PATHOLOGY. 
We (hall tranfcribe Dr. Bree's account of the fymp- 
toms of this complaint. It bears a clofe refemblance to 
the noted defcription given by Floyer, but is perhaps 
more amply detailed. “The attack of a paroxyfm of 
periodic or convnlfive afthma is preceded very generally 
by dyfpepfia, and the circumftances which occur to a re¬ 
laxed habit. This condition of the body may have pre¬ 
vailed for months or years before it takes the additional 
form of afthma; but, when that difeafe appears, dyfpep- 
iia never fails to be aggravated, and to lhow itfelf with 
violence before the lit. 
“ The firft fymptoms are flatulence and diftention of the 
ftomach and bowels; a heavy pain over the forehead and 
eyes ; eruCtation of wind, with water which is fometimes 
infipid, at others four. When the evening approaches, 
this weight over the eyes becomes more oppreflive, and 
the patient is very fleepy. Occafionally, if he be particu¬ 
larly animated by company and conversation, the drow- 
finefs does not take place, but a fhortnefs of breathing is 
perceived, and foon after much anxiety of the prascor- 
dia, with great reftleflnefs. The prefence of company 
then becomes irkfome, as it feems to increafe a certain 
heat of the body, a want of free refpiration, and an irri¬ 
tability which repels the moll cautious attentions of 
friends. Frequently at this period there is a tingling 
and heat in the ears, neck, and breaft, and a motion to 
expel the contents of the bowels is attempted with fome 
violence, and with great uneafinefs of the abdominal 
mufcles. When an afthmatic feels thefe warnings, he 
may be convinced that his enemy is at hand. At fome 
uncertain hour before midnight the patient becomes 
Suddenly fenflble of the increafed violence of the difor- 
der ; moft frequently after a dumber in bed he awakes 
with:great difficulty of breathing, and he feels the ne- 
ceflity of a more ereCt pofture of his body. Infpiration 
is performed with great effort of the mufcles, but is never 
perfe&ly deep, and the diaphragm feems to defcend with 
great difficulty againft an oppofing force. There is now 
a defire of free air, fpeaking becomes diftrefling, and the 
irritability of the mind continues, but is not lb acute as 
in the approach of the fit. There is a great ftraitnefs 
of the cheft, and a wheezing found in refpiration. An 
inclination to cough Ihows itfelf, but this is Small and in¬ 
terrupted. The pulfe is increafed in quicknefs a few 
ffrokes, but without hardnefs. There is no preternatu¬ 
ral thirft, unlefs, as often happens, the fit be excited by 
indigeftible matter in the firft paffages. There is a pro¬ 
pensity to make water, which is copious and pale, and 
frequently discharged. After fome hours of diftrefs the 
patient perceives his anxiety to be lefs, the breathing is 
lefs quick and laborious, the inspirations are longer and 
more full, the expirations are ftill attended with wheez¬ 
ing; the pulfe is not So quick, but more full; irritation 
is lefs acute. The cough probably brings up a portion of 
phlegm, and a very fenflble relief follows that excre¬ 
tion. Then the tranquil ftate of the feelings introduces 
fleep, but not unaccompanied by wheezing, which con¬ 
tinues almoft always through the firft night, and until, 
by the progrefs of the fit on the fecond or third day, a 
more considerable expectoration of mucus takes place. 
“The fecond day is ufhered in by a remiflion of the 
fymptoms, which the patient perceives from the time of 
awaking in the morning. No change of pofture is, how¬ 
ever, yet made with impunity; and particular diftrefs af- 
feCts him, if he engage in the fatigue of drefling whilft 
the ftomach is empty. The pulfe will be accelerated 
more than it was in the acme of the paroxyfm ; and mo¬ 
tion muff: frequently be fufpended, or a vehement agony 
for breath will certainly come on. During the day, if 
no particular hurry occur, the breathing becomes gra¬ 
dually more free till the evening ; an inexperienced afth¬ 
matic even flatters himfelf that his difeafe is leavinghim, 
but lie finds at the approach of night that he mult fuf- 
tain a new attack. The par.oxyfm recommences with the 
ufual fymptoms, and the night is palled nearly as the 
VOL. XIX, No. izy6. 
