IS 



MEDICINE. 



Practice. no matter generated which can be the medium of in- 

 '""V"'"'' fection, and where there is nothing of the putrid or ma- 

 lignant nature, which is supposed to indicate a tenden- 

 cy to decomposition in the constituents of the body. 

 As a point of practical importance, it has been ques- 

 tioned whether the contagion can be conveyed by a 

 third person. We are not in possession of any facts 

 which can enable us to decide positively on this sub- 

 ject, but we should suppose that this could not be the 

 case, but that the breath of the patient must be actually 

 inhaled in order to produce the disease. But whatever 

 conclusion we may form upon this point, we have suffi- 

 cient evidence from our daily experience, that conta- 

 gion is its most usual, if not its only cause. When a pa- 

 tient is under the 'influence of the complaint, the indi- 

 vidual paroxysms are generally brought on by some 

 obvious cause, as by muscular exertion, by taking food, 

 or even by sudden mental emotions. At its commence- 

 ment, the symptoms are scarcely to be distinguished 

 from those of a common catarrhal cough, and three or 

 four weeks often elapse before the characteristic marks 

 of Pertussis make their appearance. The cough gra- 

 dually becomes more severe, the expirations succeed 

 each other more rapidly, and are followed by the so- 

 norous inspiration, vomiting then comes on, and the 

 patient falls into a febrile state, which seems to aggra- 

 vate all the other symptoms. During the violent pa- 

 roxysm of coughing, the passage of the blood through 

 the lungs is so much impeded as to produce a deep suf- 

 fusion of the face ; and it frequently happens that some 

 of the small arteries are ruptured, and that blood is dis- 

 charged, mixed with the matter expectorated, or bursts 

 out through the thin cuticle of the nose and mouth. 

 When the disease has acquired its greatest degree of 

 violence, it remains for some time stationary, and then 

 declines. The period which it occupies in the whole 

 process is very uncertain, and it is sometimes protract- 

 ed for many months. Whenever it exists in its aggra- 

 vated form it is accompanied with fever, and, although 

 not necessarily of an inflammatory tendency, it often 

 produces inflammation of the chest, and in this way 

 proves fatal. In persons who are disposed by heredi- 

 tary constitution to Phthisis, this complaint is frequent- 

 ly brought on by the Hooping cough, and occasionally 

 it seems to lay the foundation for a state of general ma- 

 rasmus or tabes, which ultimately proves fatal without 

 the lungs being the actual seat of disease. 



Treatment. The cure of Pertussis is often tedious and embarass- 

 ing, and we have scarcely any general principles by 

 which to direct us in our course. General bleeding is 

 sometimes necessary at the commencement, and leeches 

 may frequently be indicated by the pain or soreness of 

 the chest; but it is not a disease in which copious de- 

 pletion is necessary, or in which it appears to be at- 

 tended with benefit. As the paroxysm is usually ter- 

 minated by expectoration, so it has been the great ob- 

 ject of the practitioner to administer medicines which 

 may promote this process. Unfortunately, however, 

 they are of very uncertain effect, and very dubious ope- 

 ration ; and it not unfrequently happens that greater 

 injury is experienced by their heating or stimulating 

 quality, than is compensated by any benefit to be deri- 

 ved from the discharge of mucus which they produce. 

 Perhaps the most unexceptionable of this class are those 

 that act as emetics ; and, upon the whole, we think 

 that the most effective treatment of-Pertussis consists in 

 giving ipecacuanha, so as to produce gentle vomiting 



once or twice daily. Antimony we think less proper, Practice. 

 on account of its debilitating operation, an objection- w ~Y"~" 

 able circumstance in a disease of such long continuance, 

 and where the patients are often young and delicate. 

 Diuretics have been prescribed in Hooping cough ; but 

 we doubt whether they are of any use, while they are 

 liable to the same objection with the expectorants. 

 Next to emetics, perhaps the most generally useful re- 

 medics are blisters, which may be small, but fre- 

 quently repeated. The disease is apt to degenerate 

 into a chronic state, and, when all the inflamma- 

 tory symptoms are gone, but the cough still remains, 

 violent, opium becomes admissible, and is often found 

 very effectual ; its good effects are increased by be- 

 ing combined with ipecacuanha. We have not much 

 confidence in the tribe of antispasmodics, which have 

 been recommended in Hooping cough. There is, how- 

 ever, one remedy, which, in the latter stage, is univer- 

 sally admitted to be very useful, a change of air ; and 

 it is remarkable, that it appears to be merely the cir- 

 cumstance of change, and not any quality in the air it- 

 self, as the same benefit is obtained, by taking the pa- 

 tient from the pure air of the country to the confined at- 

 mosphere of a crowded city. 



SECT. XV. Asthma. 



We not unfrequently meet with symptoms of simple Asthms. 

 Dyspnoea, which we find it difficult to refer to any other 

 primary affection, yet it is so generally sympathetic, 

 and its treatment depends so much upon the particular 

 circumstances of the individual case, that we shall dis- 

 miss the farther consideration of it, and proceed to 

 Asthma. Asthma is characterized by difficult and pain- 

 ful respiration, in which the breath is drawn at short 

 intervals, and with what is termed a wheezing sound, 

 attended with pain, and a sense of constriction in the 

 chest, and a degree of cough. It occurs in paroxysms, 

 which usually come on about midnight. It is frequent- 

 ly attended with a copious expectoration of'mucus : but 

 at times this discharge is not present ; and according- 

 ly the disease has been divided into the varieties of 

 moist and dry. When the fit comes on in the night, 

 the patient is affected for some hours before the acces- 

 sion with langour and drowsiness, and a degree of tight- 

 ness in the chest, with some cough. These symptoms 

 gradually increase until the paroxysm arrives at its 

 greatest degree of violence, when, in three or four hours, 

 it subsides spontaneously, leaving behind great debility 

 and heaviness. It not unusually happens, that the same 

 train of symptoms occur for several successive nights, 

 when the disease becomes less violent, and for a time 

 totally disappears. Generally, the patient is able to 

 trace these accessions to some obvious exciting cause. 

 Certain states of the atmosphere, as the air of large ci- 

 ties, fogs, or exhalations from damp ground, indiges- 

 tion, or repletion of the stomach, and violent exercise, 

 are the circumstances which we observe to operate the 

 most powerfully. When once the disease has invaded 

 the constitution, and gone through a complete set of 

 paroxysms, we find that it is much more easily excited 

 than at first; and at length it occurs when we are un- 

 able to assign any probable reason for it. The proxi- 

 mate cause of Asthma is obscure. The morbid contrac- 

 tion of the muscular fibres of the bronchia?, which has 

 been usually employed to account for it, we conceive 



