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extraction, wife of intemperate saloon-keeper, PATHOLOGY.-Cameron (2) believes that the patient said to have drank beer in modera- primary spasms of the bronchial muscles leads tion; mother of eight children, three miscar- to a subsequent temporary paralysis, by which riages during the preceding year, said to have the increased demand on the external muscles been artificially induced ; domestic relations and the dyspnea was prolonged. He sup-. unhappy and general health not good for a posed that in health the involuntary muscles year. Insanity developed suddenly, three of the bronchial tubes were actively concernweeks before admission, in the form of melan- ed in respiration; that they were probably cholia with suicidal and homicidal impulses; muscles of expiration, and that spasm of the asked her friends "to put her in the asylum bronchial muscles in asthma rendered them, because she could not trust herself.” On ad-for a time, incapable of performing their funcmission appeared well and continued sensible, tions. The consequent unusual demand on cheerful, and industrious for three weeks; the external muscles of respiration manifested gave a clear history of her attack, and soon itself in an intense dysmenorrhæa. evinced a natural desire to go home and take

ÆTIOLOGY. -- Da Costa (3) presented to her place in her family. One examination of the class in a clinical lecture, the case of a boy the urine at this time gave negative results. who was picked up in the street suffering Heart enlarged, with mitral systolic murmur. from a severe attack of spasmodic asthma, inOn twenty-second day she became melan- duced by swallowing a piece of apple which choly; quiet, with tendency to stupor, but he was eating, when he suffered an epileptic made several attempts to choke an unoffend-attack. This went down into the broncus, ing fellow-patient; increasing mental dullness caused serious trouble till finally expelled by with rapid physical wasting for one week. On

a fit of coughing. the eighth and ninth days (of this attack) showed extreme restlessness; would throw

Robinson (26) reports cases which show a herself about the floor, beat the walls, scream,

very evident causative influence of malarial etc.; tenth day in bed; died on morning of poisoning in producing bronchial irritation

and asthma. In some of the cases the ordieleventh day. A second examination of the urine made during this attack also gave nega. Warburg's extract caused immediate improve

nary means failed entirely. Quinine and tive results. Autopsy Autopsy - Venous congestion

ment. everywhere marked; heart hypertrophied, with

Knight (4) reports an interesting case: A mitral leak; kidneys large, capsule thickened and removed with difficulty from a roughly lady, aged 28, in which the asthma was caused granular surface; cortex, on section, showed by a foreign body—a bean, which gained acextensive fatty change; liver also showed cess at the age of six years. Tracheotomy fatty changes in a few places.

was performed, but the foreign body was not This case is interesting as showing the re expelled then-but in a violent fit of coughmission which is so frequently seen in the

ing three days later. She had a severe cough mental, as in other manifestations of "Bright's

during the winter, which was soon attended disease," and also as illustrating the necessity by asthma, to which she has been subject for repeated examinations of the urine.

ever since.

Bosworth (16) refers again to the statistics of his eighty cases quoted last year, in view

of the results of treatment, he thinks that it Asthma.

may be fairly claimed that of the three ele

ments which enter into the causation of BY E. S. M'KEE, M. D., CINCINNATI. asthma, viz., a neurotic habit, the nasal dis

ease and atmospheric conditions, the nasal OCCURRENCE.—Moncorvo shows how fal- disorder far outweighs in importance not only lacious is the old belief that children possess the nervous but all other elements of causaan immunity from asthma. It is found in all tion. classes, all ages, and almost all countries. Schmidtborn (6) comes to the conclusion

that the nature of the nervous asthmia is a re- recent than in old specimens. He thinks this flected cramp of the pulmonary arteries. species of streptococcus is nearly allied to, if

