- Email: [email protected]
ABSTRACT OF THE Lettsomian Lectures ON BRONCHIAL ASTHMA.
44
character, the effort of the patient being to inhale, expand and so depress his diaphragm. In other cases of
ABSTRACT
his lungs,
OF THE
asthma the abdomen wasprominent, and the chest greatly distended. These cases either were, or soon would become, complicated with emphysema, and were most commonly met with in persons getting on in life; while the intensely ON spasmodic cases, with inspiratory dyspnoea, were very common in quite young persons, and, not being complicated much pulmonary emphysema, might get perfectly well, Delivered at the Medical Society of London in January, 1879, by the young often outgrowing their asthma at or about the age of puberty. BY JOHN C. THOROWGOOD, M.D., F.R.C.P., Remarks were made on the ingravescent or culminating PHYSICIAN TO VICTORIA-PARK HOSPITAL FOR DISEASES OF THE CHEST, character of asthma. Beginning with slight wheezing and PHYSICIAN TO THE WEST LONDON HOSPITAL, AND LECTURER ON MATERIA MEDICA AT MIDDLESEX HOSPITAL. spasm, the attack gradually passed, as reflex action was powerfully excited, into most severe and alarming apnaea, with great inspiratory effort. Hence the importance of LECTURE I. an attack in limine by antispasmodic inhalations. THE subject of Dr. Thorowgood’s first lecture was the arresting The subject of bronchial hypersemia and congestion was History, Nature, and Mode of Production of Bronchial briefly touched upon towards the close of the lecture, preAsthma. Reference was made to the views expressed by paratory to the consideration of summer catarrh and hay in his treatise on Dr. the second edition of asthma in the second lecture.
Lettsomian Lectures
BRONCHIAL ASTHMA.
I
Floyer
Asthma,
which bears the date, 1717. Floyer considered asthma to be due to a contracted state of the bronchia, and he compared the motion of the chest and lungs to that of a bellows. " We can move the bellows easily, but suppose a bladder tied within over the nozzle of the bellows, so as to receive the air, and suffer none to get into the cavity of the bellows, it will follow that if no more air can enter than may be contained in the bladder the bellows could be opened but a little way, and would inspire with difficulty. So it appears, in the business of the asthma, inspiration is difficult and laborious because but little air can be admitted into the contracted bronchia. This puts the scapular and intercostal muscles and diaphragm upon a violent endeavour to press in the air and open the lungs, which nisus authors have mistaken, and supposed the pneumonic muscles, especially the diaphragm, to be convulsively affected; but it may easily be apprehended that the diaphragm cannot press the viscera downwards to enlarge the chest if the air cannot be admitted into the lungs to follow its depression and fill the . cavity of the breast, and this is the true reason why the
CASE OF LIGATURE OF FEMORAL FOR ELEPHANTIASIS ARABUM. BY R. DENHAM
PINNOCK, M.B. C.M.
GLASG.
B-, a large and stout woman, of florid complexion, aged forty, native of London, married twenty-two years, four children, one dead, two miscarriages, youngest child fiveyears old. Has been twenty-two years in Victoria. MRS.
Lived for seven years in Cambridge before leaving England. For the last eight years has earned her living as a washer. Her father died, aged fifty, of heart and liver woman. disease ; her mother died at the same age of apoplexy; both stout persons. Has had two brothers and five sisters, of whom a brother and sister are living. Two sisters died in infancy, another from dropsy, and the fourth from some unknown cause. One brother died in infancy. Does not dia’nbrH.OTD camint. move in the a.f:it.hm&bgr;.ti fit" Thii.R’Plnv4-.r remember any of her relatives being affected like herself. is not one who lends support to the of Both lower limbs of the patient were perfectly natural Bamberger, and Lehmann, that tonic spasm of the diaphragm until after the birth of the first child, twenty-one years ago, is the chief cause of asthma; he, like most observers from when the left ankle began to swell. Had no treatment for his time to the present, considered bronchial constriction to this. The swelling has been gradually increasing ever since be the chief element in causing the dyspnoea. The lecturer to its present dimensions. Enlargement of right leg began avowed himself, like Salter, Trousseau, Watson, Biermer, eight years ago at the ankle, and has also been gradually and others, an upholder of the doctrine of spasm of the increasing ever since. Ulceration of surface began on left bronchial muscle and constriction of the small air-tubes as leg at Christmas, 1877, and a fortnight later on the right leg. the essential cause of the asthmatic fit. The sudden way in The enlargement, as the accompanying engraving shows, which the seizure may come on and pass off, and the speedy is most marked from the ankle to the middle of the leg, the relief so often obtained by the inhalation of chloroform or calves, knees, and thighs not being very disproportionate to the smoke of tobacco, or stramonium-leaves burned under her general bulk. The enlarged portion of each leg is hard the nostrils, were adduced as reasons for considering the and brawny, the skin of a tinge, and covered with dyspncea of asthma to be a true primary neurosis, not neces- thick cuticular exfoliations of a tuberculous character, sarily due to bronchial hypersemia or congestion. The varying in size from a pea to a walnut. On the left leg opinions of various authorities who have written on asthma these are much more numerous than