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 dyspnoea was prolonged. 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 dysmenorrhoea. evinced a natural desire to go home and take ETIOLOGY. 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 herself about the floor, beat the walls, scream, -- Robinson (26) reports cases which show a 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 nary means failed entirely. Quinine and urine made during this attack also gave nega- Warburg's extract caused immediate improvetive results. AutopsyAutopsy-Venous congestion ment. everywhere marked; heart hypertrophied, with mitral leak; kidneys large, capsule thickened A Knight (4) reports an interesting case: and removed with difficulty from a roughly by a foreign body-a bean, which gained aclady, 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 was performed, but the foreign body was not. fatty changes in a few places. expelled then-but in a violent fit of coughing three days later. She had a severe cough during the winter, which was soon attended by asthma, to which she has been subject This case is interesting as showing the remission which is so frequently seen in the mental, as in other manifestations of "Bright's disease," and also as illustrating the necessity for repeated examinations of the urine. Asthma. BY E. S. M'KEE, M. D., CINCINNATI. OCCURRENCE.-Moncorvo shows how fal lacious is the old belief that children possess an immunity from asthma. It is found in all classes, all ages, and almost all countries. 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 may be fairly claimed that of the three elements which enter into the causation of asthma, viz., a neurotic habit, the nasal disease and atmospheric conditions, the nasal disorder far outweighs in importance not only the nervous but all other elements of causation. Schmidtborn (6) comes to the conclusion that the nature of the nervous asthma 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, claimtion, 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 form of inflammation commencing in the pharynx. asthma. Pawinski (8) reports on asthma caused by aceton in the urine. It is known that aceton is linked to an increased decomposition of the tissues may be produced by conditions in which so disastrous a breaking up of the tissue is not apparent, and might therefore be overlooked, and that the accumulation of this substance in large amounts acts as a profound poison to the central nervous system. Systematic examination of the urine in cases of asthma may lead to the selection of many conditions not now recognized as predisposing causes of asthma. Hence, if we will profit by the lesson taught by this case, we will not neglect the examination of the urine in each case when the etiology is at all obscure. Peyer (4) discusses at length, and reports in extenso sixteen cases of asthma sexuals. Eleven of these were males, of which nine suffered from spermatorrhoea. This spermatorrhoe was in most cases accompanied by functional anomalies, of which the most frequent were nocturnal pollutions and impotence, or at least a reduced potence. In two cases temporary aspermatism. Five cases which occurred in females consisted of one fibroid of the uterus, one vaginal and cervical catarrh, with hyperesthesia of the introitus vagina in consequence of masturbation; one leucorrhoea; one enlargement and induration of the uterus, with catarrh following the menopause; one chronic endometritis. Of the eleven male patients seven were very strong, well built men, while four were slim and slender. In only two cases was he able to discover family history of neurosis, which was traced to the mother's side. Among the females a nervous, hereditary tendency could only be In about all the discovered in four cases. Berkart (9) puts forward a theory-a further development of curschme thesis. In his opinion asthma is due to a progressive inflammatory process affecting the air passages, starting from the pharynx, and spreads rapidly upward to the nose and eyes, whereas its downward extension is, for a time at least, arrested by the larynx, just as erysipelas is arrested 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 property of supporting respiration in making ascents, seems to produce striking cures in appropriate cases. Cocaine 6 grain, in form of tablets, is highly recommended for the relief of the spasm. Grendelia robusteo has lost its popularity. Quebracho is a remedy in 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 nocturnal incontinence of urine; if in youth sexual abuse of any kind had been practiced, or if venereal diseases had been contracted. The menses, their duration and amount; the moli men, fluor albus and pain in the lumbar 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, 4 grain pilocarpine, with born as many other kinds. 