to a certain degree, their utmost activity is insufficient to supply the needs of the organism, and the patient suffers the tortures of an irremediable air-famine. The automatic action of the lungs has to be supplemented by a desperate muscular effort, the motions of the contracted organ become spasmodic and wheezing, the sufferer is unable to breathe in an horizontal position, and after a short slumber awakens with a sense of suffocation. But a chronic disposition to all these symptoms in their extreme malignity may exist without a phthisical diathesis, and remain latent for weeks and years. The exciting cause generally operates without a moment's warning. During the laborious digestion of a heavy dinner, or even after a moderate meal, eaten on a sultry day, the process of respiration begins to alternate with inert pauses, relieved at first by an occasional yawn, by-and-by only by a violent gasp; a feeling of uneasiness supervenes, the air-deficit becomes more and more perceptible, and the patient suddenly realizes that he is booked for a five days' struggle with a pulmonary torpor. Changes of temperature, a sudden thaw in midwinter, or a sultry day after a protracted rain, have a similar tendency, but the most frequent proximate cause is violent mental emotion—fear, anxiety, and especially suppressed anger. Nothing else so strikingly illustrates the intimate interaction of mental and physical conditions as this sudden pathological effect of a purely physical cause. In the same instant almost, when a fit of wrath—even in the form of a transient irritation—accelerates the throbbing of the heart, its reaction on the respiratory organs betrays itself by a spasmodic gasp, the patient instinctively clutches his ribs and tries to master the incipient mischief, but emotional asthma is a form of the disease that can rarely be nipped in the bud; the primum mobile can not be revoked, and the sufferer may think himself lucky to get off with a result of twenty-four hours' misery. Excessive exercise—lifting weights, running, wrestling, etc.—is merely an adjuvant of the fore-named cause. With his mind at ease, an asthmatic may chop cord-wood on the warmest day in the year, carry corn-sacks, or run up-hill till his lungs are ready to burst with panting; that panting will be entirely distinct from the ineffectual gasps of the air-famine. But, under the depressing influence of mental worry, an exhausting physical effort will bring on a fit of asthma as surely as heat and exercise would result in perspiration.
Among the rarer proximate causes are loss of blood, starvation, nervous exhaustion from mental overwork, sexual excesses, and sudden fright, or rather the shudder which sometimes follows the nervous shock produced by a real or imaginary danger, as a slip of the foot at the brink of a steep declivity, a snake-panic, the unexpected visit of a stranger, etc. Nausea in some of its forms may produce an analogous effect. "A young lady," says a correspondent of the London "Lancet," "was sitting at dinner, apparently in perfect health. She partook, among other things, of some rabbit, and in about ten minutes or