Van Walzch (7) reports a case which illus- not identical with the streptococcus erysipetrates in the most marked degree, to what ex- latos. The author does not believe in the • tent indigestible foods, acidity and fermenta- pollen theory of the origin of hay fever, claim

tion, distention of the stomach and bowels ing that were this true why does the disease with gases, and the absorption of morbid ma- commence invariably in the pharynx, as he terial by the blood, may cause prolonged and believes is the case, and not in the eyes or terrible asthma in one predisposed thereto. nose, the parts with which the irritating body The reporter thought derangements of diges- first comes in contact. The symptoms of hay tion a very frequent factor in the causation of fever are, he considers, those of a progressive asthma.

form of inflammation commencing in the Pawinski (8) reports on asthma caused by pharynx. aceton in the urine. It is known that aceton Peyer (4) discusses at length, and reports is linked to an increased decomposition of the in extenso sixteen cases of asthma sexuals. tissues may be produced by conditions in Eleven of these were males, of which nine which so disastrous a breaking up of the tis- suffered from spermatorrhæa. This spermasue is not apparent, and might therefore be torrhee was in most cases accompanied by overlooked, and that the accumulation of this functional anomalies, of which the most fresubstance in large amounts acts as a profound quent were nocturnal pollutions and impopoison to the central nervous system. Syste- tence, or at least a reduced potence. In two matic examination of the urine in cases of

cases temporary aspermatism. Five cases asthma may lead to the selection of many con. which occurred in females consisted of one ditions not now recognized as predisposing fibroid of the uterus, one vaginal and cervical causes of asthma. Hence, if we will profit by catarrh, with hyperästhesia of the introitus the lesson taught by this case, we will not neg- vagina in consequence of masturbation; one lect the examination of the urine in each leucorrhæa; one enlargement and induration case when the ætiology is at all obscure.

of the uterus, with catarrh following the menoBerkart (9) puts forward a theory—a further pause; one chronic endometritis. Of the eleven development of curschme thesis. In his male patients seven were very strong, well opinion asthma is due to a progressive inflam- built men, while four were slim and slender. matory process affecting the air passages, In only two cases was he able to discover starting from the pharynx, and spreads rap- family history of neurosis, which was traced idly upward to the nose and eyes, whereas to the mother's side. Among the females a its downward extension is for a time at least, nervous, hereditary tendency could only be arrested by the larynx, just as erysipelas is ar- discovered in four cases. In about all the rested by a projecting fold of skin. Resis- males there was present, besides the asthma, tence is, however, subsequently overcome, and that row of nervous symptoms which we call the air passages are subsequently invaded sexual neurasthenia. This was almost, withGradually, also, the tissues are structurally out exception, caused by sexual abuse. On altered, and then reactions differ. The sero- the contrary, all of the patients suffered more fibrinous exudation becomes more and more or less from hysterical or nervous symptoms, fibrinous, when such is wont to occur; and which, like the asthma, depended on the uterthe consequent mechanical interference with ine trouble. In ten patients there was a more respiratory function now constitutes the most or less high grade of emphysema, but as a rule striking of all its symptoms. The causative cannot be of very great inconvenience. The agent of the progressive inflammation, Dr. patients could walk, climb, make difficult field Berkart is inclined to see, in a streptococcus manoeuvers, &c. They only suffered slightly which he has invariably found in the expec- from frequent catarrh of the respiratory tract. toration. This is associated with Currch- In some of the patients the sexual act was man's spirals, and more abundantly present in followed with such regularity by asthma that the connection was quite clear. The forced themselves into the foreground, citrate author thinks it important that we should of caffeine perhaps stand first. The dose recomknow that one of the principal excitants mended is 1-5 grain dissolved in warm water. of asthma, both by men and women, is The relief afforded is said to be very prompt. the genital system. We should learn if our Arsenic, probably on account of its peculiar patients have suffered from congenital noc property of supporting respiration in making turnal incontinence of urine; if in youth sex-ascents, seems to produce striking cures in ual abuse of any kind had been practiced, or appropriate cases. Cocaine 16 grain, in form if venereal diseases had been contracted. The of tablets, is highly recommended for the remenses, their duration and amount; the moli lief of the spasm. Grendelia robusteo has lost men, fluor albus and pain in the lumbar its popularity Quebracho is a remedy in region must be inquired after. If by ques: much repute. And if the flow from the mutioning a leader is gained, then a sexual exa- cous surfaces is very great 15 drop doses of mination is asked for, and often we can ex- tincture belladonna every 4 hours, are very clude other causes and chagnon asthma sexual. good. If much bronchial tumefaction and This sort of asthma is naturally not so stub- dryness is present, 14 grain pilocarpine, with born as many other kinds.

