Bromide of potassium, as is well known, acts upon the vaso-motor nerves, causing contraction of the arterioles of the brain and spinal cord, and thus inducing a state of partial anæmia which results in a lessening of the irritability of these organs, quieting muscular spasm and inducing sleep. These effects would naturally lead to its employment in spasmodic asthma. Although occasionally used with success in shortening the paroxysm, it is better adapted, as suggested by Riegel, for use during the intervals, when, if given continuously, it sometimes diminishes the severity of the paroxysms and causes them to recur less frequently.
Nitrite of amyl, a most valuable addition to our materia medica, has been extensively used in the treatment of asthma, but the reports of the results attained are too contradictory to admit of our forming any just estimate of its merits. The general opinion is that it relieves the dyspnoea and makes the patient for the time being more comfortable; and this accords with my own experience. The usual method of administration is to drop one or more minims upon a handkerchief and to inhale the vapor. It is also used internally, and, in the single case that has come under my observation, with benefit. The following case, reported by Pick and cited by Riegel,25 is instructive as showing the favorable effects of nitrite of amyl: "The case was that of a medical student who from his youth onward had suffered with asthmatic troubles, which increased as he grew older and had proved rebellious to all remedies. Nothing except expectorants and narcotics afforded him the slightest amelioration of his symptoms. On inhaling nitrite of amyl he experienced immediate relief, which lasted for some time after the inhalation. He was enabled to breathe deep and with comparative ease. The relief afforded was but transitory, but, on the other hand, was so sure that the patient resorted to it whenever the attack came on." The same writer reports two other cases in which he succeeded by means of nitrite of amyl in relieving the paroxysms and in increasing the interval between them.
25 Op. cit., p. 295.
More agreeable to the taste and at the same time more effectual than the potassium iodide is hydriodic acid. It is best administered in the form of a syrup, preferably that prepared by Gardener of New York.
Salter, who appears to have had more experience with alcohol than any other writer, narrates the case of an elderly Scotch lady who, having exhausted all the known medicines and other agents used in asthma, was finally relieved by full doses of whiskey. This was invariably successful, but the dose, of course, had to be increased as the disease grew older. He also mentions another case in which nothing except chloroform afforded any relief. This he describes as the severest he has ever witnessed. "I have never seen or heard of spasms so violent or that seemed so nearly to put life in peril. His most intense spasms he calls 'screaming spasms,' from the strangling cries that the want of breath compels him to make. At the time of which I am speaking he lived on the same street with myself, and, although his house was half the length of the street from mine, his nurse has often assured me that if the doors had been open I could have heard his screams at my house at night. All remedies except the chloroform had failed, when one day his nurse advised him to try brandy. It afforded him almost instantaneous relief. He took enormous quantities of it, the first day a quart, and in the course of two months as much as twelve gallons. The spasm invariably stopped as soon as he took it, and for the last five months that he was under observation he had only what he called a 'thickness, a tight, constricted breathing,' several times during the night." Salter is particular in stating that the brandy should be given strong and hot.
Another stimulant highly recommended by Salter is coffee. In stating his objections to the use of opium it will be remembered that one of his reasons for not availing himself of that remedy was that it caused sleep, and that the exaltation of reflex action in that state favored the asthmatic paroxysm. Coffee, being a strong excitant of the nervous and vascular system, has the contrary effect and keeps the patient awake. It should be prepared as a strong infusion without the addition of either sugar or milk and given some time before the expected paroxysm. Administered in this manner, he claims that coffee will relieve two-thirds of all cases of asthma. The relief afforded is, however, very unequal, being in some cases complete, while in others it is only slight and transitory.
Quebracho in the form of an extract has been much used of late years in the treatment of asthma and other affections attended with dyspnoea. It has been found quite useful in mild cases.
The induced electrical current has been recommended by Schaeffer as a means of cutting short the paroxysm. His method is to place one pole on either side of the neck immediately below the angle of the jaw and in front of the sterno-cleido-mastoid, so as to cover the course of the pneumogastric and sympathetic nerves. The current should be sufficiently strong to enable the patient to feel the passage from one side of the throat to the other. It is applied for fifteen minutes twice a day for six days, twelve sittings being usually sufficient to afford relief. When the current is first applied it not infrequently causes dilatation of the pupils, but this is succeeded by contraction when the treatment begins to manifest its beneficent effects.
B. During the Intervals between the Paroxysms.—The diet and daily regimen of the asthmatic should be most carefully regulated, the best and most skilfully directed treatment being of little avail if these important matters are neglected.
The asthmatic patient should be encouraged to pass much of his time in the open air, but the amount of walking he should do will of course depend upon his strength and freedom from secondary affections of the heart and lungs. In a case of simple uncomplicated asthma the more the patient walks the better he will feel; but this is not to be construed to mean that he is to walk until exhausted; on the contrary, his walks should at first be quite short, proportioned to his strength and wind, and then gradually extended, but under no circumstances should he be allowed to overfatigue himself. With a view to keeping the skin in the best possible condition the body should every morning be sponged with water, the temperature of which must be suited to the condition of the patient. If he be feeble and anæmic, the water should be tepid, but whenever admissible cold is to be preferred. After the bath it is essential that the skin be thoroughly rubbed with a coarse towel until it becomes slightly reddened. The cold bath properly used not only invigorates the system generally, but by enabling the body to stand the vicissitudes of temperature diminishes the risk of the patient's taking cold.