TWO CASES OF ACUTE DELIRIUM
368 out, in the absence of the peculiar whitish-pink, abundant expectoration. It seems to me that the difference in the two conditions may lie in this-that in acute spasmodic asthma it is the pulmonary artery, or afferent system, that suffers from spasm, and in acute suffocative pulmonary o3dema, it is the pulmonary vein, or efferent system, which is affected ; for in the former case there is ansemia of the lungs with no expectoration during the attack, and in the latter there is engorgement,
... e is engorgement, with pints of it. In other words, in acute spasmodic asthma (" dry asthma ") the lungs are in much the same condition as the fingers are when they are cold, white, and "asleep," or as in Raynaud's disease. In acute suffocative pulmonary oedema ("wet asthma") they are, perhaps, in a similar condition to the extremities in certain forms of erythromelalgia. I think, therefore, one may reasonably argue that the two diseases are similar, but that they differ in the' site affected by the provocative agent, whatever it may be. Both clinical pictures may be ascribed respectively to vaso-motor spasm of the different pulmonary vascular systems. I shall certainly rely with confidence upon chloroform as a remedy for both conditions in future, for it seems to me ' , from the observation of my case that great damage was done by sedative drugs and also by stimulation by alcohol, and none of the vaunted remedies for asthma did my patient any good. She seemed to be drifting into a condition of imbecility, like an epileptic does, until the systematic administration of chloroform stopped the violence of the attacks. She still has attacks-about two a month (instead of three or four a week as in March last)-it is true, but as the duration of them is so short and the remedy inspires such confidence she feels sure eventually she will completely recover. iiolton-Ie-Moors.