The mode of onset differs very markedly in different cases. In some the attack begins quite suddenly and without warning, but in others various sensations well known to the patient announce that an attack is imminent. According to the late Dr Hyde Salter the commonest warning is that of an intense desire for sleep, so overpowering that though the patient knows his only chance of warding off the attack is to keep awake, he is yet utterly unable to fight against his drowsiness. Among other patients, however, a condition of unwonted mental excitement presages the attack. Again the secondary forms of the disease may be ushered in by flatulence, constipation and loss of appetite, and a symptom which often attends the onset, though it is not strictly premonitory, is a profuse diuresis, the urine being watery and nearly colourless, as in the condition of hysterical diuresis. In the majority of instances the attack begins during the night, sometimes abruptly but often by degrees. The patient may or may not be aware that his asthma is threatening. A few hours after midnight he is aroused from sleep by a sense of difficult breathing. In some cases this is a slowly increasing condition, not becoming acute for some hour or more. But in others the attack is so sudden, so severe, that the patient springs from his bed and makes his way at once to an open window, apparently struggling for breath. Most asthmatics have some favourite attitude which best enables them to use all the auxiliary muscles of respiration in their struggle for breath, and this attitude they immediately assume, and guard fixedly until the attack begins to subside. The picture is characteristic and a very painful one to watch. The face is pale, anxious, and it may be livid. The veins of the forehead stand out, the eyes bulge, and perspiration bedews the face. The head is fixed in position, and likewise the powerful muscles of the back to aid the attempt at respiration. The breath is whistling and wheezing, and if it becomes necessary for the patient to speak, the words are uttered with great difficulty. If the chest be watched it is seen to be almost motionless, and the respirations may become extraordinarily slowed. Inspiration is difficult as the chest is already over-distended, but expiration is an even far greater struggle. The attack may last any time from an hour to several days, and between the attacks the patient is usually quite at ease. But notwithstanding the intensely distressing character of the attacks, asthma is not one of the diseases that shorten life.
In the child, asthma is usually periodic in its recurrence, but as he ages it tends to become more erratic in both its manifestations and time of appearance. Also, though at first it may be strictly “pure” asthma, later in life it becomes attended by chronic bronchitis, which in its turn gives rise to emphysema.
As to the underlying cause of the disease, one has only to read the many utterly different theories put forward to account for it, to see how little is really known. But it has now been clearly shown that in the asthmatic state the respiratory centre is in an unstable and excitable condition, and that there is a morbid connexion between this and some part of the nasal apparatus. Dr Alexander Francis has shown, however, that the disease is not directly due to any mechanical obstruction of the nasal passages, and that the nose comparatively rarely supplies the immediate exciting cause of the asthmatic attack. Paroxysmal sneezing is another form in which asthma may show itself, and, curiously enough, this form occurs more frequently in women, asthma of the more recognized type in men. In infants and young children paroxysmal bronchitis is another form of the same disease. Dr James Goodhart notes the connexion between asthma and certain skin troubles, giving cases of the alternation of asthma and psoriasis, and also of asthma and eczema. The disease occurs in families with a well-marked neurotic inheritance, and twice as frequently in men as in women. The immediate cause of an attack may be anything or nothing. Dr Hyde Salter notes that 80% of cases in the young date from an attack of whooping cough, bronchitis or measles.
In the general treatment of asthma there are two methods of dealing with the patient, either that of hardening the individual, widening his range of accommodation, and thus making him less susceptible, or that of modifying and adapting the environment to the patient. These two methods correspond to the two methods of drug treatment, tonic or sedative. During the last few years the method of treatment first used by Dr Alexander Francis has come into prominence. His plan is to restore the stability of the respiratory centre, by cauterizing the septal mucous membrane, and combining with this general hygienic measures. In his own words the operation, which is entirely painless and insignificant, is performed as follows:—“After painting one side of the septum nasi with a few drops of cocaine and resorcin, I draw a line with a galvano-cautery point from a spot opposite the middle turbinated body, forwards and slightly downwards for a distance of rather less than half an inch. In about one week’s time I repeat the operation on the other side.” In his monograph on the subject, he classifies a large number of cases treated in this manner, most of which resulted in complete relief, some in very great improvement, and a very few in slight or no relief.
ASTI (anc. Hasta), a town and episcopal see of Piedmont, Italy, in the province of Alessandria, situated on the Tanaro; it is 22 m. W. by rail from Alessandria. Pop. (1901) town, 19,787; commune, 41,047. Asti has still numerous medieval towers, a fine Gothic cathedral of the 14th century, the remains of a Christian basilica of the 6th century, and the octagonal baptistery of S. Pietro (11th century). It was the birthplace of the poet Vittorio Alfieri. In ancient times it manufactured pottery. It is now famous for its sparkling wine (Asti spumante), and is a considerable centre of trade.
ASTLEY, JACOB ASTLEY, Baron (1570-1652), royalist commander in the English Civil War, came of a Norfolk family. In 1598 he joined Counts Maurice and Henry of Orange in the Netherlands, where he served with distinction, and afterwards fought under the elector palatine Frederick V. and Gustavus Adolphus in the Thirty Years’ War. He was evidently thought highly of by the states-general, for when he was absent, serving under the king of Denmark, his company in the Dutch army was kept open for him. Returning to England with a well-deserved reputation, he was in the employment of Charles I. in various military capacities. As “sergeant-major,” or general of the infantry, he went north in 1639 to organize the defence against the expected Scottish invasion. Here his duties were as much diplomatic as military, as the discontent which ended in the Civil War was now coming to a head. In the ill-starred “Bishops’ War,” Astley did good service to the cause of the king, and he was involved in the so-called “Army Plot.” At the outbreak of the Great Rebellion (1642) he at once joined Charles, and was made major-general of the foot. His characteristic battle-prayer at Edgebill has become famous: “O Lord, Thou knowest how busy I must be this day. If I forget Thee, do not forget me. March on, boys!” At Gloucester he commanded a division, and at the first battle of Newbury he led the infantry of the royal army. With Hopton, in 1644, he served at Arundel and Cheriton. At the second battle of Newbury he made a gallant and memorable defence of Shaw House. He was made a baron by the king, and at Naseby he once more commanded the main body of the foot. He afterwards served in the west, and with 1500 men fought stubbornly but vainly the last battle for the king at Stow-on-the-Wold (March 1646). His remark to his captors has become as famous as his words at Edgehill, “You have now done your work and may go play, unless you will fall out amongst yourselves.” His scrupulous honour forbade him to take any part in the Second Civil War, as he had given his parole at Stow-on-the-Wold; but he had to undergo his share of the discomforts that were the lot of the vanquished royalists. He died in February 1651/2. The barony became extinct in 1668.
ASTLEY, SIR JOHN DUGDALE, Bart. (1828-1894), English soldier and sportsman, was a descendant of Lord Astley, and son of the 2nd baronet (cr. 1821). From 1848 to 1859 he was in the army, serving in the Crimean War and retiring as lieutenant-colonel. He married an heiress in 1858, and thenceforth devoted himself to horse-racing, pugilism and sport in general. He succeeded to the baronetcy in 1873, and from 1874 to 1880 was Conservative M.P. for North Lincolnshire. He was a popular figure on the turf, being familiarly known as “the Mate,” and won and lost large sums of money. Just before his death, on the 10th of October 1894, he published some entertaining reminiscences, under the title of Fifty Years of my Life.