affects especially the minute. bronchi, interrupting their functions, and preventing those changes from taking place in the blood which are requisite to the support of the nervous and vital manifestations.

3. i. CATARRHAL OR MILD BRONCHITIS. This form of the disease has generally been termed Catarrhal Bronchitis (B. Catarrhalis); Mild Bronchitis (B. Mitis); Pulmonary Catarrh, Bronchial Catarrh, Catarrhal Fever; Bronchitis serosa, &c.-This is the most common form of the disease, and generally commences with coryza, or with slight hoarseness or sore throat, and other symptoms of catarrh extending down the larynx along the trachea to the large bronchi; the affection of the former parts generally subsiding as the latter become diseased. But it sometimes appears without any signs of irritation, either of the Schneiderian membrane, or of the tonsils or fauces, evidently originating in the trachea or large bronchi themselves, particularly in delicate persons, or in those disposed to coughs, pulmonary disease, and habitual expectoration.

4. A sense of roughness, with frequent attempts to clear the throat, is generally the first symptom of the disease. This is accompanied with, or followed by, titillation of the larynx, exciting a dry hard cough; hoarseness of voice, with a sense of

tightness across the chest, and sometimes slight pain or soreness upon coughing or breathing deeply. Accompanying these local symptoms, more or less constitutional disturbance is generally present. The patient complains of lassitude, pain in the limbs and back, slight shiverings or cold chills, quickness of pulse, and increased warmth, with dryness of the skin. The cough, which was at first dry, is now accompanied with a slight expectoration of a somewhat saline, glairy, and thin fluid; and as it rises towards the glottis, increases the cough, and renders the fits more frequent, probably owing to its irritating quality; in this resembling the secretion in coryza with which it. so often originates. In the slighter forms of the disease, the expectoration becomes in two, three, or four days thicker, more abundant and tenacious, less irritating and somewhat more opaque; and with this change the constriction, pain, and soreness are diminished, or very much relieved; the pulse also is less frequent; the skin cooler and more moist; the urine less scanty, paler, and deposits a sediment; and the cough less frequent, although often in longer paroxsyms. As the amendment advances, the sputum decreases in quantity, but is more opaque, tenacious, and deeper coloured, being frequently greenish-white. This amelioration is most remarkable at first in the morning, and, as convalescence proceeds, continues throughout the day. At last but little expectoration takes place, and is observed, as well

as the cough, only morning and evening. In slighter cases, the chilliness continues throughout, or alternates with some increase of heat and perspiration; the pulse is scarcely affected unless towards evening; the expectoration is neither abundant nor very viscid; the fits of cough not severe, and chiefly in the night and morning. Such are the usual symptoms and course of catarrhal bronchitis, constituting what is usually named a cold upon the chest. But it sometimes assumes other characters; and then pulmonary catarrh is no more applicable to it than to inflammation of the substance of the lungs, in which, also, it occasionally terminates.

5. This form of bronchitis appears to consist of catarrhal irritation extending to, or originating in, the mucous membrane of the trachea and large bronchi, to which it is chiefly limited, without materially affecting the sub-mucous tissue. It seems not to be actual inflammation, or, if inflammatory action be present, it is of a peculiar or specific kind, probably owing to its being seated in, or rather limited to, the mucous membrane; in which light it is viewed by HILDENBRAND, who very justly considers catarrhal irritation to be distinct from true inflammation. This variety may assume an epidemic form, when its symptoms become somewhat modified; and repeated or prolonged attacks of it often favour the development of tubercles in the lungs, or even originate them in scrofulous and delicate subjects. It may