1786: Thomas Withers and his "Treaties on Asthma":

William Cullen was among the first physicians to form conclusions about asthma based on studies he performed, as opposed to speculating about it.  He believed a muscle was a continuation of a nerve, and therefore that asthma was a nervous disorder.  In 1786, Thomas Withers wrote a book called "A treaties on Asthma," in which he expounded on the ideas of Cullen.  (1, page 75)(2, page 17-18)

Thomas Withers (1750-1809) was a physician to the New York County Hospital.   Like Cullen, he believed asthma started in the mind and resulted in convulsions of the fibres that wrap around the lungs.  He believed in the nervous theory of asthma and in the convulsive theory of asthma.  (1, page 75)

In a review on Wither's book, Tobias George Smollettt, in 1786, compared him with John Floyer, who is considered by many to be the father of the convulsive theory of asthma.  Smollet said:

'This is an old building, with a modern front and fashionable ornaments: in other words, it is the valuable work of Floyer, with explanations from the modern nervous papathology. Dr. Withers, in his former works, adhered so closely to his master's precepts, almost to his words, that we did not expect any thing new. (2, pages 17-18)

 Smollet continued:

We hoped, indeed, that experience might have opened sources of enquiry, which his unwearied diligence would have pursued; but the little which is his own, is not of the best kind. The account of the asthma, as may be expected, when we consider the sources, is clear, intelligible, and judicious: the cafes are sometimes unnecessarily minute, at others imperfect; they arc in general very trifling, and the effects of remedies unreasonably exaggerated.  (2, page 18)

Dr. Withers believed spasmotic asthma was "a nervous disorder accompanied with great irritability of the lungs." Through his various books he provided various pithy examples of cases of asthma he witnessed, along with the remedies used. (3, page 300)

He believed a good remedy for nervous, or spasmotic, asthma was opium, which "diminishes the irritability and spasmotic contraction of the air vessels; mitigates the cough; lessens the pain, anxiety and difficulty of breathing; shortens the duration and the facilitates the cure of the asthmatic fit." (3, page 300)

References: 

1. Jackson, Mark," Asthma: The Biography," 1999, New York, London, Oxford University Press???????
2. Smollet, Tobias Georgy, ed., "The Critical review, or, Annals of literature, Volume 62, 1786 , page 17-18, a professional review of withers book, "a treaties of the asthma, to which are added cases and observations, in which the asthma is complicated with other diseases." 
3. Withers, Thomas, "Observations on the Abuse of Medicine," 1775, London, 339
4. Griffiths, Ralph, Grifiths, G.E., ed.,  "The Monthly Review, or Literary Journal," London, 1787, pages 332-334, a professional review of Wither's "A Treaties on Asthma."
5. Ramadge, Francis Hopkins, "Asthma, its species and complications, or researches into pathology or disordered respiration; with remarks on the remedial treatment applicable to each variety; being a practical and theoretical review of this malady, considered in its simple form, and in connection with disease of the heart, catarrh, indigestion, etc." 1835, London,  Longman, Rees, Orme, Brown, Green, and Longman

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1785: Withering recommends fox-glove for asthma

William Withering (1741-1799)

William Withering was a contemporary of William Cullen.  While Cullen was the first to describe asthma as spasmotic constriction of the muscular fibers of the bronchi, Withering was the first to recommend for asthma a remedy called foxglove.

Withering was a physician from Shrophire, England. He graduated from Edinburgh in 1766 and then had a "large and lucrative practice at Birmingham.  

While he had other accomplishments, he is best known for his discovery of a treatment called foxglove for asthma caused by dropsy of the heart.  

So, what is dropsy of the heart? Or, better yet, what is dropsy? 

Dropsy is essentially an old term referring to edema, or swelling and redness.  It comes from the Greek term hudrop-piasis hudrops, which refers to a dropsical person.  The term hudro means hydro, which means water.  (3)

Since there was no standardization in those days, sometimes other terms were used to mean the same thing. For instance, the terms "congestion" and "hydrops" and "anascara" were also used when referring to the build-up of fluid in a certain part of the body.

When physicians like Withering observed the build-up of fluid in a certain part of the body, or a certain organ, he would simply use dropsy, hydrops or congestion, followed by the part of the body or organ affected.  To understand how these terms were used consider the following chart. 

