Diseases of the Lungs and Organs of Respiration,

what extensive ruin do they yet spread! In commenting upon these, I shall, in a trifling degree, invert the prescribed order and arrangement. Into this group are concentrated pulmonick hemorrhage, pulmonary phthisis, the various species of hectick, atrophy and tabes, nervous, sciatick, dorsal, and icterick; also asthma, dyspnœa and cough, catarrh, hooping cough, croup. Inflammation of these organs and spurious peripneumony, have already been described. These, therefore, constitute nearly the whole combined pulmonick host, and likewise some of those diseases closely connected with the pneumonick machinery, or with several of its general morbid symptoms.

Behold here one of the great caravans of dead to the stygian ferry; and tottering myriads crowding to the same shambles. View the innumerable multitude of fable mourners and weeping relations attending them in the last melancholy offices of friendship, to that eternal bourn, the grave! Every introspection of general morbid registers, and the unanimous observations of the medical profession, concord in proclaiming the notoriety of the consumptive throng, and their ruinous uncontroulable domination. Notwithstanding the prodigious improvement in the alphabet, subordinate rudiments, and appendages of the medical science, consumption as yet is one of the great oligarchy of morbid and remorseless tyrants. He would be intitled to every terrestrial honour, and to posthumous apotheosis; he would rival and eclipse the most celebrated tyrannicides, and expurgators of monsters, whether demi-gods, heroes, or saints, who could dethrone or controul this stationary monopolizer of human sacrifices, and sheathe his deadly sword.

From one fifth to one sixth of all the mortality in London, is from consumption; which is nearly double to that even of small pox. But consumption is a term too lax and indefinite. Into this gulph, no doubt, are thrown many febrile and slow hectick emaciations, from infancy to old age, in both sexes; and there are few diseases from acute and chronic sources, especially in their fatal termination, without emaciation. Consumptions and dropsies are the final wreck of a great variety of human maladies. In no two other diseases are, what pathologists term Morbi a Morbis, more apparent: and in multitudes of such cases, morbid dissections often detect the effect, and not the original cause. How many of the genuine pulmonary phthisis are consociated with this miscellaneous crowd, is difficult to guess; but, from the concurrent testimony of physicians, and of experience, we may safely affirm a very large proportion. There are few families in this kingdom whom it has not, one time or other, plunged into tears. Physicians on the continent alledge, that phthisis is more prevalent in Britain than in any other kingdom of Europe.

The next inquiry is, in what age, sex, rank of life, season of the year, and whether in city or country is consumption most predominant? It has been, from the earliest chronology, the universal echo and monotony of medical writers, to mark the principal consumptive age between 18 and 35. But, with submission, I would considerably enlarge its limits, including from birth to 5, and from 20 to 60. No age or stage of life is exempted; but we might “a priori,” and from viewing the great and general scale of mortality, assert, that between 5 and 20, a considerable number cannot possibly be swept away in the phthisical torrent. Nor do we mean to invalidate the general aphorism, that in the blossom and full maturity of vigour and comeliness, phthisis is superlatively deleterious. Between the sexes no distinction seems to be made. I conceive, however, that amongst the lower orders universally, and more especially those penned up in the foul atmosphere of cities, that phthisis is more fatal than amongst those who browse in the pure air of the country. In accommodation, cloathing, noxious trades, &c. the indigent have the disadvantage; and during sickness, from the same causes, their recovery is more desperate. With respect to seasons, winter and autumn in our climate is the most pernicious to pulmonick maladies.

Pulmonary Hemorrhage,

hæmoptysis, sputum sanguinis. The lungs spungy pneumatick and hydraulick organs, in themselves passive; but by the contraction of the diaphragm and intercostal muscles enlarging the capacity of the thorax, this ventilator is alternately distended with atmospheric air, and this sonorous fluid again quickly expelled, with either some noxious emanation from the body, or decomposition of its own vital principle. Half the blood of the human body circulates thro’ this organ: its blood-vessels are numerous and large, and rise immediately from the heart; and it is incessantly in motion and agitation. When the body has nearly attained its ultimate extension and altitude, pulmonary hemorrhage is most predominant; more especially in those of narrow thorax, prominent scapulæ, red cheeks, and acute tone of voice. Before the hemorrhage, there are shivering, horror, heat, fever, weight, oppression, pain and heat in the breast, difficulty of breathing, titillation of the fauces, dry cough, exspuition of florid blood in various quantity, and slowly or suddenly, from ounces to many pounds, or even quarts, in a few days; but the latter is rare. It may soon totally cease, or only intermit, and again return at irregular intervals. Relapses are frequent on any irregularity or intemperance; on acceleration of the circulation, or expansion from heat.

