188 PATHO 
of mint-water, with the fame naufeating ingredient, will 
anfwer better. Dr. Bree ftates, that “ it has happened 
in feveral inftances, after various means intended to miti¬ 
gate the diftrefs of the fit had failed, that the Rubigo 
ferri, or carbonate of iron, in dofes of ten grains every 
four hours, appeared mod clearly to remove the pa- 
roxyfm.” This effeft can only, he thinks, be accounted 
for by looking to the inert condition of the ftomach and 
lungs, and to the languid ftate of the circulation in the 
thoracic and abdominal vifcera. He adds, “ Whatever 
in fuch circumftances can haften the paflage of the blood 
through the lungs, and promote a quicker return to the 
heart from the lower vifcera^ mild be ufeful in the inten¬ 
tion of prefent relief, as well as of aftual cure.” It is 
in aid of this acceleration of blood to the lungs that ih- 
haling oxygen, as recomme'nded by Dr. Beddoes, is an 
ufeful meafure. See 'lherapcutics in this article. 
“ In the morning, the patient fhould take clear coffee 
as foon as he awakes, which fhould be repeated at inter¬ 
vals with dry toaft; and this drink, which feems to aft 
medicinally on afthrna, may be adminiftered, during the 
remifiion alfo, with a few drops of tinft. opii, every three 
hours, the naufeating draught being fufpended between 
the exacerbations. At the beginning of the fecond exa¬ 
cerbation the naufeating draught fhould be repeated, at 
firft with a fufficient proportion of ipecacuhan to excite 
puking, and afterwards with a lefs dofe that may only oc- 
cafion naufea. In the fecond remifiion, the plan purfued 
in the former fhould be refumed. The third exacerba¬ 
tion will probably be mild, fo that the ipecacuhan 
draughts may be fufpended, or they may be united with 
aether and tinfture of columbo in place of the ipecacu¬ 
han. With this plan there will appear on the third day 
a confiderable tendency to expeftorate, which fhould be 
promoted by ammoniac, and vinegar of fquill with tinft. 
opii, or with volatile falts. Ammoniac is called an ex- 
peftorant; but the patient, before this period, too fre¬ 
quently takes this naufeous medicine without ufe.” Bree, 
p. 283. 5th edit. 
From this time we have to turn our attention to the 
cure of the complaint during its remifiion; and what can 
be effefted for this purpofe may be ftated in a very few 
words. It is fcarcely neceffary to mention the removal 
of the exciting caufe. If bad air, a removal to a better 
fituation; if gaftric or inteftinal difturbance, (no doubt 
the primary caufe in the major proportion of cafes,) a 
rigid adoption of the treatment of Dyfpepfia (which fee) 
muft be followed. We may remark here, that, having 
fully entered into the coniideration of diet, &c. under 
that head, we fliall feel it unneceffary to refume the fub- 
jeft in our account of every one of thofe dileafes to which 
fimilar regulations are applicable. 
In afthrna thefe regulations fhould be fulfilled with 
much diligence and attention; but they will always re¬ 
quire accommodation to individual cafes, particularly 
to patients with nervous ailments. We may remark, 
that cordial and ftimulating bitters are particularly indi¬ 
cated in afthrna. Thefe remedies will require a long con¬ 
tinuance in their ufe, and frequent change of the varie¬ 
ties. 
With regard to the management of the fanguineous 
fyftem in this complaint, it is to be borne in mind, that a 
great number of cafes are on record in which it wascon- 
nefted with organic changes in the thoracic vifcera. To 
prevent therefore fuch occurrences, it is of importance 
that we by no means negleft to moderate the force of 
the circulating powers. In eftefting this purpofe, we 
muft be guided by the pulfe, with little reference to the 
nofological divifion of difeafe. 
