ASTHMA. 117 



asthmatic attack with some individuals. Then others, as we shall presently see, 

 sutK-r from a form of asthma produced by the pollen of grasses, and known as " hay- 



" Certain kinds of air may act as the exciting cause. For instance, a man may 

 be perfectly well so long as he remains in town, but suffer from asthma imme- 



!y on going in the country. It is by no means uncommon to find that an 



;uu. ran breathe perfectly well in one place, while in another he would be 

 almost suffocated. There is a special form of asthma, called " peptic asthma," which 

 always supervenes on a full meal, and is produced by nothing else. Cases of asthma 

 are often met with in which no exciting cause of the attacks can be detected. They 

 come on at a certain time, but neither the patient nor any one else can tell why. 



When called to a patient suffering from an asthmatic attack, we are often asked, 



U there any danger?" "Will he get over it?" and we can nearly always say 



positively that there is no danger to life, and the paroxysm, however severe it may 



ill undoubtedly pass off in time. We never heard of any one really dying in 

 a fit of astlima, unless there were heart disease, or some other complication. Directly 

 faintness ensues, the spasm relaxes, and the danger is over. Then there is another 

 question that is often asked, " Will he get rid of these attacks in time 1 " and that is 

 a very much more difficult matter to solve. It depends on a good many different 

 circumstances. In the first place, the age of the patient is not without its influence. 

 In young asthmatics the tendency is almost invariably towards recovery, whereas in 

 a person who is first attacked after the age of forty-five the tendency is just the 

 other way. It is probable that there is no disease in which the question of age 

 affects the prognosis more. To the young asthmatic under fifteen, whose lungs are 

 sound, we can nearly always say, " You will grow out of it." To a person whose 

 attacks have commenced between twenty and forty-five we cannot speak so hopefully, 

 and can only say that by judicious treatment and management, there is a very fair 

 chance of recovery. Above the age of forty-five, it is only under very favourable 

 circumstances that the complaint gets well by itself. 



The length of the attacks has an important bearing on the prognosis. If they 

 are short, lasting only a few minutes, or, at the most, an hour or two, we may hope 

 for the best ; but if they are very long, lasting a couple of days or even a week, as 

 they do sometimes the case is a severe one. The frequency of the attacks is 

 another point that may enlighten us as to the future. The more frequent they are, 

 the worse the omen. Then again, the completeness of the recovery between the 

 attacks is an important point. If the patient in the intervals is perfectly free from 

 any shortness of breath, it is a favourable sign ; but if he is always more or less 

 short of breath, we cannot look so hopefully to the future. When, in addition to 

 the asthmatic attacks, there is constant expectoration, the patient always spitting a 

 little, it is a bad sign, for it shows a tendency to bronchitis. A cough has much the 

 same meaning, and is also unfavourable. One often derives valuable information 

 concerning the future from the course or direction the disease is apparently taking. 

 Are the attacks becoming more severe and more frequent, or milder and more 

 distant? The loss and the acquisition of the asthmatic tendency is generally a 

 gradual process, and the future of a case is often but a reflection of its past history. 

 If you feel that your attacks have mitigated in severity, and are getting less 