This hemorrhage is very seldom in such quantities to prove precipitately fatal, unless mismanaged. From Bleeding, at least in the London registers, there is petty spoliation. Pulmonary hemorrhage is more frequently the consumptive precursor. Malign omens are an eruptive torrent; ulceration in the lungs; fever renewed; pain in the breast; difficulty of breathing; cough, hoarseness; night sweats; peripneumony; visceral obstructions; cachexy; old age; relapses. But pulmonary hemorrhage from temporary obstructions of the menses, or in pregnancy, or periodical, or without load in the thorax, or fever, are much less mischievous.

Pulmonary Phthisis.

Not one hundredth part of pulmonary consumptions commence with hemorrhage. Phthisical lineaments are emaciation, diurnal hectic fever, obstinate rebellious cough, difficulty of breathing, and usually some change in the voice. In the beginning, phthisis often resembles a catarrh, or stubborn cold; and in this insidious disguise is too frequently slighted, or neglected: but continuing longer than the usual catarrhal period, without any considerable intermission, and especially if in summer, are sufficient grounds of alarm. In that, from tubercles, there is frequent teazing dry cough, exasperated at night; some difficulty of breathing, and panting on ascending any eminence or stairs, or on exercise; some emaciation and weakness. By degrees, there is more or less expectoration of viscid, yellow, greenish purulence, intermixed, however, with natural mucus, and in the progress streaked with blood. Sooner or later, uneasiness in the breast, inability to lay on one side, pain in the side, or under the sternum, and aggravated by inspiration and coughing.

The consuming hectic fever has generally two exacerbations during the twenty-four hours, about noon and night; with some degree of chilliness and shivering, and increased sensibility to cool air, notwithstanding the skin is preternaturally hot; the palms of the hands and soles of the feet burn; a florid redness, or circumscribed spot is perceivable in the cheeks; the other features are partial sweats about the neck and breast, particularly in the morning; disturbed sleep; slender, hoarse, and obscure voice; quick pulse; sometimes vomiting after meals; thirst; salt taste in the mouth; cough and expectoration, in frequency and quantity, varying in different persons; in some, there is a very considerable discharge of purulency from the lungs. Various ordeals have been proposed for the distinction of mucus from pus, or pulmonick ulceration. Mucus is naturally more transparent, viscid, and cohesive: pus always opake, more yellow and greenish; the odour more disagreeable, and the expectoration accompanied with a hectick fever. The sinking or swimming in water of the expectorated matter, is a precarious symptom, as it depends on the quantity of entangled air.

In this island, phthisis, especially from tubercles not suppurated, may continue one, two, or more years; appearing during the winter and spring, and disappearing during the summer. Other consumptions are much more rapid; in the vernacular phrase, galloping the patient to a skeleton in a few months. Phthisical patients are rarely confined to bed, until near the deplorable stages and fatal termination. Some have even a tolerable appetite; and the generality are cheered with adulatory hopes of recovery to the last extremity. The progressive encroachment is evident, by increased debility, emaciation, and partial sweats; edematous ancles; diarrhœa; depilation; consumption and melting away of the fat and muscular flesh: at last sapless, and macerated into ghosts, the twinkling vital snuff is extinguished. It is, as yet, impossible for me to apportion the comparative mortality and recovery in real confirmed phthisis; nor could I depend upon any of the general registers which I carefully consulted with this view. We may, however, venture upon a gross estimate, by negative proof. Exclusive of individual evidence, and medical attestation, we might, by a simple algebraic process out of any specified number, with their mortal diseases, and probable proportion of sick in each, sift out the consumptive. At all events, it cannot possibly be thought exaggeration to alledge, that not one out of seven consumptive recover. From hereditary entail, or tubercles, it is still more desperate.

