64 PRACTICE OF MEDICINE. 



efforts of coughing, and unable to escape. These bronchial dilata- 

 tions, it is to be noticed, may present the auscultatory signs of tuber- 

 cular cavities. 



Sometimes the expectoration is excessively profuse, but clear ; 

 coming up once or twice in the day to the extent of many ounces. 

 Such cases are called intuitous catarrh by the French. 



Treatraent. — Occasional leechings or cuppings to obviate conges- 

 tion : blisters and other counter-irritants ; mild, nutritious, unstimu- 

 lating diet ; change of air ; tonics, such as sulphate of zinc, with 

 small doses of pill scillse comp. and opiates, to allay the cough, are 

 amongst the chief remedies for younger patients. 



For older habitual cases, and especially if the expectoration is 

 profuse, the stimulating expectorants, especially tinct. benzoes c, 

 bals. copaibse, senega, &c. are indicated ; inhalation of tar vapour 

 also is useful. 



SPASMODIC ASTHMA. 



Asthma is caused by a spasm of the muscular fibres encircling 

 the bronchial tubes, and especially the smaller ones. 



The existence of these muscular fibres was proved by Reisseissen, 

 and has been confirmed by Dr. Williams and others, who have pro- 

 duced contraction of them by galvanism. 



The exciting causes of the purely spasmodic variety of asthma 

 are those which impress the nervous system, as strong or peculiar 

 odours, mental emotions, and particular states of the atmosphere, 

 and especially, irritation of the stomach and bowels. 



The precursory symptoms of asthma are, languor, sickness, 

 flatulency, and other dyspeptic symptoms ; heaviness over the eyes, 

 and headache ; uneasiness and anxiety about the prsecordia, with a 

 sense of fulness and straitness in this region and in the epigastrium. 

 In some cases, pain is complained of in the neck, with unusual drow- 

 siness and stupor> 



Symptoms. — The attack of spasmodic asthma takes place gene- 

 rally about one or two in the morning, and during the first sleep. 

 The patient suddenly awakes with a sense of suffocation, great 

 tightness at his chest, difficulty of breathing, and excessive anxiety ; 

 he assumes with great eagerness the erect posture, and cannot bear 

 the least incumbrance about the chest. The respiration is wheezing, 

 interrupted, and laborious ; the shoulders are raised, the elbows 

 directed backwards, and every effort made to enlarge the thorax. 

 The countenance, which was at first pale and anxious, becomes, 

 especially in plethoric habits, suffused or bloated, and covered with 

 perspiration. A considerable quantity of pale urine is voided at the 

 commencement, or previous to the accession, of the paroxysm ; and 

 the lower extremities are usually cold. The pulse is generally 



