140 
PATHOLOGY. 
tion, as we have before feen; and, when the inflammatory 
ftate has come on, an inflammation of the mucous mem¬ 
brane of the bronchia is no uncommon occurrence. In 
cafes where predifpofition to difeafe exifts, idiopathic dif¬ 
eafe.enfues; but more commonly a dependance on the 
original diforder is ftill remarked in ftru&ures fecondarily 
affe&ed. Affe£tions of more feverity, and which perhaps 
have their feat more immediately in the parenchyma of 
the lungs, are thofe which dyfpepfia gives rife to when 
implicated with difordered liver. The latter vifcus in¬ 
deed holds a very important relation with the pulmonary 
organs, whether in health or in difeafe. When we come 
to treat ofinflammation of the mucous membrane of the 
bronchiae, we Ihall fpeak more fully of the fympathetic 
a£tion of the mucous expanfion. Suffice it to fay at pre- 
fent, that communicated difeafe is frequently obfervable 
between the ffomach and lungs. Dr. Haftings, in his 
Treatife on Bronchitis, has very accurately delcribed the 
difeafe in queftion. It is diftinguilhed by the ufual figns 
of bronchitis (which fee) ; fuch as, tightnefs of the cheft, 
cough, copious expeftoration, &c. and the further pre¬ 
fence of various dyfpeptic fymptoms, as well as indireftly 
by the effect of remedies ufed in indigeftion. But often 
more fevere difturbances arife ; and the violence of the 
fymptoms approaches clofely to the charafteriftics of 
ftrudtural alteration. Indeed every one fees cafes appa¬ 
rently of phthifis which yield to the treatment for indi¬ 
geftion. For our own part, we wilh to confine the word 
phthifis to the apoftematous or tubercular kinds. Now, 
with regard to the former, we conceive nc one will aflert 
that it is curable by dyfpeptic treatment; and, with re- 
fpe£t to the latter, fcarcely a bolder prognofis will be 
given. It muft be conceded, however, that the latter form 
of difeafes may be thus cured. Mr. Abernethy has de- 
monftrated to a mathematical certainty, that the repara¬ 
tive procefles are beneficially influenced in thehigheft de¬ 
gree by the treatment in queftion ; and we have only to 
extend this eftablifhed propofition from the vifible exter¬ 
nal parts to the internal furfaces ; yet, in fo doing, we 
muft confider, that both the perpetual motion and the 
aerial ftimulation of the pulmonary organs, render repa¬ 
ration of ftrufture a moll difficult talk in them. More¬ 
over it is acknowledged that we have no pathognomonic 
lign of phthifis; that not even the vomiting of pus can 
render the exiftence of apoftema unequivocal, fince pus 
may be fecreted from the mucous membrane in certain 
ftates of inflammation ; and therefore we Ihall conclude, 
that ftomachic medicines can be ufed as direct agents only 
where neither apoftema nor tubercle exifts. We muft be 
careful, however, where ae fix the bounds between fym¬ 
pathetic and real difeafe. In the 43d, 44th, and 45th, 
ieftions of Morgagni’s 21ft Epiftle, we find the difeafe 
which he calls the pleuritis verminoja treated of at fome 
length. The author mentions one cafe, in which all the 
fymptoms of pleurify were well marked, that terminated 
favourably by bloody vomiting which brought up a worm; 
and he refers to a paper of Pedratto on the pleuritis vermi- 
nofa, where the relief obtained by the expulfion of worms 
from the ftomach and inteftines is unequivocally proved. 
In this paper it appears, that all who vomited the worms, 
or palfed them by the bowels, recovered; while thofe who 
retained them died. All the common means of treatment 
in inflammation of the lungs failed; medicines which 
deftroyed the worms were alone fuccefsful. While their 
expulfion immediately removed the difeafe, it is impoffi- 
ble for us to believe that organic alteration of the lungs 
had taken place; yet in thofe in whom the difeafe had 
been allowed to take its courfe, the fame appearances 
were found in the thoracic vifeera as in thofe who die of 
other forms of idiopathic difeafe. Analogous cafes are 
not unfrequently obferved at the prefent day. 