Species of Consumption

are, hectick fever, atrophy and tabes; nervous; icterick; dorsal. Hectick fever and atrophy is described as a very frequent and fatal disease of infants, especially in cities; accompanied with emaciation, often short dry cough, hot skin and palms of the hands; quick pulse, thirst, diurnal exacerbations, sickly countenance: in some the abdomen is tense, tumid, and considerably enlarged. In simple atrophy the fever is not so acute; with tumid belly, irregular fecal discharge; voraciousness, indigestion, thirst, nocturnal sweats, unhealthy countenance. Atrophy and nervous tabes are confounded in medical diagnosticks: in both there is emaciation; but no considerable fever, cough, or difficulty of breathing; impaired appetite and digestion; leucophlegmatic sickly appearance, partial sweats; general debility, and proneness to faint on any exertion. Sometimes atrophy is circumscribed to a particular part or member. The icterick tabes is accompanied with symptoms of jaundice; and probably, under several disguises, is more frequent than medical authors have represented.

Dorsal, or spermatick, is a particular tabes; miserable spectacles of which are recorded by the celebrated Tissot. Its symptoms are, emaciation, yet good appetite; pain and weakness in the back and loins; disturbed sleep, and frequently interrupted by nocturnal dreams and pollution, either with or without pleasure; weakness of the knees and trembling of the muscles on the least exercise; sometimes a sensation as of thorns pricking the skin, and descending down the spine; pale sickly countenance, livid circle under the eye-lids; the feces and urine excreted with some difficulty, and often either with semen or prostate liquor. By degrees, the appetite decays with indigestion, hypochondriasm, melancholy; pains in various parts, headach, lumbago, universal debility, wasting of the penis, impotency and blight of future progeny. Females are not exempt from this disease; but it is much more frequent amongst the male sex, from the age of puberty through various adult stages of life: the foundation of it is often laid at schools; and in those seminaries of vice, large cities: and in some countries it is a more general habit of licentiousness than in others.

Of the predisposing and occasional causes of pulmonary hemorrhage, pulmonary phthisis, hectick, atrophy and tabes. Of pulmonary hemorrhage; hereditary; narrow thorax; weak pulmonary blood vessels, small capacity; plethora; suppressed natural or habitual hemorrhage, as nasal, hemorrhoidal, menstrual; amputation of a considerable extremity; luxurious living and indolence; violent exertion and exercise of the lungs and voice in various trades and professions; also violent efforts to cough, to exonerate the excretories; parturition; lifting great weights; violent exercise; furious passions of mind: external injuries on the thorax; wounds; confining the thorax by writing-desks, by strong whalebone stays; suppressed perspiration and exhalation of the skin and lungs by cold; light atmosphere, especially on high mountains; pulmonick inflammation; scrophulous lymphatick glands and tubercles in the lungs, or calculous concretions; polypus concretions in the large pulmonary blood-vessels; schirrus and obstruction in the abdominal viscera.

The predisposing and occasional causes of pulmonary phthisis are all the preceding causes of pulmonick hemorrhage; hereditary; scrophulous tubercles; suppuration in the lungs, and not with laudable pus; calculi in the lungs; consequence of pulmonick inflammation and suppuration, of small pox, measles, hooping cough, rickets; and of various acute and chronic diseases; venereal, icterick; chlorosis; worms; rheumatism; chronic asthma; internal abscesses and ulcers; catarrh and neglected colds; sudden suppression of perspiration, especially when the body is heated; pulmonary exhalation suppressed, and cold damp air inspired; irregularity and coldness of the climate joined to moisture; various noxious trades and occupations; noxious fumes and effluvia inspired; foul atmosphere of cities, coal fires; broken ribs and blows on the thorax; indigence; cold habitations; want of sufficient cloathing and fuel in rigorous seasons.

