Popular Science Monthly/Volume 23/September 1883/The Remedies of Nature V
By FELIX L. OSWALD, M. D.
IT has been said that no doctrine can ever attain a large degree of popularity without containing some admixture of truth. The rare exceptions from that rule do not include that most preposterous of all medical theories, the "Brunonian System of Physics." John Brown, M.D., of Preston, Scotland, divided all disorders of the human organism into "sthenic" and "asthenic" diseases: the former produced by an excess of vitality, and to be counteracted by bleeding and cathartics; the latter arising from a defect of vital power, and to be cured by beefsteaks and brandy, etc. The grain of truth in the chaff-barrel of absolute nonsense is the pathological influence of asthenia, or a deficiency of vital power. Impaired vitality can not be restored by alcoholic stimulants, but its causal connection with a large number of functional disorders admits of no doubt. Every process of the animal organism derives the impulse of its normal performance from a reserve fund of vital energy and the depletion of this fund impairs the efficiency of the organic functions. A man may be too tired to sleep. A child may be too feeble to breathe, too weak to assimilate its food. Exhaustion alone may lead to that total suspension of the vital process which we call death.
But generally asthenia is only a proximate cause of disease. It reveals a pre-established morbid diathesis by affecting the weakest part of the organism, and its influence becomes thus localized. The affected part may become the center of attraction for a variety of asthenic agencies, for each successive attack increases the morbid diathesis, and thus, as it were, confirms the pathological precedent. This convergence of asthenic influences is most strikingly illustrated in the pathology of the asthmatic affections. Asthma, or chronic dyspnœa, a torpor of the semi-voluntary muscles which effect the process of respiration, has thus far not been traced to its original cause. Professor Reese ascribes it to a spasm of the muscular fibers inclosing the bronchial tubes; Dr. E. Bock defines it as a diminished elasticity of the pulmonary air-cells, caused by an undue dilation of the lungs (as in violent exercise). Villemin considers it as a purely nervous affection. In its most frequent form, however, it seems to be a legacy of arrested tuberculosis—an intermittent affection induced by a tendency to a pulmonary torpor that may remain latent for an indefinite time, but unmistakably connected with an asthenic proximate cause. Chronic asthma, in the strictest sense of the word, occurs only during the last stage of pulmonary consumption. When the lungs have been reduced to a certain degree, their utmost activity is insufficient to supply the needs of the organism, and the patient suffers the tortures of an irremediable air-famine. The automatic action of the lungs has to be supplemented by a desperate muscular effort, the motions of the contracted organ become spasmodic and wheezing, the sufferer is unable to breathe in an horizontal position, and after a short slumber awakens with a sense of suffocation. But a chronic disposition to all these symptoms in their extreme malignity may exist without a phthisical diathesis, and remain latent for weeks and years. The exciting cause generally operates without a moment's warning. During the laborious digestion of a heavy dinner, or even after a moderate meal, eaten on a sultry day, the process of respiration begins to alternate with inert pauses, relieved at first by an occasional yawn, by-and-by only by a violent gasp; a feeling of uneasiness supervenes, the air-deficit becomes more and more perceptible, and the patient suddenly realizes that he is booked for a five days' struggle with a pulmonary torpor. Changes of temperature, a sudden thaw in midwinter, or a sultry day after a protracted rain, have a similar tendency, but the most frequent proximate cause is violent mental emotion—fear, anxiety, and especially suppressed anger. Nothing else so strikingly illustrates the intimate interaction of mental and physical conditions as this sudden pathological effect of a purely physical cause. In the same instant almost, when a fit of wrath—even in the form of a transient irritation—accelerates the throbbing of the heart, its reaction on the respiratory organs betrays itself by a spasmodic gasp, the patient instinctively clutches his ribs and tries to master the incipient mischief, but emotional asthma is a form of the disease that can rarely be nipped in the bud; the primum mobile can not be revoked, and the sufferer may think himself lucky to get off with a result of twenty-four hours' misery. Excessive exercise—lifting weights, running, wrestling, etc.—is merely an adjuvant of the fore-named cause. With his mind at ease, an asthmatic may chop cord-wood on the warmest day in the year, carry corn-sacks, or run up-hill till his lungs are ready to burst with panting; that panting will be entirely distinct from the ineffectual gasps of the air-famine. But, under the depressing influence of mental worry, an exhausting physical effort will bring on a fit of asthma as surely as heat and exercise would result in perspiration.