14 grain morphine, hypodermically gives Peyer claims that asthma is always neurotic. prompt relief. In two young married women coitus caused Albutt (15) has found good results from violent attacks of asthmatic sneezing. In Davas Platz Switzerland, and from the use of another case the patient suffered from uterine hyoscyamine, arsenic and strychnine, digitaline fibroid, with severe asthma, which disappeared and aconitine, after the dosidmetric system. after the removal of the tumor. Another was Poulet (16) has found axatic acid a remedy subject to violent asthmatic fits on becoming of great importance in asthma and dyspnea. pregnant for the first time—the asthma wa's If this is administered early it is a remedy cuied. Another suffered from chronic me- most sure. It prevents the crisis when we tritis. The cure of the uterine affection re- have recourse to its use some hours before the lieved the asthma. In all of the cases report- invasion. It is not less useful when the ated the patients were more or less hysterical, tack is imminent, or already commenced. and in two there was a distinct family history The medicine is a very faithful anti-dyspneal of neuroses. We must be careful to distin- remedy, at a price insignificant. He gives guish between the possible coincidence of oxalic acid 3ss., lye auronto cont. zii., infusiatrue asthma and disease of the sexual func- tea zvi., tablespoonful every hour till relieved. tions and the alleged form, where the former

Tamphear (17) says the great principle in is the effect of the latter. In coincidence it is the prevention of attacks is that the patient easy to understand that any aggravation of should retire with gastric digestion quite comuterine or ovarian disease, and any irritation plete, and thus preclude any pressure upof the sexual functions, might aggravate the wards against the diaphragm from flatulent asthma.

accumulations in the stomach. When there TREATMENT.-Traucher (12) recommends is dyspepsia present, and especially when in the treatment of asthma in children three flatulence occurs after meals, it is advisable to doses, 5 to 7 grains of quinine, given at inter- omit sugar, starch and potatoes as much as vals of ten minutes, 5 or 6 liours before the possible. paroxysm.

Nunes (18) claims that the tincture of loWoodbury (13) recommends continual so- belia should not be used in asthma, as alcohol lution of nitro-glycerine, in from 2 to 5 drop extracts the emetive principle. The alkaloid doses, when there is not much emphyreme, lobæline antagonizes the spasm without either and the heart is sound. Between the attacks, causing nausea or vomiting. The dose varies quinine, arsenic, or cod liver oil.

from 34 to 6 grains, and is pushed according The editors of the Canada Lancet think to the symptoms. It can also be employed that of the remedies which have recently hypodermically. In Nunes' cases he seems to have obtained excellent results from lobeline ment of asthma, so constructed by means of in the treatment of spasmodic asthma and levers and bands to exert pressure and tracbronchitic dyspnea. His cases appear per- tion on the thorax, while by means of a broad manently relieved many months after taking band the intra-abdominal pressure is increasthe lobeline. If the temporary good which ed. The ultimate effect, according to the has hitherto been gotten from lobelia in asth-author, is to render forced expiration possible, ma can be had through the new alkaloid with- to considerably decrease the volume of the out nausea, vomiting or depression, it will thorax, and to more completely 'empty the prove a boon to suffering humanity.