The predisposing and occasional causes of hectic, atrophy and tabes, are many of the causes just now enumerated: scrophulous obstructed mesenterick glands, and course of the chyle; colds; damp habitations; foul atmosphere of cities; moist cloudy atmosphere; unwholesome air; coagulated milk in the stomach and intestines; foul stomach; diseased stomach and abdominal viscera; improper diet; gluttony, sloth, uncleanliness, bad nursing, insufficient exercise; worms; repelled cutaneous eruptions and ulcers; cachexy; intoxication and intemperance; depressing passions of mind, cares, and vexations; intense study; insufficient nutriment, poverty, and want of food; frequent vomiting of food; faults in the organs of digestion; digestive fluids defective or depraved; profuse evacuations, as hemorrhages, diarrhœa, diabetes, fluor albus, salivation, seminal emission; delicate women suckling; sweats; rupture of the thoracick duct; diseases of the spinal brain; weakness of the solidum vivum; general defect of fluids, or of oil in the cellular texture; fever and absorption of the subcutaneous oil; old age and contraction of the small vessels; broken constitution, from various causes; frequent manustupration; libidinous books, prints; consequence of venereal gleets, and improper treatment.

Asthma.

In the London bills, Asthma and Tissick are forced into a connubial link: formerly it was consumption and tissick, the Italian name for consumption, and without any mention of asthma. It would appear by the London registers, that about one fortieth part of the memento mori’s in church-yards is from asthma; and its proportion to consumptive mortality as 1 to 8. I have every reason to believe that the funeral catalogue in London is not, in any outrageous degree, preternaturally overcharged with consumption or asthma. As both these diseases are properly excluded from in-patients of our hospitals, I applied to one of the largest dispensaries in London, the Aldersgate; in which there is necessarily an overflow of both these distempers; and with the intention of confronting and irradiating the bills of mortality. Almost every page of these books presented Asthma in no inconsiderable number; and above all, Phthisis, phthisis, phthisis, towering with gigantic bulk.

There is, unfortunately, in medical books such an exuberance of postulata, that I endeavoured to ascertain from facts and numbers, the sex and age in which asthma is most predominant; and also its absolute mortality. For this purpose I extracted and winnowed out of all the patients in the Aldersgate Dispensary during seventeen years, from 1770 to 1788, all the cases of asthma and dyspnœa: the result is as follows. Out of 70,000 patients, asthma and dyspnœa were 3,192; or one twenty-third of all the diseases; of which there were of males, 1613; females, 1536: dead, 169; relieved, 575: discharged, 569: cured all the remainder. The sundry ages of these were,—From birth to 10 years, 36; from 10 to 20, 25; from 20 to 30, 161; from 30 to 40, 429; from 40 to 50, 882; from 50 to 60, 949; from 60 to 70, 596; from 70 to 80, and upwards, 114.

From the preceding valuable records, and which, in this instance, happen to chime with the gross of medical observations, we may draw the following inferences: That in infancy and adolescence there are very few cases of asthma and dyspnœa: that these diseases chiefly occur in middle age and the decline of life: that more than one half of them are reported as cured; the relieved and discharged forming a neutral list, numbers of whom were either surfeited with medicines, or were discharged by their physicians when despairing of a radical cure, or fearful of their swelling the dead catalogue: in sinking of which there is a universal rivalship throughout our dispensaries and hospitals. Some of them, probably, were palliated, vamped, and amended; and indeed many were aged, for whom it would be unreasonable to expect a radical cure. I conceive, that with a part of them we may venture to double the dead list; which would raise asthmatick mortality to one of ten. But in the above estimate, what proportion legitimate periodic asthma bears to the other anhelations I could not fathom.

The term Asthma has been misapplied to every species of dyspnœa: it strictly denotes a chronic periodic difficulty of breathing, recurring and exasperated in paroxisms; and, at least in the intervals, without fever. Authors have subdivided it into several species; the spasmodic, convulsive, and periodical; the dry, humid, continued, flatulent: and from the gradations of difficulty in respiration, dyspnœa, orthopnœa. The periodick and spasmodick is the true disease. Generally, the day preceding the paroxism there is fulness of the stomach, impaired appetite, flatulence, eructation, tightness, and stricture about the breast, and difficulty of respiration; sometimes dry cough; the diaphragm descends with difficulty in inspiration: these are all increased by wine, fires, bed, and heat: the head is stupid, heavy, with slight pain, drowsiness, languor, yawning, restlessness of spirits; profuse excretion of colourless urine.

