NATURE. — CAUSATION. 519 



nomena, that these ought not to be regarded as the expression 

 of any one constantly existing structural change ; rather that 

 they are to be accepted, these phenomena, this so-called 

 asthma or broken- wind, as merely the ordinary expression of 

 conditions of a rather variable nature. It would appear to 

 be nearer the truth to view it merely as a symptom of several 

 diseased conditions, in all of which deficiency of contractile 

 power of the minute air-tubes and of the resilience of the 

 pulmonic structures is the one abiding condition. Simple 

 emphysema of lung-tissue may induce such a state ; dis- 

 turbed innervation, the result of gastric disturbance and 

 disease, may prove even a more fruitful source, and be capable 

 of explaining more. Still, I feel satisfied that the entire 

 assemblage of those symptoms we term broken-wind may 

 be met with, if not consequent on, certainly concomitant 

 with, various changes and alterations in pulmonic and bron- 

 chial tissue. I have encountered such in cases of chronic 

 bronchitis, with thickening of the lining membrane, and other 

 textural alterations of the bronchial tubes, this bronchitis 

 resulting from a previous attack of acute bronchial inflamma- 

 tion. Also where these changes were not consequent on an- 

 tecedent inflammatory action, but developed gradually and 

 of themselves, or were the sequel of a steadily continued 

 mechanical irritation. 



The same may be said of true pulmonary disease, of cardiac 

 changes, or of centric nervous disturbance. 



h. Causation. — While there appears little conformity even 

 amongst professional men as to the proximate cause of broken- 

 wind, there is, curiously enough, a wonderful concurrence of 

 oj^inion as to those conditions which, taken separately or to- 

 gether, seem to operate as more remote factors in the produc- 

 tion of those recognised phenomena characteristic of, or which 

 together constitute, the diseased condition. 



Of these may be noticed — 



1. Heredity. — It is generally admitted to be true that to this 

 abnormal condition is attached a certain amount of disposition 

 or capability of propagation from parent to progeny. Not that 

 those who support this idea suppose that the exact paralysis 

 of lung-tissue is received as an inheritance from parents, but 

 rather that, born with a certain bodily conformation or tem- 



