Discussion on the varieties and treatment of asthma / by G. A. Gibson.

  • Gibson George Alexander, 1854-1913.
Date:
1911
Catalogue details

Licence: In copyright

Credit: Discussion on the varieties and treatment of asthma / by G. A. Gibson. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    and Dixon already mentioned it is urged that inspiration, being so much more powerful than expiration, and occur- ring, as it does, before the respiratory phase has come to an end, must of necessity lead to overdistension of the lungs and its consequences. There is in this a very interesting suggestion. For many years the expiratory theory of emphysema of Mendelssohn and Jenner has been very widely accepted in preference to the inspiratory theory of Laennec and Gairdner. This is not the place to discuss the matter in full, hut you will perhaps allow me to state that in my own view the investigations of Brodie and Dixon have gone far to show us that, after all, the inspira- tory theory cannot be summarily dismissed, as has so often been done in modern times. There is one last point to which you will perhaps allow a brief reference. It is commonly said that in asthma the arterial pressure is above the normal. My present house-physician. Dr. Burrow, has kindly looked up my records of the asthmatic cases Avhich have been in my wards during the last five years, and he has found that in only one did the pressure reach even what we might call a moderate degree. This was in a man of 50, who showed a systolic pressure of 140 and a diastolic of 100 mm. Hg. In no other case did the pressure exceed 120 systolic and 90 diastolic, while in one it was actually as low as 105 systolic and 93 diastolic. During the paroxysm the arterial pressure certainly rises; but it is a matter of considerable difficulty to get accurate readings at such a time, and, indeed, we must all naturally hesitate before troubling a sufferer when in the throes of an attack. One patient (a lady of 78), who was sent to me recently by my friend Dr. Guthrie Rankin, had suffered from true neurotic asthma since her girlhood. In her case the sphygmomanometer showed a diastolic pressure of 170 and a systolic pressure of 220 mm. Hg. Although tliere was no renal complication, the impression was left upon my mind that the high pressure Avas the result of a number of factors operative in elderly people, and indeed, the large heart which the patient manifested was proof of senile conditions. We are noAV brought face to face with the second part of the subject, the treatment of asthma. As regards the general basis of management, we may assume that it con- sists in carefully watching over digestion and assimilation, in maintaining circulation and excretion, in obviating nasal irritation and bronchial catarrh. The details of management in every individual case involve the careful consideration of climatic, dietetic, and medicinal regulations. We must always be in a condition of baffling uncei’tainty as to the type of climate which Avill probably be most helpful to an asthmatic patient. We know only too well that many a sufferer from this affection, whose life is absolutely miserable when he lives in a clear, dry atmosijhere, upon a porous, gravelly soil, at once loses the tendency to the disease when he moves into a damp, foggy town built upon a cold clay soil. Such knoAvledge as this will always