Asthma is a spasmodic affection of the lungs, which comes on by paroxysms, most generally at night, and is attended by a frequent, difficult and short respiration, together with a wheezing noise, tightness across the chest, great anxiety, and a cough, terminating sometimes in a mucous expectoration; all of which symptoms are much increased when the patient is in a horizontal position.

Asthma rarely appears before the age of puberty, and attacks men more frequently than women, particularly those of a full habit. It is sometimes connected with a deformed state of the chest. In some families there seems to exist a predisposition to the disease. Persons predisposed to Asthma usually suffer from indigestion. The attacks of Asthma are usually most frequent during the heats of summer, and also in winter, when heavy fogs and sharp cold winds prevail.

An attack of Asthma is often preceded by lowness of spirits, a sense of fulness about the stomach, with lassitude, drowsiness, and pain in the head. These are followed by tightness across the chest, and difficulty of breathing, which continues to increase in intensity; the speech becomes difficult and uneasy; a propensity to coughing succeeds, and the patient can no longer remain in a horizontal position, being as it were threatened with immediate suffocation. He starts up into an erect position, and hastens to a window for air.

These symptoms usually continue till towards the approach of morning, and then begin to subside; the breathing becomes less laborious, and the patient speaks and coughs with greater ease. If the cough is attended with a free expectoration of mucus, he experiences much relief, and probably soon falls asleep. Sometimes the expectoration is very scanty, and then the term dry Asthma is applied to the disease.

When the patient awakes in the morning he still feels some de-gree of tightness across the chest, although his breathing is probably more free and easy, and he cannot bear the least motion without rendering this more difficult and uneasy; neither can he continue in bed, unless his head and shoulders are raised to a considerable height. Towards evening he again becomes drowsy; is much troubled with flatulency in the stomach, and a return of the difficulty of breathing, which continues to increase gradually till it becomes as violent as on the night before.

After some nights passed in this way, the fits at length moderate and suffer more considerable remissions, particularly when there is copious expectoration in the mornings, and this continues from time to time during the day; and the disease going off at last, the patient enjoys his usual rest by night without further disturbance.

During the fits the pulse is not usually much affected, but occasionally it is frequent with some degree of thirst and other feverish symptoms. In some cases the face becomes bloated and flushed, but more commonly it is pale and shrunk. Urine voided at the beginning of a fit is generally of considerable quantity, and with little colour or odour; but after the fit is over, what is voided is in the ordinary quantity, of a high colour, and sometimes deposits a sediment.

Asthma, but more particularly the dry or spasmodic, may be brought on by almost anything that increases the action of the heart, and which stimulates and fills the blood vessels of the mucous membrane. Thus it is produced by intense heat, by severe exercise, by strong mental emotions, by full meals, by stimulating drinks, by exposure to cold and changes in the atmosphere, and by certain effluvia, as those of hay, whether new or old, and of burning substances; congestions of blood in the lungs, noxious vapors arising from a decomposition of lead or arsenic, impure and smoky air, cold and foggy atmosphere, dyspepsia or irritation of the stomach or bowels, but particularly the stomach, suppression of long-accustomed evacuations, the sudden striking in of any critical eruption, particularly that of shingles; frequent catarrhal attacks, wandering gout, general debility, water in the chest, and other disturbing causes may bring on an attack.

Asthma is sometimes hereditary, and having once attacked a person, the fits are apt to return periodically, and more especially when excited by certain causes, as by a sudden change from cold to warm weather, or from a heavier to a lighter atmosphere, by severe exercise of any kind which quickens the circulation of the blood; by an increased bulk of the stomach, either from too full a meal or from a collection of wind in it; by exposure to cold or damp air, obstructing the perspiration, and thereby favouring an accumulation of blood in the lungs; by violent passions of the mind, by disagreeable odours, and by irritations of smoke, dust, and other subtile particles floating in the air. Persons who have become subject to the disease seldom escape an attack in the spring and autumn.

If the attacks of Asthma are neither frequent nor severe, the constitution unimpaired, and the patient young, there may be a possibility of removing the disease entirely; but where it comes on at an advanced period of life, has frequent paroxysms, and proceeds either from an hereditary predisposition, or an unfavourable habit of body, it will be almost impossible to make a permanent cure. By changing into other diseases, as consumption or dropsy in the chest, or by occasioning an aneurism of the heart or of some large vessel, it may prove fatal; otherwise it is not attended with danger, although it may seem in many cases to threaten almost immediate death by suffocation.

The respiration becoming suddenly short and quick, the pulse weak and irregular, paralysis of the arms, great depression of strength, a scanty secretion of urine, and frothing at the mouth, indicate extreme danger.

Treatment

In the first place we have to endeavour to cut short or remove the spasms; in the second place we must try to prevent their return, or, if we cannot accomplish that, to moderate their future violence.

Notwithstanding any inflammatory appearances that may exist, bleeding has almost always been attended with bad results; so also has the administration of emetics and strong purgatives; but if the bowels are confined, a gentle laxative, such as Castor Oil, or a mild dose of the Cathartic Pills, No. 4, may be taken. Most benefit will be derived from the use of Antispasmodics and Sedatives: such as Camphor, Ether, Assafoetida, Digitalis, Squills, Ammonia-cum, Henbane, and Opium. Lobelia has also been much used. Much benefit has also resulted from smoking Stramonium (Thorn-apple), and also in a less degree from smoking Tobacco.

During the continuance of the attack, the following preparations may be taken; if, after a day or two's perseverance with one of them, it does not appear to have the desired effect, another may be tried, till it is ascertained which is most suitable to the constitution of the patient.

Take Gum Ammoniacum...................Two Drams.

Powdered Squills..............................One Dram.

Extract of Henbane...........................Half a Dram-Mix, and divide into 48 pills. Take four, three times a day.

Take Sulphuric Ether........................Two Drams.

Tincture of Henbane.........................One Dram.

Camphor Mixture.............................Six Ounces. - Mix, and take two tablespoonfuls three times a day.

Take Assafoetida..............................One Dram.

Gum Ammoniacum.........................One Dram.

Camphor.......................................Half a Dram.

Extract of Henbane.........................Half a Dram. - Mix, and divide into 36 pills. Take two, three times a day.

Tincture of Lobelia..........................Two Drams.

Camphor Mixture............................Four Ounces. - Mix,

Take a tablespoonful three times a day.

Digitalis is found to act more beneficially on those patients who are pale and emaciated, than on the florid and robust. It may be taken in doses of Ten drops of the Tincture, twice or three times a day.

If the patient has a difficulty in sleeping, he may take Ten grains of Bromide of Potash, or Ten grains of Bromide of Ammonia, at bedtime.

Benefit may be derived from putting the feet in hot water, and the patient should be warmly clad.

After the attack has subsided, attention must be paid to the general state of the health. The bowels should be regulated and a tonic should be taken. The Tonic Mixture No. 11,maybe taken, or the following:-

Tincture of Cascarilla.........................One Ounce.

Tincture of Calumba...........................One Ounce.

Tincture of Orange Peel.....................One Ounce.

Take a teaspoonful three times a day, in a glass of water.

Particular attention must be paid to the diet. All indigestible articles of food must be avoided, and the patient should live, as much as possible, on boiled mutton, poultry and light puddings. Tea should not be taken more than once a day. Much benefit has been derived from the use of coffee in spasmodic asthma, but to be of service it must be taken very strong.