Old term	Description	New term
Cerebral Dropsy	Fluid on the brain	Hydrocephalis
Dropsy of ankles, legs, feet	Fluid in ankles, legs feet	Pedal edema
Dropsy of the lungs Congestion of lungs	Fluid in lungs	Pulmonary edema
Dropsy of the throat	Swollen throat	Croup or Epiglotitis
Hydrops Abdominus	Fluid in the abdominal cavity	Ascites
Hydrops Pectoris	Fluid in cavity surrounding the lungs	Pleural Effusion

Of course it must be understood for our purposes that dropsy of the lungs was usually associated with asthma, which was a generic term meaning dyspnea, or shortness of breath.  

So, what is foxglove?

Foxglove was a common remedy used in Withering's day and age for just about any ailment in the book. However, it was not prescribed because it had any beneficial effect, but because it worked to extricate fluid from the body, and thereby balance the humors.  

Foxglove the flower

You see, the dogmatic ideas of Hippocrates were still taught in medical schools, although they were adjusted slightly to suit the times.  

Noting the abuse of this medicine (sort of like albuterol in the 21st century), Withering set out to learn more about this remedy, where it came from, and what it was actually good for.  

Through his research, he learned that foxglove was first discovered by Fuchsius in 1542. He gave it the name foxglove because the blossom of the plant looked like the finger of a glove. (5, page xiv)

Shortly thereafter, he said in describing its discovery, the experimenting began, with various parts of the plant being ingested or added into the recipes of various foods and drinks and ingested that way. The toxic effects of the plant were soon noted, such that taken in large amounts caused vomiting. (5, page xiv)

Another effect soon observed was that foxglove also acted as a diuretic, meaning that it made you pee. Upon further experiment, it was learned that it worked great as a remedy for various diseases. Of course since anatomical wisdom was anemic in those days, the reason it worked, and for what remedies it truly benefited, remained inextricable. (1)(5, page 2)

Eventually the remedy was discovered to be useful for asthma, although, once again, the reason for this remained a mystery.  Therefore it was suspected that it its diuretic and nauseating properties probably helped to balance the humors, thus curing asthma.  

Knowledge that foxglove helped in cases of asthma passed to a lady who kept this a secret for many years. When she was an elderly lady living in Shrophire, Withering heard wind of her remedy for asthma, and interviewed her to learn more about it. She said foxglove was good for dropsy, and that it caused nausea (1)(5, page 2)

So now Withering started his own experiments with the remedy. He verified that in high doses it did cause nausea, although he soon learned that even patients given small amounts of the remedy had increased urination. (5, page 4)

He then realized that it was the diuretic effect of the plant, and not the nauseating effect, that was beneficial for asthma. It was by this means he learned that it was useful for dropsy. In fact, he noted that "if the medicine purges, it is almost certain to fail in its desired effect." (5, page 4)

It was in this way that he discovered the desired effect of the medicine was removal of excessive fluid in the body, which helped with pretty much any ailment that resulted in dropsy, hydropsy or congestion. (5, page 2-6)

In other words, he learned foxglove was a "powerful diuretic." It was useful as a remedy for dropsy of the lungs and hydrops of the legs, ankles and feet.  It was also useful for hydrops abdominis and hydrops pectoris.  (5, page 2-6)

It was not, however, effective for cerebral dropsy caused by head trauma. (1)

In 1785, about ten years after he began his research on foxglove, he published his findings in the book "Account of the Foxglove." He described foxglove and all the remedies he discovered it benefited.  (5, page v) 

However, as any judicious physician describing a new treatment should do, he warned that physicians should restrain themselves in its use, although not condemn and reject it as "dangerous and unmanageable." (5, page v) 

The book, he said, was essentially...

...a protest against the abuses of digitalis, which were already creeping in. (1)

Regarding foxglove and asthma, Withering wrote the following in his book:

ASTHMA

(9) THE true spasmodic asthma, a rare disease is not relieved by Digitalis. 

(10) In the greater part of what are called asthmatical cases, the real disease is anasarca of the lungs, and is generally to be cured by diuretics. This is almost always combined with some swelling of the legs

(11) There is another kind of asthma, in which change of posture does not much affect the patient. I believe it to be caused by an infarction-of the lungs. It is incurable by diuretics; but it is often accompanied with a degree of anasarca, and so far it admits of relief. 

ASTHMA and ANASARCA

(12) IF the asthma be of the kind mentioned at (9 & 11) diuretics can only remove the accompanying anasarca. But if the affection of the breath depends also, upon cellular effusion, as it mostly does, the patient may be taught to expect a recovery.