on the right, and many of them have ulcerated, and are discharging a clear fluid were referred to in illustration of the great diversity of, opinion that exists among these as to the actual state of, exudation. Patient never suffered pain in either leg till the the chest and respiration during a fit of asthma. last time she was carrying a child (five years ago), when the The lecturer endeavoured to explain the reasons for theselegs ached very much; but this disappeared after the birth contradictory statements, and gave it as his opinion that a, of the child. Has never had any impairment of general is not an invariable con- health. Catamenia regular ; lungs healthy ; examination depressed state of the comitant of a fit of asthma. The thorax may be powerfully of the heart revealed an aortic systolic murmur; liver drawn up and fixed in extreme inspiration, and, at the same) slightly enlarged; urine pale amber, acid, 1024, copious time, the diaphragm too is drawn up by the contractedIdeposit of amorphous urates, no albumen. Height, 5 ft. 4; in.; state of the lower part of the lungs. A slight rapid move-- girth of chest, 44 in. ; waist, 41 in. ; biceps, 16 in.; forearm, ment at the epigastrium shows how the respiration is main-- 13; in. Left side : Thigh, 29 in.; calf, 27; in.; ankle, 28 in. tained. The description drawn from life of a case of thisa Right side : Thigh, 28 in.; calf, 26 in.; ankle, 26 in. kind was detailed. The- patient had his first attack ojf f was first called in to this case on account of the ulceraasthma come on quite unexpectedly after an immoderate fi1t tion of the surface of both legs having become so troubleof laughter, the expiratory effort seeming to empty his lungs,:, some as to prevent the woman attending to her household and then came on the bronchial spasm. Cases were noticecd duties. Having for six weeks kept her at rest, during of patients who described their sensations as if their lung:s which period various local and constitutional remedies were tried without the slightest benefit, Carnochan’s method of rose np in the chest ; another said he felt as if his air-tube:!S contracted when his fit came on ; a third drew attention totreatment occurred to me. Erichsen gives a table of fifteen cases of ligature of the the great retraction of his epigastrium, and all these declare(d their breath difficulty to be in inspiration. In these cases femoral for elephantiasis with the following results : seven of severe spasm coming on after expiratory effort in the wa;y cures ; three improved; one improved, and relapse after of coughing or laughing the dy spncea was of inspirator,y fourteen months ; three deaths ; one no benefit.
theory
Wintrich,
reddish
.
diaphragm
.
r
character, the effort of the patient being to inhale, expand and so depress his diaphragm. In other cases of
ABSTRACT
his lungs,
OF THE
asthma the abdomen wasprominent, and the chest greatly distended. These cases either were, or soon would become, complicated with emphysema, and were most commonly met with in persons getting on in life; while the intensely ON spasmodic cases, with inspiratory dyspnoea, were very common in quite young persons, and, not being complicated much pulmonary emphysema, might get perfectly well, Delivered at the Medical Society of London in January, 1879, by the young often outgrowing their asthma at or about the age of puberty. BY JOHN C. THOROWGOOD, M.D., F.R.C.P., Remarks were made on the ingravescent or culminating PHYSICIAN TO VICTORIA-PARK HOSPITAL FOR DISEASES OF THE CHEST, character of asthma. Beginning with slight wheezing and PHYSICIAN TO THE WEST LONDON HOSPITAL, AND LECTURER ON MATERIA MEDICA AT MIDDLESEX HOSPITAL. spasm, the attack gradually passed, as reflex action was powerfully excited, into most severe and alarming apnaea, with great inspiratory effort. Hence the importance of LECTURE I. an attack in limine by antispasmodic inhalations. THE subject of Dr. Thorowgood’s first lecture was the arresting The subject of bronchial hypersemia and congestion was History, Nature, and Mode of Production of Bronchial briefly touched upon towards the close of the lecture, preAsthma. Reference was made to the views expressed by paratory to the consideration of summer catarrh and hay in his treatise on Dr. the second edition of asthma in the second lecture.
Lettsomian Lectures
BRONCHIAL ASTHMA.
I
Floyer
Asthma,
which bears the date, 1717. Floyer considered asthma to be due to a contracted state of the bronchia, and he compared the motion of the chest and lungs to that of a bellows. " We can move the bellows easily, but suppose a bladder tied within over the nozzle of the bellows, so as to receive the air, and suffer none to get into the cavity of the bellows, it will follow that if no more air can enter than may be contained in the bladder the bellows could be opened but a little way, and would inspire with difficulty. So it appears, in the business of the asthma, inspiration is difficult and laborious because but little air can be admitted into the contracted bronchia. This puts the scapular and intercostal muscles and diaphragm upon a violent endeavour to press in the air and open the lungs, which nisus authors have mistaken, and supposed the pneumonic muscles, especially the diaphragm, to be convulsively affected; but it may easily be apprehended that the diaphragm cannot press the viscera downwards to enlarge the chest if the air cannot be admitted into the lungs to follow its depression and fill the . cavity of the breast, and this is the true reason why the
CASE OF LIGATURE OF FEMORAL FOR ELEPHANTIASIS ARABUM. BY R. DENHAM
PINNOCK, M.B. C.M.
