94 DISEASES OF THE TRACHEA AND BRONCHI. 



nowever, on this account neglect this disease any more than epilepsy, 

 St. Vitus's dance, etc. As a rule, the metallic nervines (carbonate of 

 iron, gr. v x, in die. ; zinci oxid. gr. ij iv ; argenti. nitrat. gr. -J- 

 in die. ; Fowler's solution, gtt. iij v in die.) are preferred to tincture 

 of valerian, assafcetida, castor, or camphor. 



My experience induces me to doubt the efficacy of Aubreys specific 

 in purely nervous asthma. It consists of pot. iod. (twenty-five parts), 

 infus. seneg. (two hundred and seventy-five parts liquid to five of 

 root), ext. opii (two parts) ; rectified spirit and simple syrup (each 

 one hundred parts). It is colored red with cochineal. Its active part 

 is probably iodide of potassium. In two cases it has failed me utterly ; 

 while in many instances of capillary bronchitis with severe dyspnoea, 

 and with or without emphysema, it has proved effective. 



CHAPTER IV. 



SPASM OF THE RESPIRATORY MUSCLES. 



Wintrich and Bamberger describe cases of asthma in which the 

 dyspnoea is due to spasm of the diaphragm and not to spasm of 

 the bronchi. In this obscure form of asthma the sibillant rhonchi 

 of bronchial asthma are absent. The hinderance to respiration in- 

 volves the expiratory act alone. The patient must forcibly contract 

 the abdominal muscles, so as to force up the diaphragm, then rigid 

 ly fixed in the expiratory attitude. The belly hardens, its muscles, 

 project, and so forcibly compress its viscera that the urine and 

 even the faeces pass involuntarily. The face is blue, the breathing 

 but ten or twelve a minute, expiration being twice or thrice as 

 slow as inspiration ; the epigastrium does not bulge, the lower part 

 of the thorax shrinks toward the spine; the upper portion alone 

 heaving moderately. Percussion after extreme expiration shows 

 abnormal depression of the diaphragm. The clear percussion- 

 sound of the lung extends one or two inches too far downward, 

 and the heart-shock and cardiac dulness are also displaced one 01 

 two intercostal spaces. Upon auscultation, the respiratory murmur 

 is inaudible. 



The above symptoms are the immediate effects of tonic spasm of 

 the diaphragm. Should the attack last long, consciousness fails, from 

 disturbance of the cerebral circulation, and incompleteness of respi- 

 ration, whereby the blood becomes overcharged with carbonic acid ; the 