Asthmatic paroxisms commonly invade suddenly, or are greatly aggravated during the night, with constriction in the breast, anhelation and struggling in breathing, so that all the muscles of the thorax and shoulders are roused into action to enlarge the capacity of the lungs: this difficulty is greatest in inspiration: the patient is compelled to sit erect, or recumbent in bed, panting for breath, cool air, and drink; and can with extreme difficulty cough, expectorate, or speak: the respiration is slow, laborious, wheezing, and sonorous; with painful propensity to cough: from the interrupted circulation of blood through the lungs, the face and eyes are turgid and livid, in some the face is pale and bloated; with headach, somnolency; palpitation of the heart; weak and intermittent pulse; internal burning heat, and often cold extremities; eructation and flatulence, sometimes vomiting; difficult and sonorous deglutition; sweats; limpid urine; restlessness, or disturbed sleep. Some lay easier on one side than on the other. Many are under the necessity to sit erect in a chair during several days and nights, gasping for breath, not daring to repose in bed. Should both lobes of the lungs be equally constricted, the compound offices of this pneumatick and hydraulick organ will be obstructed, with more threatening symptoms of suffocation and strangling. A loaded stomach, close chambers, fires, beds, wine, noxious smells, all aggravate the paroxism.

In the duration, recurrence, intermission, and remission, asthmatic paroxisms vary. A few hours, or a few days, are the usual limits of this pulmonick tumult. In the beginning it continues only a few hours, with a diurnal remission and nocturnal renovation: in the chronic state, from two to five days is the usual duration. As the paroxism mitigates, there is flatulent explosion upwards and downwards, often with fecal discharge, and expectoration of mucus. The intermissions are proportioned to the duration of the paroxisms: the longer the paroxisms the longer the intervals, and vice versa: with a copious expectoration they sooner terminate, and are less severe. Some have had as many paroxisms in winter as in summer; and in the country as in town. Floyer had sixty in winter and twenty in summer: the latter, as usual, were more violent, and longer. During calm frosty weather asthmaticks are most secure; but at all points of the compass the paroxism may invade. Some find more ease in the city than country; others, in low ground than mountainous. Some are never entirely liberated from dyspnœa, and with periodical aggravations. Few, comparatively, die immediately in the asthmatic paroxism: numbers survive many years, even to the goal of longevity, and, emaciation excepted, without considerable diminution of strength, spirits, or appetite. After long continuance, it seldom admits of a radical cure; but only alleviation and respite. Its fatal terminations are suffocation, apoplexy; pulmonick inflammation; consumption, cachexy, partial or general dropsy; polypi in the heart and the large vessels.

The predisposing and occasional causes are hereditary; original structure of the pneumonick organs; narrow thorax; plethora; suppression of habitual or natural evacuations, and cutaneous eruptions, as menses, piles, old ulcers, sweat of the feet; consequence of catarrh and colds, and sudden suppression of perspiration: serum, pituita in excess; cachexy; dregs of fever, small pox, measles, and pulmonick inflammation; pulmonick tubercles; spasmodic stricture of the diaphragm and bronchiæ; smoky rooms and houses, especially with wood fires; noxious mineral and metallic fumes, arsenical, nitrous, sulphureous, saturnine; smoky atmosphere of cities; pulverulent trades, as stonecutters, lapidaries, millers, flax-dressers, chimney-sweepers; fetid offensive smells; sudden changes of weather and winds from heavy to a light atmosphere, portending storms, and especially snow; easterly winds; fogs, with unsteadiness of weather and seasons; possibly some secret alterations in the electrick fluid, and affecting electrometers; warm and moist air; errors and intemperance in food and drink, and ingurgitation; violent motion and agitation of body and of mind; symptomatick in various diseases, as hystericks, hypochondriasm, gout, pectoral dropsy, empyema, polypi in the heart or aorta; wounds of the lungs; diseases of the liver and spleen.

