AST 



In Sauvages's fyftcm it is clafTud under anhelationes ; in 

 Cullen'a, under fpafmi. The former enumerates no lefs 

 than eighteen fpecies thereof ; the latter only three, viz. A. 

 fpontaneum, A. exanlhematictim, and A. plethor'icum. Another 

 writer has fubdividtd this diforder into four fpecies. Some 

 of thefedi(lin£Hons are unfounded, and mod of them are of 

 little or no utility in practice. By far the greater number 

 of thofe cafes of difficult rcfpiration, which Sauvages has 

 referred to allhma, belong to dyfpnosa ; a fymptom common 

 to various and oppoiite difcafes, and dillinguifhed from 

 allhma by its manner of coming on, by its duration, and by 

 the fet of morbid phenomena with which it is aflbciated. 

 Tims the (hortnefs of breath which occurs in pleurify, pe- 

 ripneumony, confumption, catarrh, dropfy of che chert, 

 &c. is only a concomitant of thofe difcafes, but not the 

 difeafe itfelf ; and is therefore not aft'nma, but dyfpnoea. 

 The fame may be faid of thofe cafes which Floyer has enu- 

 merated as inftances of cnu'mued tijlhma. 



There is ftridlly but one idiopathic fpecies of aftlima ; 

 the periOilic or convulffve zA\in\& (the allhma f, • itaneum of 

 Cullen ; the dry^ or flatulent afthma of others) ; the hu- 

 moural afthma, as it is termed, being for the moft part a 

 variety thereof. 



Tile periodic or convulfive allhma has been fo well defcribed 

 by the ceLbrated Floyer, who himklf laboured under this 

 difeafe for the fpace of thirty years, that we fliall chiefly 

 take from him the hiftory of its phenomena. 



For feme houro preceding a lit of allhma, the patient 

 experiences a fenfe of ftraightnels, a fulncfs about the pit 

 of the llomach, and is much troubled with flatulency. At 

 the fame time there is a heaviaefs of the head, drowfinefs, 

 propenfity to yawning, and a difcharge of pale urine. If 

 thefe fymptoms come on towards the afternoon, they are 

 followed at night by a tightnefs and weight acrofs the ched, 

 by oppreffion of the breath, and fome wheezing. There is 

 generally, too, a convulfive cough, with little or no expcflo- 

 ration. In the courfe of the night, the fymptoms become 

 more urgent, the infpirations are made with the utmofl la- 

 bour, the cheft and fhoulders being lifted up with great vio- 

 lence, and in a convulfive manner. In this dillrefiing flate 

 the patient is neceffitated to get out of bed, and to remain 

 in an ereft poflure. Although the expirations are not fo 

 difficult as the infpirations, yet they are performed very 

 flowly, and with a wheezing noife. In this llage of the fit, 

 a perfon can neither fpeak nor cough. His face appears 

 pale or livid ; his hands and feet are cold ; and his pulle is 

 generally weak and irregular. He has a great deiire for 

 frefh air, and is much oppreffed by a clofe heated room, by 

 dufl, fmoke, or bad fmells ; and even by the weight of his 

 clothes upon his cheft. After fome continuance of the at- 

 tack, head-ach is fuperadded to the other fyniptoms ; and, 

 the pulfe becoming fomewhat accelerated, there is a flight 

 degree of feveriflr.iefs, the neceffary confequence of fatigue 

 and irritation. As the fit declines, there is a breaking of 

 wind both upwards and downwards, and frequently a motion 

 to ftool. The urine, which before the fit was pale, is now 

 high-coloured, and depofits a fedimcnt. If the attack laft 

 but two or three hours after rifing out of bed, the flraiglu- 

 nefs of breathing abates, and fome phlegm Is fpit up. 



When a fhort lit happens, it is accompanied only with 

 wind ?,nd fpltting ; with a quicknefs of the pulfe, a difpo- 

 fition to fweat, and a difciiarge of higher-coloured water in 

 the morning. It is not preceded, as in the former cafe, by 

 I oppreffion at the pit of the ilomach, nor by pale urine, nor 

 by much drowfinefs over-night. This is what Floyer calls 

 a fpitthig-Jit. It is only a milder form of the other at- 

 tack. 