In regarding the connexion above mentioned, we often 
find that the difeafed action of the digeftive apparatus is 
caufed by the pulmonic irritation, and that the action fo 
induced keeps up and increafes the latter irritation. 
Thefe cafes are however rare, when compared with thofe 
in which dyfpepfia is firft manifefted ; and they are feldom 
found till difeafe has been of long continuance. It is 
generally preceded by fymptoms of indigeftion, and par¬ 
ticularly by thofe which indicate fome diforder in the fe- 
cretion of bile. Contrary to what is ufual in other fpe- 
cies of the difeafe, the fpirits from the beginning are 
generally more or lefs deprefled, and the countenance is 
fallow. 
While the firft ftage of indigeftion remains, and ner¬ 
vous irritation is the only caufe of the cough, the latter 
is ufually dry, or the patient brings up a little mucus 
after a fevere and often long-continued fit of coughing, 
which feems to be rather the eft'edl of the irritation of 
coughing than any thing which had previoufly exifted in 
the lungs; for the cough in this fpecies of confumption, 
particularly in its early Itages, frequently comes in violent 
fits, in the intervals of which the patient is often but 
little troubled with it. Thefe fits are particularly apt to 
occur after he has eaten, efpecially if he has eaten a great 
deal, or any thing by which the digeftion is difturbed : 
and on lying down. 
As the fecond ftage arifes, bronchitis is the moft ufual 
form of difeafe. The cough becomes more frequent, re¬ 
turns lefs decidedly by fits, and is attended with a more 
copious expectoration. 
An expectoration at firft limpid or glairy comes on. 
As the difeafe advances, this increafes, though fometimes 
for a confiderable time without puruloid characters. By 
degrees, however, we fee fmall portions of an opake pus¬ 
like fubftance mixed with the expectorated mucus, and 
the proportion of it increafes as the difeafe advances. In 
fome cafes the quantity expectorated is aftonifhing, often 
much greater, in proportion to the feverity of the other 
fymptoms, than in idiopathic bronchitis. 
Blood is not unfrequently mixed with the colourlefs 
matter, and fometimes pure blood is coughed up in the 
early ftage of the difeafe. After the pus-like expectora¬ 
tion commences, if blood has not previoufly appeared, it 
is much lefs apt to appear than in other forms of the dif¬ 
eafe. If it appear even in fmall quantity after this ftage 
commences, Dr. Philip fays that the cafe generally proves 
fatal. The above-mentioned author is likewife of opi¬ 
nion that, while the blood is mixed only with a tranfpa- 
rent fluid, there may be good hopes of recovery; or, if 
there be no admixture of blood, there may be alfo hopes 
of recovery, if the difeafe has not lafted long. But, when 
the expectorated matter affumes a fanious appearance, it 
feems to indicate much danger. In thefe cafes there is of 
courfe the dull pain and tendernefs in the epigaftric re¬ 
gion of the fecond ftage of dyfpepfia ; and in progrefs of 
time, an irregular heCtic is formed, differing, however, 
from the true tubercular heCtic ; for, though there is 
ufually fome evening exacerbation, during which the 
face is generally flufhed, and though the hands and face 
are occafionally bedewed with perfpiration in the night; 
thefe go off before morning. The emaciation too, though 
it becomes very perceptible, does not proceed fo rapidly 
as in tubercular phthifis. 
The latter circumltance feems to difplay itfelf in the 
fame proportion as the fever. Anorexia, flatus, tender¬ 
nefs over the liver, pain in the fhoulder, or other hepatic 
or dyfpeptic fymptoms, are invariably prefent; and, though 
they vary at different times, the patient is never free from 
fome of them. The connexion between them and the 
pulmonary fymptoms is rendered evident by the latter 
increafing with the former ; fo that, when the epigaftric 
region is very full and tender, and the flatulence and acid¬ 
ity more troublefome than ufual, the cough and dyfpncea 
are fo alfo; and, on the former fymptoms fubfiding, the 
latter likewife abate. Even the rifing of wind from the 
ftomach, often, for the time, removes the tendency to 
cough. 
If the progrefs of the diforder be not checked, the 
fymptoms approach ftill nearer to thofe of tubercular 
phthifis. 
