BRONCHIAL ASTHMA AND ASTHMATIC BRONCHITIS Occurrence and Etiology.—From the vague general conception of "Asthma," we may definitely separate bronchial asthma. The same is characterized by the occurrence of conditions of expiratory dyspncea, pulmonary emphysema with dry bronchial catarrh, and is dependent on a neurosis of the respiratory system which is to be regarded mainly fiS a spasm of the muscles of respiration, or perhaps also as a neurosis of secretion of the mucous membrane of the organs of respiration.
The pure bronchial asthma with intervals of a normal respiratory system is seldom found in children; it is, however, met with occasion ally in infancy, typical cases of which I have observed. On the other hand, during the whole of childhood from the first year on mixed forms of bronchitis which may best be designated as asthmatic bronchitis are very frequent.
Hereditary circumstances have considerable influence. Bronchial asthma very frequently attacks children whose parents likewise suffer or have suffered from asthma, gout, migraine, or are otherwise affected neuropathically. Accordingly, neuroarthritismus plays an important role in this condition. Asthma itself is mostly developed from periph eral irritation, from chronic nasopharyngeal affections, especially from adenoid vegetations; and also, from chronic relapsing bronchitis. Ecze ma is important, and, less so, other affections of the skin, as strophulus infantum, and chronic urticaria. The French speak of a diathese dartrense and of asthma dartreux. It seems to me that the connection between eczema is not, in general, sufficiently appreciated in German literature. According to my own personal experience, I have found that the vast majority of cases of bronchial asthma or asthmatic bronchitis occur in children who have suffered from, or are still suffering from, in fantile eczema. Certainly, in addition, adenoid vegetations are also frequently present. The first manifestations very frequently appear during the second year, when the eczema has healed or is about to dis appear, a clinical fact which not improperly permits the layman to speak of "a striking in." Children who are predisposed to asthma are
often anaffnic, nervous, and irritable. Changes of weather arid climate, certain odors, fresh colds, and psychic factors, may be regarded as ex citing causes. In certain children every attack of bronchitis assumes an asthmatic type.
Hay asthma is a type of bronchial asthma which is produced by irritation of the nasal and deeper seated respiratory mucous membrane, from the pollen of various plants especially of grass and grain. The predisposition to hay fever is hereditary and is found in family neuro arthritismus. The disease sometimes commences at three to six years as a hay-cold, and frequently remains unrecognized during the first years, if the conjunctivitis and the well-known predisposition do not lead to the proper diagnosis. Pronounced hay asthma mostly occurs several years later. However I have seen a severe attack of pure hay asthma in a boy only four years old. of a family in whom no symptoms of any kind of the disease had been observed during previous years.
The symptoms of bronchial asthma are as marked in children as in aclults. After a short indisposition severe dyspmea suddenly sets in; filled with anxiety and with pale features the infant attempts to cling to any-one. Laborious, prolonged, and panting expiration is present, whereby all the auxiliary muscles are strained and the active abdominal muscles in particular are severely taxed. The thorax itself is rigid or makes but slight excursions and inspiratory epigastric recessions occur; cyanosis, often also cold sweats, sets in. During the early years of life, spasm of the glottis may be added. Respiration is frequently retarded. In addition to the panting expiration, dry, sibilant rale: perceptible over the entire room often occur early- or occasionally only after some time.