hitherto badly aerated alveoli, so that at the Berkart (6) places the greatest reliance on next inspiration more oxygen enters, and very the subcutaneous injection of morphine, which soon the dyspnea diminishes. The cases reinduces speedy relief, probably by relieving ported went to show that in many instances the bronchial tenesmus. In chronic cases he the respiration chair might prove an advanattaches most importance to rest. Iodide of tageous method of treatment. potassium he praises moderately, but highly Scott (24) has found paraldeyde in halfcommends jaborandi or its alkaloid, pilocar- drachm doses a very valuable remedy in cutpine. In hay asthma, and in asthma when ting short the paroxysms of asthma. He finds the acute attacks begin with sneezing and a it acts better if combined with other remedies. burning sensation at the back of the soft pal- Peyer (11) finds that the treatment of sexual ate, he recommends the use of a gargle, or asthma depends upon its origin. The physpray of borax, in concentrated solution, with sician should not forget through false prudery a few drops of liquor hydrarg. per chloridi. to draw attention to the bad results of onanQuinine in 15 grain doses is favorably com- ism and coitus imperfectus In one case remented upon.

ported by Peyer, pollutions and asthma were Illingworth, (19) acting on the view that the not improved by local treatment, because the disease is due to central venous congestion, patient continued to practice the coitus reserhe gives remedies, firstly, to stimulate the vatus. After the cessation of this custom the heart; secondly, to prevent congestion of the jollubous and asthma disappeared under regublood, and thirdly, to contract the central and lar evening applications of clystus. Those dilate the peripheral blood vessels. The two atiological factors of sexual asthma urithritis first indications are met by the carbonate and jostmar, as well as spermatorrhea, impotence acetate of ammoniæ, and the iodides and nit- and temporary. A spermatismus must in the rates of potash and soda; also by alcoholic rule receive local treatment. stimulants, and the third by belladonna.

Davis (21) occasionally found in women who Jares (20) found inhalations of a 20 oz. so- are persistently troubled with asthma during lution of menthol in oleum olivæ relieved

pregnancy, though free from it at other times, by magic a very stubborn case.

most marked benefit obtained by the persistDuenas (21) concludes that antipyrin is a ent use of viburnum prunifolium. This drug drug of extraordinary value in asthma at first; lessens the irritability of the uterine tissues, but like all other remedies it soon loses its and thus diminishes the asthma. power. It has no effect in diminishing the frequency of the attacks. He had found that

(12) Gaucher-Med. de Paris, April 20, 1889. occasionally it did harm by increasing the se

(13) Woodbury-Med. Reg., March 30 and May 11, verity of subsequent attacks; especially was 1889. this true in a case of asthma with bronchitis. (14) Editorial-Canada Lancet, p. 90, Nov. 1889.

Zipp, (22) in cases where the cause of the (15) Dasimetric Med. Review, March, 1889. attack is suspected to be in the nose, recom

(4) Knight - Boston Med. and Surg. Journal, Jan.

17, 1889. mends widening of the nasal air passages.

(5) Bosworth -N. Y., Med. Journal, Jan. 19, 1889. He introduces Hegar's bougies with ease, dis

(7) Van Valsal--Med. News, May 11, 1889. pensing with narcosis or assistance.

(8) Pawinski-Berl. Klin. Wochenschrift, Dec. 10, Gruenert (23) describes a chair for the treat- 1888. Journal Amer. Med. Ass., July 13, 1889.

as if

(16) Poudet-- Boull. Med. des Vosges, April, 1889. brane of the naso-pharynx which persists in London Med. Recorder, Aug. 20, 1889.

spite of detergent and astringent sprays and (17) Kautoma—Kansas City Med. Index, Dec., 1888. washes, is sometimes relieved by touching the Williams' Am. Jour. Med and Surg.