ASTHMA and ASCITES

(13) A RARE combination, but not incurable if the the abdominal viscera are sound. The asthma is here most probably of the anasarcous kind (10) and this being seldom confined to the lungs only, the disease generally appears,in the following form.

ASTHMA, ASCITES, and ANASARCA.

(14) THE curability of this combination will depend upon the circumstances mentioned in the "'preceding section, taking also into the account the strength or weakness of the patient. (5, page 196-7)

He also recommended asthma for phthisis pulmonalis, although he said this was not a new discovery as other physicians had found it useful and had recommended it. (5, page 9)

Note that Withering, as with other physicians of his era, regarded asthma in it's pure form, which would be asthma accompanied by no other ailments, as being a rare condition.  He offered no new wisdom about pure asthma.

He said most patients who present with asthma (dyspnea) present with more than just "pure asthma," and in these cases, the most common complication is anascara of the lungs, and it is this that he proved benefited from foxglove for its diuretic effect.

He must have also observed that many of these patients also present with dropsy of the ankles.

Thanks to his research, the medicine foxglove (digitalis) was entered into the Edinburgh Pharmacopoeia in 1783, but did not appear in the London Pharmacopoeia until 1809.(1)

Note: During the course of the next 50 years, it would be discovered that asthma caused by dropsy of the lungs or hydrops pulmonais, were actually caused by heart or kidney failure. These would ultimately become disease entities of their own, and therefore would be separated from the umbrella term asthma. In 1827 Richard Bright became the first person to distinguish between dropsy of the lungs caused by heart failure and kidney failure.  .

References: 

1. Garrison, "An introduction to the history of medicine," 1921, 3rd edition, Philadelphia and London, W.B. Saunders Company , page 367-368, 408)
2. Cullen, William, "First Lines of the Practice of the Phsych," 1784, Edinburgh, Vol. 3, 4th ed., 387-88, 397
3. "Dropsy," The Free Dictionary by Farlex, http://www.thefreedictionary.com/dropsy, accessed 6/23/13
4. "Digitalis," Drugs.com, http://www.drugs.com/npp/digitalis.html, accessed 6/23/13
5. Withering, William, "An account of the foxglove and some of its medical uses with practical remarks on dropsy and other diseases," 1785, London, Paternoster Row

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1722: William Cullen writes about asthma (editing)

William Cullen (1710-1790)

As we enter the 18th century hypothetical theories of medicine start to take a back seat to scientific evidence.  One of the first to base his asthma writings on studies he performed was Dr. William Cullen.

He was born in 1710 to the lawyer of the Duke of Hamilton.  He started his education in his home town of Hamilton in Scotland, and then went to Glasgow where he studied medicine. After he was only there a short time he was appointed apprentice to Mr. Praisley, a surgeon with an extensive library, a valuable asset for an aspiring physician.  1, page 133)(2)

In 1729 he went to London to further his career, and was appointed surgeon aboard a merchant vessel sailing from London to the West Indies. Upon his return he took a position at a local apothecary. While this was the only such trip he would take, he paid peculiar attention to the "diversity of climate on human constitution, and to observing the diseases peculiar to the West Indies." (1, page 133)(2)

He returned to London and was hired as an assistant to Mr. Murray at an apothecary shop. It was here he studied medicine (materia medica). He continued this work until 1932 when his father and brother died, and he was compelled to moved back to Scotland near the village of Shotts in Lanarkshire (now North Lanarkshire).  (1, page 133)(2)

In Schotts he cared for the invalid child of Captain Cleland, of whom he sailed with a few years earlier. He practiced medicine here for two years, before going to live with a Clergyman in Northumberland where he studied and became adept in literature and philosophy. (1, page 133)(2)

In 1734 he attended medical school in Edinburgh, and then two years later returned to his private practice in Hamilton. Here he stayed for eight years (1736-1744), honing in his medical skills at his own medical practice. He took care of the Duke of Hamilton, and was given credit for curing the Duke of a serious illness.  (1, page 133)(2)

He cared particularly for the poor, offering his services to them without fee.  It was in 1740 that he received his medical degree from Glasgow. He gave lectures on the theory and practice of physick, materia medica, and botany.  Some say he was the first physician at Glasgow.   (1, page 133)(2)

Medical historian Lindsley Bradford said that during his lectures he...