AST 



The duration of an aflhmatic paroxyfni lanes indiffefcirt 

 individuals, and in the fame individual at different limes. 

 Sometimes it continues only a few hours, at other times it 

 lafts three or four days. In thefe cafes, very little phlegm, 

 and that of a dark colour, is fpit up for the fii-ft two days ; 

 on the third or fourth it is coughed up more freely, of a 

 lefs vlfcid confidence, and of a better colour. At the end 

 of four or five days, the cough and fpitting gencrdUvccal', 

 and the patient remains free from oppreffion of the breath, 

 until the next return of a fit. The intervals between the 

 attacks are extremely various, fometimcs fliort, fometimcs 

 long.- The fhort intervals do not exceed the fpace of liire:, 

 fix, orfeven days ; the longer intermifiions extend to twelve, 

 fourteen, or fifteen days. The longer the paroxyfm, in ge- 

 neral, the longer the interval ; and vice verfa. The latcDr. 

 Heberdcn has remarked, that fome afthmatics experience 

 enly four attacks in a year ; others only two, viz. in fpring 

 and autumn ; and fome not more than one attack annually, 

 and that every winter. Others only once in two years ; but 

 thefe lad, and efpecially another indance mentioned by him, 

 mud be regarded as rare and anomalous cafes. The periods 

 of recurrence are much influenced by changts of the atmof- 

 phere. Rainy weather, foggy weather, an approaching fall 

 of fnow, a change from froit to thaw, or a change of wind 

 into the ead, will often bring on a fit ; which, however, 

 may happen from other caufes, in every kind of weatiicr. 

 As the fits ufually recur, in confirmed adhniatic \fubjccts. 

 once a fortnight, they mud often take place on or near the 

 changes of the moon. Hence the adhniatic periods have 

 been fuppofed to be regulated by the phafes of that ccledial 

 body. The recurrence of the paroxyfrr.s, however, is 

 known to happtn at other times ; fo that it is evident 

 there is no neceffaiy conncclion between them and the 

 lunar changes. Alterations of the weather, happening 

 at thofe periods, are (as Floyer has remarked) the probable 

 caufe. 



Adhma may occur at any ai;e; but, except where there is 

 a mal-conforniation of the ched, it feldom attacks in early- 

 life. It ufnally atEidls perfons of mature or advanced age. 

 People who follow certain occupations arc more liable to it 

 than others ; fuch are millers, malflers, llone-cutters, wool- 

 combers, flax-drcffeii, &c. Many^of thefe inllances, however, 

 of ihort breathing belong rather to dyfpnora, than to adhma. 

 Although the attacks are fo fevcrc and dlrtreffing for the 

 time, yet in the intervals the patient commonly enjoys a to- 

 lerable fliare of health, and is able to engage in the purfuits 

 of bufinefs or pleafure, according to his dation iji life ; nor 

 do they feem, in numerous inllances, to have much effeft 

 in fhortening the natural period of human exidence, many 

 adhmatics having been known to live to the age of feventy 

 and upwards. The difeafe, however, terminates at length 

 in peripneumony, conlumption, dropfy, lethargy, or apo- 

 plexy. 



OEdematous fwellings of the legs, ulcers in thofe parts, 

 the bleeding piles, a fit of the gout, or an eruption on the 

 flvin, have fuddenly produced, in very defperate cafes, a fa- 

 vourable termination of an attack, and have fufpended tlic 

 recurrence of the paroxyfms for a great length of time. 



Befides the changes of the atmofphcrc, and certain irrita- 

 tions (fuch as dud, fmoke, &c.) before mentioned, there 

 are other caufes which are capable of exciting a fit of adhma ; 

 fuch are errors in diet, violent exercife, long failing, pro- 

 fufe evacuations, intenfe dudy, retropulfion of cutaneous 

 eruptions, and of gout, pafTions of the mind, &c. With 

 regard to the proximate caiife, Cullen ftippofed it to confid 

 in a fpafmodic condriftion of the mutclar fibres of the 

 bronchia, preventing' the free ingrefs and egrefs of the air, 



U 2 and 



