CLASS III. i . i . 1 1 . OF VOLITION. 293 



Opium. Afafcetida. Warm bath. If the caufe can be detect- 

 ed, as in toothing or worms, it (hould be removed. As this 

 fpecies of afthma is fo liable to recur during ileep, like epileptic 

 fits, as mentioned in Section XVIII. 15. there was reafon to be- 

 lieve, that the refpiration of an atmofphere mixed with hydro- 

 gen, or any other innocuous air, which might dilute the oxygen, 

 would be ufeful in preventing the paroxyfms by decreafing the 

 fenfibility of the fyftem. This, I am informed by Dr. Beddoes, 

 has been ufed with decided fuccefs by Dr. Perriar. See Clafs 

 II. i. i. 7. 



n. AJlhma dohrificum. Angina pe<^oris. The painful 

 afthma was firft defcribed by Dr. Heberden in the Tranfaclions 

 of the College ; its principal fymptoms confift in a pain about 

 the middle of the fternum, or rather lower, on every increafe of 

 pulmonary or mufcular exertion, as in walking fafter than ufual, 

 or going quick up a hill, or even up flairs ; with great difficul- 

 ty of breathing, fo as t& occafion the patient inftantly to ftop. 

 A pain in the arms about the infertion of the tendon of the pec- 

 toral mufcle generally attends, and a defire of refting by hang- 

 ing on a door or branch of a tree by the arms is fometimes ob- 

 ferved. Which is explained in Clafs I. 2. 3. 14. and in Seel. 

 XXIX. 5. 2. 



Thefe patients generally die fuddenly ; and on examining the 

 thorax no certain caufe, or feat, of the difeafe has been detect- 

 ed , fome have fuppofed the valves of the arteries, or of the 

 heart, were imperfect ; and others that the accumulation of fat 

 about this vifcus or the lungs obftrutted their due action ; but 

 other obfervations do not accord with thefe fuppofitions. 



Mr. W , an elderly gentleman, was feized with afthma 



during the hot part of laft fummer ; he always waked from his 

 firft fleep with difficult refpiration, and pain in the middle of 

 his fternum, and after about an hour was enabled to fleep again. 

 As this had returned for about a fortnight, it appeared to me to 

 be an afthma complicated with the difeafe, which Dr. Heberden 

 has called angina pecloris. It was treated by venefe&ion, a ca- 

 thartic, and then by a grain of opium given at going to bed, with 

 ether and tincture of opium when the pain or afthma recurred, 

 and laftly with the bark, but was feveral days before it was per- 

 fectly fubdued. 



This led me to conceive, that in this painful afthma the dia- 

 phragm, as well as the other mufcles of reipiration, was thrown 

 into convuliive action, and that the fibres of this mufcle not hav- 

 ing proper antagonifts, a painful fixed fpafm of it, like that of 

 the mufcles in the calf of the leg in the cramp, might be the 

 caufe of death in the angina pectoris, which I have thence ar- 

 ranged 