Dyspnœa and Coughs

are symptoms of many diseases; and they are also primary, and very general maladies, especially in this island. It is true, we have here no compass to steer by: these are an exploded banditti; a sort of rebels to the symmetry of system, whose diagnosticks and therapeuticks are as yet slovenly and imperfectly noticed by medical authors. From the universal connection of the organs of respiration, their functions are more or less interrupted by and warped with other diseases and morbid symptoms. Many of the chronic impediments in breathing, and the broken-winded, may be called asthmatic excrescences, without its periodical paroxisms, exacerbations, and remissions; and without any rapid emaciation or hectick: they are spurious asthmas and chronic catarrhs. All the parts about the fauces and pharynx are crowded with mucous glands, from which, as in angina and catarrh, there is often a profuse secretion. Many persons advanced in life, and the aged, have a large discharge of mucus, variously, from the fauces, pharynx, larynx, lungs, stomach; all requiring frequent expectoration or hawking. The predisposing and occasional causes are many of those already enumerated under consumption and asthma. To these may be superadded cold pituitous temperament; air hot, cold, weighty, light, moist, impure, stagnant; changes and vicissitudes of the winds; cold moist climate and atmosphere, and especially in winter, autumn, and spring, and interchanges of the seasons; sudden vicissitudes, disorders and inconstancy of the surrounding elements; suppressed perspiration, and pulmonary exhalation; catarrhal defluxion on the lungs, larynx, fauces; mucus in excess, tenacious; faults in the mucus glands and ducts; trachea too sensible or irritable; calculi, chalky concretions, and inspissated mucus in the larynx; vascular or parenchymatous diseases of the lungs; original faults of the lungs, bronchiæ, larynx; wasted lungs; extravasated air; spasm of the respiratory muscles; flatulent farinaceous food, slimy food, and drink; weak or foul stomach, voraciousness; infants swallowing saliva; symptomatick in various diseases of the thorax, as consumption, asthma, empyema, polypus, aneurism, cum multis aliis: symptomatick in various diseases of the abdomen interrupting the play of the diaphragm; as full stomach, flatulence; pregnancy; dropsy; enlarged spleen or liver; tympany; nephritis; worms; injured abdominal muscles.

Catarrh,

colds, influenza, coryza, gravedo. In our irregular climate, during the annual revolution of the seasons, few escape slight catarrhs and colds, to which all ages are liable. That particular epidemick species of erratick catarrh, called Influenza, has sometimes spread suddenly over a kingdom, and some the greatest part of Europe. In no other epidemick do so few die in proportion to the number infected. Its continuance is generally short; and the little depredations committed during its itinerant incursions, are principally upon declining, consumptive, asthmatick, those of diseased lungs, worn out constitutions, and aged. In such forlorn complaints, catarrhal influenza has hastened the final dissolution sooner than it would otherwise have happened. In some, from neglect or irregularity, it has excited consumption, or pulmonick inflammation: in others, recovering from fevers, and convalescents of various descriptions, it has occasioned relapses. These observations are also applicable to simple catarrh skirmishing in less formidable inroads. Frequent relapses, from imprudence, in persons of phthisical or asthmatic constitutions, may expedite the inflammation of latent tubercles; or in aged persons subject to pituitous coughs, spurious peripneumony.

Catarrhal symptoms are increased secretion of mucus, from the membrane of the nose, fauces, and bronchiæ, with slight fever. It generally begins with some difficulty of breathing through the nose; dull pain and weight in the forehead; oppression in moving the eyes; distillation from the nose, sometimes from the eyes, of a thin fluid, often acrid, and exciting frequent sneezing; lassitude and languor of the body and spirits; sometimes shivering and heat, and increased sensibility to cold air; hoarseness, soreness of the trachea and fauces, with some difficulty of breathing, frequent cough and irritation at the glottis, at first dry; sometimes slight inflammation or angina, and pains resembling rheumatic about the neck and head. In some, the appetite is impaired, but not considerably; but in all the smell and taste. By degrees, the cough and sternutation are accompanied with a copious excretion of mucus, progressively incrassating, with less laborious efforts of coughing and hawking. Some catarrhs or colds, affect principally the membrane of the nose, and the different sinusses or cavities communicating with that emunctory; wherein stagnating mucus becomes more tenacious: others are lower situated in the fauces, pharynx, and trachea. Catarrh seldom continues beyond a few days, or weeks: that from contagion is more febrile and chronic. The predisposing and occasional causes are, cutaneous perspiration and pulmonary exhalation suddenly checked; cold moist atmosphere; sudden atmospheric changes; cold habitations and beds; wet feet; head or breast exposed or naked, thin ragged clothing; excessive effeminacy and warm rooms; epidemick state of the air.

