Those who breathe thick without fever, like those who have run fast, are
said to be _asthmatic_, that is to say, to pant for breath; and from
their being obliged to keep the chest erect for fear of being suffocated,
they are called _orthopnoic_. The affection arises from thick and viscid
humours becoming infarcted in the bronchial cells of the lungs. Dyspnœa
is a common symptom which accompanies these and many other complaints.
The indication of cure in asthmatic complaints is to consume the viscid
and thick humour by attenuant and detergent medicines. Wherefore the
vinegar of squills will answer well with them, and the oxymel prepared
from it; the baked squill itself when triturated with honey; the antidote
called hiera, continued purging with drastic medicines, and vomiting
from radishes. And, in like manner, the round birthwort may be drunk,
the root of the great centaury, the fruit and root of cow-parsnip, the
fruit of calamint, hyssop, iris, and gith. Put a sextarius of slaters,
into an earthen vessel, roast upon the coals; when whitened, pulverize,
and, mixing with boiled honey, give a mystrum thereof before and after
food. If there be any urgent necessity, before doing all these things,
open a vein and evacuate proportionably to the patient’s strength; and
stimulate the belly by clysters. Externally to the chest we may apply
cataplasms from figs, the flour of iris, and of barley, containing rosin,
wax, and honey; and iris and manna may be sprinkled upon them. Some
benefit may also be derived from raw barley-flour, with rosin, wax, iris,
and manna. We may use the more heating ointments, such as those of iris,
dill, and rue. But the following application is particularly proper: Of
pumice-stone, p. j; of burnt lees of wine, p. iv; of arsenic, p. j; of
the schenanth, p. ij; of alcyonium, p. j; of aphronitrum, p. ij; pound,
sift, mix with the ointment, and with it rub the parts about the chest,
and use emollient ointments for attracting the humours.
_A draught for asthmatics._ Of poley, of southernwood, of castor, of
ground pine, of ammoniac perfume, equal parts; mix with honey, and
give.—_Otherwise_: Some give a spoonful of aphronitrum in three cyathi
(cupfuls) of honied water.—_Another_: Of aphronitrum, dr. ix; of pepper,
dr. j; of laserwort, dr. ss; give a spoonful in water.—_Another_: Of
castor, of ammoniac perfume, of each, dr. vj; of pepper, xl grains; mix
with must, and give to the size of a bean in honied water.—_Another_:
Of mustard, dr. j; of the spuma nitri, three oboli; of elaterium, a
diachylon (i. e. half an obolus): form the whole into eight trochisks,
and give two every two days; for they will evacuate upwards gently. To
those who are choked for want of breath, give, of aphronitrum, dr. iij,
with three cyathi of hydromel, and sometimes with cardamom, and it will
relieve them immediately. It is also useful in ischiatic disease.
* * * * *
COMMENTARY. The following ancient works may be consulted: Hippocrates
(Aphoris.); Galen (de Comp. Med. sec. loc. vii); Celsus (iv, 4); Aretæus
(Morb. i, 11); Cælius Aurelianus (Morb. Tard. iii, 1); Aëtius (viii, 63);
Oribasius (Loc. Affect. iv, 79); Actuarius (Meth. Med. iv, 4); Marcellus
(de Med. 17); Nonnus (127); Octavius Horatianus (ii, 2, 12); Serapion
(ii, 24); Avicenna (iii, 10, 1, 38); Mesue (de Ægrit. Pect.); Haly Abbas
(Pract. vi, 8; Theor. ix, 20); Alsaharavius (Pract. viii, 5); Rhases (ad
Mansor. ix, 56; Contin. viii.)
Our author’s theory of the disease is borrowed from Galen, and seems very
plausible. It being admitted by our best modern pathologists, that there
is no organic alteration of structure in ordinary cases of convulsive
asthma, it seems likely that the paroxysm is occasioned by thick and
viscid humours infarcted in the lungs; or, most probably, in many cases
from the system being loaded with such humours which nature casts off by
the lungs. We need scarcely add, that it is now well ascertained that
asthma is frequently produced by _engorgement_ of the lining membrane of
the bronchi, thus forming what is called the dry catarrh. Galen, like our
author, maintains that the use of attenuant and detergent medicines is
indicated. His internal remedies are squills, pepper, wormwood, opopanax,
storax, sulphur, oxymel, millepedes, &c. He forbids all things which
are either of a very hot or cold nature, as in either case they tend to
thicken the humours.
Aëtius gives nearly the same account as our author, both having evidently
borrowed from Galen. He strongly praises vinegar of squills, myrrh,
pepper, and the like. In certain cases he advises the application of the
actual cautery to the head (see Book Sixth, Sect. I) under the impression
that the disease is occasioned by a defluxion from it. He also speaks of
burning the chest in several places for the purpose of making issues; and
further recommends strong rubefacients.
Among the articles recommended by Marcellus, the Empiric, for difficulty
of breathing, we remark vinegar of squills, natron (_soda_), opium,
horehound, &c. The first article, it will be perceived, among his
remedies for asthma is vinegar of squills. Almost all the ancient
authorities praise the virtues of squills in this disease.
