flammation, and its follicular structure was very apparent.

The membrane lining the bronchiæ was highly vascular, but no disease existed in the lungs, heart, or abdominal viscera.

Remarks.

Every case of ulcerated pharynx, larynx, and trachea, which has fallen under my observation, has terminated fatally, and I feel myself incapable of suggesting any perfectly satisfactory or successful mode of treatment ; I suspect however that much time is lost in having recourse to constitutional remedies, instead of regarding it as a local affection.

The disease is extremely insidious in its approaches and progress, and will often commit extensive and irremediable ravages before its existence or nature can be ascertained.

From the frequent application of blisters along the larynx, trachea, and parts adjacent, some advantage will be derived; blood ought also to be often drawn from the same parts by means of leeches. I have never seen much benefit result from the inhalation of any vapour. In Birch's case, which was suspected to have a syphilitic origin, mercury was exhibited and the fumes of cinnabar inhaled. Where such a suspicion exists, no doubt can arise as to the propriety of this practice.

Query? Would it be advisable to make an opening into the trachea or larynx, and apply such substances to the ulcer as would have the effect of exciting a healthy action upon its surface? I have seen several ulcers upon the surface of the body, bearing a very strong resemblance to ulcers of the larynx, cured by one or two applications of nitrated silver.

That this is a hazardous operation, I am ready to admit, but perhaps the fatality of the disease fully justifies its being resorted to. Ample experience has shewn

that, if the disease be left to itself, or combated only by internal remedies, it will uniformly prove, sooner or later, fatal.

There are many chronic affections, which, to be conducted to a happy termination, require as prompt and active assistance as the most acute. Until professional

men arouse themselves from that apathy with which they too frequently contemplate danger at a distance, the practice of medicine will be unsatisfactory and inefficient, and many valuable lives will be sacrificed to their supineness.

GEORGE CARTER, aged forty years, on the 6th of December, 1813, from exposure to great heat in a sugarhouse, to which he was not accustomed, and afterwards going into the open air, was attacked with what seemed to be symptoms of pneumonia. These symptoms becoming daily more severe, he was compelled to relinquish his occupation, and on the 20th of the same month applied for relief.

Upon his admission, he laboured under the following symptoms:

Great pain in the chest, and about the scrobiculus cordis; dyspnea; an inability to lie on either side, or on the back; he could only remain in bed in an upright posture, or while resting his head upon his hands and knees, with the trunk bent forwards; he had a violent cough, and spat a quantity of mucus, of a purulent appearance; he passed but little urine, the pulse was extremely rapid and full, and his countenance indicative of effusion into the thorax.

Dec. 23. On the 21st and 22d he was bled, and from sixteen to twenty ounces of blood taken away at each operation; a blister was also applied to the chest ; purgatives administered; six drops of the tincture of digitalis taken three times a day, and a lohoc to relieve the cough. The blood exhibited no buffy appearance.

He found but little benefit from this treatment, the symptoms continued nearly as violent, and he was obliged to sit in a chair through the night, as in a recumbent posture he was threatened with suffocation; so laborious and difficult was his respiration. Pulse 130, but not so full; tongue white.

He was directed to take one grain of calomel and two grains of powdered squills at bedtime, and eight drops of the tincture of digitalis every eight hours.

Dec. 24th. Felt fatigued last night and desired to go to bed; he expired very shortly afterwards, and was found lying on his side.

Examination.

On opening the chest, the lungs with the other thoracic viscera, presented externally a most healthy appearance; the pleura costalis and pulmonalis had no inflammatory appearance; no adhesions were formed, nor was there any effusion into the cavity of the chest. The structure of the lungs, when examined by the hand felt natural.

The pericardium contained about an ounce of fluid of a red tint; no peculiarity existed either in the structure of the pericardium or heart. The liver, with the chylopoietic and other assistant chylopoietic viscera, presented every mark of health.

The symptoms which existed previous to dissolution making this appear remarkable, an investigation of the internal lining of the trachea, bronchiæ, and their ramifications was instituted. Their membrane was found to be inflamed to a high degree; a purulent secretion had

been the consequence of this inflammation, and the bronchiæ were filled with the fluid. Throughout all their ramifications which could be traced, the same appearances were met with.

That this pus was thrown out from the membrane of the Bronchiæ is evident, as there was not the slightest vestige of an abscess in the substance of the lungs.

Observations.

There is no disease to which the lungs are liable, more formidable in its appearance, or dangerous in its nature than bronchitis. To treat it successfully, we must attack it in its earliest stages with the lancet. We ought not to be satisfied with the abstraction of sixteen or twenty ounces of blood in the course of twenty-four hours; we must take away thirty, forty, fifty, or even more, if the patient be not relieved.

The patient whose case is above related, had laboured under the malady fourteen days before he applied for medical assistance; it was then fully formed; effusion into the bronchiæ had taken place. Venesection, or any other remedy could avail but little.

In addition to general depletion, a great number of leeches ought to be applied along the course of the trachea, but more particularly in the vicinity of its bifurcation. Blisters, an antiphlogistic regimen, &c. are indicated, but nothing is to be relied upon except the copious general, and local evacuation of blood.

The disease, in its latter stages, may be sometimes mistaken for hydrothorax, but the expectoration of purulent matter, together with the inflammatory diathesis, which, even in its latter stages prevails, constitutes a striking difference.

Delirium is frequently a symptom attendant upon bronchitis.

CHAPTER IX.

Hæmoptysis.

Genarum rubor; molestiæ aut doloris, et aliquando caloris, in pectore sensus; dyspnoea; titillatio faucium; tusis aut tussicula sanguineum floridum sæpe spu mosum rejiciens.-Cl. i. O. iv. G. xxxvii. CULLENI,

THE propriety of venesection in this disease has been disputed by some medical writers. I know of no other remedy upon which we can rely; of nothing which so effectually restrains the hemorrhage, lessens the force of the circulation, or prevents the disease from terminating in phthisis.

We are often reduced to the alternative of taking blood from the arm, or of allowing it to rush from the lungs. Which mode I would enquire is attended with the greater hazard and inconvenience to the patient?

After proper bleeding, digitalis may be sometimes advantageously exhibited; I must confess, however, that this medicine is not a favourite article with me. I have certainly seen it of service; but in my opinion the good which has been derived from it, bears no proportion to the mischief it has produced. Unless given in sufficient doses to produce its specific effects, it frequently increases the force of the pulse and the rapidity of the circulation; if administered in quantities large enough to bring the system under its influence, it will sometimes, in spite of all our vigilance, destroy life. I could instance many cases of its deleterious and even fatal effects; one or two shall suffice.

CASE XV.

A woman, twenty two years, of age, labouring under symptoms of acute pneumonia, and a supposed effusion into the cavity of the thorax, after a moderate bleeding, was directed to take half an ounce of the infusion of