The symptoms of the rheumatic grade of chronic bronchitis differ from those just described mostly in the more severe paroxysmal character of the {175} cough, with either no expectoration or only a scanty quantity of a glairy, tenacious mucus; in the more soreness or dull pain in the intercostal muscles and attachments of the diaphragm; and in the more marked influence of sudden and severe meteorological changes. Perhaps the most marked and distressing cases of this variety of bronchitis are those we occasionally meet with in old persons whose joints, especially those of the extremities, have long been stiffened and sometimes enlarged from chronic rheumatism, and who are harassed and worn from a harsh, suffocative cough, the worst paroxysms of which are almost always during the latter part of the night and the early morning, accompanied by the expectoration of considerable quantities of a thick, viscid, and very tenacious mucus, which is dislodged with so much difficulty that in the midst of the more violent paroxysms of coughing the action of the stomach is reversed and its contents ejected by vomiting. This is very liable to happen just after breakfast, and to occasion the loss of the morning meal. The condition of these patients is very generally ameliorated during the warm months of summer, but on the whole they emaciate and grow more helpless from year to year, until they die either from exhaustion or the supervention of pulmonary sclerosis (fibroid phthisis), endocarditis, or chronic diarrhoea. There is one grade of rheumatic irritation which is liable to attack the fibrous texture of the smaller bronchi and to give rise to a very persistent form of asthma, which increases with every returning cold season of the year; but as asthma in all of its forms is treated in other parts of this work, I only allude to it in this connection. PATHOLOGY AND MORBID ANATOMY OF BRONCHITIS.--The special pathology of inflammation involving the mucous membrane and other structures of the bronchi does not differ from that of similar grades of inflammation in any other structures of the body. It consists essentially of an increase or disturbance of those properties of living organized matter which regulate the molecular movements constituting nutrition, disintegration, secretion, and cell-evolution to such a degree as to cause accumulation of blood in the capillaries, followed by exudation and increased cell-proliferation, which may organize into plastic material or pseudo-membrane or degenerate into pus, according to the coincident circumstances and condition of the patient.