become cold, and his countenance is generally distressed, pale, and haggard, though sometimes it is rather flushed and turgid. Often the pulse is small, feeble, and irregular, though sometimes it is scarcely disturbed. Sometimes the heart palpitates, and flatulency becomes troublesome; the urine becomes copious and pale, and even the fæces are passed with the impatient hurry of spasmodic action. The speech of the sufferer is interrupted and difficult; and there is a propensity to cough which he sometimes favors, with the hope of forcing away the impediment to his breathing.

The disease, however, appears in different instances, with very different degrees of severity. Sometimes its influence is so slight, that the patient, by having his head pretty highly elevated, can sleep in bed without great inconvenience. The disturbing effect may even be less than this. He sleeps in the ordinary position, but is occasionally awakened; or, if not awakened, he has unwelcome dreams, in consequence of oppression at the chest and inconvenience in respiration.

The physical signs are mostly of a negative character. The sibilant rale, however, is commonly well developed, both in inspiration and in expiration; and it has the peculiarity of being a more protracted sound than is heard in any other disease. Frequently, instead of this rale, or in combination with it, we hear what may be called a wheezing sound, and may be described as a course and rough whistling, or a sound somewhat related to the sonorous rale. It is made in the larger aud the medium-sized tubes, by means of their continuation and the modification of their form and size arising from the presence of thick stringy mucus. Asthma may be complicated with bronchitis, and then we may have some of the other rales, and some of the diseased sounds of respiration; but the sibilant rale, and a modification of it, in a prolonged sound, are all that strictly characterize asthma itself, except at the period when a paroxysm is leaving. When a copious quantity of mucus is detached and about to be expectorated, its presence in the larger bronchi creates the mucous rale.

A paroxysm of asthma, usually commencing, as I have said, in the night, very commonly passes entirely away with the

approach of morning light, or early in the forenoon. It, however, is very liable to return, each succeeding night, and annoy the sufferer nightly, for a considerable time; after which it may disappear for several weeks or even months. With some persons who are subject to severe attacks, it will, on being by any cause induced, last for several days, and, at length, will either gradually decline, or be suddenly relieved by a free discharge of glairy mucus, very commonly in connection with vomiting, and a copious perspiration, and sometimes being attended with abnormal urinary and fæcal secretions. In some cases, the discharge of mucus is much greater than in others. When it is somewhat copious, the asthma is frequently characterized as humid, but, when the discharge is scanty, the disease is called dry asthma. This distinction, however, is not important. I will only add to this description of the manner in which the disease manifests itself, that, while in its mildest forms it is but little regarded, it sometimes is so severe as to alarm both the patient and the attendants. Indeed, suffocation seems almost unavoidable. One person whom I have several times treated, in the severity of a paroxysm, has found respiration, for hours and even for two or more days, when unable to procure the proper treatment, so exceedingly difficult, that it seemed to him, to use his own language, "as though every breath must be the last." His nervous system, too, would be so generally involved, that he could scarcely endure the slightest whisper in the room, or the lightest tread on the floor.

There are other diseases which create a dyspnoea somewhat resembling that of asthma. Among these are emphysema, bronchitis, tubercles, and such tumors as press upon the trachea or the larger bronchial tubes; also, certain diseases of the heart, an aneurism of the aorta, and the nervous affection, called angina pectoris. Each of these diseases, however, has its peculiarities; and no one of them has all the symptoms characterizing asthma. The paroxysmal character, the wheezing, and the prolongation of the sibilant rale, especially, all differ, in a marked degree, from what is witnessed in any other disease.

Asthma is common to both sexes, but is experienced by men more frequently than by women. It is regarded as belonging more to the middle portion of a person's life than to the extremes

of youth and old age. In the latter extreme, I presume, it seldom begins. As far, however, as my own observation has gone, those who have been subject to attacks of it in middle age have pretty generally retained the liability, as they have advanced in life. It occasionally, too, shows itself in youth and even in the young. I once knew it to appear, in its marked form, in a female child aged but four years.

The prognosis in asthma, is, in a sense, almost always favorable; that is, the disease, not only does not prove fatal in itself, but its paroxysms are generally removed in a short time. It is far more annoying than it is really dangerous.

TREATMENT.-In delineating the treatment suited to the relief of asthma, I would premise, that occasionally the disease is arrested. After afflicting a person paroxysmally for years, it makes its final exit unbidden. In such a case, there is, of course, a cause, although it is unassignable.

