powder may be employed. A dose may be given intermediate between the doses of the expectorant, or at the same time, at pleasure.

Dr. W. Beach recommends the following expectorant :-Sirup of squills, wine tincture of ipecac, and sirup of white poppy, employed in equal parts. Of this a dose is from one to two teaspoonfuls, repeated as required. This, however, is an agent far less valuable than the one above recommended. There is, in lobelia and sanguinaria, sufficient anti-spasmodic and sedative power, for the treatment of all ordinary cases. If, however, a decidedly narcotic article seems at any time desirable, the atropa belladonna is unquestionably the best article to be employed. It may be given in the form of an extract or a tincture. The dose of the extract is from one sixth to one twelfth of a grain for a child two years of age, to be given two or three times daily, and to be gradually increased, till a grain or more is given daily. Of the tincture, an equivalent quantity should be taken; but, being variously prepared, it differs materially in the degree of its strength. The dose may, therefore, vary from five to eight or ten drops. I prefer the extract; and I recommend dissolving a small quantity in the compound sirup, and so administering it, with that sirup, in doses of from a twelfth to a twentieth of a grain.

Gentle aperient medicines should be given, if necessary to regulate the bowels, and all the secretions should be kept in a good condition.

In the later period of the disease, the energies of the system having become somewhat reduced, it is sometimes desirable to combine some bitter tonic with the expectorant employed. In such cases, a fourth of a grain of quinine or half a grain of salicine may be united with the dose of the compound sirup, to be given several times a day. Or one or two drams of the decoction, or the infusion of hydrastis canadensis, populus tremuloides, cocculus palmatus, or some similar bitter tonic, may be given in connection with the compound sirup. I have, however, seldom found. any tonic necessary or desirable. If the proper expectorant, antispasmodic and anti-inflammatory treatment is sufficiently early and vigorously pursued, it will so far meliorate and shorten the disease, that the vital energies will not often be much impaired.

ure.

By some practitioners, the macrotys racemosa has been highly extolled, as a remedy for pertussis, suited to all periods of the disease. It possesses alterative, expectorant, nervine, and slightly tonic properties; and these cannot fail to render it serviceable. It may be given in the form of an infusion, a decoction, or a tinctThe saturated tincture is, for administration, the most convenient of these forms; and, of such a tincture, the dose is fifteen or twenty drops, every four or six hours, for a child of two years. The macrotine, however, which is the resinoid principle of the crude article, is decidedly the best preparation. Of this, to a child of two years, one fourth of a grain may be given every four

hours.

Counter irritants applied over the lungs, anteriorly, have been recommended; but they are seldom necessary, scarcely, if ever desirable. They have, also, been thought serviceable, when applied between the shoulders, over the spine, posteriorly. Their effect, in the latter position, is to stimulate the action of the nerves connected with the function of respiration. This may, sometimes, be favorable; but it is not so much an increase of respiratory power as an allaying of the spasmodic tendency, that is wanted. Accordingly, it is not so much a stimulant as an anti-spasmodic, which is required. Hence, a plaster made of the extract of belladonna, and applied between the shoulders, will alleviate the symptoms far more than any mere stimulating application. Indeed, a plaster of this kind is often decidedly beneficial.

[Dr. Gabbert speaks highly of the following compound for the cure for pertussis:-Molasses, and sweet oil equal parts, tincture of lobelia one fourth part. To be administered like the common expectorant sirup. C.]

CHAPTER III.

ASTHMA.

PATHOLOGY.-Asthma, in Greek ardua, literally signifies a gasp for breath, or a deep, heavy, laborious breathing. The term, however, by professional consent, is now limited to a disease which consists essentially in a spasmodic constriction of the bronchial

tubes, but is attended with great dyspnea, more or less paroxysmal, and a secretion of thick viscid mucus. From the nature of the case but little can be said of the pathology of the disease. It is strictly a neurosis. The evidences that the bronchial tubes are spasmodically constricted are sufficiently strong. In the first place, the apparent absence of an inflammation, or other appreciable lesion favors the belief that the difficulty must be nervous. Again, its paroxysmal character forbids the supposition of any marked or permanent change wrought in the structures, but clearly indicates something of the nature of spasm. Then, too, the patient has a sense of constriction in the chest, very similar to that of cramp in the limbs or other portions of the body; and, sometimes, the attack is actually accompanied by ordinary manifestations of cramp. Still further, the patient experiences the effects of nervous irritability,-such as great flatulence, and a urinary secretion like that produced by hysteria. The lodentia and the juvantia, too, indicate the same thing,-the attack being produced by almost any cause of irritation, even by mental suffering, and being relieved more or less, by all anti-spasmodic agents. And, finally, the beneficial effects of galvanism, which not only strengthens weak nerves, but relieves the irritable, corroborates the same view.

