1363. With respect to the cases depending upon the first set of causes, I must repeat here what I said with respect to the like cases of syncope, that I do not know any means of curing them. They, indeed, admit of some palliation, first, by avoiding every circumstance that may hurry the circulation of the blood; and, secondly, by every means of avoiding a plethoric state of the system, or any occasional turgescence of the blood. In many of these cases, blood-letting may give a temporary relief: but, in so far as debility and mobility are concerned, in such cases this remedy is likely to do harm.

1364. With respect to the cases depending upon the other set of causes, they may be various, and require very different measures: but I can here say in general, that these cases may be considered as of two kinds; one depending upon primary affections in other parts of the body, and acting by the force of the particular causes; and another depending upon a state of mobility in the heart itself. In the first of these, it is obvious that the cure of the palpitation must be obtained by curing the primary affection; which is not to be treated of here. In the second, the cure must be obtained, partly by diligently avoiding the occasional causes, partly and chiefly by correcting the mobility of the system, and of the heart in particular; for doing which we have treated of the proper means elsewhere.

CHAP. V.

OF DYSPNOEA, OR DIFFICULT BREATHING.

1365. THE exercise of respiration, and the organs of it, have so constant and considerable connection with almost the whole of the other functions and parts of the human body, that upon almost every occasion of disease, respiration must be affected. Accordingly, some difficulty and disorder in this function are in fact symptoms very generally accompanying disease.

1366. Upon this account, the symptom of difficult breathing deserves a chief place, and an ample consideration in the general system of Patho logy; but what share of consideration it ought to have in a treatise of Practice, I find it difficult to determine.

1367. On this subject, it is, in the first place, necessary to distinguish between the symptomatic and idiopathic affections; that is, between those difficulties of breathing which are symptoms only of a more general affection, or of a disease subsisting primarily in other parts than the organs of respiration, and that difficulty of breathing which depends upon a primary affection of the lungs

themselves. The various cases of symptomatic dyspnoea I have taken pains to enumerate in my Methodical Nosology; and it will be obvious they are such as cannot be taken notice of here.

1368. In my Nosology I have also taken pains to point out and enumerate the proper, or at least the greater part of the proper idiopathic cases of dyspnea; but, from that enumeration, it will, I think, readily appear, that few, and indeed hardly any, of these cases, will admit or require much of our notice in this place.

1269. The Dyspnoea Sicca, species 2a; the Dyspnœca Aërea, sp. 34; the Dyspnoea Terrea, sp. 4th; and Dyspnoea Thoracica, sp. 7th, are some of them with difficulty known, and are all of them diseases which, in my opinion, do not admit of cure. All, therefore, that can be said concerning them here is, that they may admit of some palliation; and this, I think, is to be obtained chiefly by avoiding a plethoric state of the lungs, and every circumstance that may hurry respiration.

1370. Of the Dyspnoea Extrinseca, sp. 8th, I can say no more, but that those external causes marked in the Nosology, and perhaps some others that might have like effects, are to be carefully avoided; or, when they have been applied, and their effects have taken place, the disease is to be

palliated by the means mentioned in the last para graph.

1371. The other species, though enumerated as idiopathic, can hardly be considered as such, or as requiring to be treated of here.

The Dyspnoea Catarrhalis, sp. 1st, may be considered as a species of catarrh, and is pretty certainly to be cured by the same remedies as that species of catarrh which depends rather upon the increased afflux of mucus to the bronchiæ, than upon any inflammatory state in them.

The Dyspnoea Aquosa, sp. 5th, is certainly to be considered as a species of dropsy, and is to be treated by the same remedies as the other species of that disease.

The Dyspnoea Pinguedinosa sp. 6th, is in like manner to be considered as a symptom or local effect of the Polysarcia, and is only to be cured by correcting the general fault of the system.

1372. From this view of those idiopathic cases of dyspnoea, which are perhaps all I could properly arrange under this title, it will readily appear, that there is little room for treating of them here; but there is still one case of difficult breathing, which has been properly distinguished from every other under the title of Asthma; and, as it deserves our particular attention, I shall here sepa rately consider it.

CHAP. IV.

OF ASTHMA,

1373. THE term of Asthma has been commonly applied by the vulgar, and even by many writers on the Practice of Physic, to every case of difficult breathing, that is, to every species of Dyspnoea. The Methodical Nosologists, also, have distinguished Asthma from Dyspnoea chiefly, and almost solely, by the former being the same affection with the latter, but in a higher degree. Neither of these applications of the term seems to have been correct or proper. I am of opinion, that the term Asthma may be most properly applied, and should be confined to a case of difficult breathing that has peculiar symptoms, and depends upon a pe culiar proximate cause, which I hope to assign with sufficient certainty. It is this disease I am now to treat of, and it is nearly what Practical Writers have generally distinguished from the other cases of difficult breathing, by the title of Spasmodic Asthma, or of Asthma convulsivum; although, by not distinguishing it with sufficient accuracy from the other cases of Dyspnoea, they have introduced a great deal of confusion into their treatises on this subject.

VOL. II.