...was independent and spoke so slightly of Boerhaave that he was called a Paracelsus, a van Helmont, a whimsical innovator. And the Lord Provost Drummond even requested him to speak respectfully of the Leyden professor... he was much loved by his students." (1, page 134)(2)

In the meantime, in 1741, he married and had children. He also earned himself a good reputation.

In 1755 he returned to the University at Edinburgh where he was ultimately named sole professor of medicine, a position he held until just before his death in 1790 at the age of 78. He ended up having 11 children, some of whom earned fame of their own. (1, page 134)(2)

Throughout most of his adult life he would study natural medicine, and was particularly interested in scientifically classifying diseases. He thus became a nosologist, and a pretty good one at that.

He was a solidist, in that he was more interested in the living solid parts of the body as opposed to the fluids. In this way he believed most diseases were fostered by some kind of disorder of the nervous system, and that the muscle was "a continuation of nerve."   (1)(2, page 135)(3, page 318)

He essentially believed that life itself was a continuation of the nervous system. This belief would affect his description of diseases, their causes, and the remedies used to treat them.  (1)(2, page 135)(3, page 318)

Still, when it came to asthma, he found the task of classifying it as a disease, and distinguishing it from other forms of dyspnea, to be a major challenge. The main reason was because most physicians of his day were stuck on the idea that all or most shortness of breath was asthma. Not only was this a challenge for him, it continues to be a struggle for some physicians in the modern world. 

Cullen became one of the first asthma experts to base his beliefs, or at least try to confirm them, based on studying signs and symptoms of that disease while a person was alive, and comparing it with what he saw in autopsy.  This was a common trend among physicians of his era.

The fact that he saw defining asthma as a challenge can be observed by the following quote from Cullen's 1794 book, "First lines of the practice of the psych,":

"The term of asthma has been commonly applied...by many writers... to every case of difficult breathing, that is, to every species of dyspnoea.  The methodical nosologist, also, have distinguished asthma from dyspneoea chiefly, and almost solely, by the former being the same affection with the latter, but in a higher degree.  Neither of these applications of the term seems to have been correct or proper.  I am of opinion, that the term asthma may be most properly applied, and should be confined, to a case of difficult breathing that has peculiar symptoms and depends upon a peculiar proximate cause which I hope to assign with sufficient certainty."  (4, pages 387-88)

In this way he was the first to define asthma as a specific disease, as opposed to an umbrella term for any malady that causes dyspnea and wheezes.  In other words, he was perhaps the first to suggest that all that wheezes is not asthma.  From this point on each physician would form their own theories regarding asthma based on their own experiences and observations.  The debate as to how to define asthma would continue well into the 20th century, and we can thank Cullen for beginning it.

Cullen, therefore, became the first to form a specific theory regarding asthma.  He said that while many authors before him said asthma was spasms of the air passages, none distinguished asthma from other forms of dyspnea.  Cullen, therefore, proposed the term "asthma" be used only to denote spasmotic asthma alone, and not the hundreds of other medical conditions that cause dyapnea

He likewise notes that even while some authors have defined asthma as spasmotic asthma, they have not distinguished the term from other forms of dyspnea. Cullen would propose that the term asthma be used to denote spasmotic asthma alone, and not other conditions that cause shortness of breath.

In this way, perhaps, William Cullen can be referred to as the father of the spasmotic theory of asthma.  We can also call it the convulsive theory of asthma, or, in the modern world, the bronchospasm theory of asthma. All mean the same thing.

Thus, in his 1772 book " Nosology: or, a systematic arrangement of diseases, by classes, orders ," he defined asthma as:

Difficult respiration recurring at intervals, with sense of stricture in the breast, respiration performed with a wheezing noise; difficult cough at the beginning of the fit, sometimes none, free towards the end; and often with copious discharge of mucus."  (5, page 118)

In, "The first lines of the practice of the psychic," he defines asthma as:

"Spasmotic, constriction of the muscular fibres of the bronchiae: which not only prevents the dilation of the bronchiae neccessary to a free and full inspiration, but gives also a rigidity which prevents a full and free expiration like many other convulsive and spasmotic affections is readily excited by a turgescence (swelling) of the blood, or other cause, of any unusual fulness and distention of the vessels of the lungs (inflammation?)"  (4, page 397)

He defined asthma as a nervous affection as compared to the accumulation of mucus which he regarded as part of dyspnea cararrhalis.  and containing the following "facts,": (4, page 387)

