AST 



AST 



Kid conftquently itit: due expnnfiou of toe lungs. This 

 opinion, however, is not alcpgetlier reconcil .able with the 

 kiio.vnilrufture of the bronchia, and has accordingly been 

 controvcrtid by a late writer ( Dr. Bret} ; wlio has alTicjnotl 

 in its fteaJ, irritation, either from ati o'Fending material in 

 the lungs themfslvcs, or from acrimony and difenfe in the 

 ilomach, intellines, and other vifccra of the abdomen. There 

 is little doubt, however, that the mucus which he fnppofes 

 to be the caufe, is rather the efteft of the morbid aftion of 

 tlie lun^s. Others have attempted to refer all the pheno- 

 mena of an afthmatic attack to a fpafuiodic afTetlion of the 

 diaphragm (Burlcr. liiHitut Medicin;e PraAic-x, vol. iv. 

 pars i. in nota ad feft. ccii.), which, according to Fluyer's 

 defcription of his own feelings, fecms to be rendered lliff, 

 Hnd tied or drawn up by the medialtinum. The rLfillance 

 thus oppofed to the natural dilatation of the chcft, would, 

 it is faid, neceffinily occafion a vehement and convullive 

 aftion of the intercoRal and other mufclcs concerned in 

 rcfpiralion. All this, however, is mere conje>Ture ; and it is 

 to be regretted, that diffeftions have been of very little ufe 

 towards elucidating tliis pathological difcuilion. 



Whatever be the proximate caufe of afthma, all its fymp- 

 toms are flamped \\ ith the charadterof fpalm and irritation ; 

 a circumftance which at once points out the plan of treat- 

 ment that fhoukl l>e ajloptcd ; in regard to which, we are 

 to confider, l. The remedies which Ihonld be rtforted to 

 during the fits ; and, 2. Thofe which f.'.ould be employed 

 during the intervals, to prevent their recurrence. 



When a lit comos on, the patient, if recumbent, (liould be 

 .raifed up, and kept in a fitting pofture. All external prel- 

 fiire from clothes or bandages ftiould be removed from the 

 breail, and frefli air (hould be admitted into the room ; 

 which fhould be kept cool, and free from fmoke, dull, and 

 every fort of dilagreeable fmell. Should there be much ten- 

 dency to fickncfs, an ipecacuanha emetic will be proper ; 

 after the operation of which an antifpafmodic draught fliould 

 be gi'-'en, compofed of .tthcr, callor, and opium, mixed with 

 a fuiScient quantity of peppermint water, or cinnamon water. 

 In fome cafes, a few drops of fpirit of ammonia may be 

 added to this draught, which (hould be repeated every hour, 

 or every fecond hour, according to the urgency of the fymp- 

 toms. The (Irong fmelliug antifpafmodics, fuch as amber, 

 inuik, and afa foetida, Hiould be avoided. From the white 

 oxyd of zinc (calcined zinc), or uilpliat of zinc (vitriolated 

 zinc), lefs benefit has been dsrived, than the reports of fome 

 authors had given reafon to expeft. The digitalis has been 

 employed with advantage, according to fome late accounts, 

 in the paroxvfm of convulfive al'lhma ; but it promifts to be 

 more generally ufcful in that fpccies which is termed the 

 humoiira! njlhma, under which we ftiall therefore mention its 

 dofes aud mode of exhibition. With a view of promoting a 

 <!iap'iorelis, the aqua ammoniac acetatie may be given, in con- 

 junction with the an'Jfpafmodics above mentioned ; but all 

 heating fudorirics will be improper. In fome inftances, the 

 wine of tartarized antimony may be added with good effect 

 to the antifpalmodic medicines. Floyer has recommended 

 the internal uie of vinegar ; but though it may have afforded 

 relief in fome cafes, wc are perfuaded it will dil'agree with 

 the majority of fuch patients; and will, indeed, be extremely 

 hurtful to hyilerical and gouty ailhmatics. For thefe, the 

 abforbent earths, fucli as magnefia and chalk (with wliich 

 k(l a few grains of rhubarb (hould be joined), will anfwer 

 much better. While thefe medicines are given, a bhfter 

 (hould be applied between the (houldtrs, but not upon the 

 (lernum, where its weight would incommode the patient. 