Hooping Cough,

chincough, tussis convulsiva, epidemick, and contagious: is generally prevalent in infancy and adolescence, and but once in life: adults are rarely afflicted with it; and it is not confined to any particular season of the year. In the London registers, hooping cough and cough are confounded, and conjointly make no inconsiderable augmentation to the funerals. By the records of Dr. Armstrong in the dispensary of infant poor, of 732 cases of hooping cough, only 25 died; that is, about 3½ per cent. or 1 of 33. But this is too favourable a representation as a general scale of mortality. Its beginning resembles a slight catarrh continuing some days, or one, two, and three weeks before the formation and maturity of the convulsive paroxisms. These consist of many successive expiratory motions, so as to exhaust the lungs of air, succeeded by a full inspiration and pulmonick gulp, which rushing thro’ the glottis, makes a particular loud hooping sound. The duration of these pneumonick convulsive paroxisms, is from one to several minutes, in which the child’s face is turgid with blood, tears trickle down the cheeks, and it seems almost in the agony of suffocation and strangling. At the termination of each paroxism there is usually some mucus expectoration and excreation: this, at the beginning, is thin and not considerable; but by degrees increases in quantity and tenacity; and frequently at the same time, the contents of the stomach are evacuated. The pneumonick convulsions vary in their recurrence: they often return, frequently in the course of twenty-four hours, especially during the night: and thus may continue to persecute from one to three months, and sometimes a much longer space. Throughout, the senses are not injured; nor in the beginning the appetite; and in the intervals, children return to their amusements as if nothing had happened.

The younger the child there is more danger; as also in those born of phthisical or asthmatic parents, or in a state of debility, when seized with the hooping cough. When it begins in the form of catarrh, and is attended with fever, difficulty of breathing, and little expectoration, it may prove fatal in the early immature stages, unless the convulsive cough supervenes, and with copious expectoration. After some continuance of the disease, fever, with nocturnal exacerbation and difficult respiration, sometimes occur, and always with danger. Some fall down in the paroxisms; others have convulsions: violent paroxisms of coughing have excited epilepsy, apoplexy, or suffocation; but fever, dyspnœa, and pulmonic inflammation are to be most dreaded. With moderate expectoration the paroxisms are neither frequent nor violent: but expectoration in either extremes of scantiness or excess are both unpropitious, more especially with dyspnœa. Paroxisms terminated by vomiting, and succeeded by craving for food, are favourable omens; and recovery may be predicted by longer intervals from coughing, and shorter paroxisms; by restitution of natural appetite and respiration, of tranquil sleep, of fecal excretion, by evanescence of fever, and recruit of strength. The predisposing and occasional causes are, a certain epidemick state of the air or specifick contagion, the nature of which, and in truth of the disease beyond empirical observation, are as yet very imperfectly understood.

Croup,

suffocatio stridula. This disease has been particularly discriminated by modern authors. It is principally inimical to children, seldom until after ablactation; and never after the age of twelve, or of puberty at the utmost: it may attack the same child more than once: it is most frequent in winter and spring; and is not contagious nor general amongst the community. It commonly invades like a catarrh; and sometimes with its own permanent features, which are sudden paroxisms, as in spasmodic asthma, of laborious struggling respiration, and wheezing, as if the air-passage was straited; hoarseness, and shrill ringing sound, both in coughing and speaking, as if the voice came through a brass tube; cough, if any, dry, or with excreation of membranous fibres; thirst, quick pulse, anxiety, restlessness; and during the intervals, the senses and appetite are unimpaired: sometimes there is appearance, sometimes none, of inflammation in the fauces. It is always dangerous, infinitely more so than the preceding disease: death may suddenly ensue on the third, fourth, or fifth day, and perhaps when no such event was suspected: the impending hurricane may be prognosticated by laborious struggling in respiration, and symptoms of strangulation; with anxiety, restlessness, quick weak pulse.

The predisposing and occasional causes are yet the subject of litigation; whether inflammatory, or spasmodick, or a combination of both. On dissection, mucus accumulated has been found lining the larynx, by degrees incrassating, and interrupting the air from entering the lungs. We require same additional illumination on this subject.