This is a spasmodic disease, producing a constriction of the bronchial tubes, often hereditary, incident to both sexes, but more common in men than in women. The air tubes of the lungs are encircled by minute bands of muscular structure, which like other muscular fibres may be affected by spasms. These spasms of course contract the air tubes, and the difficulty of breathing and the wheezing respiration is occasioned by the air being forced through the narrowed channels for respiration.

Diagnosis

There is great difficulty of breathing; coming on in paroxysms and accompanied with loud wheezing respiration, passing off in a few hours with more or less expectoration.

If the patient has ever suffered from an attack, there are generally premonitory symptoms sufficiently prominent to indicate its approach, such as loss of appetite, languor, drowsiness, oppression, and chilliness. The dyspnoea more generally comes on after midnight, but not unfrequently occurs during the afternoon and evening. There is a sense of constriction about the chest, and urgent desire for fresh air, often causing the patient to rush to the open window, however cold may be the night, and a loud wheezing respiration. These symptoms often last for several hours, when remission gradually takes place. The attacks may return at longer or shorter intervals, and when they cease with little or no expectoration, the case is said to be one of dry asthma, but when expectoration is copious; it is called humid or humoral asthma. Asthma is often connected with organic disease of the heart and large blood-vessels.

Causes

This disease, as we have already said, may be hereditary, or it may be occasioned by certain states of the atmosphere irritating the surface of the air-passages, or by certain influences, which affect in a peculiar way the nervous system; thus nearly all the exciting causes of catarrh may produce asthma. Some breathe with the most freedom in the keen air of the mountain top, others in moist, low places; not unfrequently the breathing will be exceedingly difficult in one street and perfectly easy in another not half a mile distant. A person at a hotel in Paris could sleep perfectly well in a room in the front of the house, but found it impossible to sleep in the back part, from the asthma.

Treatment

Before giving the symptomatic indication for the different remedies it may present the treatment in a clearer light, to classify the remedies according to the exciting causes of the disease.

When occasioned by a congestion of blood in the chest, Acon., Bell., Nux-v., Phos., Cupr. or Puls, may be consulted.

By a derangement of the menses: Bell., Cocc., Nux-v., Puls., Sep., Cuprum.

By flatulence: Cham., Chin., Nux-v., Sulph., Verat.

When it simply presents the form of cramps in the chest: Bell, Coc, Cupr., Moschus, Nux-v., Stram., Stib. and Bryonia.

When occasioned by inspiration of dust: Calc, Sil^ Sulph., Ipecac.

When the result of a chill: Dulc, Acon., Bell., Bry., Ipecac., Arsenic.

In consequence of moral emotions: Ignatia., Coff., Cham., Nux-vom.

From suppressed catarrh: Ars., Ipecac., Nuxvom., Samb., Stibium.

In hysterical women: Coff., Ignatia, Moschus, Stram., Asa., Ipecac., Ars., Pulsatilla.

In aged persons: Con., Op., Camph., Carb.-v., Arscnic.

When moist with accumulation of mucus in the bronchia: Ipecac., Ars., Bay., Puls., Sulph., Stan., Phos., Stibium.

Symptomatic Indications

Ipecac., Arsenic and Bryonia are the most prominent remedies, and perhaps more frequently indicated, than any other. If the attack should come on suddenly, it would be safe to give a dose of Ipecac., until the remedy most indicated could be ascertained.

Ipecac., - Nocturnal paroxysms of suffocation, spasmodic constriction of the larynx, rattling in the chest from mucus; great anguish; short dry cough, redness and heat, or paleness and coldness of the face alternately; nausea with cold perspiration on the forehead, anxious, rapid and moaning respiration, or respiration short and obstructed, as from dust. It may be followed or alternated with Arsenic, Bryonia or Nux.

Bryonia

Obstructed respiration, increased by talking or movement, particularly at night or toward morn ing, frequent cough with pressure or shooting pain in the chest aggravated by movement; palpitation of the heart; difficult, moaning anxious respiration, intermixed with deep inspirations.

Arsenicum - Obstructed respiration, cough, and accumulation of thick mucus in the chest; oppression at the chest and want of breath at every movement; constriction in the chest and larynx with painful pressure on the lungs, worse in a warm room. Suffocative fits, particularly at night or in the evening in bed, with panting or wheezing respiration, great anguish and cold perspiration. Remission of the attack on the appearance of cough, and renewal during rough weather and changes of temperature. The attacks are often accompanied with great weakness and burning pain in the chest, Arsenic is frequently required after Ipecac., and is indicated in most cases of chronic as well as acute asthma.