(11) Peyer-- Berlmer Klinik Heft 9, 1889. Brit Med. surface here and there with a saturated soluJournal, Aug. 31, 1889.

tion of chromic acid. (2) Cameron-Brit. Med. Jour., June 1, 1889.

Batteries sometimes fail to give satisfaction (18) Nunes

Editorial Amer. Practitioner and because the connecting wires break off inside News, Nov. 23, p. 345. First Brazilian Congress of the insulating cover and the connection is Medicine, 1888. British Medical Journal. N. Carolina

only made occasionally. Med. Journal, June, 1889. (21) Duenas-Revista de Ciencias Medicas, Habana,

The following prescription has given great Oct. 1888. Brit. Med. Journal, April 20; 1889. Lond. comfort to some of our patients suffering from Med. Recorder, March 20, 1889.

piles of great tenderness, but of short dura(22) Zipp-Med. Chır. Rundschan Weekly Medical tion and no marvelous magnitude: Review, July 27, 1889. Deutsch Med. Wochenschrift,

R. Plumbi iodidi

3ij. . May 16, 1889.

Tr. iodini co. (23) Gruenert-Lond. Lancet, June 22.

3xx. (1) Moncorvo-Rev. Mens. des Mal de l'Enf. January

Pubo. galli

gr.xx. 18-9. Arch. Pedriatics, June, 1889.

Ext. opii

gr.xx. (6) Schmidtborn Volkmanns Lammbury Klinvor- Cacoae butter

3ij. tiage, M 328, 1889. Schmidt's Jahrbinchre, April, Misce et ft. supposit. No. xx. 1889.

Apply one night and morning after replac(6) Berkart- Bronchial Asthma, its Pathoiogy and Treatment. Churchill, London, 1889. Brit. Medical

ing the hemorrhoids. Journal, July 27, 1889, p. 195.

For infantile diarrhea we have this summer (19) Iliogworth-Med. Press and Circular, July 24, adopted the following treatment in most cases 1889.

and with happy results. Stop milk and all (25) Davis-Journal Amer. Med. Ass., May 25, 1889.

other food and give only Mellin's food or one (24) Scott-Times and Register, Aug. 10, 1889.

(20) Jares-Journal Amer. Med. Ass., May 25, 1889. of those akin to it. Give one of the following Therapeutiche Monatshefte, April, 1889.

powders every hour till the stool becomes less (3) Da Costa-Bost. Med. and Surg. Jour., Dec. 29, offensive in odor and more natural in consis1888.

tency: (2) Robinson-Phila. Med. News, Aug. 31, 1889.

R. Salol

Zinci sulphocarbolat Little Things we have Noticed Lately, M.

gr. j. gr. ss.

W. D. B.

Menthol dissolved in vaseline, five grains to the ounce can be sprayed into the throat and MENTHOL, IN THE VOMITING OF PREGforced thence into the ear by Valsalva's meth- NANCY.-Menthol has been recommended od. This is a very neat and simple way of (Repertoire de Pharmacie, February 10, 1890) applying a medicament to the lining of the in the treatment of the obstinate vomiting eustachian tube and when the tympanic cavi- of pregnancy. One part of menthol should be ty is inflated in this manner the result is more dissolved in twenty parts of alcohol and thirty marked and more permanent than when infla

parts of simple syrup, one teaspoonful being tion without spraying is practiced. The above spray will relieve the irritation given each hour. This prescription is claimed

to be extremely successful in arresting nausea of chronic asthma when other remedies fail to

and vomiting.-Therap. Gazette. give satisfactory results. Nothing is much more disagreeable the

DR. SHELDON gets the drop on the hay moment it is applied to the nasal mucous fever every year by visiting the mountain or membrane or much pleasanter five minutes lake regions, at the same time Mr. Hay, delater, than a solution of iodoform in ether, sires to call on him. He has practiced the one-half drachm to the ounce.

usual deception this year and has returned to Chronic inflammation of the mucous mem- the city fresh and ready for the year's work.

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