The inhalation of chloroform has long been esteemed as a potent agent in overcoming the bronchial spasm. One would naturally suppose that the use of such a powerful sedative as chloroform would be a dangerous proceeding in a disease which, like asthma, is attended with so much embarrassment of respiration and circulation; but experience does not justify this fear, and Salter, who has used it with good effect in 12 out of 13 cases, assures us that he has administered it "in the very agony of the worst attacks; that, so far from fearing it under such circumstances, it has been able to relieve the intensest asthma that nothing else would reach; that he has given it, and that he has never seen any bad effects from it." He goes on to state that as chloroform relaxes the bronchial spasm, and thus removes the cause of the "asphyxial stoppage, the intensity of the apnoea, so far from being a reason against the administration of chloroform, is the great reason for its immediate employment." He considers neither muscular weakness of the heart nor valvular disease as any contraindication to its administration, provided the circulation is not materially affected. According to Stokes, the paroxysm is not entirely suppressed by chloroform, but returns as soon as the patient passes from under its influence; hence it must be repeated as occasion may require. It should always, if possible, be given at the commencement of the paroxysm, and should never be allowed to produce complete insensibility, nor should so seductive a remedy be left in the hands of the patient. The danger of the self-administration of chloroform is only too well attested by the frequent accounts in the journals of persons found dead in their beds from the effects of that agent, death in such cases being usually due to the patient's unconsciously leaving the handkerchief over the mouth and continuing to inhale the chloroform after having become insensible. When given sufficiently early, a few whiffs may be all that is necessary to overcome the paroxysm; and this repeated as soon as it threatens to return, will often enable us to control the symptoms without resorting to larger quantities.

An old and still very popular treatment—said to have been introduced by an American, Nicholas Frisi,24 in 1843—consists of the inhalation of the fumes of burning saltpetre or in smoking cigarettes made of paper which has been soaked in a saturated solution of that substance. Inhaled into the bronchi, it is supposed to act as an anæsthetic, and produces relaxation of the constricted bronchial muscles. In point of efficiency these inhalations rank quite high, and are probably more generally used than any other remedy. Aside from the relief which they undoubtedly afford, this method derives much of its popularity from being within easy reach of the patient himself. The preparation of the papers is exceedingly simple: A sheet of bibulous paper is dipped into a saturated solution of the nitrate of potassa prepared with cold water; after drying it is divided into strips of the size required. These papers are burnt before the patient, the windows and doors of the apartment having been previously closed to prevent the escape of the fumes. Nitrate of potassa has been prepared in a variety of other ways for the use of asthmatic patients, one of the most convenient of which is the Kidder pastilles so extensively used in this country. Another method is to roll the paper prepared as above into cigarettes, the smoke of which is inhaled by the patient. The nitre is best used early in the attack, but is also beneficial when the paroxysm is at its height. The efficacy of this treatment is attributed by Germain Sée to the formation of protoxide of nitrogen and carbonic acid gas, which act as an anæsthetic, and perhaps also to the particles of carbon in the smoke floating in the air, a smoky atmosphere being beneficial to many asthmatics.

24 Germain Sée, op. cit., p. 709.

The smoking of the Datura metel having been found efficacious in asthma in India, Anderson of Madras in 1802 sent some of the leaves to Gen. Gent, an English officer, by whom they were introduced into England. Simms of Edinburgh, believing that the Datura stramonium might prove equally good, tested it with such good results that it soon came into general use, not only in asthma, but in other forms of dyspnoea. This is the ordinary Jimson or Jamestown weed which is so widely distributed over the Southern, Middle, and Northern States, and, like nitrate of potassa, is much used, not only by the profession, but largely as a household remedy for asthma. The dried leaves are either smoked in a pipe or in the form of a cigarette. The effects, however, are quite uncertain, sometimes acting like a charm, while at others it affords no relief; its physiological action is that of a sedative. Of late years another species of Datura has been introduced—the Datura tatula. Its properties and uses are similar to those of stramonium, but it is supposed to be less narcotic.

Belladonna and its alkaloid, atropia, are often used in the treatment of asthma, but their action is uncertain and often unsatisfactory. The three last-mentioned remedies are also used in combination, as in the well-known Espic cigarettes, the formula for which, according to Trousseau, is as follows, viz.:

Rx.Fol. belladonnæ,gr. vj;
Fol. hyoscyami,gr. iij;
Fol. stramonii,gr. iij;
Fol. phillandrii aquatic.gr. j;
Ext. opii,gr. ¼;
Aq. lauroceras,q. s.

The leaves, after being cut up, should be thoroughly mixed, after which they are moistened with the cherry-laurel water, in which the opium has been previously dissolved. The wrapper of the cigarette is also soaked in the same solution and dried. One or two of these cigarettes should be smoked during the attack. Abbott has been very successful with belladonna applied as a spray (drachm j of the extract to one ounce of water) when the spasm threatens.

Tobacco is a powerful depressant, and in those who are unaccustomed to its use is an invaluable remedy in asthma. In the uninitiated it excites nausea, vertigo, cold sweats, and other symptoms of relaxation which Salter not inaptly compares to those of sea-sickness. "The moment this condition can be induced the asthma ceases, as if stopped by a charm." It may, however, be asked whether the remedy is not worse than the disease. Those who retain a vivid recollection of the horrible consequences of their first smoke will hesitate before prescribing tobacco for one unaccustomed to its use. There are many who, not wishing to lose the beneficial effect of tobacco in asthma, never smoke unless a paroxysm threatens.

Lobelia, like the above also a depressant in its action, was formerly much employed in asthma. It is still used, but its effects are disagreeable and by no means certain.

The intimate nervous connection which exists between the lungs and stomach would naturally lead us to anticipate good results from emetics. In asthma, as in laryngismus stridulus, an emetic often affords prompt relief and arrests the paroxysm. The nausea which precedes the act of vomiting, acting as a depressant, causes relaxation of the spasm, while the emesis by unloading the stomach removes an important source of irritation. Like tobacco and lobelia, remedies of this class are only beneficial when pushed far enough to produce the symptoms of depression and collapse to which we have alluded; these once established the relief is usually complete. Tartar emetic and ipecacuanha are the representatives of this class most used in asthma. Tartar emetic, owing to the excessive and long-continued depression which it occasions, is now rarely employed, having been almost entirely superseded by ipecacuanha, which is equally efficacious and more prompt. Its effects also disappear more rapidly than those of antimony. Like other remedies intended to cut short the paroxysm, ipecacuanha should be given as early as possible. It should be taken in full doses of at least twenty grains.