181 
PATHOLOGY. 
thofe caufes of cough which have their feat in the lungs. 
Accordingly, in the order Pneumonica we have fix ge¬ 
nera. 
Genus I. Be.v, [Greek.] Cough. Catarrhus, Cullen. 
Generic character—Sudden and violent expulfion of air 
from the lungs. There are three fpecies. 
i. Bex humida, or common cough, is too well known 
to require a particular defcription. There are four va¬ 
rieties. 
x. B. mucofa, ufually comes on with flight fluffing of 
the nofe, and fenle of fulnefs in the palate and contigu¬ 
ous parts; a flow of mucus follows, which unloads the 
fecreting veflels, and a fpontaneous cure occurs. Its na¬ 
ture is fo generally allowed to be the fameas Catarrhus, 
that to that genus we muft refer the reader for a full ac¬ 
count of the feverer forms. 
( 3 . B. anhelans. (Dyfpncea catarrhalis, Cull.) The 
chronic cough of old age. This alfo can be confidered 
in no other light than a confequence of previous inflam¬ 
mation of the mucous membrane, and hence it were 
perhaps better to treat of it under Catarrhus ; but, as 
its very prolonged ftage may be merely the refu It of in- 
creafed exhalation, we ftiall not difturb our nofologift’s 
arrangement. We take a defcription of it from the ex¬ 
cellent work of Dr. Haftings on Bronchitis. He fays, 
“The cough generally attacks the patient in the com¬ 
mencement of the cold weather, and fometimes conti¬ 
nues throughout the whole of the winter months. The 
mucous membrane is fo irritable, that the flighted change 
of temperature is fenfibly felt. The refpiration is always 
uneafy, and a peculiar wheezing of the breath is often 
prefent. The cough is molt violent in the morning, the 
patient never failing to cough fora confiderable time af¬ 
ter he awakes; and the fit feldom goes off till the air- 
cells are unloaded of the fecretions which have collected 
there during the night. Throughout the day the cough 
is often quiet for feveral hours together, and only comes 
on in confequence of increafed exertion, or when the 
ftomach is loaded with a hearty meal. The expectora¬ 
tion is copious, and ufually confifts of tenacious mucus 
mixed with a pus-like fluid. Sometimes, however, it is 
much lefs confident, and it is white and frothy. The 
patient has feldom any pain in the cheft, and if he have, 
it is flight and tranfient. Some fymptoms indicative of 
diforder in the digeftive organs are generally prefent. 
There is a fenle of weight in the epigaftric region, and 
the patient is frequently affeCled with pain in that part. 
The tongue is white and loaded, and the appetite fails. 
The pulfe is quicker than natural, though rarely hard. 
The urine is often high-coloured, and not feldom fcanty. 
The bowels are irregular. Such a combination of fymp¬ 
toms as that above ftated is common; but we fometimes 
meet with chronic bronchitis which has exifted for fome 
time without producing much conftitutional ailment. 
The patient is affe&ed with cough, copious expectora¬ 
tion, and uneafy refpiration ; but there is no fever, and 
the pulfe is not at all accelerated. Thefe fymptoms occa- 
fionally become the foundation of hydrothorax; but 
more commonly, as the warm weather comes on, the 
cough fubfides, and the patient’s health is reftored.” 
The chronic cough is however much modified, accor¬ 
ding to the degree of bronchial inflammation which pre¬ 
ceded it. When this has happened in an intenfe degree* 
we do not obferve, fays Dr. Haftings, the flow and gra¬ 
dual progrefs of the firft ftage, which is fo remarkable 
when this difeafe fupervenes under the forms of catarrh ; 
for the acute inflammation has previoufly reduced the pa¬ 
tient to the loweft ftate of debility, and the powers of 
life are funk. The refpiration is opprefled and laborious, 
the cough is frequent and haraffing, the pulfe rapid, and 
death is hourly expeCted. It however fometimes hap¬ 
pens, that the violence of thefe apparently-fatal fymp¬ 
toms is in fome meafure fubdued, and the patient gains 
fome ftrength,. fo as to be enabled to lit up for a ffiort 
time. The cough is mitigated, the refpiration is lefs 
laborious, and the wheezing is notfo perceptible. The 
expectoration, however, is increafed, though the matter 
expectorated is not of the fame nature throughout : 
fome part of it is tenacious, tranflucenf, and cannot be 
diffufed in water; other parts are opaque and purulent. 
