Spirals of Curschmann are not limited to any particular part of the bronchi, but are absent in the alveoli. The for mation of spirals is caused by the whirl ing of the air during long paroxysms of dyspncea or violent fits of coughing. Presence of fibrin noted in the sputum of six out of eight cases. Schmidt (lied. Chronicle, Nov., '92).
Post-mortem in two cases showed that the majority of the middle-sized and small bronchi of both lungs were full of the most perfect spiral coagula, com pletely blocking the lumen of the smaller divisions. Conclusions: There is a for mation of very considerable quantities of an exceptionally tough mucus. As this mucus is extruded from the cells, but still sticks closely to them on account of its toughness, it is swayed backward and forward by the respiratory currents, and thus exerts on the neighboring ele ments a stretching influence by which they are not only mechanically loosened from their connections, but also finally attenuated into the thread-like forms described. The next stage in the process is that these elongated threads get more and more twisted round each other, and in this way produce, together with the mucus present, the spirals. Fraenkcl (Dent. med. Woch., Mar. 19, 1900).
large lymphoid bodies and granules, the eosinophile cells of Ehrlich, are also found.
[These also have been found in the contents of mucous polypi. SAJOITS.] The urine is generally very copious, of low specific gravity, and light colored. It is usually more toxic after a night attack.
Essential, or nervous, asthma the re sult of toxaemia, occurs more frequently at night, because sleep is in itself a form of toxaemia, urine passed after the night being usually more toxic than urine passed after the day. Huchard (Rev. Gen. de Clin. et de Thor. Jour. des Prat., Feb. 22, '96).
Complications. — The most important complication of asthma is emphysema. This is due to the repeated narrowing of the bronchi, which, assisted by the resulting local congestion, becomes more or less permanent and causes dilatation of the alveoli.
The pulmonary circulation is inter fered with and dilatation of the heart and oedema may occur. The confor mation of the patient's frame becomes changed, owing to modified action of the muscles of the back and chest. The
sufferer stoops and his shoulders become raised.
Case in which the hands and arms were symmetrically enlarged from meta carpo-phalangcal joints to a point cor responding to the middle of the biceps muscle. Under iodide of potassium and euphorbia the asthma improved some what, but the enlargement of the arms remained. John S. Billings, Jr. (N. Y. Med. Jour., May 22, '97).
Differential Diagnosis. — Attacks re sembling those of the typical form may be induced by pressure on the trachea, aneurisms, goitre ("thymic asthma"), foreign bodies, vertebral disease, gland ular enlargement, growths of the larynx and of the infraglottic space.
They may also be due to irregularity of the bronchial circulation through car diac disorders, tuberculosis, bronchitis, or narrowing of the respiratory area by mediastinal tumors.
infraglottic disorders, growths, and syphilis especially may give rise to a form of dyspncea simulating that of asthma. Sajous (Jour. of Laryn., and Otol., Sept., '95).
The great majority of urgent cases of acute stenosis seen occurred low down in the larynx, either in region of true or false vocal cords or below the glottis. INIacintyre (Jour. of Laryn., Sept., '95).
BRONCHITIS.—In children asthma sometimes assumes the character of cap illary bronchitis. In all forms of bron chitis there are absence of periodicity, greater amount of expectoration, marked increase in number of respirations, free chest-motion, and more or less fever. PNEUMONIA.—In this disease the res pirations are greatly increased in ber, and there is panting, besides free chest-motion. There is also high fever. CROUP AND OTHER LARYNGEAL DIS EASES.—In these disorders there is terference with the respiration: inspira tory instead of expiratory. EMPHYSEMA.— In emphysema the dyspno2a is continuous, though liable to exacerbations.
The dyspncea of emphysema is too often attributed to asthma. While bron chial asthma of nasal origin occurs when the patient is at rest, and espe cially at night, the dyspncea of emphy sema mostly appears on exertion. Schech (Mtinchener med. Woch., Aug. 18, '96).