NOTE

A

Physician,

as

ASTHMA.1

R. Charles, M.D., F.R.C.P.,

J.

Of asthma,

ON

Bristol

Royal Infirmary.

is well known, there

etiological

are

very many factors, i.e. underlying causes, many of which are hereditaiV, and also numerous exciting causes. From time to time

specif

attention is devoted to

innumerable

other of these

disturbances exudative diathesis-

At times the influence of metabolic

factors.

holds the field ; More

one or

recently

at others the so-called

the attention

devoted to sensitisation

of the

all sorts of

by

been

has

physician

foreign proteins-

Excess of various forms of food, e.g. acids and fats, various emotional disturbances, the influence of climate, and local affections of the nose, All

part.

of these

throat and

produce

may

so

forth all

play then

of

spasmodic

attacks

asthma. Intrathoracic pressure may, however, be a factor, as e.g. in the case of a small aneurism, rule the true

cause

a

by Lapage

and

some

interest

Paper

glands

read at

a

and and

local lesions

they regard

Meeting

has

recently

in

the

been

25th,

1925.

chest

their action

of the Bath and Bristol

British Medical Association, March

84

cause

Royal Society of Medicme 0 Adams (November 24th, 1924). The point was the frequency with which they fonnd

determining factors, A

such

The m1

paper read before the

intrathoracic

1

some

as a

though

of this will become manifest.

portance of seeking for stressed in

determining

as

Branch

not

of t

A

NOTE ON ASTHMA.

entirely mechanical. Among 68 cases they found by clinical and X-ray ^sions in 50, viz. :? Bronchial

glands

Mediastinal Cervical

of asthma in children examination

definite

in 31. in 6.

glands

glands

85

in 5.

Fibrosis of root of

lungs

in 18.

Adhesions in 5. Chronic bronchitis in

11.

One child

suddenly coughed up large pieces of debris calcareous gland. Luckily he did not choke, and as result of the mass coming away he was very much better

fr?Ht a

a

ar,d his asthmatic attacks subsided.

With regard

to

intrathoracic

pressure,

opposed that the symptoms would Xery considerable degree of pressure

Prolonged they do

readily

overlooked.

In the

case

bathing to do

a

case

may be

patient had always degree of good

considerable

very that when at school he

capacity, long distance cross-country so

a

produced by other

in the individual

under observation the

person with

a

cause

but

may be existent with and the attacks when

freedom from any attacks, may be so typical of asthma

that the true

be

might

continuous,

occur

ca.Uses

^een

be

it

runs

was

able

with considerable

and sometimes beat records, and in the ordinary way, eVen with considerable exertion, had never had any shortness

?*

breath.

at

intervals to typical asthmatic attacks, by which I mean having gone to bed perfectly free and comfortable in

reathing,

But

throughout

his life he had been

he would wake up at

2

or

3

a.m.

with

subject

severe

^spnoea and all the usual symptoms of asthma, which would

C^ar up

in the usual way,

leaving

him free from it the

86

DR.

following day,

J.

CHARLES

R.

be

to

perhaps

repeated

on

subsequent

nights. throughcontinuous, though worse, at night-

On several occasions the out the

day

and had been

Climate had

a

great

dypsncea

had continued

deal to do with these attacks, e.g.

?n

train of events occurred and remained persistent until he leftHe went up to the Midlands, and immediately the whole

going

to Cornwall some years ago the whole of this

condition subsided, and the conclusion

suffering solely from entirely by the climate. It

was

asthmatic

was

never

was

drawn that he

produced

trouble

suspected

for one

gross intrathoracic pressuieSometimes it had been thought that exposure to the weather when motoring in an open car might have been an exciting that he

moment

had

any

subsequent events threw great supposition, because quite probably sUC^ attacks were produced by hemorrhage into an intrathoracic car, cyst following such exertions as winding up a refractory and not by exposure. During last summer he noticed for the first time a slight the enlargement of the thyroid which appeared just behind the Later on asthmatic attacks exactly right clavicle.

cause

of the attacks, but

doubt

on

this

before became

same as

occasion the attack

but later side

a

bending

be due to recent

so

severe

that

?ne night, and on to he was unable

pressure 1

improve which on he had another, and was then X-rayed, definite shadow in the mediastinum on the right

suspected

showed

was

at

all for five hours, and then for the first time

move at was

frequent

more

an

as a

possible

the trachea

cause.

over to

The attacks

the left, which

intrathoracic adenoma of the

hemorrhage

had taken

place,

thyroid

which

was

proved into

to

whid

successful

time no 1924, since which asthmatic attacks have occurred.

removed

on

Both Mr.

November 26th,

Berry,

who did the

operation,

and Sir

Wilhan

Hale

White considered that this

years' duration and had been

the trouble.

Here, then,

was

87

NOTE ON ASTHMA.

A

of very many for the whole of

was

responsible

of

case

a

cyst

typical

asthmatic attacks

occurring in the middle of the night, and definitely influenced % climate, which could only have acted as an accessory

fector,

the

cause

of which

*t Was never even

?found h^d

almost

occurred

therefore

^?""ray

the

was

suspected,

entirely

overlooked because

but which could have been

many years ago if the thought the chest should be X-rayed ; and

certainly that

example

of this

examination in any

is

case

case

a

plea

for

having

an

of asthma which has not

if any form Whatsoever of intrathoracic pressure may be at the root ?t the trouble.

Satisfactorily responded

to

Prolonged intermittency asthmatic

on

the

attacks,

characteristics of the attacks do

*he possibility of he learnt

some

from this

The

see

of attacks, nocturnal incidence

climatic influences

attacks,

to

treatment,

tumour

eriUcleation

such cause,

as can

and

not

typical

preclude

quite definitely

case.

which

was

removed

by

resection

adenoma

and

well-encapsuled cystic weighing Microscopically it proved to be a simple unilocular c?hoid cyst, with recent hemorrhagic ooze into it. Many the previous attacks of asthma had probably been ^Ue to similar hemorrhagic oozing following unusual was a

? ?zs.

e:certion.

XLII.

No. 156

A Note on Asthma.

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