266 PATHOLOGY* 
latter is very opprefiive. Some ex peroration is generally on immediately after the difappearance of any affe&ion 
prefent in the early ftage of this difeafe; and its ceflation, 
if the dyfpncea continue, is one of the word figns, as it 
(hows that there is not ftrength enough remaining to 
enable the patient to relieve the cheft from the matter 
which is poured out into the bronchia; it muft confe- 
quently accumulate, and at length entirely fill them and 
the air-cells. The {kin, lays Dr. Badham, is dr}', the 
tongue foul, and the urine high-coloured and fcarce ; 
the pulfe, however, varies in other refpefts, always hard, 
the neceffity of immediate venefeftion for the mod part 
obvious. Wheezing is not fo confiant an attendant on 
this as on the firlt variety. It is chiefly noticed towards 
the clofe of the difeafe. 
The ftage of excitement, if not met by appropriate re¬ 
medies, almoft invariably terminates in a corretponding 
finking.of all the powers of the fyftem : dyfpncea takes 
place; the lips become purple ; the pulfe finks, and is 
much increafed in frequency ; the heat of the furface is 
greatly diminifhed ; the {kin is generally damp, and the 
forehead and chin are bedewed with cold perfpiration. 
Expe&cration, from being copious, becomes fcanty, or 
altogether ceafes ; and the patient dies from the accu¬ 
mulation of the fecreted fluids in the air-cells. The vio¬ 
lence of the dyfpncea, and the tendency of this difeafe to 
terminate fatally as early as the fifth or fixth day, form 
its moll flriking features. 
When vigorous meafures are early employed, fo as to 
make an impreflion on the conftitution, thefe dangerous 
fymptoms occafionally give way. The dyfpncea abates; 
the conftriftion acrofs the cheft fubfides; the cough is 
relieved, being attended with a more copious and thicker 
expectoration, which affords much relief. The pulfe, 
the furface, and the tongue, become more natural, and 
by degrees the patient is free from prefent danger. The 
great debility which has been induced, however, necef- 
i'arily renders recovery very flow; and frequently a te¬ 
dious chronic difeafe enfues, which is charadterifed by a 
frequent and violent cough, and a very copious expec¬ 
toration of a pus-like matter. The pulfe is greatly 
quickened, the face is often flufhed, particularly towards 
evening, and in the night partial perfpirations break 
out. To thefe fymptoms is fometiines added extreme 
emaciation : indeed almoft all the fymptoms of a fuper- 
vening phthifis appear, and the death of the patient feems 
inevitable. 
The difcrimination of acute catarrhus from pneumo¬ 
nitis is difficult; and thefe difeafes cannot be always dif- 
tinguifhed from each other. The countenance is fre¬ 
quently pallid in catarrhus; it is not fo in pneumonitis. 
The dyfpncea and anxiety are more diftrefling in the for¬ 
mer difeafe than in the latter. Pain is feldom com¬ 
plained of in catarrhus, a diffufed forenefs of, or a pe- 
cuW&rJhaitnefs acrofs, the cheft being alone felt; whilft 
pain almoft conftantly attends pneumonia. When the 
expectoration commences, it is much more copious in 
inflammation of the bronchial membrane than in inflam¬ 
mation of the fubftance of the lungs or pleura. The 
wheezing noife which almoft conftantly attends fome of 
the varieties of inflammation of the bronchia is feldom 
heard in that of the lungs. There is fomething alfo pe¬ 
culiar in the refpiration in almoft every inftance of acute 
catarrhus ; it is hurried and anxious ; and, as Dr. Bad¬ 
ham obferves, the efforts of all the voluntary mufcles 
that can be called into adtion render the opprefled ftate 
of the lungs fufficiently evident. The anxiety of coun¬ 
tenance is much greater in catarrhus than in pneumoni¬ 
tis. The pulfe is alfo different in bronchial inflamma¬ 
tion ; it is frequent, but it wants the hardnefs and vibra¬ 
tion of the pleuritic pulfe. 
