inflammatory cough from the very commencement. And thus it happens that the cough of incipient phthisis presents so many differences both in character and severity, the tubercular and inflammatory varieties alternating or intermixing with each other in every possible manner. But it is only when a cough, which seems to be tubercular, is associated with other phthisical indications, that it can be looked upon as any evidence of consumption; since other coughs of a comparatively trivial nature very closely resemble it. The gastric or stomach cough; the hysterical or nervous cough; the catarrhal cough; and the bronchial cough, are of this kind; and as they are the frequent occasion of unnecessary alarm, I propose giving a short account of their individual characters. Gastric or Stomach Cough, which may appear at any period of life, invariably proceeds from some irritation in the abdominal viscera. In children it is often brought on by over-feeding, or by intestinal worms; and, very frequently, it depends upon the irritable condition of the entire mucous membrane produced by teething. In adults it may arise from dyspepsia, hepatic derangements, or habitual constipation, and, indeed, from anything which deranges the digestive organs. Whatever its immediate cause may be, it has always the same character; being short," hacking", and unattended, or nearly so, by expectoration, and, in these respects, so closely resembles the cough of incipient phthisis, that, very often, the two are not distinguishable, except by close attention to other symptoms. The absence of hæmoptysis, of loss of weight, — of hereditary taint, etc.; and the predominance of abdominal derangement, with lowness of spirits, are amongst the first points which would lead to the suspicion of the cough being gastric; but should these signs be somewhat ambiguous, its progress, together with its speedy yielding to such simple remedial measures as would fail to have any effect upon a cough of tubercular origin, will generally serve to distinguish it. In children, the mere inspection of the gums,—an enquiry into the dietetic arrangements, or, the effect of a simple vermifuge, is all that is requisite to determine its nature. The nervous cough is likewise unrestricted to age or sex. Sometimes it is met with in persons who have associated with others suffering from coughsimply as the result of imitation,-in which case its character will depend upon that of the cough which has given rise to it; this is particularly observable in females and young children, but I have also seen it in medical men, and others, who have been attending upon the sick, and have even known it spread through an entire family, The purely nervous or hysterical cough, arising from nervous irritability, is pretty uniform in its character, being short, irregular, easily excited, more or less spasmodic and dry-or, at most, attended with a slight mucous secretion. It is not limited to the female sex, but is often seen in youths, especially at or about the period of puberty. The general debility and loss of health, with which it is sometimes associated, are the frequent occasion of anxiety. But the previous history of the case,the long unaltered character of the cough itself,— the excess of symptoms, manifestly of nervous origin, the usually anæmic aspect and timid mien of the patient, added to a careful physical examination of the chest,-will scarcely ever fail to indicate, at once, its real nature. Catarrhal Cough makes its appearance as the attendant of, or sequel to, ordinary catarrh, and proceeds from an irritable, rather than an inflammatory state of the upper part of the bronchial mucous membrane. At first it is short and dry, but is soon accompanied by slight mucous expectoration. In most persons it runs but a short course, and is little cared for; but in others it becomes more lasting and troublesome, and is kept up or renewed by the least imprudence or exposure to cold. In some such cases the spirits become depressed, the health gradually declines, the patient loses in weight, and nothing but a careful examination of the chest will show that he is not consumptive. It is, however, in its first or dry stage, that this cough is most liable to be mistaken for a symptom of phthisis; but the presence, or antecedence of catarrh, or feverishness, the absence of a phthisical history, added to physical examination of the thorax,-are generally sufficient to establish its more simple character. But as consumptive persons are very liable to catarrh, and to be affected with this kind of cough, it should never be disregarded when conjoined with the least phthisical indication, because, under such circumstances, it may, if at all severe or of long continuance, become, as already observed, the exciting cause of tubercular deposition. Bronchial Cough-which depends upon a subacute inflammatory state of the mucous surface of the larger bronchi-varies considerably in different cases, but is more severe and lasting than the preceding, and attended with a greater or less amount of mucous expectoration. Many persons are prone to it upon exposure to atmospheric changes, and seem, upon each recurrence, to have an increased susceptibility to its renewal. Sometimes it will subside in a few days, but occasionally it is disposed to become chronic and difficult to remove. repeated attacks it is apt to leave some structural change in the mucous membrane, which causes, for some time afterwards, an excessive secretion of bronchial mucus, producing habitual cough. What is popularly called the "morning cough", which is merely the effort by which the accumulated secretion of the night is expelled, commonly originates in this manner. After It occasionally happens that during the progress of the bronchial cough, the mucous membrane of the pharynx and adjacent parts of the respiratory passages, become congested, and a small quantity of blood escapes from its surface; this, getting mixed with the expectoration, causes considerable alarm, and may readily be mistaken for a phthisical symptom. I have seen several cases of this description; and have reason to believe that they constitute many of the "cures" of consumption so much talked about. Although the character and circumstances of this variety of cough will generally serve to distinguish it from a phthisical one, yet, for accurate diagnosis, a physical exploration of the chest is indispensable; and even with this, a too hasty conclusion should not be arrived at; for, it is to a cough of this description, that persons of consumptive predisposition seem particularly liable, and, indeed, have not unfrequent occasion to attribute the commencement of their tubercular disease. It is unnecessary to say anything of acute coughs, such as are met with in pneumonia, acute bronchitis, and pleurisy, as their association with the distinctive symptoms of these diseases renders it impossible that either of them should ever be mistaken for that of phthisis. Expectoration. The phthisical cough is, at first, what is termed "dry"; but, after a time, which varies very much in different cases, it is attended with |