LUNGS DISEASES OF THE LUNGS. 38' 



shortness of breath, and listen to his paroxysmal cough, we conclude that he is 

 probably suffering from chronic bronchitis. These are not infallible signs, but to the 

 practised eye they are replete with meaning. 



A patient's occupation or mode of life undoubtedly exert a marked influence in 

 determining the nature of the lung disease from which he will suffer. The clerk 

 spending his days in a dark, dull, ill-ventilated office, working in a constrained 

 attitude with his chest-walls fixed, falls a victim to consumption, whilst the bargee 

 or street hawker, exposed day after day to the inclemency of our climate, constantly 

 getting wet through, without the opportunity of changing his soaking garments, 

 contracts chronic bronchitis. Although the primary complaint made by both these 

 patients may be the same, it will be found on entering more fully into detail that 

 their cases are essentially different. Both, for instance, complain of cough. The 

 consumptive tells us that he has a nasty dry hacking cough that keeps him awake at 

 night, and this came on so gradually that he can hardly say when it began, but he 

 is positive he has had it for only a few months. The patient with winter cough tells 

 a very different story ; he has had his cough every winter for years ; it is an old 

 business with him he has been to eveiy doctor and hospital in London, and says he 

 does not expect to be cured, and all he wants is something to ease the cough and 

 stop the shortness of breath which makes him "wheeze like a broken-winded horse." 



In the early stage of consumption there is often little or no expectoration, but 

 the winter cough man on the contrary is always spitting up "a lot of phlegm," 

 "thick, yellow, nasty-looking stuff," " all black from the fog." The consumptive not 

 unfrequently spits blood, although this is not to be regarded as a constant symptom. 

 We have known cases in which the disease has run its course from first to last 

 without the appearance of a single drop of blood. In chronic bronchitis there is 

 never any real spitting of blood, although after a violent bout of coughing, such as 

 the patient often gets the first thing in the morning, there are not unfrequently 

 streaks of blood in the expectoration. This often alarms people very much, but 

 quite unnecessarily, for it is no indication of the existence of consumption, and 

 simply shows that the paroxysm of cough has been more violent or more prolonged 

 than usual. Many doctors make it a rule never to regard anything as spitting of 

 blood unless it amounts to a tea-spoonful at a time. There is often a little oozing 

 of blood from the gums, or perhaps from some trifling abrasion of the throat, and 

 to a superficial observer, or to a hypochondriac, this might readily be magnified 

 into an attack of blood-spitting. Hence the necessity, when any one tells 

 you that he has been spitting blood, of ascertaining the precise quantity that has 

 "been expectorated. Then, as to shortness of breath. This is usually a far more 

 prominent symptom in chronic bronchitis than in consumption. The consumptive 

 complains of weakness and debility, but is not conscious of any shortness of breath, 

 at all events in the early stages. In winter cough, on the other hand, shortness of 

 breath is always a prominent symptom, and is often so marked that the patient 

 cannot walk across the room without puffing and blowing, whilst getting up-stairs is 

 almost a morning's work. Loss of flesh occurs more frequently in consumption than 

 in other lung affections. In chronic bronchitis, it is true, there is usually some loss 

 of flesh in the winter, but the patient quickly regains it when the summer comes 



