A system of practical medicine. By American authors. Vol. 3 : $b Diseases of the respiratory, circulatory, and hæmatopoietic systems
Science
A system of practical medicine. By American authors. Vol. 3 : $b Diseases of the respiratory, circulatory, and hæmatopoietic systems
Medicine -- Practice
Mental emotion, if sufficiently powerful, may sometimes prevent the
occurrence of the asthmatic paroxysm; thus, Steavenson, referring to
his own case, states that although subject to frequent attacks he never
had one on going up for an examination; and the writer is acquainted
with a patient whose attack of hay asthma could frequently be checked
by an exciting game of cards.
Asthma, like other neuroses, is much more frequent among the educated
and refined than among the coarser and more ignorant classes of
society, and those leading luxurious lives are more liable to the
disease than those of simple and frugal habits. Of the various
professions, those which involve much exertion of the voice furnish the
largest contingent; hence it is common among public speakers,
clergymen, and lawyers.
In former days the retrocession of cutaneous eruptions was supposed to
play an important rôle in the production of asthma, but of late years
this theory of causation has found but few advocates among intelligent
physicians, the only author of any prominence who still adheres to it
being Waldenburg, who has proposed to designate such cases as a.
herpeticum.
PATHOLOGY.--We have elsewhere alluded to the various theories with
which the older writers endeavored to explain the phenomena of asthma,
and need not here refer to them again.
The first step toward a truly scientific theory of the pathology of
asthma was the discovery by Reisseisen of the smooth muscular fibres of
the bronchial tubes. These fibres are found not only in the large and
medium-sized bronchi, but even in those of the smallest calibre,
Kölliker having {194} demonstrated them in bronchioles 0.18 millimeter
in diameter. It was ascertained by Williams that by irritating the lung
he could cause contraction of these fibres, and Longet subsequently
proved that the same effect could be produced by galvanizing the
pneumogastric nerve. Guided by these important discoveries, most modern
pathologists have arrived at the conclusion that bronchial asthma is a
spasmodic contraction of the middle and finer bronchi, dependent upon
some derangement in the function of the pneumogastric nerve. This, the
so-called spasmodic theory, is not entirely new, Willis, as we have
before stated, having described as early as 1682 a variety of asthma
which he believed to be the result of a "spasmodic action of the
muscles and nerves of respiration," and to which he applied the term
"asthma convulsivum." Although revived from time to time, it was not
until some two hundred years later, and after Romberg had definitely
settled the question of the essential character of the disease, that
the spasmodic nature of asthma received general recognition. Bergson
adopted it in his prize essay in 1840, and ten years later it found a
warm supporter in the person of Hyde Salter, whose valuable
contributions have added so much to our knowledge of bronchial asthma.
The theory that asthma is due to spasm of the bronchial muscles met
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