4 grain morphine, hypodermically gives prompt relief. In Peyer claims that asthma is always neurotic. In two young married women coitus caused violent attacks of asthmatic sneezing. another case the patient suffered from uterine fibroid, with severe asthma, which disappeared after the removal of the tumor. Another was subject to violent asthmatic fits on becoming pregnant for the first time-the asthma was cured. Another suffered from chronic metritis. The cure of the uterine affection relieved the asthma. In all of the cases reported the patients were more or less hysterical, and in two there was a distinct family history of neuroses. We must be careful to distinguish between the possible coincidence of true asthma and disease of the sexual functions and the alleged form, where the former is the effect of the latter. In coincidence it is easy to understand that any aggravation of uterine or ovarian disease, and any irritation of the sexual functions, might aggravate the asthma. TREATMENT.-Traucher (12) recommends in the treatment of asthma in children three doses, 5 to 7 grains of quinine, given at intervals of ten minutes, 5 or 6 hours before the paroxysm. Woodbury (13) recommends continual solution of nitro-glycerine, in from 2 to 5 drop doses, when there is not much emphyreme, and the heart is sound. Between the attacks, quinine, arsenic, or cod liver oil. Albutt (15) has found good results from Davas Platz Switzerland, and from the use of hyoscyamine, arsenic and strychnine, digitaline and aconitine, after the dosidmetric system. Poulet (16) has found axatic acid a remedy of great importance in asthma and dyspnœa. If this is administered early it is a remedy most sure. It prevents the crisis when we have recourse to its use some hours before the invasion. It is not less useful when the attack is imminent, or already commenced. The medicine is a very faithful anti-dyspnoeal remedy, at a price insignificant. He gives oxalic acid 3ss., lye auronto cont. ii., infusiatea 3vi., tablespoonful every hour till relieved. Tamphear (17) says the great principle in the prevention of attacks is that the patient should retire with gastric digestion quite complete, and thus preclude any pressure upwards against the diaphragm from flatulent accumulations in the stomach. When there is dyspepsia present, and especially when flatulence occurs after meals, it is advisable to omit sugar, starch and potatoes as much as possible. Nunes (18) claims that the tincture of lobelia should not be used in asthma, as alcohol extracts the emetive principle. The alkaloid lobæline antagonizes the spasm without either causing nausea or vomiting. The dose varies from 4 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 dyspnoea. 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 without nausea, vomiting or depression, it will prove a boon to suffering humanity. to considerably decrease the volume of the thorax, and to more completely empty the hitherto badly aerated alveoli, so that at the next inspiration more oxygen enters, and very soon the dyspnoea diminishes. The cases reported went to show that in many instances the respiration chair might prove an advan Berkart (6) places the greatest reliance on the subcutaneous injection of morphine, which induces speedy relief, probably by relieving the bronchial tenesmus. In chronic cases he attaches most importance to rest. Iodide of tageous method of treatment. potassium he praises moderately, but highly commends jaborandi or its alkaloid, pilocarpine. In hay asthma, and in asthma when the acute attacks begin with sneezing and a burning sensation at the back of the soft palate, he recommends the use of a gargle, or spray of borax, in concentrated solution, with a few drops of liquor hydrarg. per chloridi. Quinine in 15 grain doses is favorably commented upon. Scott (24) has found paraldeyde in halfdrachm doses a very valuable remedy in cutting short the paroxysms of asthma. He finds it acts better if combined with other remedies. Illingworth, (19) acting on the view that the disease is due to central venous congestion, he gives remedies, firstly, to stimulate the heart; secondly, to prevent congestion of the blood, and thirdly, to contract the central and dilate the peripheral blood