ASTH′MA

(ăst′mă [98] ). [Eng., Ger., L., Gr.] Syn. Asthme , Fr.; Engbrüstigkeit , Ger. In pathology , a well-known disease coming on by fits, and characterised by shortne and difficulty of breathing, accompanied by a wheezing sound, cough, stricture and tightne of the chest, with other like symptoms. These gradually increase until the patient can no longer remain in a recumbent position, being, as it were, threatened with immediate suffocation; and they generally terminate, after the lapse of a few hours, in copious expectoration. The attack usually commences towards evening, and the symptoms increase in urgency during the night—often occurring suddenly after the first sleep—until at length, on the approach of morning, a remi ion takes place, and, in all probability, the patient, worn out and exhausted, falls into a sound sleep. On awaking in the morning he still feels the ‘tightne ’ at the chest, breathes with some difficulty, which is increased by moving, and cannot lie in bed unle his head and shoulders are greatly raised. After a repetition of the fits for some nights, they at length moderate, and after more considerable remi ions, pa off at last, leaving the patient in his usual state of health for a time, or until fresh exciting causes produce a return of the disease. For an evening or two previous to the fit the patient generally feels drowsy, indolent, and low-spirited, and experiences a sensation of fulne about the stomach, with headache, general uneasine , and indigestion—these are the premonitory symptoms. [98] Asth′ma (with th fully sounded), as given by Knowles, is difficultly pronounceable, and is now obsolete. Asthma is principally confined to the later periods of life, and appears in many cases to be hereditary. It is generally severest in the heat of summer, or in the foggy or damp or windy weather of winter. The fits vary in duration from two to several hours. Sometimes copious expectoration commences early, which has led to the division of asthma, by nosologists, into two kinds—dry, nervous, or spasmodic asthma ( ASTHMA SIC′CUM , L.) and humid a. ( A. HU′MIDUM , L.). The exciting causes of asthma are exposure to sudden changes of temperature, particularly from heat to cold; unwholesome effluvia, hard drinking, heavy meals, indigestion, violent exercise, and cold, damp, foggy, and sometimes windy weather. Treatm. A dry, warm, and airy situation as a residence should, if po ible, be sought. The use of flannel next the skin, and tepid or warm bathing is also advantageous. The bowels should be kept regular by mild aperients, and the stomach preserved in order by the adoption of a light and wholesome diet; particularly avoiding exce in either eating or drinking. The severity of the paroxysm may be generally le ened by adopting the sitting posture, and inhaling the vapour of hot water or of an infusion of chamomile. Small doses of camphor, ether, and opium, frequently repeated, may also be tried. The inhalation of the vapour of a little tar liquefied by heat is said to often produce considerable relief. The fumes arising from the slow combustion of porous paper dipped in a solution of nitre, and dried, have also been recommended. “The fumes of a piece as big as one’s hand being placed on an earthenware plate, and ignited, presently become sensible throughout the room; and within a quarter of an hour their influence in many cases is rendered evident, in clearing the pa ages and gradually opening the air tubes.” “Of calming vapours that of chloroform is, however, the one likely, in respect of its soothing power, to supersede all others. Inspired in moderate quantity, far le than is requisite to produce general insensibility, it has been found of singular efficacy in allaying, at once, the spasmodic distre of an asthma-fit. But it is a remedy too potent and subtle to be entrusted to the discretion of the patient himself.” (Dr Watson); unle , indeed, he well understands its properties and nature, and has some friend near him to restrain his using it too freely—a thing he is, unfortunately, often tempted, by the urgency of the symptoms, to do. “Bleeding is an imprudent operation in every species of asthma” (Dr Bree); and has often proved highly injurious, especially in elderly persons. It is only in full plethoric habits, or when the paroxysms are very severe, and attended with signs of congestion of the lungs and brain, indicated by lividity of the countenance, stupor, extreme dyspnœa, ., that blood should be taken; and then only by ‘cupping’ between the shoulders, or by leeches to the chest. Emetics and active purgatives must also be avoided during the paroxysm; at which time costivene may be best removed by an aperient clyster containing a afœtid a. At other times, emetics (of ipecacuanha) and diaphoretics, followed by mild purgatives, may be administered with advantage; indeed, an emetic, taken a few hours before an impending fit, will frequently prevent its acce ion. Dyspeptic symptoms must be treated in the usual manner. “Chalk and opium will astonish the asthmatic, by the excellence of their effects when the irritation proceeds from dyspepsia of the first pa ages only.” (Dr Bree.) The same authority also states that vinegar, separately administered, counteracts the flatulence and distension of the stomach. Various other remedies have been recommended for asthma; among which are the smoking of tobacco and stramonium. In using the latter herb, the root and lower parts of the stem are chopped up and placed in the bowl of a common tobacco-pipe, and a few whiffs are occasionally taken. Drinking at the same time should be avoided. Lately lobelia in flat a (Indian tobacco) has been highly extolled in asthma, in doses of—tincture, 20 or 30 drops, to 2 teaspoonfuls—powder, 5 to 15 or 20 gr.; taken at the commencement or shortly before the acce ion of the fit, and repeated after the interval of an hour, if nausea or expectoration does not intervene. Sir John Floyer is said to have been cured of an asthma of 60 years’ standing, at the age of 80, by the constant use of very strong coffee. Sir John Pringle adopted the same remedy with great succe . He remarks, “One quality occurred to me which I have observed of that liquor (coffee), confirming what you have said of its sedative powers. It is the best abater of periodic asthma which I have seen. The coffee used ought to be the best Mocha, newly burnt, and made very strong immediately after grinding it. I commonly order an ounce for one dish, which is to be repeated with fresh coffee after the interval of a quarter or half an hour; and which I direct to be taken without milk or sugar.” [99] [99] ‘Letter to Dr Percival.’ Very recently cigars and cigarettes of datura tatula , Linn.—a peculiar species of stramonium—have been prepared by Me rs Savory and Moore; and are strongly recommended by Drs Watson, Latham, Fergu on, and many other physicians of eminence, as the very best remedy yet introduced for asthma. A change of diet and habits, and particularly a change of residence, will often produce a marked improvement in asthmatic patients, and even effect a cure, when medicines have failed. The use of bark and bitters, or mild chalybeate tonics (when not contra-indicated), tends to improve the tone of the system, and may be adopted, in nearly all cases, with perfect safety. See Bath , AIR (Compre ed), Cigars , Datura , . Treatment for Horses. Ether and belladonna; chlorodyne; inhalation of chloroform; or amyl nitrite; subcutaneous injection of morphine or atropine; arsenic; and regular digestible diet.