A practical inquiry into disordered respiration, distinguishing the species of convulsive asthma, their causes and indications of cure / by Robert Bree.

  • Bree, Robert, 1759-1839.
Date:
1807
    of the pulmonary vessels may exist as^ by com- pressinj::; the vesiculap and bronchia, may prevent their perfect expansion, but I have taken the liberty of calling such affection Dyspnoea, or a slight Asthma, because, unless it produce eflusion of se- rum from the exhaleiits, or be attended in its pro- gress by some new organic irritation, it does not periodically excite the convulsive paroxysm. The attack of a paroxysm of Periodic or Con- vulsive Asthma is preceded very generally by Dyspepsia, and the circumstances which occur to a relaxed habit. This condition of the body may ’ have prevailed for months or years before it takes the additional form of Asthma, but when that dis- ease appears. Dyspepsia never fails to be aggravatec!, and to shew itself vritli violence before the fit. The first symptoms are flatulence and distension of the stomach and bowels ; a heavy pain over the forehead and eyes; eructation of wind, witli water which is sometimes insipid, at others sour. When the evening approaches, this weight over the e}^es becomes more oppressive, and the patient is very sleepy. Occasionally, if he be particularly ani-
    45 mated by company and conversation, the drowsiness does not take place, but a shortness of breathing is perceived, and soon after much anxiety of the prse- cordia, with great restlessness. The presence of company then becomes irksome, as it seems to in- crease a certain heat of the body, a want of free respiration, and an irritability which repels the most cautious attentions of friends. Frequently at this period there is a tingling and heat in the ears, neck, and breast, and a motion to expel the contents of the bowels is attempted with some violence, and with great uneasiness of the abdominal muscles. When an asthmatic feels these warning s, he mav be convinced that his enemy is at hand. At some uncertain hour before midnight the patient becomes suddenly sensible of the increased violence of the disorder; most frequently after a slumber in bed he awakes with great difficulty of breathing, and he feels the necessity of a more erect posture of his body. Inspiration is performed with great effort of the muscles, but is never per- fectly deep, and the diaphragm seems to descend with great difficulty against an opposing forcC; There is now a desire of free air, speaking be- comes distressing, and the irritability of the mind continues, but is not so acute as in the approach of the fit. There is a great straitucss of the cliest, and
    fi wlirozinC!^ sound in respiration. An incliiiatiori to congh shews itself, but this is small and in- terrupted. The pulse is increased in quickness a few strokes, but without hardness. There is no preternatural thirst, unless, as often happens, the fit be excited bv indigestible matter in the first pas- sages. There is a propensity to make water, which is copious and pale, and frequently dis- charged. After some hours of distress the patient perceives his anxiety to he less, the breathing is less quick and laborious, the inspirations are longer and more full, the expirations are still attended with v/heezing; the pulse is not so quick, hut more full; irritation is less acute. The cough probably brings up a portion of phlegm, and a very sensible relief follows that excretion. Then the tranquil state of the feelings introduces sleep, but not unaccompanied by wheezing, which continues almost always thro ugh the first night, and until, by the progress of the lit on the second or third day, a more considerable ex- pectoration of mucus takes place. 9 T^he second day is ushered in by a remission of the symptoms which the patient perceives from the time of awaking in the morning. No change of posture is, how ever, yet made w ith impunity, and particular distress affecls him, if he engage in the
    4S CONVULSIVE fatigue of dressings, whilst the stomach is empty. The pulse will be accelerated more than it was in the acme of the paroxysm^ and motion must fre- quently be suspended, or a vehement agony for breath will certainly come on. During the day, if no particular hurry occur, the breathing becomes gradually more free till the evening ; an inexpe- rienced asthmatic even flatters himself that his disease is retiring, but he finds at the approach of I night that he must sustain a new attack. The paroxysm recommences with the usual symptoms, and the night is passed nearly as the former, but the sleep is more perfect, and productive of more relief. The third day, the remission is more complete, there is some additional expectoration, and bodily ' motion is performed with less distress, but still with great inconvenience. After the paroxysm has been ^ renewed in this manner for three nights, the ex- pectoration generally becomes free, but there is no I certain termination of the fit at a fixed period. I However, except in particular cases, it goes off after I a few days; and as the daily remissions become more perfect, the urine is higher coloured, and in smaller quantities; the expectorated mucus is more copious and digested, strength of pulse and vigour I of action increase, and good humour and sunshine ! again enliven the mind. I I
    The expectorated mucus lias been said to be streaked with black, or to have a blackish tinge, and this appearance certainly prevails in ihany in- stances, but not invariably. The taste of the ex- pectorated mucus is also equally uncertain; it is sometimes sweetish, but more frequently it is saline, and it is occasionally coloured minutely with I blood; There is a considerable variation in tlie periods of the accession of the paroxysm, and in its duration, , in the intervals of the fits, the quantity of mucus expectorated, and the freedom of that discharge. I These circumstances of the disease vrill be in- ! fluenced by the predisposing causes and occasional I accidents. - . The disease appears to invade all temperaments; but, I believe more particularly the melancholic, or that which is between the melancholic and san- guine. The sanguine being in fact more liable to .fall into phthisis. This description seems to apply "to the con^ vulsive Asthma of Professor Cullen. I wish it to be received as that of the First SpecFs of this Inquiry, which the Author suffered in his own per- son for many years. E i y 9 I t