ASTHMA.
The theory that this disease is the result of anaphylaxis has opened up a new field for preventive and curative treatment, but an underlying neurotic condition is probably always present, and the exciting causes which bring the spasmodic mechanism into play are very numerous. The first step in the management of an asthmatic patient is to try and find out the chief exciting cause which determines the attack; this is of the greatest importance in young patients, as each spasmodic seizure probably renders the reflex mechanism more sensitive to subsequent stimuli. Perhaps the most common cause is a catarrhal attack originat ng in the upper air passages or larger bronchi, and though every effort should be made to guard against undue exposure to cold and damp air, coddling should he avoided. The opposite extreme of submitting the child to so called " hardening " influences by light clothing, cold baths in winter, and unreasonable exposure must be carefully guarded against when a warm and equable climate cannot be selected in which atmospheric changes may be safely disregarded. Carefully planned respiratory gymnastic exercises are always valuable.
The nose and naso-pharynx, tonsils and throat should be carefully examined in every instance in the child or adult, and any unhealthy state remedied at once so as to admit of; free passage of inspired air. It will also be judicious to see to the state of the teeth. Enlarged tonsils, polypi, adenoids, thickening of the membrane over the turbinated bones as is seen in hypertrophic rhinitis should be removed, as all these conditions_tend to the production of recurring catarrhs. The use of the knife and cautery for this purpose is not to be confounded with another form of treatment based upon the fact that spasm of the bronchial tubes can be produced by stimulation of certain sensitive areas on the mucous membrane of the nose. Hence Francis has advocated the cauterisation of the mucosa of the septum, even when no pathological condition is found there. 'I'he writer has seen permanent benefit follow this treatment in many instances where there were no indications of the asthma being of nasal origin. Syme applies Nitrate of Silver io per cent. to the interior of the
bronchi.
The next most common exciting cause of the attacks appears to be some abnormal condition of the gastric or intestinal mucous membrane, and the theory has been promulgated that there are hypersensitive areas in these regions like those known to exist in the nasal mucosa. The fact is proved by clinical experience that an overloaded stomach, an attack of acute dyspepsia, or even the presence of intestinal parasites some times brings on an asthmatic seizure, recurrence of which is prevented by regulation in the hours of feeding and a revision of the dietary, or by the use of anthclmintics to clear out round-worms, &c.
There can also be little doubt that the gouty condition of the blood may precipitate an asthmatic attack possibly by rendering these areas so hypersensitive that ordinary stimuli may be sufficient to cause spasm of the bronchial tubes.
The inhalation of various emanations and of dusty particles of many kinds is a well-recognised exciting cause. Thus the odours arising from cats, dogs, birds, or certain flowers, pollen of grasses, and the dust which clings to feathers may be found on careful scrutiny of the history of attacks to be causative. Many patients experience immunity for long periods whilst avoiding the use of feather-beds.
Obscure atmospheric conditions apart from dust-laden air are known by common experience to he active, and it is a well-recognised fact that many asthmatics enjoy freedom from attacks in the dusty air of cities, while a removal to a pure seaside or country atmosphere is followed in such patients by a series of severe spasmodic seizures. Even removal from one part of a city or country district to a place a few miles away may markedly alleviate or increase the number of the attacks. Only the knowledge gained by the patient himself can he utilised in the treatment of the disease by change of air and climate, and no theory of the physician as regards absence of dust, variations of barometric pressure, sunlight, ozone, temperature, &c., can enable him to foretell the probable results of a change of residence.