We may likewife be aided in forming our djagnofis 
by attending to the origin of the difeafe. If the pedto- 
ral attack fucceed to rubeola, it is more than probable 
that it is feated in the bronchial membrane. In the 
fame manner, if difficulty of breathing and cough come 
4 
of the fkin, there is good ground to fufpedt that the 
mucous membrane lining the air-paflages may be in a 
ftate of difeafed adtion. In variola, when much difficulty 
of breathing occurs,' it is probable that inflammation of 
the bronchial membrane may have taken place. In 
chronic ulceration of the trachea, when any fudden at¬ 
tacks of difficult breathing happen, and continue for 
fome time, it is likely that the more minute air-paffages 
are inflamed. 
The danger from acute catarrh is different in the dif¬ 
ferent varieties ; but it is true of both, that, when the 
breathing is not very difficult, the cough not fevere, the 
expedtoration copious and free, and affording relief, the 
pulfe regular and firm, and not very frequent or hard, 
and the ftrength not much reduced, the prognofis is not 
unfavourable. When the breathing is very high and la¬ 
borious, a degree of coma fupervenes, the nails become 
livid, and the voice is hoarfe and indiftindt: when the 
anxiety and fenfe of oppreflion are very great, and the 
pulfe weak, quick, and fluttering, the fatal event will 
almoft inevitably occur. There are few difeafes, how¬ 
ever, in which the prognofis is more uncertain than in 
the firft variety of bronchitis. Our chief dependence 
may be placed on the ftate of the expedtoration. When¬ 
ever the difeafe terminates favourably, the expedtoration 
is free and copious ; and, in proportion as the danger 
increafes, the lungs become more opprefled, the expedto- 
ration fcanty, and the debility great. 
When bronchitis attacks the ftrong and plethoric, the 
danger is feldom equivocal. No inflammatory affedtion 
of the pulmonary organs is more frequently fatal than 
this. There is much to dread, even if vigorous meafures 
be employed at an early period. The fenfe of conftridtion 
acrofs the cheft ; the hurried, anxious, and laborious, 
breathing; the cough without much expectoration, the 
dry and hot fkin, the foul tongue, the high-coloured 
urine, and the quick pulfe, indicate the feverity of the 
inflammation. The prognofis is more favourable if the 
breathing be relieved, and the cough be attended with a 
free expectoration. But it is much worfe if we obferve 
the fiighteft purple tinge on the cheeks, or if the expec¬ 
toration diminifli, and the breathing beeome more diffi¬ 
cult; or, finally, if the eyes be rather prominent, and 
the patient alternately reftlefs and lethargic. The cafe is 
altogether hopelefs when the pulfe becomes quite feeble 
and frequent; or when partial fweats break out, and the 
expectoration ceafes. In young children, the prognofis 
is more unfavourable than at any other age. 
Catarrhus arifing from cutaneous difeafes is more dan¬ 
gerous than that proceeding from cold. 
The following is a concife view of the means we have 
recourfe to for removing thefe inflammatory affedtions. 
To moderate the excitement of the fanguiferous fyftem, 
general blood-letting, and abltinence from all ftimulat- 
ing food. To promote expedtoration and perfpiration, 
antimonial and faline medicines. To direCt the fluids 
towards the furface, and relieve the congeftion of the 
debilitated capillaries, local blood-letting, blifters, and 
rubefacients. The above means are general and local. 
Of thofe which are general, blood-letting is by far the 
molt powerful for diminiftiing the excitement of the fyf¬ 
tem ; but it is not equally called for in all the varieties 
of bronchitis. In the firft variety, where the difeafe oc¬ 
curs in phlegmatic habits, venefedtion is generally proper; 
but, on account of the peculiar habit of body, blood¬ 
letting fliould be employed with caution ; for Sydenham 
obferves, (and all fucceeding writers have admitted the 
accuracy of his obfervation,) that patients of this de- 
fcription do not bear bleeding well. The abftradtion of 
ten ounces of blood from the arm early in the difeafe, 
fometimes mitigates the fymptoms ; after which it is ge¬ 
nerally more fafe to depend upon an attention to diet, 
proper expectorants, and local evacuations. The pecu¬ 
liar tendency to effufion often renders the treatment of 
