ASTHMA (from the Greek, acrOtta; from, aw, I blow).
Definition. — A neurosis characterized by more or less severe paroxysmal dysp ncea, due to spasmodic narrowing of the bronchial lumen, alternating with spasm of the muscles of the thorax.
Symptoms.—In the typical form pre monitory symptoms—such as uneasiness about the chest, pallor, or a feeling of exultation, due to unusual good health —occasionally warn the patient that an attack is impending.
Prodromata of asthma: (1) the dysp nceic laugh; (2) repeated sneezing; (3) stridulous laryngitis. Moncorg6 (La Loire Medicale, Dec. 15, '95).
Suddenly, in the early hours of the morning in the vast majority of cases, great constriction of the chest and more or less marked suffocation, referred to the sternal region, are experienced. The dyspncea, in bad cases, almost reaches the stage of apncea; the respiration is wheezing in the milder cases, but in the others it is scarcely audible. The suf fering of such cases is intense; the patient assumes various positions calcu lated to assist respiration; there is prom inence of the eyeballs, distension of the superficial vessels of the neck, blueness of the lips; the skin is clammy and cov ered with sweat, etc.
The number of respirations per min ute is usually reduced and the expira tions are very much prolonged. The chest remains expanded; the abdomen is inordinately protruded through the descent of the diaphragm, and its mus cles are tense and hard. Percussion gives rise to a drum-like, somewhat high pitched note over the areas of the chest in which the distension of the alveoli by the imprisoned air is most marked. The cardiac and hepatic dullness outline becomes narrow and occasionally pressed by the overlying inflated lung.
Auscultation reveals sibilous rhonchi of varying pitch and intensity, following the rhythm of the respiration. They re semble the chirping of birds of different varieties and size, simultaneously heard. This is accompanied or followed by mu cous riles.
The variations in the pitch of the notes heard are due to the variations in the diameter of lumina left in the bron chi. Mucous rides are present, absent,
coarse, or fine according to the nature of the secretions present. Sometimes noth ing but the sibilous rhonchi are heard.
The pulse is usually slow and weak and the temperature is normal in the majority of cases, rarely reaching 100° F. Frequently it descends to 97 F.
After a period varying from half an hour to several hours the symptoms abate and end by a more or less profuse expectoration of viscid, stringy mucus, varying in opacity according to the se verity of the attack.
In a small proportion of cases the fever, cough, and purulent nature of the sputum tend to show that catarrhal bronchitis is present as a complication. It is in these cases that emphysema is most likely to occur later on.
The expectorated substance is found to contain minute angular, octahedral crystals, visible with medium-power lenses, and recognized as the Charcot Leyden crystals. They are soluble in warm water, the alkalies, and the mineral acids.
[These properties, as shown by Sal kowski, are those of mucin. The asso ciation is further supported by the fact that Loewy found the same crystals in the gelatinous nasal polypus, although asthma was not present. SAJous.] The sputum also contains Cursch mann's spirals, which are frequently sufficiently large to be recognized with the naked eye. They consist of a fine, closely-packed layer of epithelial cells arranged in a spiral form around a longi tudinal canal-like film. They are usu ally found in the thickest portions of the sputum.
[These are not pathognomonic of asthma, being also found in the diseases characterized by exudative inflammation of the bronchioles, as shown by Vierordt. SAJous.] By pressing melted wax through a fine hole the spirals of Curschmann are imi tated; they are produced when mucus is pressed through the contracted bronchi oles; they must, therefore, be considered as a product, not as the cause, of the bronchial spasm. Lisberg (Hygieia, '90).