Among the rarer proximate causes are loss of blood, starvation, nervous exhaustion from mental overwork, sexual excesses, and sudden fright, or rather the shudder which sometimes follows the nervous shock produced by a real or imaginary danger, as a slip of the foot at the brink of a steep declivity, a snake-panic, the unexpected visit of a stranger, etc. Nausea in some of its forms may produce an analogous effect. "A young lady," says a correspondent of the London "Lancet," "was sitting at dinner, apparently in perfect health. She partook, among other things, of some rabbit, and in about ten minutes or so after she had eaten of it she was attacked "with acute urticaria (nettle-rash), showing large erythematous patches and wheals very prominent on the face and neck. She then was seized with violent attacks of spasmodic asthma, which obliged her to leave the table. I inquired if she had ever suffered this before, and she informed me she had, after eating hare."
Asthma is a warm-weather disease. The first frost mitigates its worst symptoms as surely as it would cure a fever or relieve insomnia, and "hay-asthma," often ascribed to the effect of some vegetable pollen, is probably a consequence of the relaxing influence of the first warm weather; for in midwinter, when the air is entirely free from vegetable spores, a single mild day, following upon a protracted frost, may produce symptoms exactly resembling those of a hay-catarrh. The complication of chronic bronchitis, sometimes described as bronchial asthma, should properly be called bronchial congestion, and differs from an asthmatic affection as a constipation differs from a gastric spasm. Asthma proper occurs under three forms: phthisical asthma (in the last stage of pulmonary consumption), chronic asthma, and acute spasmodic asthma. In the latter phase the disease recurs at longer intervals than in its chronic form, and limits its attacks to a few minutes or hours, but involves a greater amount of distress than any other disorder of the pulmonary organs—not excepting the pleuritic tortures of pneumonia. In pneumonia the difficulty of breathing consists in its painfulness; in asthma, in the persistent torpor of the respiratory organs. The patient feels as if the expansion apparatus of his chest were utterly paralyzed, the inhaled breath seems to come to the gate of the lungs and no farther; no gasping avails; the increasing distress of the air-hunger appears only to aggravate the stubbornness of the inert organ. The violence of the paroxysm often tarns the color of the face into a livid purple, the throbbing of the heart becomes spasmodic, but, when the hopes of the sufferer are almost reduced to the supposed euthanasia of strangulation, the rigor suddenly relaxes, a deep gasp fills the lungs to their very bottom, and a few minutes after the breathing becomes quiet and regular, and only a cold perspiration reminds the patient that he has passed through the chill shadow of death.
As the primary cause of asthma is as yet unknown, its diathesis is not directly curable, though its latency may be prolonged by avoiding and counteracting the well-ascertained proximate causes. The mode of treatment varies with this twofold object: prevention and palliation—which frequently differ where we have to deal with spasmodic affections that call for the promptest means of relief. Thus horseback riding is an approved cure for epilepsy, but during the progress of the fit the application of the specific might lead to strange consequences. Yacht-sailing in a storm would be a bad way of curing sea-sickness, though it diminishes the danger of future attacks. We have seen that a strenuous physical effort can under circumstances become the direct cause of an asthma-paroxysm, yet under proper precautions exercise is the best corrective of an asthmatic disposition; for all vital vigor is based upon muscular strength. It would be a mistake to suppose that the invigoration of the lungs alone could be a protection against asthma. An asthmatic diathesis may coexist with a perfect freedom from the usual symptoms of weak lungs; nay, chronic asthma seems to counteract the development of pulmonary phthisis. The asthmatic predisposition seems rather to consist in a general want of vital energy, and the object of the treatment should therefore be the invigoration of the whole system, not by means of "chest-expanders" alone, but by out-door life, pleasant exercise—such as gardening, hunting, or cooperative gymnastics by a free use of cold water, and a liberal but non-stimulating diet. The latter proviso would exclude a large number of comestibles which the Brunonians would enumerate among the essentials of a "tonic regimen": The beef-and-beer cure deals in sham-remedies. We are not nourished by what we eat, but by what we digest. Plethora is not strength, but often its very opposite: the accumulation of expletive fat impairs the disease-resisting power of the organism; a gaunt wood-cutter, a wiry peddler or mail-rider, will survive epidemics that slaughter hecatombs of stall-fed burghers. The modern macrobiots, the long-lived inhabitants of the Ionian Archipelago, subsist on figs, goat-milk, and maize-bread; the herculean natives of the eastern Caucasus live on honey, barley-cakes, and poor cheese. The self-made Samson of modern times, Dr. Winship, of Boston, satisfied his craving for animal food with an occasional box of oiled sardines, and, on a diet of fruit and farinaceous dishes, spiced with daily gymnastics, made his body a complex of superhuman muscles and sinews. A constitution, built up after that pattern, might not secure the possessor against heart-disease, nor—if he confined himself to in-door gymnastics—against consumption, but it would insure him against asthma. In ninety-nine out of a hundred cases, an asthmatic disposition is combined with a deficient muscular development.
