improved by the routine treatment of asthma, but is successfully combated with that of epilepsy. This guides us to the adoption of a new line of treatment of remarkable efficacy.

Thymic asthma, described by Kopp, is considered by him as nothing less than epilepsy analogous to asthma. He designates it as epileptic asthma instead of emanating from the gastro-pulmonary filaments of the vagus nerve. It has its seat of origin in the laryngeal filament of the eighth pair of nerves.

42

Oot.

Holm describes an inspiratory dyspnoea which has not been previously brought before the profession. One peculiarity is that the paroxysms never come during the night. He considers this disease a neurosis of the phrenic nerve, and does not think it the psychical asthma of Hecker and Leyden.

Pathology has not been replete with advances during the past year in this intractable trouble.

5

Sept.

Bosworth considers asthma dependent on (1) a general neurotic condition; (2) a diseased condition of the nasal mucous membrane; (3) some obscure conditions of the atmosphere exciting the paroxysms. From the immediate relief experienced from the use of cocaine in the nose during the exacerbation, this author is led to believe that a majority of cases of asthma are dependent on some obscure lesion in the nasal cavity. Also the same conclusion is reached from the cure of so many cases by the removal of the destructive lesions in the upper air-passages. The most intricate, delicate, and important part of the whole respiratory tract lies in the nose in that mass of blood-vessels which we call the turbinated tissues, and which serve to supply the inspired air with moisture. A diseased condition of the nasal cavity might predispose a neurotic patient to an attack of asthma under favorable atmospheric conditions. One of the noted subjects of idiosyncrasy in which the nose is implicated is Prof. Austin Flint, of New York, who cannot sleep on a feather pillow. He is so susceptible that he is able to detect feathers placed under his pillow by persons whose design is to catch him in his idiosyncrasy.

May 15

192

Walsh considers the causes predisposing and exciting, and also believes that heredity plays an important role in the former. Anything which will produce an irritation of terminal ends of the respiratory nerves will produce a paroxysm.

Treatment.-Weill has used carbonic acid gas to relieve

Mar.8

dyspnoea. He had the patient inhale the pure gas from five to ten minutes at a time, using from two to five litres (four to ten pints) once or twice a day. This treatment was suggested to him by observing the experiments of Brown-Séquard on the inhibitory effect of a current of carbonic acid gas on the larynx. In using the gas there seems to be an abolition of the reflex sensibility of the pharynx and larynx. It appears to cut the paroxysms short when given during the attacks, and the palpitations which follow are much diminished. The cough stops and the respiration falls to half its previous rate, while the patient at once experiences a feeling of relief. If used between the attacks it has the effect of preventing them and diminishes their frequency. Linossier has confirmed the experiments of Weill. He found the dyspnoea and cough both quickly relieved by simply inhaling the gas given off from a glass containing a solution of bicarbonate of soda and tartaric acid in effervescence.

3

May 23

May 27

May 1

Lépine says the inhalation of carbonic acid gas by Weill has shown itself, even to the present time, a useful and innocent remedy in certain cases of dyspnoea, especially those of the tubercular variety. Its action on the dyspnoea and on the spasms of coughing is very great. The relief continues sometimes for several hours and even for days. Chabannes has made a large number of experiments with inhalations of carbonic acid gas, and invented a number of instruments used in this treatment. He considers carbonic acid inhalations superior to any other empirical treatment, as, for example, morphine, because there is no risk of intoxication and the effects are permanent. In reality the carbonic acid is absorbed in very little quantity. Its direct action is inhibitory on the larynx, and not indirect through the circulation. Chabannes z describes a simple method of manufacturing carbonic acid gas. In a bottle closed with a rubber stopper, into which he passes a tube, is placed twelve grammes (3 3) of tartaric acid and fifteen grammes (34) of bicarbonate of soda, a quantity sufficient to produce four or five litres (quarts) of carbonic acid. The patient places the tube in his mouth, and the gas is very easily inhaled on account of its force of expansion. This can also be done with a common glass.

Jan

3

Ellis considers quebracho (aspidosperma quebracho) a good remedy for dyspnoea. He has not observed the disagreeable effects,

as headache, partial unconsciousness, dizziness, and copious salivation, reported by some. He gives a teaspoonful of fluid extract of quebracho, repeated every hour as required. The second or third dose usually produces the desired effect. He accepts as plausible the hypothesis of Penzoldt that this remedy enables the blood to take up more acid than usual, and thus to satiate the intense demand.

Feb. 18

Antipyrin has been quite successful in the hands of Dodge. After a trial of lobelia, grindelia robusta, iodide of potassium, and pyridin he gave fifteen grains (1 gramme) every three hours during the night, and five grains (0.32 gramme) every three hours during the day. Apomorphine and antipyrin have been found of much benefit by Bories,, who, in despair, injected one-twelfth of a grain (0.0054 gramme) of apomorphine. Prompt emesis ensued, and the patient fell into a deep sleep, from which she did not awaken for four hours. In a subsequent attack she suffered from a severe headache, for which antipyrin was prescribed with much benefit, both to the asthma and headache.