GLASG.
B-, a large and stout woman, of florid complexion, aged forty, native of London, married twenty-two years, four children, one dead, two miscarriages, youngest child fiveyears old. Has been twenty-two years in Victoria. MRS.
Lived for seven years in Cambridge before leaving England. For the last eight years has earned her living as a washer. Her father died, aged fifty, of heart and liver woman. disease ; her mother died at the same age of apoplexy; both stout persons. Has had two brothers and five sisters, of whom a brother and sister are living. Two sisters died in infancy, another from dropsy, and the fourth from some unknown cause. One brother died in infancy. Does not dia’nbrH.OTD camint. move in the a.f:it.hm&bgr;.ti fit" Thii.R’Plnv4-.r remember any of her relatives being affected like herself. is not one who lends support to the of Both lower limbs of the patient were perfectly natural Bamberger, and Lehmann, that tonic spasm of the diaphragm until after the birth of the first child, twenty-one years ago, is the chief cause of asthma; he, like most observers from when the left ankle began to swell. Had no treatment for his time to the present, considered bronchial constriction to this. The swelling has been gradually increasing ever since be the chief element in causing the dyspnoea. The lecturer to its present dimensions. Enlargement of right leg began avowed himself, like Salter, Trousseau, Watson, Biermer, eight years ago at the ankle, and has also been gradually and others, an upholder of the doctrine of spasm of the increasing ever since. Ulceration of surface began on left bronchial muscle and constriction of the small air-tubes as leg at Christmas, 1877, and a fortnight later on the right leg. the essential cause of the asthmatic fit. The sudden way in The enlargement, as the accompanying engraving shows, which the seizure may come on and pass off, and the speedy is most marked from the ankle to the middle of the leg, the relief so often obtained by the inhalation of chloroform or calves, knees, and thighs not being very disproportionate to the smoke of tobacco, or stramonium-leaves burned under her general bulk. The enlarged portion of each leg is hard the nostrils, were adduced as reasons for considering the and brawny, the skin of a tinge, and covered with dyspncea of asthma to be a true primary neurosis, not neces- thick cuticular exfoliations of a tuberculous character, sarily due to bronchial hypersemia or congestion. The varying in size from a pea to a walnut. On the left leg opinions of various authorities who have written on asthma these are much more numerous than on the right, and many of them have ulcerated, and are discharging a clear fluid were referred to in illustration of the great diversity of, opinion that exists among these as to the actual state of, exudation. Patient never suffered pain in either leg till the the chest and respiration during a fit of asthma. last time she was carrying a child (five years ago), when the The lecturer endeavoured to explain the reasons for theselegs ached very much; but this disappeared after the birth contradictory statements, and gave it as his opinion that a, of the child. Has never had any impairment of general is not an invariable con- health. Catamenia regular ; lungs healthy ; examination depressed state of the comitant of a fit of asthma. The thorax may be powerfully of the heart revealed an aortic systolic murmur; liver drawn up and fixed in extreme inspiration, and, at the same) slightly enlarged; urine pale amber, acid, 1024, copious time, the diaphragm too is drawn up by the contractedIdeposit of amorphous urates, no albumen. Height, 5 ft. 4; in.; state of the lower part of the lungs. A slight rapid move-- girth of chest, 44 in. ; waist, 41 in. ; biceps, 16 in.; forearm, ment at the epigastrium shows how the respiration is main-- 13; in. Left side : Thigh, 29 in.; calf, 27; in.; ankle, 28 in. tained. The description drawn from life of a case of thisa Right side : Thigh, 28 in.; calf, 26 in.; ankle, 26 in. kind was detailed. The- patient had his first attack ojf f was first called in to this case on account of the ulceraasthma come on quite unexpectedly after an immoderate fi1t tion of the surface of both legs having become so troubleof laughter, the expiratory effort seeming to empty his lungs,:, some as to prevent the woman attending to her household and then came on the bronchial spasm. Cases were noticecd duties. Having for six weeks kept her at rest, during of patients who described their sensations as if their lung:s which period various local and constitutional remedies were tried without the slightest benefit, Carnochan’s method of rose np in the chest ; another said he felt as if his air-tube:!S contracted when his fit came on ; a third drew attention totreatment occurred to me. Erichsen gives a table of fifteen cases of ligature of the the great retraction of his epigastrium, and all these declare(d their breath difficulty to be in inspiration. In these cases femoral for elephantiasis with the following results : seven of severe spasm coming on after expiratory effort in the wa;y cures ; three improved; one improved, and relapse after of coughing or laughing the dy spncea was of inspirator,y fourteen months ; three deaths ; one no benefit.
theory
Wintrich,
reddish
.
diaphragm
.
r