The cure of Pertussis is often tedious and embarrass ing, and we have scarcely any general principles by which to direct us in our course. General bleeding is sometimes necessary at the commencement, and leeches may frequently be indicated by the pain or soreness of the chest ; but it is not a disease in which copious de pletion is necessary, or in which it appears to be at tended with benefit. As the paroxysm is usually ter minated by expectoration, so it has been the great ob ject of the practitioner to administer medicines which may promote this process. Unfortunately, however, they are of very uncertain effect, and very dubious ope ration ; and it not unfrequenly happens that greater injury is experienced by their heating or stimulating quality, than is compensated by any benefit to be de rivea from the discharge of mucus which they produce. Perhaps the most unexceptionable of this class are those that act as emetics ; and, upon the whole, we think that tile most effective treatment of Pertussis consists in giving ipecacuanha, so as to produce gentle vomiting once or twice daily. Antimony we think less proper, on account of its debilitating operation, an objection able circumstance in a disease of such long continuance, and where the patients are often young and delicate. Diuretics have been prescribed in Hooping-cough ; but we doubt whether they are of any use, while they are liable to the same objection with the expectorants. Next to emetics, perhaps the most generally useful re medies are blisters, which may be small, but fre quently repeated. The disease is apt to degenerate into a chronic state, and, when all the inflamma tory symptoms are gone, but the cough still remains violent, opium becomes admissible, and is often found very effectual ; its good effects are increased by be ing combined with ipecacuanha. We have not much confidence in the tribe of antispasmodics which have been recommended in Hooping•cough. There is, how ever, one remedy, which, in the latter stage, is univer sally admitted to be very useful, a change of air ; and it is remarkable, that it appears to be merely the circum stance ol change, and not any quality in the air itself, as the same benefit is obtained, by taking the patient from the pure air of the country to the confined atmosphere of a crowded city.
We not unfrequently meet with symptoms of simple Dyspncea, which we find it difficult to refer to any other primary affection, yet it is so generally sympathetic, and its treatment depends so much upon the particular circumstances of the individual case, that we shall dis miss the farther consideration of it, and proceed to Asthma. Asthma is characterized by difficult and pain ful respiration, in which the breath is drawn at short intervals, and with what is termed a wheezing sound, attended with pain, and a sense of constriction in the chest, and a degree of cough. It occurs in paroxysms, :which usually come on about midnight. It is frequent ly attended with a copious expectoration of mucus ; but at times this discharge is not present ; and according ly the disease has been divided into the varieties of moist and dry. When the fit comes on in the night, the patient is affected for some hours before the acces sion with langour and drowsiness, and a degree of tight ness in the chest, with some cough. These symptoms gradually increase until the paroxysm arrives at its greatest degree of violence, when, in three or four hours, it subsides spontaneously, leaving behind great debility and heaviness. It not unusually happens, that the same train of symptoms occur for several successive nights, when the disease becomes less violent, and for a time totally disappears. Generally, the patient is able to trace these accessions to some obvious exciting cause. Certain states of the atmosphere, as the air of large ci ties, fogs, or exhalations from damp ground, indiges tion, or repletion of the stomach, and violent exercise, are the circumstances which we observe to operate the most powerfully. When once the disease has invaded the constitution, and gone through a complete set of paroxysms, we find that it is much more easily excited than at first ; and at length it occurs when we are un able to assign any probable reason for it. The proxi
mate cause of Asthma is obscure. The morbid contrac tion of the muscular fibres of the bronchi?, which has been usually employed to account for it, we conceive to be a point of doubtful existence, and scarcely ade quate to the effect. There are, however, many circum stances connected with the disease, which lead to the supposition that it is a primary affection of the nervous system. We not unfrequently observe individuals who pass a long life under the influence of Asthma, and ap parently do not experience any considerable evil, ex cept the pain and inconvenience arising from the actual presence of the disease ; but there are many cases in which it terminates in Phthisis, Hydrothorax, chronic inflammation of the chest, enlargement of the heart, Aneurism, &c. by inducing a state of gradual decline, in which all the functions lose their due action, and ulti mately proves fatal.
The obvious indications of cure in Asthma are, to mo derate the violence of the paroxysm, and to prevent its recurrence, both of which we unfortunately find it very difficult to accomplish. Although the violence and fre quency of the disease have rendered it an object of great attention to all practitioners, so that every one must have had much experience of the effect of remedies upon it, yet still we feel considerable uncertainty respecting their operation, or the degree of benefit which is to be expected from them. Depletion does not, upon the whole, seem to be useful ; and although the sense of fulness about the chest, and the febrile state of the sys tem, during the paroxysm, might seem to indicate bleed ing, yet we believe it has not been productive of the expected relief. Nor is the good effect of purgatives so evident as in many of the Neuroses ; and we may make the same remark with respect to blisters, which, in ;affections of the chest, are usually resorted to with much advantage. The fit frequently terminates in ex pectoration ; yet it would not appear that any decided advantage is obtained by the administration of what are termed expectorants, and even emetics are said to have failed in shortening the paroxysm, while the efforts to evacuate the contents of the stomach have materially added to the distress of the patient. Very favourable re ports have been made of some of the sedatives or nar codes, especially tobacco and stramonium ; but it does not appear that they arc equally successful in all cases, and where they have proved efficacious when first em ployed, they have afterwards appeared to lose their power ; the same remarks may be made respecting opium, which, in moderate doses, has occasionally proved useful, but perhaps has more frequently failed. The inhalation of the steams of hot water is a palliative, which may be salely employed ; and as the patient is usually affected with flatulence and eructatiohs, we may obtain some relief from magnesia and the carbonated alkalies. Nor are the means which we possess for preventing the recurrence of the fit much more certain than those for shortening its duration. When Asthma is connected with at,y constitutional malady, it will be proper to en deavour to remove this latter, or if possible to obviate its exciting cause ; and we must carefully watch the state of all the functions, more particularly of the stomach and bowels, and endeavour to restore their healthy ac tion when deranged, but beyond this we fear that our efforts will be nearly unavailing. Like other nervous diseases, Asthma is supposed to degenerate into that chronic state, in which the paroxysms occur, although the exciting cause is no longer supposed to exist, as if by the force of habit. It may indeed be doubted bow far this idea is well founded, but we certainly observe instances where the complaint appears to be relieved by a change of situation, or a complete alteration in the mode of life and occupations of the patient.