The pathological peculiarities of the disease make it safest to begin the movement-cure in midwinter, and suspend it during premature spring weather, and again during the moist, hot weeks of early summer—June being, par excellence, the asthma-month of the year. I knew people who could foretell the very week when they had to get their "asthma-weeds" ready. By a permanent suspension of his exercises an hygienic gymnast would gradually lose the gained vantage-ground, but during a few days' pause the unemployed surplus of vital energy is put at the disposition of the organism. Such pauses, therefore, become advisable whenever the premonitory symptoms of the disease indicate the agency of asthenic influences, and for greater security also after every annoying mental emotion. The occasions for such annoyances should, however, be carefully avoided, even at the risk of incurring the penalties of social non-conformity. An asthmatic old Antwerp merchant of my acquaintance used to retire to his gardenhuys, a little summerhouse at the farthest end of his garden, whenever his feelings became unduly excited, and also after dinner, as he had noticed that an interruption of his siesta was apt to react on his lungs. One afternoon, however, he had a visit from a commercial associate who had threatened to break the partnership, but now came to lubricate matters and tender a very acceptable peace-offering. At his return from the interview Mynheer made no attempt to conceal his glee, but suddenly became thoughtful and monosyllabic. "What's the matter?" asked his broker, "are you afraid it's a trap?"—"No, no," said he, "N—— is all right, but"—with a sigh—"d—n bim, anyhow; it will cost me a week's tussle with old Nick." "With the asthma? What!—the mere excitement?"—"Yes," he groaned, "the talk, the miserable formalities, and the tight necktie—and right after dinner!"
Any waste of vital power may bring on a fit of spasmodic asthma, and the aggravating effect of incontinence is so prompt and so unmistakable that experience generally suffices to correct a penchant to errors in that respect. Like gout, asthma is a moral censor, but its reproofs do not so often come too late. With an ordinary amount of will-force, even persons of an inherited tendency to asthma may manage for years to keep its worst symptoms in abeyance.
Among the palliatives of spasmodic asthma cold water ranks first. A plunge-bath into a pond (or tub) of water, of a sufficiently low temperature to produce a gasp and a shiver, rarely fails to break the spell of the suffocating stricture. It is the most reliable remedy, for, unlike chemical antispasmodics, it acts irrespective of precedents—its efficiency does not decrease with each subsequent application. After the second or third time, "asthma-weeds" have to be used in almost lethal doses before they produce any appreciable effect, though their disagreeable after-effects are perceptible enough. For these weeds are generally strong narcotic poisons. Tabac de Chine, or "Chinese tobacco," is a mixture of tobacco-leaves and inspissated opium. Stramonium (Datura ferox) is as virulent as belladonna, and the smoking of the leaves produces vertigo, heart-spasms, and violent headaches. It does relieve asthma, on the principle that diseases yield to more serious diseases. Thus the languor of dyspepsia can be temporarily relieved by alcoholic stimulants, but the dose has to be steadily increased, till the remedy becomes worse than the original evil. Such household remedies as black coffee (swallowed by the quart) or sulphur-and-vinegar fumes are liable to the same objection. They help once or twice, and afterward only in monster doses. Coffee-poisoning, which old habitués avoid by a very gradual increase of the dose, is a frequent sequel of an asthma-cure by domestic narcotics. The mediæval physicians, with their penchant for heroic remedies, cured asthma with actual cautery—the application of a hot iron to the ribs of their patients, who naturally preferred the risk of suffocation: Dr. Zimmermann ascertained that the mere proposition of the hellish corrective made the delinquent gasp in a way that relieved the stricture. But the agreeable disappointment probably impaired the efficiency of subsequent threats; and the chill of a cold plunge-bath never fails to produce a contraction of the diaphragm that serves the same purpose.