 Bleeding is rarely admiffible. The diet during the fit (lioiild 

 ey;ifill of cold toall iiad water, milk and water in a tepid 



(late, a cup of firong coffee, &c. Solid animal food 

 and puddings (hould be withheld ; nor (liould a glafs of 

 wine be allowed, except to very infirm and aged ailhmatics, 

 or in cafe of alarming delicpiium. F,ven then, a dofe of fal 

 volatile drops in water will generally be preferable. 



As the lit declines, and a tendency to fpitting (liews 

 itfelf, that efTett (liould be promoted by the exhibition of 

 expeftorating medicines ; fuch as ipecacuanha, oxyniel of 

 fquill, and ammoniacum. Of the firft of thefe, not more 

 than two or three grains (liould be given for a dofe, fo as 

 to excite, in this Ifage of the diiorder, merely naufea, but 

 p.ot vomiting. The two others fhould be joined together 

 in the form of a drau.dit or mixture, with or witlunit the 

 addition of xther. Ccllivcnefs (hould be prevented by a 

 laxative-clyiler, or by other means ; but it fhould bertnitm- 

 bcred, that much evacuation by the bowels Is aUvaya hurt- 

 ful in thele cafes. 



Confidcriug the (Irong defire expreffed by perfons labour- 

 ing under an attack of adhma for frefli air, and that the ap- 

 pearances e* the fputum are fuch as feem to indicate an 

 txcefs of the carbonaceous principle in the blood, it was 

 natural to fuppofe much relief might be obtained by the in- 

 halation of oxygen gas. Accordingly this gas mixed with 

 common air in various proportions, has been adminillercd 

 by differet.t praftitionerj to fuch patients ; but not with the 

 expected fuccefs. Other fadlitious airs have alfo been tried, 

 fuch as hydrogen and hydrocarbonatc. But if in any cafi; 

 of adhnia, thefe gafeous fubfhuiccs have produced a bene- 

 ficial elfeCt, it has been too trar.fitory and incoufiderable to 

 entitle them to be ranked among the remedies that may be 

 relied upon for the cure of this difeafe. The vapour of ra- 

 dical vinegar, or acetic acid (fee Duncan's Annals of 

 Medicine, vol. iii.), will be found an equally uncertain auxi- 

 liary ; and cether-vapour is much better adapted to that con- 

 dition of the lungs which occurs in conlumptions. 



When the fit has gone through its courfe, fuch remedies 

 (liould be prelcribed as are calculated to preve t its return. 

 Thefe (hould be taken from the clafs of tonics and ftomachics, 

 fuch as the Peruvian bark, bitters, chalybeatcs, &c. With 

 thefe (hould be joined the temperate bath, or cold bath (in 

 fnmmer and autumn}, change of air, and regiikr exercifc 

 of walking, or riding on horftback. The benefit derived 

 from following the plough, as alTerted by Baglivy, is to be 

 attributed partly to the country air, but more to the exer- 

 cife of walking. A dry and pure air, but not that of ar» 

 elevated fituation, is in general belt fuited to ailhmatics ; 

 there are, however, frequent exceptions to this obfervation, 

 fome patients having fewer and lefs violent attacks in the 

 contaminated atmofphere of ijie metropolis and other large 

 towns than in the country. The bowels (hould be kept 

 regular, by rhnbarb and aloelic aperients. Small dofes of 

 calomel may be given with great advantage, in many caus; 

 and efpecially where the allhmatic atfettion is connected 

 with a difeafe of the fliin. Whenever the patient's feelings 

 warn him of an approaching attack, he (hould take an 

 emetic, and after its operation an opiate : and at all times 

 he (liould encourage a tendency to fpitting, by amn-.onia- 

 eum and fquill. Iflues have b.'en recommended by fome 

 praetitioncrs for kfleniug the frK|uency and violence of the 

 paroxyfms. It is faid that king William continued perfedly 

 tree from his allhmatic complaint, dui-ing the whole of 

 the time that the wound he received on his fhoulder, in 

 the battle of the Boyne, kept open and difcharged 

 matter. 



The diet, during the intervals of the fits, fhould be care- 

 fully attended to. All flatulent vegetables, all forts of pal- 

 try and puddiugs, all fat and (limy food, and broths, fltould 



be 