Hyoscyamin, hypodermically, is recommended by Musser, if a rapid effect is desired, 14-15 grain (0.00046–0.00054 gramme) for the spasmodic asthma of emphysema.

12

Brügelmann, approves the dictum of Boecker: "In the treatment of asthma the treatment of the whole constitution of the patient is of the greatest importance." He considers iodide of potassium only of service in bronchial asthma, and of some temporary benefit in the toxic form. Arsenic, he thinks, has no effect except in neurasthenic asthma. Amylene hydrate did good service in nasal and pharyngeal and also in bronchial asthma, although the relief was transient. In his hands cannabis indica had proven a very uncertain drug. Pyridin was of temporary benefit in a few cases of bronchial asthma, but failed in all others, especially when

Cocaine, administered internally and by injections, at times gave surprising results in neurasthenic asthma. It frequently fails in other forms and causes alarming symptoms. Chloral is indispensable, as it gives the required rest in all varieties. He finds the induced current to act very strikingly in bronchial asthma, and sometimes in the toxic form; but in the other varieties it is inactive. The constant current he has found without result.

Feb. 19

109

Oct.

Poulet has obtained marvelous effects in his so-called epileptic asthma from bromide of potassium in six-gramme (gr. 92) doses daily, in conjunction with six milligrammes (gr. 1') of picrotoxine and an equal amount of soda. The paroxysms were almost entirely suppressed at one stroke, but a single attack occurred at the end of ten days. Sawitzki, after having tried a legion of anti-asthmatic remedies, including iodine, tincture of lobelia, nitrite of amyl, nitro-glycerin, paraldehyde, aspidospermin, pyridin, etc., concluded that the hypodermic injection of morphine in moderate doses, about grain (0.008 gramme), renders the best service. Nitro-glycerin, one-drop doses of 1 per cent. solution, promptly relieves the asthmatic seizures. It will remove the helmet-like headache in one minute. Inhalations of oxygen and cocaine by insufflation, according to this authority, are highly beneficial. Bosworth emphasizes the fact that local treatment of the intra-nasal disease affords by far the most satisfactory method of controlling this disease, particularly in cases under twenty years of age. Gaul has had beneficial results from the use of weed known as Spanish needle-bidens bipinnata.

Feb.

5 S

176

Mar.

60

Sep. 15

Lewis and many others bear testimony to the benefit of smoky atmospheres. The immunity of certain patients in London and other large cities has been long noticed.

5

Williams highly favors the time-honored remedy of iodide of potassium, and thinks the effect is due to the action of the iodine in reducing enlarged bronchial glands. The indications for prescribing this remedy are (1) the absence of catarrh; (2) the well-marked presence of the neurotic element; (3) the detection of dullness along the right or left edge of the first portion of the sternum or in both intercapsular regions showing enlargement of the bronchial glands. He combines arsenic with the iodide of potassium with much benefit. The application of rarefied air or compressed air in bronchial asthma has been used to a considerable extent by him, and almost invariably with excellent results. The great relief comes from the reduction of the chest circumference, the reappearance of hepatic and cardiac dullness, the greater freedom of respiration, as well as many other minor improvements. Contra-indications are distinct valvular disease of the heart, extensive cardiac dilatation, fatty degeneration of the heart, or atheromatous degeneration of the arteries.

DISEASES OF THE HEART.

BY ALFRED L. LOOMIS, M.D., LL.D.,

AND

CHARLES E. QUIMBY, M.D.,

NEW YORK.

ARTERIAL DISEASE AS ETIOLOGICAL FACTOR IN DISEASE OF THE HEART.

THE rapid advance which arterial disease has made during the past few years to a foremost position among the causes of cardiac affections, and the intimate relations which are known to exist between the two conditions, offer sufficient excuse for placing what has been added to our knowledge of this subject during the year at the beginning in our attempt to arrange the somewhat disjointed facts in rational order.

371 61 Bd. 19, No.15; Feb.11

The importance of vascular disease is well-illustrated by Algot Key-Aberg through a series of papers in which he considers the relations of arterial disease as a primary cause of sudden death, holding such disease responsible for its legitimate sequelae. The earlier part of the paper relates to "sudden death" from various stand-points, especially the medico-legal.

In the later portions, statistical considerations based upon over eight hundred autopsies lead to the conclusions (1) that 74.5 per cent. of all cases of sudden death, from a medico-legal stand-point, occurring after the age of fourteen, were due to endarteritis chronica deformans or one of its sequela; (2) that the usual sequelæ are paralysis of the heart, rupture of the heart, aneurism, rupture of the aorta, and intracranial hæmorrhage.

Concerning disease of the coronary arteries and subsequent cardiac changes ending in cardiac paralysis, he states that out of thirteen cases, in four there was no muscular degeneration or necrotic softening, and in only two of the thirteen did the muscle show any general fatty change. Such facts are hardly in accord with generally accepted beliefs, and we doubt if more general statistics would afford any such results.

The view that fatty degeneration is not the only, if common