After the first strangling-spell has been relieved, a very simple mechanical contrivance will help to restore the regularity of the respiration: "Take a straight stick, about six feet long and one inch in diameter, and mark it from end to end with deep notches, at regular intervals, say two inches apart, with smaller subdivisions, as on the beam of a lever-balance. Then get a ten-pound lump of pig-iron, or a large stone, and gird it with a piece of stout wire, so as to let one end of the wire project in the form of a hook. The exercise consists in grasping the stick at one end, stretching out arm and stick horizontally like a rapier at a home-thrust; then draw your arm back, and (still keeping the stick rigidly horizontal) make your hand touch your chin, thrust it out again, draw back, and so on, till the forearm moves rapidly on a steady fulcrum. Next, load the stick—i. e., hook the stone to one of the notches, and try to move your arm as before. It will be hard work now to keep the stick horizontal; even a strong man will find that the effort reacts powerfully on his lungs: he will puff as if the respiratory engine were working under high pressure. On the same principle, the lungs of a half-drowned man may be set awork by moving the arms up and down, like pump-handles. But the weighted stick, bearing against the sinews of the forearm, still increases this effect, and overcomes the stricture of the asthmatic spasm, as the movement of the loose arms relieves the torpor of the drowning-asphyxia" ("Physical Education," p. 137).
But a lethargic feeling about the chest still remains behind: the spasm has ceased to obstruct the entrance of the air, but breathing has still to be effected by an effort of the voluntary muscles, as if the lungs were yet too weak to perform their proper work. After an attack of spasmodic asthma this lethargy may continue for twenty-four hours; in chronic asthma, where it constitutes the chief symptom of the complaint, it may last for a week or two. Next to out-door exercise, the best corrective is conversation, laughing, and singing—any continued vocal effort seems to overcome the passive resistance of the torpid organ. Many physicians must have noticed that a large proportion of their asthma-patients are persons of solitary habits. Laughter is a peptic stimulant, while silence and brown studies favor dyspepsia, asthma, and sleeplessness. Bed-ridden garret-dwellers can at least talk to themselves; and, with the aid of a pet squirrel or a copy of the "Asthma-Cure Almanac," may manage to organize an occasional private laugh. Wealthy bachelors should at once pack a valise, and (as the period of their martyrdom will generally coincide with the excursion-season) take a steamboat-ticket to some popular picnic grove, and associate with the noisiest and merriest of their traveling companions. Mirth itself has a stimulating effect. Sorrow deadens the energy of the vital powers, for Nature is too economical to prolong a losing game, and, if the burdens of life begin to outweigh its pleasures, the organic apparatus gravitates toward a suspension of its functions. The mainspring has lost its tension. But, if life becomes visibly worth living, the soul procures a new lease of vital power; every organ seems to work with a will, and asthenia disappears without the aid of Dr. Brown's brandy-bottles. "Being happy," says Ludwig Boerne, "is a talent that can be cultivated"—certainly a talent of great hygienic value; the gift of confining the flow of ideas to a pleasant channel, of wearing roseate spectacles as others would wear an electric belt, of enjoying life by a sheer effort of will-force, may be a faculty that can only be exercised during a limited period, but that period suffices for the cure of various distressing complaints, insomnia, for instance, and many symptoms of chronic dyspepsia, but especially chronic asthma. Asthma does not prevent longevity; there are people who have smoked stramonium-leaves for half a century, and, if they had chronicled their experience, they would find that in ' the dullest years they had to light the greatest number of pipes. A piece of good news is worth bushels of asthma-weeds; buoyant spirits seem to react directly on the stringency of the bronchial tubes, and the relief thus obtained is not apt to be followed by a relapse.
There is also a curious correlation between asthma and close stools. They come and go together. Any thorough and permanent aperient serves at the same time as an asthma-cure. Drastic purges act only for a day or two, and then leave the bowels in a worse condition than before. The cathartic effect of Glauber's-salt, for instance, is almost invariably followed by an astringent reaction. For a permanent relief of costiveness a change of diet is the safest plan, and no dietetic aperient of the Graham school can compare with the three legumina—beans, lentils, and peas. Stewed prunes rank next, and next such household remedies as blackberry-soup, clabber and rye-bread, or molasses with warm water. But the aperient effect of molasses decreases after each repetition of the dose, while stewed peas taken like medicine, three times a day, will prevail where Glauber's-salt fails. As an asthma-cure it can do no harm to apply the remedy beyond the alimentary wants of the system, temporary overeating being a lesser evil than continual under-breathing. At the end of the second or third day the bowels will yield, and the simultaneous improvement of the asthma-symptoms is generally permanent.