Unlefs from the above confideration, bleeding fhould 
be cautioufly reforted to. Dr. Bree ftates, that, “ under 
confiderable evacuations of blood, the fudden depletion 
of the veflels may leave their coats without the ftimulus 
receffary to produce a contraftion equal to the fpace 
LOGY. 
which the blood had occupied ; the heart will participate 
in the injury, and will alfo be deficient in vigour of con¬ 
traftion. If, therefore, blood be taken, it fhould be 
drawn from the veflels at intervals, and in fmall portions, 
which would allow of a contraftiie power being exerted, 
in proportion as the vefiel lofes its contents; and fo much 
fluid would not finally be taken away as to leave it with¬ 
out the ftimulus of diftention, fo eflential to its returp 
of health.” He fays alfo, that, “ before the pulmonary 
veflels have relieved themfelves by their exhaling orifices, 
blood may pofiibly be drawn with fome advantage; but, 
when effufion has taken place, a certain debility follows, 
and a lofs of contraftiie power in the veflels.” 
The fame purpofe is alfo effefted by digitalis, though 
the good effeft of this remedy is atterted by fome in cafes 
where no extraordinary degree of pulfation was manifeft 
in the arteries. The aftion of this remedy is by no means 
well underftood. It is of much importance to excite the 
minute parts of the circulatory fyftem, for the purpofe 
of unloading the great veflels. From what we obferve 
in other complaints, we fhould be inclined to ufe the 
warm bath ; but Dr. Bree reports unfavourably of it: it 
feemed, in this one cafe efpecially, to aggravate the ma¬ 
lady. Of the cold bath this author, in common with 
many others, fpeaks favourably. The firft effeft of the 
bath feems to be painful and injurious: but, when re-ac¬ 
tion follows, (and it fhould only be ufed when this does 
follow,) the cutaneous capillaries are excited, and thus 
unload the circulation ; independently of which, they 
communicate a fympathetic vigour to the pulmonary ex- 
halants. 
The tendency to fpitting fhould be promoted by the 
exhibition of expectorating medicines ; fuch as ipecacu¬ 
anha, oxymel of fquill, and ammoniacum. Of the firft 
of thefe, not more than two or three grains fhould be gi ven 
for a dofe, fo as to excite, in this ftage of the diforder, 
merely naufea, but not vomiting; the two others fhould 
be joined together in the form of a draught or mixture, 
with or without the addition of tether. 
A dry and pure air, but not that of an elevated fitua- 
tion, is in general belt fuited to afthmatics ; there are, 
however, as before ftated, frequent exceptions to this ob- 
fervation. The bowels fhould be kept regular, by rhu¬ 
barb and aloetic aperients. Small dofes of calomel may 
be given with great advantage, in many cafes; and efpe¬ 
cially where the afthmatic affeftion is connefted with a 
difeafe of the fkin. Whenever the patient’s feelings warn. 
him of an approaching attack, he fhould take an emetic, 
and after its operation an opiate : and at all times he 
fhould encourage expeftoration ; but oleaginous emul- 
fions and fweet mixtures fhould be profcribed. Ifl’ues 
have been recommended by fome praftitioners for lef- 
fening the frequency and violence of the paroxyfms. 
It is faid that king William continued perfeftly free 
from his afthmatic complaint, during 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 utility of counter-irritants feems here very equi¬ 
vocal, efpecially in young fubjefts. Dr. Bree fays, 
“ In very old afthmatics, ifiues are fometimes necef- 
fary. In younger fubjefts, when the difeafe is not yet 
inveterate, they may occafionally be ufeful, by diverting 
aqueous humour from the lungs, and giving a better op¬ 
portunity for the operation of tonic remedies.” 
Diuretics have been very generally reforted to, often 
perhaps becaufe in this complaint the urinary fecretion 
is difordered ; but this is generally traceable to the dyf- 
peptic fymptoms to which our attention fhould be prin¬ 
cipally direfted. There are cafes, however, in which diu¬ 
retics are plainly indicated. When Dyfpncea remains 
after the fit, and the urine is at the fame time fmall in 
quantity, and high coloured, faline diuretics fhould be 
given; and mercurials are alfo then ufefully com¬ 
bined, as the cafe is probabiy complicated with vifceral 
obftruftions. 
