There are two distinct species of this disorder, each of which requires a different treatment: 1. When it is attended with an accumulation and discharge of hu-mours from the lungs, in which case it is called humid asthma; and 2. When the patient is not troubled with coughing, or at least has no expectoration, which is termed dry asthma. Yet these complaints seldom affect persons in early life, and then chiefly the male sex.
Asthma, in general, is distinguished by paroxysms, preceded by a sense of tightness in the chest, and in general, occurs during the night. The patient cannot lie in an horizontal posture, without danger of suffocation; and, when seized, is immediately obliged to sit upright. After continuing for several hours in this state; he becomes easier; his breathing is less difficult and oppressed, the cough not so frequent, and an expectoration of mucus 'taking place, the paroxysm .next nigh; but the symptoms contue in a greater or less degree, during the day, according to the particular state of the atmosphere, and other circumstances. The attack is sometimes induced by external heat, at others by cold; but in either case, their sudden accession will sufficiently distinguish the asthma from symptomatic shortness of breath. There is a greater probability of curing it in youth, than at an advanced age. But, in the former case, it is often succeeded by a confirmed pulmonary consumption; and, after a long continuation, generally terminates, either in dropsy of the breast, or an aneurism of the heart or arterial system. A tremulous respiration, paralysms of the arms, and a diminution of the urinary secretion, are unfavourable symptoms.
This is one of the chronic diseases, which may continue for a considerable number of years. Sir John Floyer, when he published his celebrated treatise on this subject, had suffered under repeated paroxyms for almost thirty years. The usual treatment is, to bleed, during a fit, unless extreme weakness or old age should forbid the use of the lancet; to inject a purging clyster, containing a solution of asafoetida ; and, if the violence of the symptoms do not speedily abate, to apply a blistering plaster to the neck or breast. Previously to a fit, emetics have been found useful, especially when the stomach was loaded with crudities. In the intervals, lac ammoniacum, vinegar of squills, asafcetida pills, and other stimulating and deobstruent medicines, are usefully employed. Sir John declares, that a strong infu-6km of roasted coffee is the best remedy he ever experienced, to abate the paroxysms. The coffee must be of the best Moco, newly burnt, and made very strong, im-mediately after grinding. He orders an ounce to one dish, which is to be repeated after the short interval of a quarter or half an hour, and taken without milk or sugar. By the use of this remedy, he lived many years tolerably easy, under his asthmatic complaint. Dr. Per-cival also asserts, that he has employed it with great success.
In a violent paroxysm of asthma, from the effects of which there is imminent danger of suffocation, administration of an emetic is sometimes advisable, as vomiting tends to produce immediate relief. This remedy, however, can only be re-sorted to with safety, under the following circumstances: ]. That there be no symptoms of inflammation discoverable: 2. That the humid matter in the pectoral organs be loose, and ready for expectoration ; which may be ascertained by a free rattling of the throat; 3."When respiration itself is not extremely impeded; and 4.When the patient's strength is not too much exhausted.
On these conditions, an emetic may prove the only means of saving his life; though it may also acce-terate the fatal catastrophe, especially if the breast be clogged with matter, and the patient possess not vigour and breath sufficient to support the operation of an emetic. Hence a judicious practitioner will, in such cases, not hesitate to direct a brisk dose, in order most speedily to produce the desired effect, and to save the constitution from being unnecessarily exhausted. But this illustration also evinces the importance of every step in the practice of physic; and that neither officious friends, nor mercenary pretenders, are the most proper persons, who services can be useful on such or similar occasions. We, therefore, think it our duty to corroborate this proposition still farther, by exhibiting a concise view of those causes, from which that formidable disease may arise in different individuals. The principal of these are as follow:
1. Collections or congestions of blood in the lungs; from which there may not only arise the dry asthma, but likewise the Suffocative Catarrh, which is, strictly, an acute disease, occasioned by an extravasation or effusion of blood into the cellular substance of the lungs, and of which we propose to treat in its proper place.
2. Congestions of serous and pi-tuitous humours, arising gradually, and producing, in general, the humid asthma : but if this collection of humours takes place suddenly, as is the case in inflammations of the chest, they are then attended with the suffocative catarrh.
3. Spasms in hypochondriacal and hysteric persons ; which often lay the foundation of a dry, convulsive asthma.
4. Worms in the first passages.
6. Asthma may likewise be a symptom of dropsy of the chest.
7- Scrophulous, rheumatic, gouty, psoric, and scorbutic acrimony - all may occasion the asthma, either in the lungs themselves, or by consent of parts.
9. The introduction of dust into the lungs, to which millers, masons, flatters, etc. are subject.
10. Tubercles in the lungs, from which arises the dry asthma.
11. The abuse of ardent spirits.
13. Every thing that oppresses the vessels, such as an expansion of the uterus, obesity or preternatural fatness, aneurisms, fleshy and other tumors in the chest, a distended abdomen by dropsy, obstipations, etc.
14. General debility, by which respiration is frequently rendered difficult, without any other particular cause. This affection may be ascertained from the circumstance, when the patient ascends a number of steps with greater facility than he is able to descend, because the latter requires a greater degree of muscular effort than the former.
What a variety of causes do we here behold—many others being reserved, as too abstruse for nonprofessional readers ; and who will be bold enough to pretend, that he has discovered a specific for the cure of asthma ?
Beside the remedies already pointed out, as proper for the general treatment, we shall here briefly observe, that in the periodical asthma, infusions of bitter herbs, such as wormwood, lesser centaury, the blessed thistle, as well as gum ammoniac, vinegar and honey, acids in any form, nay, mixed with proportionate quantities of laudanum, have been used with the best success. The exercise of riding on horseback is indispensably necessary. Changes of weather are very sensibly felt by asthmatic persons, who, in general, cannot live with any comfort in the atmosphere of large cities, though some are to be found, who feel themselves better in an air replete with gross effluvia; and breathe with greater ease in a crowded room, where there is a fire and candles. A principal advantage, however, will be derived in this obstinate disorder, from a light and frugal diet, consisting of such animal food only as may be digested, and at the same time, avoiding all flatulent and heating substances, as well as liquors; for instance, wine, milk, turnips, cabbages, etc. not exposing the body to the influence of hot air, strong smells, offensive vapours, and the like. As a most excellent diet-drink, we can, from experience, recommend the use of toast and water, in which a few grains of nitre, or sal ammoniac, might be dissolved ; or with the addition of a little pure vinegar. And, if any alterative medicine should become necessary, after the proper evacuations, by either bleeding and blistering between the shoulders, or, according to circumstances, by gentle laxatives, and nauseating doses of ipecacuanha (See APPETITE), we have found the following mixture frequently of great advantage:— Take oxymel of squills, and cinnamon water, two ounces of each, and pure spring water four ounces; two table-spoonfuls, each dose, every three or four hours.