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DOMESTIC MEDICINE

CHAP. XL.

OF THE ASTHMA.

THE asthma is a disease of the lungs, which seldom admits of a cure. Persons in the decline of life are most liable to it. It is distinguished into the moist and dry, or humoural and nervous. The former is attended with expectoration or spitting; but in the latter the patient seldom spits, unless sometimes a little tough phlegm by the mere force of coughing.

CAUSES. - The asthma is sometimes hereditary. It may likewise proceed from a bad formation of the breast; the fumes of metals or minerals taken into the lungs; violent exercise, especially running; the obstruction of customary evacuations, as the menses, haemorrhoids, &c. the sudden retrocession of the gout, or striking in of eruptions, as the small-pox, measles, &c. violent passions of the mind, as sudden fear, or surprise. In a word, the disease may proceed from any cause that either impedes the circulation of the blood through the lungs, or prevents their being duly expanded by the air.

SYMPTOMS. - An asthma is known by a quick laborious breathing, which is generally performed with a kind of wheezing noise. Sometimes the difficulty of breathing is so great that the patient is obliged to keep in an erect posture, otherwise he is in danger of being suffocated. A fit or paroxysm of the asthma generally happens after a person has been exposed to cold easterly winds, or has been abroad in thick foggy weather, or has got wet, or continued long in a damp place under ground, &c.

THE paroxysm is commonly ushered in with listlessness, want of sleep, hoarseness, a cough, belching of wind, a sense of heaviness about the breast, and difficulty of breathing. To these succeed heat, fever, pain of the head, sickness and nausea, great oppression of the breast, palpitation of the heart, a weak and sometimes intermitting pulse, an involuntary flow of tears, bilious vomitings, &c. All the symptoms grow worse towards night; the patient is easier when up than in bed, and is very desirous of cool air.

REGIMEN. - The food ought to be light, and of easy digestion. Boiled meats are to be preferred to roasted, and the flesh of young animals to that of old. All windy food, and whatever is apt to swell in the stomach, is to be avoided. Light puddings, white broths, and ripe fruits baked, boiled, or roasted, are proper. Strong liquors of all kinds, especially malt-liquor, are hurtful. The patient should eat a very light supper, or rather none at all, and should never suffer himself to be long costive. His clothing should be warm, especially in the winter season. As all disorders of the breast are much relieved by keeping the feet warm, and promoting the perspiration, a flannel shirt or waistcoat, and thick shoes, will be of singular service.

BUT nothing is of so great importance in the asthma as pure and moderately warm air. Asthmatic people can seldom bear either the close heavy air of a large town, or the sharp, keen atmosphere of a bleak hilly country; a medium therefore between these is to be chosen. The air near a large town is often better than at a distance, provided the patient be removed so far as not to be affected by the smoke. Some asthmatic patients indeed breathe easier in town than in the country; but this is seldom the case, especially in towns where much coal is burnt. Asthmatic persons who are obliged to be in town all day, ought, at least, to sleep out of it. Even this will often prove of great service. Those who can afford it ought to travel into a warmer climate. Many asthmatic persons who cannot live in Britain, enjoy very good health in the south of France, Portugal, Spain, or Italy.

EXERCISE is likewise of very great importance in the asthma, as it promotes the digestion, preparation of the blood, &c. The blood of asthmatic persons is seldom duly prepared, owing to the proper action of the lungs being impeded. For this reason such people ought daily to take as much exercise, either on foot, horseback, or in a carriage, as they can bear.

MEDIC1NE. - Almost all that can be done by medicine in this disease, is to relieve the patient when seized with a violent flt. This indeed requires the greatest expedition, as the disease often proves suddenly fatal. In the paroxysm or fit, the body is generally bound; a purging clyster, with a solution of asafoetida, ought therefore to be administered, and if there be occasion, it may be repeated two or three times. The patient's feet and legs ought to be immersed in warm water, and afterwards rubbed with a warm hand, or dry cloth. Bleeding, unless extreme weakness or old age should forbid it, is highly proper. If there be a violent spasm about the breast or stomach, warm fomentations, or bladders filled with warm milk and water, may be applied to the part affected, and warm cataplasms to the soles of the feet. The patient must drink freely of diluting liquors, and may take a tea-spoonful of the tincture of castor and of saffron mixed together, in a cup of valerian-tea, twice or thrice a-day. Sometimes a vomit has a very good effect, and snatches the patient, as it were, from the jaws of death. This however will be more safe after other evacuations have been premised. A very strong infusion of roasted coffee is said to give ease in an asthmatic paroxysm.

IN the moist asthma, such things as promote expectoration or spitting ought to be used; as the syrup of squills, gum ammoniac, and such like. A common spoonful of the syrup of oxymel of squills, mixed with an equal quantity of cinnamon-water, may be taken three or four times through the day, and four or five pills, made of equal parts of asafoetida and gum-ammonlac, at bed-time. After copious evacuations, large doses of aether have been found very efficacious in removing a fit of the asthma. I have likewise known the following mixture produce very happy effects: To four or five ounces of the solution of gum-ammoniac add two ounces of simple cinnamon-water, the same quantity of balsamic syrup, and half an ounce of the paregoric elixir. Of this two table-spoonfuls may be taken every three hours.

FOR the convulsive or nervous asthma, antispasmodics and bracers are the most proper medicines. The patient may take a tea-spoonful of the paregoric elixir twice a-day. The Peruvian bark is sometimes found to be of use in this case. It may be taken in substance, or infused in wine. In short, every thing that braces the nerves, or takes off spasm, may be
of use in a nervous asthma. It is often relieved by the use of asses milk; I have likewise known cows milk drank warm in the morning have a very good effect in this case.

IN every species of asthma, setons and issues have a good effect; they may either be put in the back or side, and should never be allowed to dry up. We shall here, once and for all, observe, that not only in asthma, but in most chronic diseases, issues are extremely proper. They are both a safe and efficacious remedy and though they do not always cure the disease, yet they will often prolong the patient's life.

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