ON THE ACTIONS AND USE OF CERTAIN 

 REMEDIES EMPLOYED IN BRONCHITIS 

 AND PHTHISIS.* 



* Kead before the Medical Society of London, December 19fcli, 1880. 

 (Reprinted from the Lancet^ January 1st, 1881, p. 4.) 



In both bronchitis and phthisis the first symptoms that attract 

 notice are cough and expectoration, and the first remedies that 

 claim our attention are the so-called sedatives and expectorants. 

 Cough consists in deep inspiration, closure of the glottis, and 

 violent expiratory effort, by which the glottis is forcibly opened 

 by the compressed air, which carries with it, in its exit, mucus 

 or other matters which may have lodged in the lungs* or respi- 

 ratory passages. The nervous centre for this act lies in the 

 medulla oblongata. It is bilateral, and situated on each side of 

 the central raphe. It is excited into action reflexly by irritation 

 of the respiratory branches of the vagus distributed to the 

 glosso-epiglottidean folds, to the whole interior of the larynx, 

 to the trachea, especially at its bifurcation, and to the bronchi, 

 and the substance of the lung itself, as well as the pleura when 

 it is inflamed. Irritation of the internal auditory meatus at 

 the point to which the auricular branch of the vagus is distri- 

 buted also causes coughing, and so also may irritation of the 

 liver and of the spleen. As coughing is a reflex act, excited by 

 irritation applied to a sensory nerve, and reacting through a 

 nerve centre upon the respiratory muscles, it is obvious that it 

 may be lessened, either by removing the source of irritation or 

 by diminishing the excitability of the nervous mechanism 

 through which it acts. Both methods are employed in medicine. 

 One of the commonest is that of lessening irritation by the use 

 of glutinous and saccharine substances. These have in them- 

 selves little or no action upon the nervous mechanism. They 

 do not pass down to the bronchi, or lung substance, so that they 

 can have no direct effect upon the mucous membrane there, nor 