vessels. The two first indications are met by the carbonate and acetate of ammoniæ, and the iodides and nitrates of potash and soda; also by alcoholic stimulants, and the third by belladonna. Jares (20) found inhalations of a 20 oz. solution of menthol in oleum olivæ relieved as if by magic a very stubborn case. Duenas (21) concludes that antipyrin is a drug of extraordinary value in asthma at first; but like all other remedies it soon loses its power. It has no effect in diminishing the frequency of the attacks. He had found that occasionally it did harm by increasing the severity of subsequent attacks; especially was this true in a case of asthma with bronchitis. Zipp, (22) in cases where the cause of the attack is suspected to be in the nose, recommends widening of the nasal air passages. He introduces Hegar's bougies with ease, dispensing with narcosis or assistance. Peyer (11) finds that the treatment of sexual asthma depends upon its origin. The physician should not forget through false prudery to draw attention to the bad results of onanism and coitus imperfectus In one case reported by Peyer, pollutions and asthma were not improved by local treatment, because the patient continued to practice the coitus reservatus. After the cessation of this custom the jollubous and asthma disappeared under regular evening applications of clystus. Those ætiological factors of sexual asthma urithritis jostmar, as well as spermatorrhoea, impotence and temporary. A spermatismus must in the rule receive local treatment. Davis (21) occasionally found in women who are persistently troubled with asthma during pregnancy, though free from it at other times, most marked benefit obtained by the persistent use of viburnum prunifolium. This drug lessens the irritability of the uterine tissues, and thus diminishes the asthma. (12) Gaucher-Med. de Paris, April 20, 1889. (13) Woodbury-Med. Reg., March 30 and May 11, 1889. (14) Editorial-Canada Lancet, p. 90, Nov. 1889. (5) Bosworth-N. Y., Med. Journal, Jan. 19, 1889. Gruenert (23) describes a chair for the treat- 1888. (16) Poudet-Boull. Med. des Vosges, April, 1889. London Med. Recorder, Aug. 20, 1889. (17) Kautoma—Kansas City Med. Index, Dec., 1888. Williams' Am. Jour. Med and Surg. (11) Peyer-Berlmer Klinik Heft 9, 1889. Brit Med. Journal, Aug. 31, 1889. (2) Cameron-Brit. Med. Jour., June 1, 1889. (18) Nunes - Editorial - Amer. Practitioner and News, Nov. 23, p. 345. First Brazilian Congress of Medicine, 1888. British Medical Journal. N. Carolina Med. Journal, June, 1889. (21) Duenas-Revista de Ciencias Medicas, Habana, Oct. 1888. Brit. Med. Journal, April 20; 1889. Lond. Med. Recorder, March 20, 1889. (22) Zipp-Med. Chir. Rundschan Weekly Medical Review, July 27, 1889. Deutsch Med. Wochenschrift, May 16, 1889. (23) Gruenert-Lond. Lancet, June 22. (1) Moncorvo-Rev. Mens. des Mal de l'Enf. January 18-9. Arch. Pedriatics, June, 1889. (6) Schmidtborn Volkmanns Lammbury Klinvortiage, M 328, 1889. Schmidt's Jahrbinchre, April, 1889. (6) Berkart-Bronchial Asthma, its Pathology and Treatment. Churchill, London, 1889. Brit. Medical Journal, July 27, 1889, p. 195. (19) Illingworth-Med. Press and Circular, July 24, 1889. (25) Davis-Journal Amer. Med. Ass., May 25, 1889. (24) Scott-Times and Register, Aug. 10, 1889. (20) Jares-Journal Amer. Med. Ass., May 25, 1889. Therapeutiche Monatshefte, April, 1889. (3) Da Costa-Bost. Med. and Surg. Jour., Dec. 29, 1888. (2) Robinson-Phila. Med. News, Aug. 31, 1889. Little Things we have Noticed Lately. 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 cavity is inflated in this manner the result is more marked and more permanent than when inflation without spraying is practiced. The above spray will relieve the irritation of chronic asthma when other remedies fail to give satisfactory results. Nothing is much more disagreeable the moment it is applied to the nasal mucous membrane or much pleasanter five minutes later, than a solution of iodoform in ether, one-half drachm to the ounce. of pregnancy. One part of menthol should be dissolved in twenty parts of alcohol and thirty parts of simple syrup, one teaspoonful being given each hour. This prescription is claimed to be extremely successful in arresting nausea and vomiting.-Therap. Gazette. DR. SHELDON gets the drop on the hay fever every year by visiting the mountain or lake regions, at the same time Mr. Hay, desires to call on him. He has practiced the usual deception this year and has returned to Chronic inflammation of the mucous mem- the city fresh and ready for the year's work. |