137 
former; but the fleep is more perfect, and produ&ive of 
more relief. 
“ The third day, the remiflion is more complete; there 
is fome additional expectoration ; and bodily motion is 
performed with lefs diftrefs, but ftill with great incon¬ 
venience. After the paroxyfm has been renewed in this 
manner for three nights, the expectoration generally be¬ 
comes free, but there is no certain termination of the 
fit at a fixed period. However, except in particular 
cafes, it goes off after a few days ; and, as the daily re- 
mifllons become more perfeCt, the urine is higher co¬ 
loured, and in fmaller quantities; the expectorated mu¬ 
cus is more copious and digefted ; ftrength of pulfe and 
vigour of aCtion increafe, and good humour again enli¬ 
vens the mind. 
“ The expectorated mucus has been faid to be ftreaked 
with black, or to have a blackilh tinge ; and this appear¬ 
ance certainly prevails in many inltances, but not inva¬ 
riably. The tafte of the expectorated mucus is alfo 
equally uncertain; it is fometimes fweetilh, but more 
frequently it is faline, and it is occafionally coloured mi¬ 
nutely with blood. There is a confiderable variation in 
the periods of the accefiion of the paroxyfm, and in its 
duration, in the intervals of the fits, the quantity of 
mucus expectorated, and the freedom of that difcharge. 
Thefe circumftances of the difeafe will be influenced by 
the predifpofing caufes, and by occafional accidents.” 
Dr. Bree’s Practical Inquiry into Difordered Refpiration. 
Afthma may occur at any age; but except where there 
is a mal-conformation of the cheft, it feldom attacks in 
early life. It ufually afflicts perfons of mature or ad¬ 
vanced age. People who follow certain occupations are 
more liable to it than others; fuch as millers, maltfters, 
ftone-cutters, wool-combers, flax-drefl'ers, &c. Many of 
thefe inltances, however, of Ihort breathing, belong rather 
to Dyfpncea than to Afthma. Although the attacks are 
fo fevere and diftrefling for the time, yet in the intervals 
the patient commonly enjoys a tolerable fhare of health, 
and is able to engage in the purfuits of bufinefs or plea- 
fure, according to his ftation in life ; nor do they feem, 
in numerous inltances, to have much effeCt in Ihortening 
the natural period of human exiftence, many allhmatics 
having been known to live to the age of feventyand up¬ 
wards. The difeafe, however, terminates at length in 
peripneumony, confumption, dropfy, lethargy, or apo¬ 
plexy. 
In the treatment of afthma, we have two purpofes to 
effeCt; viz. to relieve the paroxyfm on the one hand, and 
to reCtify the morbid condition of the pulmonary organs 
on the other. 
We have feen that the paroxyfm is moft frequently 
excited by diftention of the ftomach and bowels, or by 
the accumulation of irritating fecretion in the bronchial 
tubes. Hence we mult labour to evacuate the offending 
matter from each cavity ; we mult further allay, by anti- 
fpafmodic medicines, the irregular aCtion of the mufcu- 
lar parts. An emetic is the firft remedy to be applied. 
By gentle vomiting we may obtain fome knowledge of 
the ftate of the firft paflages; and the paroxyfm will go 
on with milder exacerbations, if irritating matter be re¬ 
moved from thfe ftomach and duodenum. Further than 
this, naufea and vomiting difcharge the fubtil and Acrid 
particles which have been received in infpiration, by pro¬ 
moting fuch a fecretion of lymph as may envelope them, 
and excite expectoration ; befides which, this dilution 
probably defends the membrane from further irritation. 
Afterwards a draught with one ounce of diftilled vinegar, 
and from one to three grains of pulv. ipecac, in pure wa¬ 
ter, may be taken every four hours, as a means of deter¬ 
mining to the furface of the body, and promoting abforp- 
tion and exhalation. If coftivenefs prevail, it will be 
neceflary to remove it, by the ufe of rhubarb or infufion 
of fenna; but we mult avoid full purging. If acid eruc¬ 
tations are frequent, then, inftead of the acetous 
draughts with ipecac, chalk or magnefia ufta in a draught 
3 C of 
