NERVOUS ASTHMA. 93 



not in favor of the tincture of lobelia inflata, so famed in treatment of 

 asthma (gtt. x xxx every 15 30 minutes). Nor have I observed 

 much of the reputed benefit derived from smoking a pipe containing 

 twelve or fifteen grains of stramonium-leaf, mixed with tobacco or sage- 

 leaves, or from the use of the stramonium cigars of the shops, to say 

 nothing of the fact that, in most instances, such procedures result in 

 distressing headache. In a few instances, inhalation of chloroform vapor 

 affords marked, but, as a rule, only temporary relief. The experiment 

 of burning saltpetre-paper (blotting-paper soaked in a saturated solution 

 of saltpetre and then dried) may always be made, although the vapors 

 thus generated are very unpleasant to many asthmatic patients, and are 

 of no benefit to them. In severe attacks we may administer an emetic, 

 which often proves of great use. When the paroxysm threatens to 

 prolong itself, instead of the emetic we may exhibit tartrate of anti- 

 mony, or ipecacuanha, in nauseant doses. (Koliler especially recom* 

 mends an infusion of ipecac, gr. v vi to j, with extract pulsatilla 

 3 ss.) This internal medication may be combined to advantage with 

 cutaneous stimulation, such as friction upon the chest with warm turpen- 

 tine, and the application of sinapisms to the wrists and calves of the 

 legs, warm hand and foot baths. The patients, who feel as if in the 

 agony of death, beg incessantly that " something more " be done to 

 alleviate their sufferings. 



In order to avert future attacks, we should, first of all, caution tho 

 patient to avoid exposure to any irritants which, according to his expe- 

 rience, have been the cause of previous paroxysms. Such instructions 

 must be as exact and comprehensive as possible, no matter how odd the 

 supposed source of the attacks may seem, and even although the con- 

 nection between the cause and effect be altogether unintelligible. For 

 instance, if the attack comes on whenever the patient sleeps in a dark 

 or close chamber, he must always have a light burning, and leave his 

 doors open. It is desirable that all asthmatic persons should reside in a 

 pure, dry atmosphere ; that they should avoid dusty, smoky, and windy 

 localities, and that they should not sleep too long. 



Among medicaments especially in repute for the prevention of new 

 paroxysms, and for the radical cure of asthma, quinine stands first. The 

 shorter and more regular the intervals of the attacks, so much the more 

 is to be expected from this drug. It is unsuitable when the pauses be- 

 tween the seizures are very long or irregular in their occurrence. In 

 such cases we must have recourse to other remedies from the list of tin 

 so-called nervines. Unfortunately, the mode in which this class of 

 medicines modifies the function and nutrition of the nerves is very ob- 

 scure, and the indication for the selection of one or other of them is so 

 indefinite that we are reduced to a blind empiricism. (We must not, 



