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