• It's hereditary
• It seldom occurs early in life, and hardly to the time of puberty, or after it
• It effects both sexes, but most frequently the male
• I have not observed it to be more frequent in one temperature or another
• It does not seem to depend upon any general temperament of the whole body, but a particular constitution of the lungs alone 
• It frequently attacks... but hardly ever continues to be repeated for some length of time without occasioning an emaciation of the whole body
• Attacks are generally in the night or toward the approach of night (yet occasionally in the day)
• It comes about suddenly
• It may go into remission
• It is there for the person's whole life
• Returns happen with different circumstances with different persons
• Fits are more frequent in the summer
• It may threaten immediate death, seldom occasions it
• Many persons have lived long under this disease
• Seldom entirely cured
• It effects each person differently
• Each patient has unique external triggers  (4, page 387)
• There is a greater chance of curing the disease in youth than in advanced age (9 page 390)
• It's a chronic disease, which may continue to give very great distress at intervals, for a considerable number of years (9, page 390)

The following were his signs and symptoms of asthma:

• Sudden dyspnea
• Tightness of of stricture across the breast
• A sense of straightness of the lungs impeding inspiration
• Desire to get into an erect position
• Desire for free and cool air
• The difficulty of breathing goes on for some time
• Both inspiration and expiration are performed slowly
• With a wheezing noise
• Speaking is difficult and uneasy (in violent fits)
• Often some propensity to coughing, but it can hardly be executed
• Sometimes the pule increases
• Sometimes fever (usually with increased pulse)
• If urine is voided early it's usually with little colour or odour
• If urine voided late it's usually of a high color and sometimes deposits a sediment
• Sometimes the face is flushed and turgid, more commonly pale and shrunk
• After long continuance, it often ends in a hydrothorax
• Occasionally some aneurism of the heart or great vessels (it thereby proves fatal) (4, pages 387-410 )

Even after some sleep and the breathing becomes easier and easier, the following signs and symptoms may continue for some time:  (4, pages 387-410 )

• Feels some soreness across chest
• Cannot breathe easy in horiontal posture
• Can hardly bare any motion of his body
• In afternoon has uneasy flatuency of his stomach
• Unusual drowsiness
• Difficulty of breathing returns toward evening
• May occur for several nights
• Followed by remission (especially after coughing up copious sputum) (4, pages 387-410 )

These symptoms may continue for many hours, Cullen said, "then a remission takes place by degrees; the breathing becomes less laborious and more full, so that the person can speak and cough with more ease, and, if the cough brings up some mucus, the remission becomes immediately more considerable, and the patient falls into a much wished for sleep." (4, pages 387-410 )

There are two forms of asthma:

1. Humid: With expectoration of mucus.  This is also called humoral asthma.  
2. Dry: Without expectoration of mucus. This is also called spasmotic asthma.

Cullen described things that excited asthma as exciting causes, or things that cause the disease to be "readily excited.  He said these are unique from person to person.  He said when the disease cannot be cured "by our art," it can often be cured by encouraging the patient to escape from the exciting cause.  Some exciting causes were: (4, pages 387-410 )

• External heat (weather or warm chamber)
• Warm bathing
• Summer weather (particularly dog days)
• Changes of weather (especially sudden colder to warmer)
• Full meal
• Air in stomach
• Exercise (or whatever else can hurry the circulation of the bloos)
• Cold
• Excitement of nervous system, as by passions of the minds
• Odors
• Smoke 
• Dust  
• Hysteria 
• Hypochondriasis
• Dyspepsia
• Atonic gout 
• Other conditions that cause dyspnea  (4, pages 387-410 )
• Weather changes (9, page 393)
• Large cities (9, page 393)

Things that are hot or cold excite an attack by the following means: 

An asthmatic fit seems thus to depend upon some fulness of the vessels of the lungs, it is probably that an obstruction of perspiration, and the blood being less determined to the surface of the body may favour an accumulation in the lungs, and thereby be a means of exciting asthma. This seems to be the case of those asthmatics who have fits most frequently in the winter season, and who have commonly more of a catarrhal affection accompanying the asthma; which therefore occurs more frequently in winter, and more manifestly from the application of cold." (4, page 395-396)

On the other hand, things like smoke or dust or hysteria, hypochondria, dyspepsia and atonc gout "excite the powers of the nervous system."  (4, page 397)