Nux-Vom

Where Arsenic fails to produce relief, and where the constriction is in the lower part of the chest, even the clothes producing a sensation of tightness and oppression; short cough with difficult expectoration; sputa tinged with blood; congestion toward the chest, with heat, burning, palpitation of the heart, and general uneasiness; asthma relieved by lying on the back, turning and sitting up.

Belladonna

Particularly in children, and women subject to spasms, with congestion and pulsation in the head and chest; oppressed breathing and want of breath; dry cough at night; anxious and moaning respiration, at times deep, at others short and rapid; constriction of the larynx with danger of suffocation, and sometimes loss of consciousness.

Pulsatilla - especially in children after the suppression of a miliary eruption; and in hysterical persons after the cessation of the catamenia or from taking cold: rapid, short and rattling respiration; choking as from the vapor of sulphur; paroxysms of suffocation, with anguish, palpitation of the heart, spasmodic constriction of the larynx and chest, particularly at night or on lying in a horizontal position; short, panting cough, expectoration of sanguineous mucus, tension, fullness, pressure 9 and shooting in the chest. Asthma aggravated by movement

Phosphorus

Dyspnoea, obstructed respiration and oppression of the chest, especially in the evening and during movement; great anguish or spasmodic constriction in the chest; nocturnal attacks of suffocation as from paralysis of the lungs; palpitation of the heart, short cough, shooting pain, heaviness, fullness, and congestion of blood to the chest. Alternate with Belladonna, and where there is danger of paralysis of the lungs, with Stibium.

Stibium

Especially in children and aged persons, and where there is anxious oppression, dyspnoea; choking and paroxysms of suffocation in the evening or morning, with rattling of mucus in the chest, violent cough, palpitation of the heart, and congestion of blood to the chest.

Sulphur

Particularly in chronic cases, where there are nocturnal paroxysms of suffocation, and obstructed respiration, fullness, painful weariness, burning, and congestion in the chest; expectoration of mucus, detached with difficulty and sometimes of a bloody appearance; spasms in the chest, constriction and pain in the sternum short respiration and inability to speak.

Veratrum

In spasmodic asthma where there is prostration and coldness of the extremities.

Sambucus

Principally in children, and where there are choking when lying down; wheezing and rapid respiration, nocturnal paroxysm of suffocation with spasmodic constriction; great anguish rattling of mucus in the chest and paroxysms of suffocating cough.

Aconite

Principally in sensitive persons and young girls of plethoric habit, especially if occasioned by moral emotion, and where there is dyspnoea, suffocative cough at night, anxious, short, and difficult respiration, congestion in the head with vertigo.

Cuprum

In children and hysterial persons, after a fright, anger, a chill, and before the catamenia; spasmodic constriction of the chest; obstructed respiration on walking; short, spasmodic cough with paroxysms of suffocation, and whistling on trying to take a deep inspiration.

China

Dyspnoea and oppression with inability to breathe on lying with the head low; wheezing in the chest when drawing breath; spasmodic cough and noc-tural paroxysms of suffocation; sanguineous sputa; palpitation of the heart, and prostration of strength.

Cocculus

Especially in hysterical persons, where there is dyspnoea, constriction in the throat and chest, with oppression, particularly at night.

Chamomilla

In children after a cold or a fit of passion, and when there are paroxysms of suffocation, swelling about the pit of the stomach, agitation and cries.

Moschus

For hysterical persons and children, and where there is oppression and spasmodic constriction of the chest and larynx, particularly after a cold.

Opium

Deep stertorous and rattling respiration; obstructed breathing, choking, suffocating cough, and paroxysms of suffocation during sleep, like nightmare.

Calcarea

In chronic cases, and where there is obstructed respiration, and frequent dry cough, as from dust, particularly at night.

Ignatia

Especially when occasioned by fright, grief or indignation.

Dose

Two drops, or twelve globules, of the selected remedy, in a tumbler of water, a tablespoonful at a dose; or a powder, or six globules on the tongue. In severe cases give every half hour, increasing the intervals to four hours. In chronic cases give morning and night.

Diet And Regimen

Persons subject to the asthma should bathe the chest morning and night, at first with tepid water, gradually lowering the temperature until it reaches the natural coldness. Coffee and greasy substances should be avoided. Often when the paroxysm is excessively severe, it may be relieved by strong coffee, tobacco, or strammonium smoke.