On Bronchial Asthma: Its Pathology and Treatment

a " miserable looking wretch," too tall or too short, pale and emaciated or purple and obese, with spinal deformity, and a thorax also deformed and too small. These stigmata are attributed to rickets, the accompanying alteration in the bone marrow being held responsible for the eosinophilia. Typical asthma is preceded by signs of inflammation of the respiratory tract, such as colds and coughs, and is itself characterised by rapidly varying dry sounds, which, however, become moist at the end of the paroxysm, this change being accompanied by the expectoration of very tenacious compact masses containing definite bronchial casts composed of round and cylindrical epithelial cells, white spiral threads and Charcot-Leyden crystals. Their expectoration brings relief. During the last 25 years post-mortem examinations have been reported upon seven cases of asthma, and in all these cases there has been obstruction of the bronchial tree by those substances which may be observed in the sputum during life, the medium-sized and smaller bronchi were dilated, and the alveoli mostly emphysematous. The author's conception of the underlying changes is that the dyspnoea being constantly associated with an abnormal exudation, is a symptom of catarrh. The complex character of the sputum points to its being formed gradually as an exudation from, and degeneration of cells producing hollow or solid casts. The process being patchy in distribution, these casts do not produce symptoms of obstruction unless they become displaced and suddenly block a bronchus supplying a larger area of lung, in fact, he considers that in nearly all cases it is this displacement and impaction which is at the bottom of bronchial asthma, the displacement in turn resulting from an increase in the depth of respiration such as accompanies coughing, laughing or sneezing, the increased demand for oxygen after a meal, or the change from town to the fresh air of country or seaside. In yet other instances a sudden overtaxing of the heart in kidney or heart disease with its associated congestion or oedema