Regardless of the exciting cause, the "proximate cause of this disease is... spasmotic, constriction of the muscular fibres of the bronchiae: which not only prevents the dilation of the bronchaie necessary to a free and full inspiration, but gives also a rigidity which prevents a free and full expiration.  This preternatural constriction, like many other convulsive and spasmotic affections, is readily excited by a turgescence of the blood, or other cause of any unusual fulness and distention of the vessels of the lungs." (4, page 397-398)

Regarding the prognosis of asthma, he says the following:

The asthma, though often threatening immediate death, seldom occasions it; and many persons have lived long under this disease. In many cases, however, it does prove fatal; sometimes very quickly, and perhaps always at length. In some young persons it has ended soon, by occasioning C c 4 a a phthisis pulmonalis. After a long continuance, it often ends in a hydrothorax; and commonly, by occasioning some aneurism of the heart or great vessels, it thereby proves fatal. (4, page 399-400)

As far as remedies, he says the following:

As it is seldom that an asthma has been entrely cured, I therefore cannot propose any method of cure which experience has approved as generally successful. But the disease admits of alleviation in several respects from the use of remedies; and my business now shall be chiefly to offer some remarks upon the choice and use of the remedies which have been commonly employed in cases of asthma. (4, page 400)

The remedy generally depends on the cause of the symptoms.  From here he classifies asthma into three groups:

1.  Idiopathic:  Without manifest cause, or being accompanied with other disease

2.  Symptomatic:  From erruption or other acrid effusion being repelled.  Of this group there are two varieties:

• Gouty (asthma arthriticum): I believe here he's referring to asthma that results from swelling of the air passages. He calls it gouty because it mimics the inflammation from gout or arthritis.
• Syphilitic (asthma venereum): Again, this is possibly referring to inflammation in asthma being similar to that of syphilis. 

3.  Other asthma dyspneas and orthopnea symptomatic of cardiac and pulmonary difficulties and obstructions (he's probably referring to conditions we'd refer to as bronchitis, pneumonia, or heart failure)

Thus, if asthma arrises from "difficult transmission of the blood through the vessels of the lungs (swollen broncheolar muscles), threatening suffocation," the best remedies are noted below: (4, page 400)

• Blood letting (less and less necessary as disease progresses, although it was a common 18th century remedy for swelling, or congestion (turgescence) of blood in the tissues) (4, page 401-403)
• Emollients (relieving the bowels helps to ease breathing, as an empty stomach is beneficial) (4, page 404)
• Moderately laxitive glysters (have been found to give considerable relief) (4, page 404)
• Gentle vomits by emetics (flatuency of stomach are frequent attendants, and very troublesome for asthmatics, used to prevent and treat asthma)  (more useful in winter than summer) (4, page 404)
• Issues (useful in obviating plethora, although this rarely occurs with asthma) (4, page 405)
• Acids and neutral salts to treat asthma fits excited by turgescence of blood (also recommended by Floyer "On the Asthma.") (4, page 405)
• Ether (an antispasmotic found to give the best relief.  It's also safe, but not long lasting) (4, page 407)
• Opium (Works best for spasmotic or dry asthma; Best antispasmotic has been found effectual and safe; may use large doses if needed) (4, page 407)(9, page 393)
• Simply avoiding the occassional or exciting cause (4, page 408)
• Breathing the air low to the ground, as compared to mountain air (4, page 408)
• Good diet, or a spare, light and cool diet is proper(4, pages 408-409) (9, page 393)
• Avoiding a large meal (4, page 409)
• Avoiding food that is of slow and difficult solution in the stomach (slow to digest)
• Eating animal food of the lighter kind, and in moderate quantity (4, page 409)
• Avoid vegetables that are flatulent (4, page 409)
• Drinking water and cool water liquors is generally safe (4, page 409)
• Gentle exercise (riding horseback, going in a carriage, sailing, (4, page 410)
• Coffee (9, page 392)
• Emetics (works well for humid asthma) (9, page 392)
• Smoking or chewing tobacco (9, page 392)
• Various other remedies (recipes provided in his book)  (9, page 392-393)
• Inhaling the vapour of Ether (9, page 393)
• Inhale hydrocarbolic air, or air with increased oxygen, for humid asthma (9, page 393)
• Inhale hydrogen if dry asthma (9, page 393)
• Ipecacuanha in small doses for dry asthma; may give 3-10 grains every other day (great remedy) (3, page 393)
• Blistering between shoulders necessary for asthma arthriticum (not for pure asthma)