But when means, designed or undesigned, are used, sometimes those apparently the most trifling in their nature will prove effective; at least, for a season, as, for instance, an apparently insignificant impression made directly on some portion of the nervous system, or even only indirectly through the influence of the imagination. Sometimes a slight change of residence or of atmospheric influence, will issue in speedy relief to the sufferer.

Hygienic means may also accomplish something in the way of removing or of warding off the disease. Hence, the adoption of a more wholesome kind of food, the use of demulcent and alkaline drinks, bathing under proper circumstances, and other attentions to the surface, will serve as a protection to the system.

Among the more strictly medicinal agents employed to relieve paroxysms of asthma, we may reckon opium, hyoscyamus, stramonium, digitalis, and other narcotics. These, however, taken by the stomach, seldom have much efficacy. Stramonium, tobacco, green tea, and other narcotics and anti-spasmodics have been smoked sometimes with decided advantage; that is, the smoke from these articles burning, being drawn into and diffused through the bronchial tubes, sometimes, by its local effect, relaxes the spasm. So, too, in some instances, will the vapor of camphor

inhaled, by the patient's breathing through a quill which contains a small quantity of the gum. The camphor slowly volatilizes, and thereby comes in direct contact with the lungs. The inhalation of the smoke of dried paper, after having been saturated with nitrate of potassa water in many cases will give relief.

Sometimes the nauseants combined with diaphoretics, have some favorable effect, as the sirup of squills in connection with senega. Even ipecacuanha, the dust of which will induce an attack with some persons, has occasionally afforded partial relief.

Sometimes stimulants, as sulphuric ether, or alcoholic stimulants, especially brandy, and various vegetable stimulants, by giving a more vigorous and healthy action to the nerves, afford some temporary relief. For a like reason, irritants, applied between the shoulders posteriorly, so as to stimulate the spine, often have a favorable effect. Warm water applied to the feet, the spine or the chest will sometimes relieve, by removing congestion, and relaxing the nervous system.

But of all remedies now known none is so efficacious in affording speedy relief, as a preparation of lobelia inflata. It is an anti-spasmodic and a nervine. In other words, it subdues the spasm and strengthens the nerves. I prefer, however, to combine. it, in equal proportion, with another simple nervine; and I use either the cypripedium pubescens, or the scutellaria lateriflora. Take of either of the latter nervines one part and of lobelia one part, and make a wine tincture with Sicily Madeira, or other pure wine. The dose is one fluid dram, which may be repeated in severe cases, at intervals of fifteen or thirty minutes, till it produces vomiting. In milder cases, the same dose may be given, once in from two to four hours. It then quiets the It then quiets the spasm without emesis. If, in union with this, the patient takes also spirits of turpentine, in doses of from fifteen to thirty drops once in four hours, perhaps the remedy will relieve a spasm as quickly and as completely as any agent now known. Lobelia may also be applied over the chest anteriorly, or over the spine behind the chest with a good effect. So, too, may the spirits of turpentine, used alone, or united with lobelia tincture, acetic acid, essential oil of lemons, or suspended in the yolk of an egg.

But among all the agents worthy of a local application, none,

I believe, is more effective than electricity or galvanism. The best method of applying this, ordinarily, is by the use of plates of copper and zinc, so united and adjusted that the perspiration of the body shall sustain the galvanic action of the plates. A common battery, however, may be employed, the positive and the negative buttons being placed, one over the last cervical or the first dorsal vertebra pósteriorly, and the other anteriorly over the sternum and near the ensiform cartilage.

The means thus far named are principally employed to palliate or relieve a paroxysm; though some of them may, with propriety, be employed to keep in subjection the tendency to attacks. Other remedies have been recommended, to be regularly or occasionally employed to subdue the asthmatic propensity. Among these none has a greater reputation, or has been more effective, probably, than the seed of the sinapis alba, called the white or English mustard. This should be taken unground, in doses of a full teaspoonful or more in connection with each meal.

In the severe case to which I have already referred, the paroxysm would always be greatly palliated by the use of the tincture of lobelia and cypripedium. Still, they would return; and the propensity to the attacks seemed scarcely lessened by any agent employed, till the patient resorted to the use of the white mustard, in doses as above directed. Since commencing the use of this remedy, now more than a year, he has been almost entirely exempt from asthmatic attacks.

CHAPTER IV.

MORBID CHANGES IN THE BRONCHI.

PATHOLOGY.-There are two classes of lesions to which the bronchi are subject, and which uniformly result from pertussis or some form of bronchitis. They are dilatation and contraction. Though they are so different from each other, and, in some respects, opposed, yet they have also points of intimate relation, and I choose, therefore, to consider them in connection. The former is, by far, the more frequent lesion, and is worthy of more careful consideration. It is produced by the violence of