Human health, or, The influence of atmosphere and locality, change of air and climate, seasons, food, clothing, bathing and mineral springs, exercise, sleep, corporeal and intellectual pursuits, etc. on healthy man, constituting elements of hygiene / By Robley Dunglison.
- Dunglison, Robley, 1798-1869.
- Date:
- 1844
Licence: Public Domain Mark
Credit: Human health, or, The influence of atmosphere and locality, change of air and climate, seasons, food, clothing, bathing and mineral springs, exercise, sleep, corporeal and intellectual pursuits, etc. on healthy man, constituting elements of hygiene / By Robley Dunglison. Source: Wellcome Collection.
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![ASTHMA. 219 found in the luxurious habits of later times, which have carried to a dangerous excess the comforts of our dress and habitations. In nothing is there a greater contrast between us and our ancestors than in the luxurious closeness and warmth of our apartments; and it will scarcely be denied that the result of such a mode of living has been to render us more easily affected by the rigour and changeableness of the climate out of doors, which, unhappily, appears rather to have retro- graded than improved, while the endless invention of new modes of defence in our domestic arrange- ments, has made the contrast still greater. No author has dwelt so much on the consequences of these luxurious habits in predisposing to asth- ma, as Withers, whose observations are most pertinent, and well merit the attention of the reader. (See his Treatise on Asthma.) It is frequently by inducing this sensibility to the im- pression of cold, and by thus predisposing to catarrh, that dyspepsia lays the foundation of asthma. Many other of the remote causes of asthma operate in the same manner, and among these, certain mental states, particularly the de- pressing passions. Sedentariness and seclusion, the natural consequences of grief and melancholy, give rise to dyspepsia, and dyspepsia induces the languid circulation in the skin, extremities, and mucous membranes, which seems to be the im- mediate cause of the increased sensibility to cold. II. Exciting causes*—Under this head must be comprehended all such circumstances as have been known immediately to induce a paroxysm, whether in the predisposed or not. These are extremely numerous and various. Joseph Frank alone enumerates upwards of forty, and it is but justice to this learned and indefatigable writer to state that he gives his authority in every case. (Prax. Med. Univ. Pars ii. vol. vii. p. 386.) Our countryman Willis, in general and more pithy terms, conveys nearly the same information when he informs us that “ asthmatics can bear nothing violent or unusual. From excess of heat or cold, from any great bodily exertion or mental emotion, from change of season or of weather, from errors, even of a slight kind, in the non-naturals, and from a thousand things besides, they fall into fits of dyspnoea.”* By far the most common and most important of these cases, we consider to be the application of cold, or, at least, one or more of those circumstances, whatever they may be, which, in ordinary cases, produce catarrh. Al- though it will appear from what is gone before that we do not deny the existence of cases of asthma of a purely nervous kind, and altogether independent of any permanent local affection of the bronchial membrane, we are decidedly of opinion that they constitute an extremely small proportion of the cases met with in practice. And we are further of opinion that out of the immense majority of cases of asthma from other causes, nine-tenths are complicated with some form of catarrh, or, at least, with a morbid susceptibility * Asthmatic! nihil violentum aunt inassuetiim ferre possunt: a frigoris vel caloris e.xcessu,a vehcrnenti quo- vis corporis aunt anirni motu, ab aeris aunt anni inuta- tionibus quibusque magnis, ab erratis vel levioribus circa res non naturales, iino propter niille alias occasio- nes in dyspnoete paroxysmos incidunt. — De Medicam. Oper. p. 209. of the bronchial membrane to be affected by cold. In this very numerous class of cases, then, all those circumstances which induce catarrh, and which may generally be considered as some form or modification of cold, applied to the whole body or to a part of it, must be understood to be the usual exciting causes of the asthmatic paroxysm. [Yet in regard to the exciting causes, there are some which induce asthma, and can scarcely be considered amongst the causes of catarrh. In general, a cold and dry air suits the asthmatic, but there are singular differences in this respect. Closing a door has been known to bring on a paroxysm; and, with some, darkness increases the violence of the attacks. One cannot bear smoke ; another exists better in a smoky apart- ment. (Dunglison’s Practice of Medicine, 2d edit. i. 327 : Philad. 1844.)] All practical writers on asthma lay great stress on this exciting cause, but none with such pre- cision and effect as Withers, Ryan, and Watt. The latter author in particular, in a short but most valuable essay published in his Treatise on Diabetes, has very strikingly and beautifully illus- trated the subject. In several cases there recorded, he has pointed out, with the greatest minuteness and perspicuity, the gradual influence of the cause, from the first impression of the cold up to the in- vasion of the paroxysm. (Cases of Diabetes, &c. p. 254. Glasgow, 1808.) Ryan bad previously made the same observation^ an>d applied it to prac- tical purposes of the greatest importance. (Ob- servations on Asthma, p. 40. London, 1793.) In these opinions our own experience leads us fully to concur ; almost every case of asthma which we have met with being traceable to the usual causes of catarrh, and most of them being ad- vantageously treated only on the principles which regulate the practice in that disease. Treatment of AstSima*—In this, as in other diseases, the attainment of a just pathology would wonderfully abbreviate the labour of therapeutical prescription. In the writings of the older authors, who were, in general, guided either by empirical views or by fanciful theories of disease, we find no end to the array of medical formulae, until every thing that had been put on record by their predecessors, or had been imagined by themselves or their contemporaries, as useful or likely to be useful in the individual disease under considera- tion, has been displayed at full length. In our own days, and in the diseases of the nature of which we have acquired some accurate views, a few general precepts will convey to those ac- quainted with the general principles of thera- peutics all that we have to deliver respecting the treatment of a disease. We have not yet attained, in the case of asthma, to a pathology perfect in all its parts ; yet we trust that enough has been re- corded in the preceding pages to permit us to be more brief in the delivery of our practical precepts than some of our predecessors. In entering upon this part of our subject, it is desirable that the reader keep constantly in mind that almost every thing in the succeeding pages respecting the treatment of asthma applies exclu- sively to the chronic forms of that disease. It will be recollected that the disease termed acute asthma is either a variety of bronchitis, or a violent](https://iiif.wellcomecollection.org/image/b29331663_0469.jp2/full/800%2C/0/default.jpg)
