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tysis. Asthma would seem in this case to be developed in consequence of chronic bronchitis, and emphysema. Spasmodic asthma is a disorder depending probably on a peculiar susceptibility of that part of the nervous system which supplies the bronchial tubes and pulmonary cells, but a susceptibility which is rarely manifested in a decided manner until some additional influence is exerted, such as indigestion, gout, bronchitis, or cardiac disturbance. The emphysematous condition of the lungs, which frequently accompanies asthma, is well entitled to your careful study. It is connected with an atrophied condition of the pulmonary cells. If at an early period of the disease you make a microscopical examination of the affected lungs, you will observe on the membrane which sustains the vessels, a number of little bright dots, like oil-globules. At a later period you will find the membrane cribriform, and its meshes of vessels more widely separated than in the natural condition. Partly in consequence of the deficient supply of blood, and partly, it may be, from venosity of the circulating fluid, diminished liability to phthisis is a characteristic of emphysema. When cicatrized cavities are found in any part of the lungs, it is common to discover emphysematous portions in the adjoining structure, probably because the obliteration of vessels which attends such cicatrization tends to diminish the supply of blood to the neighbouring cells. Even when you have reason to suspect the existence of phthisis in emphysematous subjects, you have ground to hope that the tubercular disease will be slow in its progress.
There is something very capricious in the asthmatic susceptibility. Some individuals have paroxysms only in town, some only in the country; others indifferently in town or country, but experience relief from the attack by immediate change either to one or the other. The late Duke of Sussex, who became asthmatical at a very early age, always escaped the paroxsyms when at the foot of Vesuvius, but suffered repeatedly when residing in Naples. Measures which immediately relieve the fit in one individual are useless in another. Sometimes indeed in the same subject a remedy at one time efficacious, will at another time utterly fail. Thus, in our patient, C. B—-, whose case has just been described, smoking stramonium at first afforded instantaneous relief, but subsequently failed. The inhalation of chloroform almost invariably relieves the asthmatical paroxysm, but its use is not to be indiscriminately recommended. In B— the pulsation of the heart can be seen at the epigastrium, indicating, what is very common in such cases, some dilatation of the right side of the heart, as a consequence of the obstruction in the pulmonary circulation ; and what you know of the influence of chloroform on the heart should make you cautious of its administration under such a complication.
It is therefore satisfactory to have other measures in reserve; and in many instances I have found remarkable relief experienced from the use of blotting-paper dipped in a saturated solution of nitrate of potash, dried, and then set fire to on a plate so placed as to expose the patient
Whether the efficacy of this measure be owing to empyreumatic bituminous vapour, or to nitrogenous fumes, I cannot tell. I can neither explain its remarkable efficiency in some instances, nor its failure in others; but it is a remedy of real value, and has been particularly recommended by Mr. Harrison, of Broughton, near Manchester.
to the vapour.
But it is not enough to relieve the paroxysms : you must aim to accomplish permanent amendment, and with this view must not be satisfied till you have rectified every disordered function, and improved to the great possible extent the nervous tone of your patient. Above all, endeavour to subdue any accompanying bronchitis. In many instances grain doses of mercurial pill with antimony, when watchfully regulated so as to avoid salivation, and gradually suspended, as the rhonchus moistens, are with this view singularly efficacious. When, however, there is the least threatening of consumption, it is desirable to find a substitute for the mercurial pill, and the combination most similar in effect is probably iodide of potassium mixed with antimony, which latter medicine would seem to have a tendency to direct the influence of the iodide of potassium to the bronchial tubes. Bhas therefore taken a mixture according to the following prescription : iodide of potassium, three grains ; potassio-tartrate of antimony, ten minims; tincture of henbane, fifteen minims; decoction of sarsaparilla, one fluid ounce ; make a draught, to be taken three times a day; and the benefit has been obvious: the breathing having become easier, the paroxysms no longer recurring, and the sibilant rhonchus, which was formerly audible during both inspiration and expiration, being confined to the latter, thus showing that the more minute tubes, which were previously so affected as to oppose an ob
stacle to the free admission of air during inspiration, have recovered their natural condition.
Is it probable that alum might prove useful as a remedy in asthma ? It is almost a specific in lead colic and in hooping-cough ; diseases not without some analogy to asthma, in the paroxysmal character of the attacks, and perhaps in the correspondence of the nervous fibres through which the morbid influence is conveyed.
When a medicine is proved to have remarkable efficacy in any one disease, we may often extend its use to the treatment of other affections, if we can succeed in discovering what particular condition the remedy modifies, and in classifying together such other disorders as present a distinct analogy in reference to this condition.
Further illustrations of cracked-metal sound-Gangrene of hand
-Obstruction of arteries by coagula-Hemoptysis : its relation to consumption; causes, tendencies, and treatment.
At our last lecture, gentlemen, you had an opportunity of examining a patient in whom the cracked-metal sound was elicited by percussion. Here is another patient in whom this sign may be detected, namely, S. A. M-, a young woman, aged sixteen, admitted Oct. 28, 1850 ; who was born, and has always resided in London. Lost her father, mother, and sister from phthisis. Attributes her illness to getting her feet wet twelve months since, after which she began to cough, and shortly afterwards to expectorate. The expectoration six months since was very copious; on one occasion it was for a day and night offensive in taste and smell, and appeared to her to come in large quantity from the left side. At the time of admission she was subject to frontal headache ; appetite good, but tongue red, and bowels relaxed ; pulse, 98; respiration, 32.
Physical signs.-Flattening beneath both clavicles. Right side : defective expansion ; dull percussion ; cavernous respiration and cough. Left side : very slight movement in inspiration ; percussion sound still duller