116 THE TREATMENT OF DISEASES. 



case it is constant and characteristic, there is the greatest variety. Many of the 

 intervals appear to be arbitrary, and one cannot account for them in any way; 

 but many of them are natural, corresponding to the period of recurrence of certain 

 conditions, either in the external world or within the body. Thus, with many people, 

 an attack of asthma occurs regularly at intervals of a day, a week, a month, or a year. 

 When the asthma is dependent upon the state of digestion, it is common for 

 the attack to appear daily, the patient usually having his fit every afternoon 

 after dinner. When the attack is diurnal, it nearly always depends on some 

 daily-recurring exciting cause. Yery often an attack occurs regularly once a 

 week, at the same hour of the same day. The case is recorded of an asthmatic 

 boy, who for years had an attack every Monday morning. On every other day in 

 the week he awoke well ; but as sure as Monday morning came round, so surely did 

 his asthma appear. A suspicion arose on the part of his parents that he was 

 shamming, or any rate making the most of his complaint, in order to escape school. 

 It was not till this had been going on for a long time that the real cause was 

 discovered. On Sunday evening he took supper, and on other evenings he did not ; 

 and the Monday morning's asthma was caused by the supper over-night. On taking 

 supper on other occasions, it was found that asthma invariably followed. He left off 

 the suppers altogether, and the regular Monday morning's asthma at once disappeared. 

 When the attack occurs at monthly intervals, it is usually associated with the men- 

 strual periods, and is not a common form except in women. When asthma occurs 

 at intervals of a year, it is probably either hay-asthma, of which we shall speak in 

 detail in due time, or bronchitic asthma asthma that is dependent on an attack of 

 bronchitis. 



It is a curious circumstance that each attack seems to impart for a time an 

 immunity from a repetition of it. For some time after an attack the time vary- 

 ing according to the interval characteristic of that particular case the patient may 

 expose himself to the ordinary exciting causes of the paroxysms without the slightest 

 fear of inducing one. As this period draws to a close, exposure to the provocations 

 of the attack is attended with more or less risk, and when it has transpired the 

 slightest imprudence is certain to bring on a fit. 



We must now consider certain points respecting the causes of the disease and 

 its relation to age, sex, and so on. In the first place, is it hereditary ? Of this 

 there can be no doubt, and it is said that a disposition to it is transmitted in nearly 

 half the cases. Asthma is a disorder which is incident to both sexes, but it occurs 

 far more commonly in men than in women. The time of life of the first access is 

 very variable. It may make its appearance at any time from the earliest infancy to 

 old age. A few days after birth the infant may give unmistakable signs of it, or 

 the old man after spending a long life without an asthmatic symptom may suddenly 

 become its victim. In cases in which the disease is hereditary it appears at an 

 earlier age than when acquired, a circumstance quite in accordance with what occurs 

 in gout, and many other transmissible diseases. 



An attack of asthma may be excited in many different ways. In some people, 

 fog, or smoke, or the fumes of a lucifer match, or of a recently blown-out candle 

 would be quite enough. Ipecacuanha has the curious power of producing an 



