Asthma and divine stramonium – April 2015
Any nurse or paramedic student will be able to explain in detail the three key elements of asthma and the role of various medications used to prevent or to relieve episodes. Like all medical problems though, it certainly hasn’t always been this way.
The ABC of nursing treatment in accidents and illnesses put out by the Scientific Press in 1910 provides advice on the management of acute asthma. I quote:
Often preceded by sense of tightness in the chest, flatulence, chilliness or constant desire to pass water. After sleep, the patient wakens in great distress, tries to breathe, but can only do so in jerks. He starts up, seizes some solid object to help him in his efforts. The attack may lessen after a few minutes, ending with expectorating pellets of mucus. Treatment: inhale amyl nitrate, always kept at hand. Aspirin 10grains, may give relief. Asthma cigarettes are useful. The feet may be placed in hot mustard water, the patient inhaling ammonia, with nostrils closed – the bottle held about eighteen inches away. After the attack give a cup of strong black coffee. Bread, sugar, and all carbohydrate foods must be avoided in the evening and no food taken after 6 o’clock p.m.
It is easy to consider such a prescription as ridiculous. By the middle of the twentieth century a reasonable appreciation of bronchodilator medications had taken forth including use of adrenaline but that was decades after this. Howevert looking at this management plan more closely, it isn’t that bad. First amyl nitrate. Predominantly a smooth muscle relaxant and vasodilator it also provides a feeling of euphoria. This may have seemed to ‘chipper up’ the patient but maybe not much else. It is quite useful in managing angina but may have offered something for the asthmatic.
Aspirin has some anti-inflammatory properties that may offer something for acute asthma. Trouble is though that aspirin is better known for its ability to cause asthma in those predisposed so is probably better avoided.
Enter divine stramonium. Asthma cigarettes are very real. They were all the rage in the nineteenth century and into the early twentieth. They contained a range of material including stramonium. This is a herb derived from the nightshade plant. It contained atropine, capable of producing bronchodilation. Not unrelated at all to the current Atrovent. Other drugs including hyoscamine and scopolamine are also derived from nightshade. So they actually may have offered something of benefit provided you can overlook the down side of smoking with asthma.
In fairness, all history should be put into the context of the time. By the mid 1800s it was appreciated that the so called ‘unstriped muscles’ of the smaller airways were responsible for asthma. It was also understood that there was a fair bit of mucous involvement as well. Inhalation therapy made a lot of sense. This was also a time when more people smoked pipes, cigars and cigarettes than didn’t. Any smoking therapy was quite normal. Smoking cannabis and opium also caused no concern for either medical or for recreational purposes. Asthma cigarettes were considered more useful as a preventative than acute cure with many patients advised to smoke regularly, particularly at night. Until more useful beta agonist bronchodilators came along these were one option that actually offered some therapeutic benefit.
They may have offered some benefit but also many side effects including hallucinations and tachycardia. The alternative treatments that included opium, morphine and even having the nose cauterised would also have made asthma cigarettes look beneficial.
Mustard oil is not really rubbed onto the feet anymore but it continues to be a natural herbal remedy by rubbing onto the chest and the back. Inhaling ammonia may actually cause asthma attacks in some cases. It has not been shown to be of any use in treating asthma but its sharp and irritating odour may have appeared to heighten the patient’s awareness in some way suggesting benefit.
Coffee has long been understood to contain theophylline, of long known benefit for asthma. A cup of coffee after an attack may also have offered some benefit. Finally, carbohydrates suggest obesity, not of any benefit to the asthmatic.
Today’s medicine needs more therapies that start with ‘divine’.
Jeff Kenneally www.prehemt.com