Diseases of the Air Passages

DISEASES OF THE AIR PASSAGES General Measures.—An important function of the nose is to see that the air reaches the warmed, moistened and filtered from micro-organisms. In this connection the importance of adequate treatment, either medical or surgical, of conditions causing nasal or pharyngeal obstruction and therefore leading to mouth breathing, has become more generally recognized. For the same reasons, the treatment of septic conditions in the nose and nasal sinuses is more commonly carried out. The value of scien tifically devised breathing exercises is also more widely accepted. Such measures lessen the risks of catarrhal infections, and in young people prevent deformities of the chest with their attendant disadvantages. The use of the bronchoscope has proved to be of great value in the extraction of inhaled foreign bodies. In America, Chevalier Jackson of Pittsburgh has pioneered this method with brilliant results. By its means the majority of inhaled foreign bodies can be removed, and the serious and often fatal results so common formerly are obviated.

The use of vaccines (see VACCINE THERAPY) in the prevention of the "common cold" and the more serious forms of catarrh of the air passages has given encouraging results. It is usual to em ploy a "stock" vaccine, containing a mixture of catarrh-producing organisms. An autogenous vaccine, i.e., one made from the patient's own infective organisms, is, however, sometimes em ployed. At present, however, these protective vaccines have not proved as generally effective as the use of antityphoid and anti paratyphoid vaccines in the prevention of the enteric fever group of diseases. With increasing knowledge of the catarrh-producing organisms, a somewhat large and diverse group, and of the condi tions favouring their activity, greater success may be obtained.

In the case of bronchitis, the use of vaccines in treatment has proved somewhat disappointing, except in the form due to the pneumobacillus of Friedlander, though in chronic cases they are helpful.

Gassing.

The employment of irritant and poisonous gases in the World War largely increased our knowledge of their effects, and in some measure led to advances in means for the prevention of such effects and for the treatment of the resultant conditions occurring in civil life from accidental or occupational causes. Some of these, such as chlorine and phosgene, lead to oedema of the lungs; others, such as mustard gas, to acute bronchopneumonia; and others, such as carbon monoxide, to changes in the blood. Tuberculosis as a sequel of gassing has proved to be relatively infrequent, but severe chronic bronchitis and emphysema are common.

Asthma.

The idiosyncrasies of asthmatics are well known, and their susceptibility to the emanations of certain animals was long ago recognized by Hyde Salter. This peculiarity has found a rational explanation in recent work on anaphylaxis (q.v.). Some, if not all, cases of asthma seem to fall into a group of toxic idiopathies—i.e., disease conditions due to hypersusceptibility to certain foreign protein substances. These may be derived from animals, such as the horse, dog, cat, etc. ; or from articles used as foods; or again they may be toxic agents prodUced by bacteria.

This aspect of the disease has been closely studied by Chandler Walker in America and by Fleming and Coke in Great Britain. It was hoped that by testing the sensitiveness of the skin of asthmatic patients to large numbers of such substances, collec tively called antigens, by means of scratches to which they are applied in solution, it would be possible to discover the particular agents to which the patient was susceptible, with a view either to avoiding contact with them if possible, or to desensitization by inoculation with minute but increasing doses of the particular sub stances concerned. Some good results are on record, but on the whole this method has been disappointing. Probably hypersensi tiveness is not the only factor in asthma, and there may be, in addition, an inherited or acquired instability of the centre in the brain controlling the innervation of the bronchi.

The non-specific method of treatment of hypersusceptibility called protein shock therapy (see THERAPEUTICS) has been exten sively tried in this disease, with some benefit in certain cases, but on the whole also with disappointing results. Of medicinal agents, apart from the iodides and the antispasmodic group of drugs such as belladonna, stramonium, grindelia and lobelia, small injections of adrenalin or of pituitrin, alone or together, have proved most useful.

Bronchiectasis.

Bronchiectasis (q.v.), was for a long period almost the despair of treatment. The application of surgical methods in suitable cases, if employed sufficiently early, seems to promise hope of real amelioration, or even of actual cure. In a small proportion of the cases, where pleural adhesion has not oc curred, artificial pneumothorax may be sufficient ; but, in the majority phrenicotomy or a more or less extensive thoracoplasty may be necessary. By these means the sputum may be lessened or entirely lost, and its offensive character ended.