circumstances. It is necessary to distinguish asthma from the stridulous or anginous affections, of which I have previously treated, and which are entirely fortuitous, whilst asthma often persists throughout the whole of life, or at least for a long period, since the asthmatical only lose their infirmity by age. True asthma is recognised by certain peculiar signs. The asthmatic is or has been rickety: his head is between his shoulders, his skull is large, his back is curved, and his chest is flat; his respiration is sonorous, sometimes loud and whistling, without râles (except during the paroxysms). The latter commence gradually, the respiration becomes more and more difficult and jerking; the face, at first pale, expresses great anxiety, and afterwards becomes injected and blue; the asthma is then at its height, and carbonic asphyxia declares itself; indeed, the expired air contains eleven volumes of carbonic acid to eighty-nine of nitrogen. What has taken place? Evidently, there has been spasm of the small bronchi, and therefore dilatation of the pulmonary cells; the chest is also sonorous on percussion. Towards the base there is often tympanism, because there is accumulation of gas in the stomach. Vesicular breathing is diminished, suppressed, or replaced by a tubo-vesicular respiration, which, when the air at moments penetrates into the lungs, is rough and hurried. There are movable sonorous and sibilant râles, that is to say, they change from place to place every moment. The sibilant râles are sharper, intenser, and longer on expiration than on inspiration. At the end of the paroxysm, the râles become humid, and the bubbles larger and larger. The accession begins suddenly, or by degrees, and also stops. suddenly, or gradually, with cough and a thick expectoration. It leaves a feeling of great lassitude behind it, and the whole body feels as though broken. The warmth having returned, abundant diuresis takes place. The urine is loaded with urates. Rarely is there a single paroxysm, or if there is, it is rather of the nature of a sternalgia. (Vide Neuralgias.) There are periods composed of several successive paroxysms. Asthma ceases with age; but it often happens that ere asthmatic persons reach that age when their infirmity should leave them, they are carried off by organic maladies of the heart or lungs. Before speaking of treatment, I will say a word concerning the differential diagnosis, because it is the latter which should decide the question. I have given the stamp of the asthmatic; the absence of all physical signs of organic maladies of the heart and lungs, moreover, corroborates this first view. I will not speak of angina pectoris, which is so distressing and painful, and which gives rise to fever, sometimes continuous, and sometimes remittent or periodic. In asthma, there is complete absence of pain, and the paroxysm terminates by the return of heat; in angina pectoris, on the contrary, the heat is often the commencement of a cardio-pulmonary inflammation. In asthma, congestion is always passive. The treatment of asthma should be that of the different general or local conditions of the disease. As to the general condition, it is evident that there is either a hereditary or an accidental dyscrasia. The latter is easier to remove than the former, seeing that though climates may be avoided, inherited vices cannot altogether be escaped. Nevertheless, many asthmatical persons are cured or relieved by change of climate; those who inhabit a marshy country should remove to a dry .one. A humid atmosphere is especially noxious to an asthmatic person. A dry atmosphere does not, however, uniformly suit him (inter utrumque). The asthmatic will receive benefit from a residence at the sea-coast, because there the barometrical pressure is the greatest. Elevated plateaux would only add to the difficulty of respiration, on account of the rarity of the air. Here, again, there are intermediate localities.* case, * A patient of mine always receives benefit from a few weeks' residence at Davos Platz, in Switzerland. For further particulars of this and also of its dosimetric treatment, see the Répertoire of 1881. Compressed air-baths are sometimes beneficial in asthma.-H.A.A. In the second place, the blood crasis will be ameliorated by the reconstituents, such as arseniate of strychnine and arseniate of iron A granule of each, together, three to four times a-day. During the paroxysms, hydroferrocyanate of quinine, and hyosciamine will be given :— A granule of each, together, every half-hour, until the paroxysm ceases. It is necessary to take into account the dyscrasias or diatheses which have produced accidental asthma, or which have exaggerated constitutional asthma. Thus, the asthma of the gouty requires the treatment of the gouty and rheumatic diathesis-colchicine, quassine and jalapine, on account of the inertia of the digestive and urinary passages : A granule of each, together, morning and night. The asthma of the syphilitic requires the mercurials and the iodides. Toxic asthma demands the treatment for the poisoning to which it is due. Such is the asthma of workers in lead, copper and mercury. (Vide those Diatheses.) In short, there are several other asthmas due to poisoning: such as the asthma of smokers, the asthma of drinkers, the asthma of opium smokers, in a word, the asthma of every excess which induces dyscrasia of the blood. In every one of these conditions, the bowels must be kept free by the daily use of Seidlitz salt. DOSIMETRIC TREATMENT OF INSANITY. Hypochondriasis.-This affection may be placed at the head of the various forms of insanity, because it is often but a step to mental alienation. Hufeland has defined hypochondriasis "the hysteria of man,” and there is some amount of truth in that definition, since inasmuch as hysteria is common among women, so is hypochondriasis among men. In both affections, there is also an abdominal neurosis, which is the cause of the brain being occupied with sad, anxious, and suspicious ideas. In hypochondriasis there is dyscrasia, that is to say, incomplete elaboration of the blood, and the same phenomena of spasm and swelling are observed as in hysteria. The predominant symptom is constipation; black, resinous-like stools indicate an engorgement of the whole abdominal venous system. The first care ought, consequently, to consist in maintaining abdominal freedom by the morning use of Seidlitz salt; and in case of obstinate constipation, by podophylline, to which should be added hyosciamine, for the purpose of relaxing intestinal spasm : A granule of each, together, morning and night. The hypochondriac must be made to take plenty of exercise, having some definite object in view. Respecting therapeutical treatment, as visceral engorgements most often exist, arseniate of soda must be administered :— Two granules at meals. Anæmia will be best combated by arseniate of iron, with the arseniate of strychnine as a vital incitant :— A granule of each, together, morning and night. Phrenzy. It is difficult to separate those mental alienations classed under the above designation, from the abdominal neuroses (hysteria and hypochondriasis). It may be said that it is the animal sphere which usurps the intellectual sphere; whence that painful contest which Guislain has described under the name of phrenopathy. The individual is no longer master of his actions or of his will, and in consequence of his dangerous tendencies, it is necessary to confine him. Indeed, in these cases, the instincts of animals are mostly observed. Thus there are the homicidal insane, the quarrelsome insane, the howling insane, the thievish insane, etc. This would seem to support Gall's theory concerning the localisation of the cerebral faculties. Lunacy must not be confounded with the aberrations or deliriums due to material lesions of the brain, and which lead to paralysis after a period of more or less prolonged excitement. These are generally produced through physical excesses, such as the abuse of spirits. The physician who is consulted in these cases as to the propriety of confinement, should distinguish between these two orders of mental affections. Unhappily, there are no special establishments, and the mad and the delirious are shut up in the same tomb. I say tomb, because they rarely quit it, and if they do, it is with loss of reputation. The treatment of cerebral madness should be similar to that of hypochondriasis, that is to say, care must be especially taken to maintain the abdominal freedom by the use of the Seidlitz salt, podophylline, hyosciamine, quassine, and jalapine. But what is especially important in the treatment of cerebral madness, is to remove the fixed delusions of the individuals by means of bodily fatigue, even as grief is forgotten by work. Unhappily, the regulations of our asylums are opposed to such a system. The colonial system of Gheel is therefore preferable. In that colony there is an infirmary, used in cases |