Every physician of much practical experience knows, however, that, in defiance of all the remedies and methods of treatment hitherto devised, there are many cases of chronic bronchial inflammation which will continue, and be aggravated at every returning cold season of the year, so long as the patient lives in a climate characterized by a predominance of cold and damp air with frequent and extreme thermometric changes. And yet a large proportion of these, by changing their residence to a mild and comparatively dry climate, either greatly improve or entirely recover. Consequently, in all the more severe and persistent cases such a change is of paramount importance, and should be made whenever the pecuniary circumstances of the patient will permit. Probably the best districts in our own country to which the class of patients under consideration can resort are the southern half of California, the more moderately elevated places in New Mexico and the western part of Texas, Mobile in Alabama, Aiken in South Carolina, and most of the interior parts of Georgia and Florida. My own observations lead me to the conclusion that the unfortunate invalid, suffering from any grade of chronic bronchial inflammation, can find in some of the regions named all the relief that could be gained in the most celebrated health-resorts on the other side of the Atlantic. But adherence to strictly temperate and judicious habits of life, with regular daily outdoor exercise, is essential to the welfare of the invalid in whatever climate he may choose to reside.
In the foregoing pages I have said nothing concerning the management of those cases of asthma, emphysema, interstitial pneumonia, etc. which often occur either as complications during the progress of bronchial inflammations or as sequelæ, simply because they will all be fully considered in the articles embracing those topics in other parts of this work.
BRONCHIAL ASTHMA.
BY W. H. GEDDINGS, M.D.
SYNONYMS.—Asthma convulsivum (Willis); Spasmus bronchialis (Romberg); Asthma nervosum; Krampf der bronchien.
DEFINITION.—A violent form of paroxysmal dyspnoea, not dependent upon structural lesion; characterized by wheezing respiration, with great prolongation of the expiration, and by the absence of all symptoms of the disease during the intervals between the attacks.
HISTORY.—Derived from the Greek [Greek: asthmatnô] to gasp for breath, the term asthma was employed by the older writers to designate a variety of affections of which embarrassed respiration was the most prominent symptom, thus including a great number of diseases which a more extended knowledge of pathology has since distributed among other nosological groups. By the earlier authors simple embarrassment of breathing was designated as dyspnoea; if attended with wheezing it was called asthma; while those forms in which the difficulty in respiration was so great as to prevent the patient from lying down were appropriately styled orthopnoea (Celsus). Ignorant to a great extent of pathological anatomy and unprovided with the improved methods of physical diagnosis which we now possess, they described as asthma not only the dyspnoea due to cardiac and pulmonary diseases, but also that occasioned by affections of the pleura and greater vessels. Covering such an extensive range of territory, it was found necessary to subdivide the disease into a number of varieties, each author classifying them according to his conception of the cause, seat, and nature of the trouble. Some of these—e.g. a. dyspepticum—still find a place in medical literature, but the vast majority of them, having ceased to be of any practical significance, have been discarded, and are now only interesting as examples of the crude and fanciful notions which prevailed in an age during which science rather retrograded than advanced.1 Of the writers of this period, Willis in the seventeenth century is especially worthy of notice as being the first to describe the nervous character of asthma. Without discarding the accepted forms of the disease, he mentions another variety, characterized by spasmodic action of the muscles of the chest, to which he gave the name asthma convulsivum.