Aretæus gives a good description of the symptoms of the disease, which he
attributes to a humid, thick, and glutinous _matériel_ in the lungs. He
says, the lungs are primarily affected, and through them sympathetically
the diaphragm, and parts about the chest which assist in respiration. But
if the heart be affected, he adds, the issue is speedily fatal. Among the
incipient symptoms he mentions flatulence of the bowels, restlessness,
and latent heat by night. As the paroxysm proceeds, the cheeks become
red, the nose sharp, the eyes prominent as if from strangulation, there
is a _râle_ even when awake, and still more so when asleep; the voice
is humid and devoid of resonance, with an insatiable desire of cold
air, panting, and orthopnœa. To these symptoms are added, paleness
of the countenance, with the exception of the cheeks; profuse sweats
about the face and chest; constant and difficult coughing, with little
expectoration. His chapter on the treatment is lost.
As Oribasius, Actuarius, and Nonnus follow the principles laid down by
Galen, we need not give any account of their opinions.
Octavius Horatianus adopts Galen’s theory, which he thus explains:
“Pingui autem et frigido phlegmate pulmonibus adhærente, cavernæ, vel
meatus, quibus naturaliter spiritus redditur et accipitur, concluduntur;
et ex hoc impedimento suspirium, vel anhelitus molestissimus, nascitur,
ut sedendo magis quam jacendo respiret.” He recommends bleeding, if
not contra-indicated; but, if that is the case, frequent abstinence.
Among his internal remedies we remark oxymel, gum ammoniac, castor, and
vinegar of squills. He approves also of emetics. He recommends stimulant
applications to the chest, also fomentations and sinapisms. A long
journey, he says, is beneficial.
Cælius Aurelianus disapproves of burning the head and of strong purging.
He approves of bleeding, if the patient’s strength permit, of clysters,
cupping the breast, gestation, friction, vociferation, emetics from
radishes, or even from hellebore, and of giving the vinegar of squills.
He speaks favorably of the cold bath. His description of humid asthma is
very striking, and has been commended by late authorities on the subject.
The sounds within the chest are thus described: “stridor, atque sibilatio
pectoris, cum vocis debilitate.”
Cassius discusses the question why there is a sibilant murmur in cases of
orthopnœa, and decides that it is because the affection is a contraction
and falling-in of the cells of the lungs, and the breath rushing through
a narrow passage produces this murmur. (Prob. 82.)
Serapion recommends friction, exercise, squills, fumigations with
arsenic, &c. Mesue also recommends arsenic in various forms. Avicenna’s
account is particularly full and judicious. He properly remarks that
asthma is sometimes connected with derangement of the heart, liver, and
stomach. Like the others, he approves of arsenic, both in pills and in
solution.
Haly Abbas, like Galen, refers asthma to a collection of gross phlegm
about the cells of the lungs. His remedies are of an attenuant and
incisive nature, and he particularises the vinegar of squills. He
cautions asthmatics to beware of indigestion, and, therefore, forbids
exercise after food, but recommends it before a meal. After exercise
he enjoins hard friction, no doubt with the intention of favouring the
cutaneous perspiration. Rhases commends squills and the tepid bath. Like
the others, he approves of inhaling the vapours of arsenic.
Vegetius, the veterinary surgeon, recommends squills with wine,
assafœtida, and oil, for these complaints in cattle.
Respecting the use of arsenic in asthma, Prosper Alpinus remarks:
“Præterea audent aliqui arsenicum summè exitiale venenum illis exhibere.
Narrant quidam nepotem patris fratri decrepito orthopnoico, ut cum
interimeret, clam in ferculo ex cucurbitâ parato porrexisse arsenicum,
coque non modo non interimisse decrepitum, verum et ab asthmate prorsus
sanasse.” (De Meth. Med. x, 13.) He states further, by the way, both in
that work and in the one “de Medicina Ægyptiorum,” that the Egyptians
were in the practice, for the cure of asthma, of applying cones of
cotton to the breast, and setting them on fire. Fracastorius, who
recommends this practice of imbibing the fumes of arsenic, for contagious
phthisis, speaks of it in the following terms: “Nonnulli antiquorum
jubent Sandaracæ nidorem per anhelitum in pulmones trahi: quum autem
Sandaracam dico non eam intelligi volo quæ vernix vulgo vocatur, sed quæ
auripigmentum a nobis dicitur: porro nec per auripigmentum velim a te
accipi priorem illam speciem quæ citrina est sed alteram, quæ est ruffa,
et propriè Sandaraca vocatur.” (Morb. Contag. iii.)
Dr. Hill, however, properly remarks that the arsenic of the ancients, or
orpiment was a much more innocent substance than the factitious arsenic
of the moderns. See also Cleaveland (Mineralogy p. 680.) The arsenic of
the ancients, in fact (as will be shown in the proper place), was the
mineral substance called yellow orpiment, consisting of sixty-two parts
of arsenic and thirty-eight of sulphur, according to the analysis of
Klaproth. The sandarach was _realgar_, which consists of seventy-five
parts of arsenic and twenty-five of sulphur.