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such as prostration of strength, emaciation, hectic flush, and nocturnal perspirations. By the administration of alterative and anti-spasmodic inhalations she rapidly got better, and remained tolerably well for three months, when, in consequence of taking cold, a slight relapse of the old symptoms occurred; they were again combated by the like means, and she perfectly recovered from the bronchial affection, and has remained in good health up to the present time.

REMARKS. This satisfactory case was occasionally seen by a talented practitioner (the former attendant of the patient), who, since this occurrence, has taken much interest in my mode of treatment, and has jointly employed it with me in many cases with the utmost advantage.

CASE XV. CHRONIC COUGH.-I was consulted, many years ago, by an aged lady, who had been subject to an hereditary cough the greater portion of her life. The lady appeared to be in tolerably good general health, and she only complained of great distress and difficulty in dislodging the phlegm, more especially upon first waking in the morning, when she often feared that she should be suffocated. For the purpose of arousing and augmenting the nervous power in the bronchial tubes and lungs, from the loss of which the difficulty of expectorating mainly proceeded, I prescribed ammoniacal and balsamic inhalations, which completely accomplished the desired object.

CASE XVI. CHRONIC NERVOUS COUGH.-A captain in the navy, residing at Portsmouth, whose constitution, it appeared, was much broken down by a residence in a tropical climate and intemperate habits, consulted me, many years ago, for a chronic cough, to which he had been subject since his return to this country, a period of five months. He very minutely described his symptoms, which denoted great nervous debility, and a continued irritation of the mucous membrane of the bronchial tubes, with impeded breathing, and functional derangement of the liver and digestive organs. Sedative inhalations, together with a course of alteratives, and subse

quently light vegetable tonics, quite removed the cough, and caused the digestive functions to be carried on with greater activity; in short, his general health and strength became better than it had been for very many previous years, and it has continued so up to the present time.

CASE XVII. LOSS OF VOICE.-A clergyman, residing in the country (who had paid much attention to the study of medicine), consulted me, per letter, respecting a friend who had for a long period complained of great irritation in the throat, and a weakness or relaxation of the chordæ vocales (or muscles concerned in the formation of the voice), attended with loss of voice, which rendered him quite incapable of performing his professional duties. The gentleman attributed the complaint to over exertion of the vocal organs. Many remedies had been tried in vain. I prescribed astringent and tonic inhalations, which in seven days quite removed the irritation in the throat, and restored the voice. A slight return of the complaint took place some few months afterwards, but it was quickly overcome by the same remedies; since that period the gentleman has remained quite well.

REMARKS.—I have had numerous cases of aphonia in which inhalations have been successful after all other remedies had failed. So eminently valuable, indeed, are suitable inhalations in these common and distressing affections, that I scarcely remember an instance (where alone caused by excessive use of the voice in public speaking) in which their curative influence has not been speedily experienced and acknowledged by those who have adopted them. Their good effects would seem to arise, not only from acting directly on the part implicated, but also from imparting their influence, by a sympathetic action, to the nerves of the throat and bronchial tubes.

CASE XVIII. NERVOUS AFFECTION OF THE LARYNX.— The subject of this distressing complaint was a lady of pale and melancholy aspect, suffering under great nervous irritation, produced by trouble and anxiety of mind. She com

plained of a choking sensation, and a peculiar “crowing” cough, somewhat similar in sound to the whooping-cough, caused by a spasmodic constriction of the glottis. Inhalations, to act locally on the part affected, and mineral tonics, to diminish nervous irritability and improve the general health, together with pure air, change of scene, and the use of the shower-bath, quite reinstated the health of the patient. CASE XIX. CHRONIC COUGH.-A lady, aged forty, of a nervous temperament, who had, at times, for four years, suffered from cough, dependent upon irritation of the trachea, consulted me, June 27th, 1835. Inhalations of conium were at first prescribed, but without producing much benefit; subsequently belladonna was substituted, and removed the cough, the cessation of which greatly improved the general health. The cough remained quiet for nearly nine months, when it returned, although in a somewhat modified form; similar inhalations were again resorted to with complete success, and the lady has been quite well since that time.