In exceptionally malignant cases it may be necessary to supplement the legumen-cure by refrigeration—sponge-baths, or artificially cooled bedrooms; and while there is any danger of a relapse it is the safest plan to postpone the bed-hour beyond the usual time. After rolling and tossing about till relieved by that form of sleep which the Germans call "Ein-dämmern"—the twilight state between sleeping and waking—the patient is almost sure to start up with a feeling of strangulation, but the slumber induced by the silence and drowsiness of the small hours is not apt to be thus interrupted. Leaving the club-house at 11 p. m., or the family circle at 10; then a few hours with an interesting book, reserved for that special purpose; perhaps a little midnight lunch (but no coffee, unless habit has palliated its anti-hypnotic effect); then a somnolent old story-book; an easy-chair within reach of a boot-jack, ready to take advantage of the first drowsy spell—for those spells come and go—and a well-timed attempt will secure immediate success, with large odds in favor of a good night's rest.
An horizontal position aggravates dyspnœa, and with a few extra pillows, or by simply raising the head of the bedstead, the patient can sleep in a half-sitting posture, and should still further assist nature by opening the bedroom-windows, or removing his bed to the airiest place in the house. After a heavy supper, an unventilated dormitory alone can lethargize the lungs to a suffocating degree, for a nightmare is mostly nothing but a transient fit of asthma.
Fresh air, combined with a lung-stimulating exercise, is the last resort in an obstinate case of chronic asthma, and a foot-journey in summer adds to those stimulants the too often underrated nerve-tonic of sunlight. Maurus Nagy, the Hungarian Natur-Doctor, used to cure his asthma-patients by making them strip to the waist, and keeping them at work in his mountain-vineyard. The ancient Romans had establishments for regular sun-baths (solaria); and I can not help thinking that the robust health of their country population had much to do with their habit of working bareheaded and bare-shouldered in
the sunlit fields, imbibing vitality at the fountain-head, for the same sun that evolved the fern-forests of the Miocene alluvium has still means of his own for quickening the vital energy of the most complex organisms. That tonic catholicon operates even through the triple teguments of a French uniform. After the tedium of a long voyage, and the delay in the Vera Cruz harbor-barracks, the French troops in Mexico suffered from a form of asthma that resisted all medication, but a six days' march through the hills of the tierra templada brought permanent relief, except to a few invalids who had been transported in closed ambulances. At first, though, the remedy is apt to aggravate the evil. After a couple of sleepless nights, the first day of a pedestrian tour, even through the paradise of a June landscape, is steep, uphill work, but, with the aid of a merry traveling-companion and a. light knapsack, Nature will at last prevail, and three days' hardship is a cheap price for the remission of a three weeks' daily and nightly martyrdom—besides the possible sequelæ. For the chief danger of chronic asthma is the probability of serious pathological complications. The direct result of dyspnœa is the impoverishment of the blood by an impeded process of aeration, and the concomitants of the disease are therefore analogous to those of pulmonary phthisis and protracted in-door life—hypertrophy of the heart, emphysema, or swelling of the lungs, inflammation of the bronchi, dropsical swellings of the extremities. Even short attacks often lead to malignant aftereffects—insomnia, indigestion, headache, and a peculiar affection of the lungs that closely simulates the premonitory symptoms of pneumonia; after the asthma proper has entirely subsided, a new difficulty of breathing supervenes in the form of twitching pains in the pleura and the upper lobes of the lungs. Before the end of the second day, rest, embrocations with hot mutton-tallow, and a spare diet, generally relieve these symptoms, which follow more frequently after a drug suppressed case of asthma than after the pedestrian-cure. The latter method of treatment is intuitively indicated by the restlessness of asthma-patients. The same hygienic instinct which makes a passionate longing for refrigeration a regular symptom of climatic fevers seems here to prompt peripatetic enterprises by associating in-door life with the idea of apoplexy and suffocation.
Like consumption, asthma is a house-disease. Want of fresh air and exercise will counteract all prophylactics, while the out-door liver can confine his precautions to the beginning of the warm season. A frugal diet, both as an hygienic aperient and a sedative of irate passions, will help the patient over the asthma-weeks (May and June in the north, and April and May in the lower latitudes); an airy bedroom and cold baths, over the summer season. The winter months will take care of themselves, and every year thus passed diminishes the danger of relapse.