Frequent occurrence of asthma among persons who, in their youth, suffered from stubborn cutaneous eruptions. Von Noorden (Zeit. f. klin. Med., B. 22, '92).
Case of urticarial asthma due to mussel poisoning, indicating the rela tionship between urticarial eruption of the skin and that of the mucous mem brane, strongly advocated by Andrew Clark as the main cause of asthma. G. Marlyn (Brit. Med. Jour., June S, '95).
Case of a boy whose mother was an asthmatic and who suffered from parox ysms of asthma and eczema which were sometimes concurrent, sometimes defi nitely alternating, sometimes overlap ping each other, the patient at no time being quite free from either. Latterly he has had intermissions of from four to five weeks in the asthmatic fits, but the chronic eczema has been more or less constant. Personal belief that asthma may be due to some sudden vascular en gorgement or erythematous blush of the bronchial mucosa. As against the ec zematous origin of these attacks, atten tion called to the non-evanescent nature of eczematous eruptions. Taylor (N. Y. Med. Jour., Oct. 21, '99).
4. Irritability of pneumogastric nerve following whooping-cough, measles, or infantile bronchial disorders, or through pressure upon it of enlarged bronchial glands.
In infants the bronchial glands are often the site of congestive and inflam matory conditions following bronchitis, measles, and pertussis, the causes of the attacks being those which produce con gestion of the glands, crying, variation of temperature, chilling, etc. Joal (Arch. Gen. de MOd., Apr., '91).
There is only one way of artificially producing asthma, and that is to divide the left vagus in the neck and gently stimulate the proximal end with elec tricity. By this method asthma is pro duced in the right lung and spasmodic contractions in the right half of the diaphragm. We must look, therefore, for the cause of asthma in some tissue or tissues supplied by the vagi and the sym pathetic nerves, or in a lesion of the nerves themselves. E. Kingscote (Brit. Med. Jour., Oct. 13, 1900).
The four above-mentioned factors are able to give rise to the pulmonary and muscular phenomena, owing to the un toward accumulation in the system at large of (1) products of metabolism which fail to be eliminated through htematopoietic or renal insufficiency, uric acid, acetone, etc.; (2) extraneous tonics, such as lead, mercury. etc.
Case in which asthma replaced epilep tic fits. The pent-up nerve-storm, instead of discharging itself in the customary channel in an epileptic seizure, expended its energy upon the bronchial muscular fibre, giving rise to the protracted asthmatic phenomena. After many hours it exhausted itself by way of an orthodox "fit," thus bringing the dis turbance to a conclusion. Francis Tay lor (Lancet, June 10, '92).
An excess of uric acid in the blood contracts the arterioles all over the body and produces high arterial tension. Asthma represents the effect on the thoracic circulation of this high arterial tension, while migraine and epilepsy represent its effect upon the circulation of the brain. A. Haig (International Clinics, vol. iv, '94).
Nervous asthma is usually due to in toxication. The attacks occur at night, because the urine is more toxic then than in the day-time. Huchard (Revue
Gen. de Clin. et de Thor. Jour. des Prat., Feb. 22, '96).
Five cases which occurred in aged pa tients, all of them showing evidence of arteriosclerosis and weakness of the cardiovascular system, and a number of them had attacks resembling angina pec toris. The essential feature of the case was that they had severe attacks of asthma which came on almost solely at night, and that in all these instances the use of catheter disclosed a certain de gree of retention of urine, and the evacu ation of the bladder caused the entire disappearance of the dyspncra. with sur prising rapidity. Autointoxication v as probably the cause, due to greater diffi culty in emptying the bladder when the patients are at rest in a horizontol posi tion. Pawinski (Revue de Med., Mar. 10, '99).
Asthma due to dyspepsia. The most typical cases occur in children usually of neurotic inheritance. To suppose that they are due to autointoxication is the most easy assumption, but the ptomaines and toxins hitherto isolated for the most part act differently upon the heart: slacken it instead of accelerating. Prob ably there is an increased bulbar reeeptiv ity in these eases, and reflexes are more easily exciting than usual. Acetonuria is not infrequently present. Strong evi dence of the dyspeptic nature of the attacks is afforded by the cases in which the exhibition of purgatives or emetics gives prompt and immediate relief. Moreover, there are generally signs of dyspepsia; for example, furred tongue, foul breath, nausea, and vomiting. Treatment should be directed accord ingly. Landi (Clinica Mod., An. 5, No. 24, '99).
Two fatal cases have proved the cor rect persona] former belief that the anatomical findings in the lumen of the bronchi are not always the same. There exists, however, a bond of union between them all in the abundant epithelial des quamation. A. Fraenkel (Deut. med. Wadi., Apr. G, 1900).
Chronic dyspeptic asthma witnessed in 5 cases. The acute type occurs after meals and is characterized by dyspncea, cyanosis, and irregularity of the pulse. In the chronic type there is continuous shortness of breath on slightest exer tion. Both forms yield readily to treat ment of the gastric disorder. No par ticular form of stomach trouble is re sponsible for the condition. F. H. Mur doch (N. Y. Med. Jour., Jan. 12, 1901).
Prognosis.—The prognosis of asthma depends upon the nature of its under lying cause. Cases of reflex asthma in which the primary disorder is easily reached and properly treated,—such as nasal hypertrophies, polyi, aural growths, etc.,—are frequently cured and remain so, provided the causative affection does not remain. The prognosis is also good in young subjects with well-formed chests and in whom direct heredity can not be traced. In all others, however, the chances of recovery are very limited.
Death rarely ensues from spasmodic asthma, but its complications may prove fatal.
Treatment.—The treatment of asthma consists of (1) arrest of the paroxysm; (2) prevention of the paroxysms by measures calculated to annul the effects of exciting factors; and (3) removal of the pathological conditions forming the basis of the paroxysms.