DEP/DUA/1/47/18 (Normalised version)

John Miller

(1789)

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N^o30 John Miller at 32.

Can hardly perhaps be said that in this case have all characteristics of Asthma of spasmodic kind

Particularly patient not affected with that peculiar sense of stricture on breast which so commonly attends the disease.

And which perhaps to be considered as one of principle proofs that the difficulty of breathing the effects of spasm.

Has not also the usual termination of fit a very copious sputum.

Or as happens in some cases a copious flow of urine.

Both one & other probably to be considered as evidence of resolution of spasm.

Here indeed it must be allowed this appearance not altogether wanting.

For towards close of paroxysm slight cough with some expectoration.

This however by no means that copious discharge which generally takes place on conclusion of paroxysm

But although thus some common marks wanting can have little doubt in viewing it as an instance of that disease.

Thus abundantly evident from suddenness & frequency of attacks without any obvious cause.

From severity [which] occurs particularly during night, & obliging him to rise out of bed.

And finally from peculiar [wheezing] noise with which respiration during this state of difficulty is attended.

All these circumstances at least much more easily explained on supposition of spasmodic stricture than any other.

And without entering farther into controversy as to particular situation of spasm may I apprehend consider this as constituting disease of present patient.

Here however perhaps proper to point out also, what may be considered as another peculiarity.

The return of affection viz on exposure to cold.

Pure spasmodic asthma very generally at least much more distressing in hot than in cold weather.

And when consider, that disease must naturally be increased by everything tending to augment irritation this by no means surprising.

For little doubt that heat a tendency to augment mobility of nervous power, cold again to produce torpor.

The contrary of this however seems to have taken place in present instance

Or at least, after some intervals ascribes occurrence to cold.

But even then probably acted only as exciting cause.

And disease you will observe commenced in August when weather commonly at least the warm Dog days¹.

But whether in this respect much peculiarity or not, have I think, but little reason to flatter ourselves, that shall soon be able to overcome this affection.

For when disposed to such inordinate action once takes place very apt to be renewed by slight causes.

Accordingly not a few who may be considered as subjected to the disease for course of many years.

During that period however tendency to fits sometimes greater sometime less.

And this probably depends on corresponding states of morbid irritability.

Which at times even so great that fits induced by slightest cause by circumstances even although escape observation.

Hence title of asthma spontaneous.

Upon other occasions however morbid irritability will almost entirely cease.

And thus long interval without any fits.

As then tendency to spasm so far diminished, that many exciting causes, will act upon body, without producing any effect.

This in some degree points out to us what should be great objective in cure.

When threatening of approaching spasm should be endeavoured if we can to anticipate or prevent its occurrence.

When has already taken place to bring about resolution.

But above all, when free from fits to remove that morbid irritation of moving fibres, by which subjected to inordinate action from very slight causes.

Is with two first of these intentions that have here had recourse to a mixture with vitriol aether.

And with last, that have directed the Zincum praecipit with valerian.

From these hardly I own expect a radical cure.

Yet hope that shall be able in some degree to diminish both frequency & severity of fits.

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Explanatory notes:

1) The dog days or dog days of summer are the hot, sultry days of summer. They were historically the period following the heliacal rising of the star system Sirius (known colloquially as the 'Dog Star'), which Hellenistic astrology connected with heat, drought, sudden thunderstorms, lethargy, fever, mad dogs, and bad luck.