That the mucous membrane of the bronchi sometimes suffers inflammation, during the continuance of the disease, is unquestionably true; but this is to be regarded, rather as a complication of bronchitis with asthma, than as a part of the disease itself. The fact, too, that there is a copious mucous secretion, of itself only indicates an excretory office, the mucous follicles being irritated by the blood, which is in an abnormal condition.

Just how the action on the nervous system is produced, we do not yet sufficiently understand. Dr., Watson, with propriety, regards it as a "spasmodic disorder of the excito-motory system of nerves ;" and he thinks, that "the spasm may be of centric or of eccentric origin." That is, he thinks the impression may originate in the nervous centres, they responding, somehow but mysteriously, to certain feelings of the mind, and conveying their influence to the part affected, through efferent nerves; or the impression may originate without, be conveyed, by afferent nerves, to

nervous centres, and thence be reflected, as in the other case. When the spasm is of this latter character, or of eccentric origin, the proximate cause or immediate influence, I believe, is often, if not always, congestion of the pulmonary blood-vessels; the blood in these vessels being in an abnormal condition and exciting an abnormal nervous action.

As to the remote causes, if we divide them into predisposing and exciting, we may rank, among the former, a hereditary influence; as the disease often descends from parents to children, and is common to various branches of the family. Neglect, too, in any of the habits tending to promote health, though not sufficient of itself to develop the disease, yet may predispose to do it.

The exciting causes are extremely various; but, the most of them—perhaps not all are such as directly affect the nerves of respiration or the mucous membrane of the air-passages,-as, for instance, the inhalation of certain perfumes or deleterious gases, the respiration of air in a close room, and possibly those changes of the atmosphere which are shown by the thermometer, the barometer, and the hygrometer, and, indeed, almost any atmospherical change. Sometimes, a change from a country to a sea air, or vice versa; or from a higher and more airy part of the same town to a lower and more confined, or vice versa, will induce an asthmatic attack. With most persons of an asthmatic tendency, the dust of hay produces a ready effect; and, in some parts of England more especially than in this country, many asthmatics cannot pass a field in which hay is being made in the summer, without great suffering. By this influence a paroxysm will often be immediately developed in those who were entirely free from any apparent influence of the disease, before they approached the exciting cause. In some persons, too, the dust of the powder of Ipecacuanha will instantly and severely excite the affection. The suppression, however, of some normal drain to the system, as the catamenia in the female, or of a long-continued abnormal drain with either sex, as the discharge of an ulcer, by disordering the circulation and congesting the blood-vessels of the bronchi, will develop the disease. So, too, sometimes, will the arrest of a rheumatic or a neuralgic affection,-by a direct diversion of nervous influence. But the most common of all causes, probably, is ex

posure to cold, usually called taking cold. By this we are not necessarily to understand the development of any appreciable bronchitis; but the checking of the perspiration and the congestion of the bronchial blood-vessels, while the system is predisposed to asthma, will excite the nervous derangement.

The conditions, which, in the same individual, give rise to the disease, usually remain nearly the same; but, in different individuals, very unlike, and even the most opposite conditions will become the exciting cause. The idiosyncrasies in this disease are among the most striking to which the human system is subject; and, in the present state of physiological science, are altogether inexplicable. The opinion has quite extensively prevailed, that asthma is, in its nature, incompatible with phthisis. It is, however, quite certain that the former disease gives place to the latter; so that a person who has been asthmatic for years, at length dies of tubercular consumption.

DIAGNOSIS. The symptoms indicating asthma are various. Some of them are premonitory, and, by those who are accustomed to the affection, are understood as warnings of an approaching attack. Among these are loss of appetite, flatulence, eructation, languor, irritability, drowsiness, oppression, and chilliness. Perhaps, he retires at night with a sense of uncomfortableness.

It is very common for an attack actually to commence sometime after midnight, or about 2 or 3 o'clock in the morning, and the general signs are much like the following:-Often the person is aroused from sleep, by a feeling of constriction across his chest, or inability properly to expand it. He raises himself in bed, and sits bowing forward, perhaps with his elbows resting on his knees drawn up before him. His breathing is labored, and attended with a wheezing noise, often so loud as to be audible in another apartment or at a distance. He asks for more air to be admitted. into the room, and he makes a strong voluntary effort to expand his chest in inspiration and to contract it in expiration; or, if able, he rises from his bed, and hastens to a door or a window, which he opens, and at which, however cold the weather, he often long remains. The labor of respiration gives warmth to his body, and he often perspires freely. His extremities, however, are liable to