SPASMODIC ASTHMA. 



65 



quick, weak, and somewhat irregular. During the fit, the patient has 

 commonly an instinctive desire for cool air. When the fit has con- 

 tinued from half an hour to one, two, three, or even four hours, 

 some degree of cough and expectoration comes on, which relieve 

 the patient; and after a brief period, his respiration, pulse, and feel- 

 ings assume their natural state. 



Such is the common course of a first and moderate attack of this 

 disease. Occasionally the patient has but one such fit, but more 

 generally a slight constriction of the chest is felt through all the 

 succeeding day, and the paroxysms return at the usual period of the 

 night ; this may occur for several nights, and at last the patient is 

 altogether released from the attack. The disease may be suspended 

 for several months, but it is liable to recur from changes of air, 

 errors of diet, and the operation of other causes. 



Physical signs. — In spasmodic asthma, during the fit, the chest 

 does not sound well on percussion, and the respiratory murmur is 

 indistinct, even on the most forcible inspiration. But if the patient, 

 after holding his breath a short time, be desired to breathe again 

 quietly, the spasm will be for a moment overcome, and the entry of 

 air into the cells will be heard in a clear and sometimes puerile 

 sound ; after one or two inspirations, the spasm again comes on, 

 and the respiration becomes as dull as before. 



In treating of the pathology of this disease, it was stated that the 

 muscular fibres were in a state of spasm during the paroxysm ; the 

 obstruction to the entrance of the air into the small bronchi and 

 vesicles thus produced is obviously the cause of the diminution of 

 the respiratory murmur. By this contraction also the lungs are in 

 a manner collapsed within the chest, and the parietes of the thoracic 

 cavity, pressed by the atmospheric weight on them, lose that sonorous 

 elasticity produced by a fulness of their aerial contents. 



Complicated asthma. — A pure spasmodic asthma, affecting lungs 

 otherwise healthy, is by no means common. In general there is 

 some disease of the heart, or some chronic bronchitis acting as a 

 source of permanent congestion, which both adds to the difficulty of 

 breathing, and predisposes the parts to be more easily affected with 

 fits of spasm. 



Sometimes a severe attack of dry catarrh is aggravated by spasm. 

 This constitutes the bronchial asthma of Andral. 



Morbid appearances. — The changes which have been noticed in 

 those who have died of asthma are to be regarded chiefly as acci- 

 dental occurrences, or associated maladies, and, perhaps, more fre- 

 quently as the remote results of repeated or protracted attacks. No 

 lesions, sufficient to account for the phenomena of uncomplicated 

 asthma, could be detected by Laennec, Andral, Cruveilhier, Bouil- 

 laud, and many other investigators. The most common conse- 

 quences of the disease are, chronic inflammation and dilatation of 



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