NERVOUS ASTHMA. 91 



rise to the most frightful dreams. When the sufferer awakes, he 

 has, as Homberg aptly describes it, "great desire to draw a deep 

 breath, but feels that the air does not penetrate into the chest be- 

 yond a certain point. Hissing, whistling, purring noises are audi- 

 ble, both upon inspiration and expiration, which are perceptible to 

 the patient himself, and may often be heard even at some distance. 

 The embarrassment increases ; the respiratory muscles, and even 

 their auxiliaries, are brought into action ; the alse nasi work ; the 

 contour of the sterno-cleido-mastoidei muscles stands out distinctly ; 

 the head is thrown back, and the arms are braced, so as to expand 

 the chest but in vain. The vesicular murmur ceases, is replaced 

 in some parts by hissing, which suddenly comes and goes, while the 

 inspiratory sounds of the larynx and air-passages continue, not only 

 undisturbed, but even are louder and stronger. Terror is depicted 

 upon the countenance ; the eyes are widely opened ; cold sweat 

 bedews the forehead ; the complexion is pale, the impulse of the 

 heart violent, unequal, irregular ; the radial pulse is small and 

 weak ; the temperature of the hands and cheeks is depressed. 

 Such an attack, after lasting for a quarter of an hour, or perhaps 

 several hours with brief remissions, either ceases suddenly, the air 

 rushing forcibly into the occluded bronchi and air-cells, causing 

 puerile breathing, or a cessation conies about gradually, accom- 

 panied by eructations, yawning, more rarely coughing, with an in- 

 creased secretion from the bronchial mucous membrane, which con- 

 tinues for some time." 



The latter symptom of this truly classical picture finds a com- 

 plete analogue in the course of a neuralgia of the frontal nerve. 

 As in the one case the attack often ends in hypersemia and swelling 

 of the conjunctiva, with increased mucous and lachrymal secretion, 

 in the other the neurosis of the vagus terminates with hyperaemia 

 and augmented secretion of the mucous membrane of the bronchi. 



DIAGNOSIS. [One would think, a priori, that there ought to be 

 no difficulty in distinguishing between nervous asthma, with its sud- 

 den onset and complete intermission, and the dyspnoea of organic 

 disease. And yet difficulties do arise, because with the asthma there 

 is often a bronchitis. Asthma, moreover, may finally induce em- 

 physema, and thus mask the original neurosis. So, too, in cases of 

 bronchitis or of emphysema which have originally been quite inde- 

 pendent of nervous asthma, we sometimes see severe attacks of 

 dyspnoea which cannot be ascribed to the catarrh, so that we may 

 attribute them to a reflex bronchial cramp.] 



PROGNOSIS. The prognosis as to life is better than the appear- 

 ances indicate. Although the sufferer, often as he may have safely 