The following he proved to not work:

• Purging (seldom found to relieve vessels of thorax,and does not relieve congestion of the lungs) (4, page 403)(9, page 390)
• Blistering between shoulders or on breast (rarely found it useful in pure asthma) (4 page 404)
• Fetid gums (an antispasmotic proved not to work and be sometimes hurtful) (4, page 407
• Musk (antispasmotic not properly tried) (4, page 407)
• Liquors (few asthmatics can bear strong, warm, tepid drinks because it weakens nerves of stomach) (4 page 409-410)
• Tea  
• Emetics ("The effects of full vomiting cannot be durable, nor its operation be conveniently repeated, so full vomiting cannot always be employed to prevent the recurrences of the... spasm") (6, page 469)
• Infusion of tobacco as an emetic (It's too dangerous (9, page 392)

In an era when physicians were using scientific methods to learn more about human anatomy, and the changes that occur in the body the result in the symptoms observed, it was only a matter of time before one of these physicians used science to better define asthma.  The man who did this was William Cullen.  

Click here for more asthma history.

References:

1. "William Cullen," britannica.com,"  http://www.britannica.com/EBchecked/topic/146062/William-Cullen, accessed 11/12/13
2. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey
3. Garrison, "An introduction to the history of medicine," 1921, 3rd edition, Philadelphia and London, W.B. Saunders Company
4. Cullen, William, "First Lines of the Practice of the Phsych," 1784, Edinburgh, Vol. 3, 4th ed., 387-88
5. Cullen, William, "Nosology: or, a systematic arrangement of diseases, by classes, orders," London, 1800, page 118
6. **Jackson, Mark, "Asthma, Illness and Identity," The Lancet, Volume 372, Issue 9643, Pages 1030 - 1031, 20 September 2008
7. Cullen, William, "A treaties of the Materia Medica," Vol. II, Edinburgh, 1789, page 469 
8. Cullen, William, "Professor Cullen's Treaties of the Materia Medica", edited by Benjamin Smith, 1812, Vol II, Philadelphia, page 175 

9. Cullen,William,"The Edinburgh practice of physic, surgery, and midwifery" Vol. II, London, 1803

References:

1. "William Cullen," britannica.com,"  http://www.britannica.com/EBchecked/topic/146062/William-Cullen, accessed 11/12/13
2. Cullen, William, "First Lines of the Practice of the Phsych," 1784, Edinburgh, Vol. 3, 4th ed., 387-88
3. Cullen, William, "Nosology: or, a systematic arrangement of diseases, by classes, orders," London, 1800, page 118
4. Cullen, "First lines...," op cit, page 397
5. ****Cullen, William, "The first lines of the practice of psychic," Vol. III, Edinburgh and London, 1784, pages 387
6. Cullen, op cit, "First lines...," pages 387-410 (Cullen offers a great synopsis of his theory on asthma)
7. Cullen, op cit, "First lines...," pages 387-410 (Cullen offers a great synopsis of his theory on asthma)
8. Cullen, op cit, "First lines...," pages 387-410 (Cullen offers a great synopsis of his theory on asthma)
9. Cullen, op cit, "First lines...," pages 387-410 (Cullen offers a great synopsis of his theory on asthma)
10. Cullen, op cit, "First lines...," pages 387-410 (Cullen offers a great synopsis of his theory on asthma)
11. **Jackson, Mark, "Asthma, Illness and Identity," The Lancet, Volume 372, Issue 9643, Pages 1030 - 1031, 20 September 2008
12. Cullen, op cit, "First lines...," pages 387-410 (Cullen offers a great synopsis of his theory on asthma)
13. Cullen, William, "A treaties of the Materia Medica," Vol. II, Edinburgh, 1789, page 469 
14. Cullen, William, "Professor Cullen's Treaties of the Materia Medica", edited by Benjamin Smith, 1812, Vol II, Philadelphia, page 175 (same explanation found in reference #13 above)
15. Cullen, William, "Professor Cullen's Treaties of the Materia Medica", edited by Benjamin Smith, 1812, Vol II, Philadelphia, page 175
16. Garrison, "An introduction to the history of medicine," 1921, 3rd edition, Philadelphia and London, W.B. Saunders Company

Other readings:

• Cullen,William,"The Edinburgh practice of physic, surgery, and midwifery" Vol. II, London, 1803

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