Small quantities of blood are now alfo often intermixed 
with the fputa : the pulfe lofes its hardnefs, but becomes 
weaker and much quicker. We have generally com¬ 
bined with thefe unpromifing fymptoms increafed ema¬ 
ciation, and inability to make any mufcular exertion. 
Irregular fweats break out, and a flufliing of the cheeks 
occurs. 
In fome cafes, the untoward fymptoms do not proceed 
further; they gradually amend. The expectoration di¬ 
minishes, the cough is lefs haraffing, and the refpiration 
not fo uneafy. The patient begins to gather a little 
ftrength, and the appetite returns. A change of air and’ 
favourable feafons are particularly advantageous at this 
period, and by thefe means the patient frequently reco¬ 
vers his health, although months fometimes elapfe be¬ 
fore fuch progrefs is made as enables us to fpeak with any 
confidence as to ultimate recovery. But, if no fuch alte¬ 
ration in the charaCIer of the diforder take place, a 
greater degree of general debility occurs, with a further 
lofs of fleffi. The cough becomes extremely haraffing, 
the refpiration more quick and laborious. The expe&o- 
ration increafes, and is more purulent in its appearance. 
The pulfe is rapid. During the night general perfpira- 
tion breaks out, and the face in the day is often flulhed. 
The patient can ftill, for the molt part, take a deep in- 
fpiration without pain, and lying down does not produce 
much increafe ofdyfpnoea. He feldom complains of any 
ftiooting pain in the breaft. Even from this almoft hope- 
lefs ftate patients occafionally recover ; but, when the 
difeafe has exifted fo long as tocaufe extreme emaciation 
and very copious pus-like expectoration, there is little or 
no hope. It fometimes happens that dropfical fymptoms 
come on before death. 
In the treatment of this complaint, our firft endeavour 
ffiould be directed to moderating the force of the circula¬ 
tion, which is fometimes, though rarely, extraordinary; 
more frequently it will be merely neceflary to diminiffi 
local plethora by leeches; after this, the irritable ftate of 
the mucous membrane may be checked by blifters and 
rubefacients, or iffues, which may be fteadily perfevered 
in. It is a remarkable faCt, noticed by Dr. Haftings, 
that, during the ufe of thefe counter-irritants, purulent 
expectation is occafionally converted into the iecretion 
of natural mucus. 
Emetics have often been recommended in that variety 
of chronic bronchitis which appears in old people, and is 
denominated tuffis fenilis. The cough and dyfpncea are 
in fuch cafes much aggravated by the accumulation of 
redundant Iecretion in the trachea, bronchia, and air- 
cells, which* by the adtion of vomiting, is frequently 
thrown up. Whenever, therefore, the lungs appear 
loaded with phlegm to any great degree, they may be re¬ 
lieved by an emetic : but this pradfice does not appear 
to have much eft'edt in forwarding a radical cure. The 
tinCre of meadow-faffron (Colchicum) poflefles very 
remarkable powers in chronic cough. It allays the 
cough, promotes the flow of urine, and keeps up a regu¬ 
lar alvine difeharge. Moreover, from the power it pol- 
fefles over the fecretions, this medicine tends to relieve 
fever. The dofe generally preferibed is twenty drops 
three times a-day. In fomecafes this muft be diminiffied 
on account of its aftion on the bowels, fevere diarrhoea 
being occafionally brought on by its ufe. Sometimes 
the patient is not affefted by twenty drops : if this ffiould 
happen, the dofe may be gradually, increafed, until the 
bowels, the Ikin, or the kidneys, are a< 5 ted upon. Pa¬ 
tients rarely bear more than thirty drops three times a- 
day without being a good deal purged, which is not to 
be defired in prolonged cafes of this difeafe. If there be 
much. 