CASE XX. CHRONIC COUGH.-A young unmarried lady, of slight figure and delicate constitution, consulted me in December, 1836, for a severe cough, which had baffled medical treatment for a period of ten months. She was greatly debilitated; pulse quick; slight and difficult expectoration; tongue feverish; bowels torpid. Stethoscopic examination gave no indication of pulmonary disease; but, upon pressing the trachea under the thyroid cartilage, the patient flinched, and informed me that all along there had been great tenderness at that part. It was evident to me that the case was one of chronic inflammation of the lining membrane of the trachea. I prescribed inhalations of chlorine and conium, counter-irritation, &c. The administration of the chlorine at first caused some little difficulty of breathing, and increased the cough; but the quantity and frequency of the inhalations being reduced, these unpleasant symptoms soon subsided, and in six weeks she had quite recovered. Simultaneously with the inhalations were given preparations of steel, to improve the

general health, and they fully accomplished the object that was intended.

CASE XXI. ASTHMA.-Many years ago I attended a married lady, aged about forty, who had been asthmatic for a considerable period. On the occasion of my first visit I found her lips of a deadly hue, the extremities cold, with a clammy perspiration, and she was fighting in extreme agony for breath, as if fearing immediate suffocation; the fit lasted for about twenty minutes, and was finally relieved by a copious expectoration of puriform matter. Her friends informed me that she had been under medical treatment, but the remedies employed neither mitigated the distress nor altered the condition of the disease; and as her general health, which had been previously pretty good, now visibly declined, they became anxious about the result, and were desirous that she should put herself under my treatment. I prescribed balsamic and anti-spasmodic inhalations, with a very mild alterative medicinal course to improve the different functions, which were irregularly performed. Under this plan the dislodgment of the bronchial secretion was considerably facilitated, the difficulty of breathing removed, and by steadily pursuing the treatment advised for a short period she was cured of the complaint, and restored to a good state of health.

REMARKS.-The immediate cause of the spasm in asthma appears to consist in a morbid contractility in the bronchial tubes, so diminishing their calibre as to produce a very limited admission of air, and thus prevent the change of the blood from venous to arterial. Hence it will be observed that the most extraordinary efforts will be made by the patient, in endeavouring by every muscular movement to enlarge the capacity of the chest, and increase the expansion of the lungs.

There are scarcely any conditions of the body which present a stronger picture of physical distress than a very aggravated case of spasmodic asthma. The patient feels as if his chest were bound with cords, and the larynx grasped with a tight hand; at moments he dreads suffocation; he desires every

window and door to be opened, that he may have as much air as possible; he heaves and gasps and breathes convulsively; the lips and cheeks become purple, changing to a livid paleness; the eyes have a wild stare; the pulse is irregular, small, and quick; and a cold sweat starts out, and stands in drops over the forehead.

In many hundred cases of different species of asthma, in which the above distressing symptoms have been experienced, I have found treatment similar to that described in the preceding case-modified according to circumstances and idiosyncracy-equally successful. In fact, there are but very few cases of this nature which may not be materially relieved by appropriate inhalations, both in the paroxysms and intervals.

When the object is to remove viscid phlegm, and prevent its formation, various expectorants may be added to the inhalations, which, by exciting the trachial or pulmonary exhalant vessels to secretion, produce a free and easy dislodgment of it. When ipecacuanha is administered as an emetic (which is desirable in some cases of asthma, characterised by a congested state of the mucous surface of the lungs, by obstruction of the bronchial tubes from accumulation of phlegm, or a torpid state of the liver and biliary apparatus), this remedy does not, by inhalation, cause that prostration of strength and disturbance of the system which follow from taking it by the stomach; at the same time, it creates a peculiarly beneficial topical effect.

CASE XXII. CHRONIC COUGH.-A request was made that I should visit a lady a Birmingham, which (thanks to the expedition and facility of communication by railways) I was enabled to comply with. The patient, who was aged about thirty, of a lymphatic temperament, and enceinte, complained of a dry hacking cough, which had existed, more or less, for ten months, and was accompanied with loss of voice, tenderness at the throat, and great irritation throughout the whole of the upper part of the chest. The paroxysms of

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