Management applies more to the regular school practice than to ours. Homoeopathy cures; allopathy treats, practices empiricism while ours is the task of specificism. These patients come with their own diagnosis made. The physical examination is uninforming except for a noisy chest. The “regulars” spend infinite detail in verifying a diagnosis that is already self-evident. Homoeopathy does something about it.
Asthma, like any other disease, is a symptom, meaning labored breathing, of a general disorder and should be treated from the standpoint of the patient in his entirety. Here the disease syndrome has its concentration in the disequilibrium of the vago- sympathetic mechanism. The treatment of allopathy dwells on the local spasm and what general measures are considered are usually impractical. It is not always so easy for a patient to leave his business and go to the seashore, desert or mountains to spend his days.
They classify asthma into the extrinsic and intrinsic forms; as far as we are concerned they are practically all intrinsic unless there be some outstanding occupational handicap. It goes without saying that all offending external agents should be removed insofar as humanly possible; these include the feather pillow or any other animal emanation, and elimination of poisonous foods, etc.
At this moment I would like to deviate from our line and comment on the following allopathic treatment used at the present time.
Asthmatic crisis is the result of a rupture of equilibrium between the antagonistic actions of the pneumogastric, which has become hypertone, and the inhibited sympathetic. Theoretically, nothing seems easier than the suppression of asthmatic crisis were we able either to inhibit the pneumogastric or excite the sympathetic. In fact and in practice the problem is more complex and more empirical.
While in the period of crisis, or if exposed to a cause which may produce a crisis, the asthmatic patient before retiring for the night and for several days following should be submitted to a preventive treatment. This treatment consists of luminal, belladonna, valerian, mine, etc.
In mild or moderate crisis, the patient usually succeeds in calming his dyspnoea and falling asleep if the inhales the fumes produced by the combustion of different powders which have thorn-apple and nitrated paper as a basis. Such means are usually insufficient when the crisis is severe, and it is then a question of adrenalin administration. At the onset of the crisis in fact, the method of choice seems to be the stimulation of the sympathetic.
Adrenalin alone or in combination with the total suprarenal extract, hypophyseal extract or papaverine, etc. products of which there are several specialties-constitute the best remedy in asthmatic crisis, suppressing it in a few minutes in a remarkable manner by means of a dose of 1/2 or 1 milligram. Injected at the beginning of the attack, adrenalin stops the emphysemic crisis in a few minutes.
All symptoms of emphysema disappear and respiration resumes its normal character. From all that we know about adrenalin action, its ineffectiveness in normal lungs, its bronchodilating effect on lungs in prior state of spasm, we must concede that despite the evident conditions of emphysema, the bronchial muscles of asthmatic individuals are in a state of hypertony-this being in the nature of a paradox-and cause an apparent disagreement between experimentation and the clinic.
Frequently, adrenalin medication gives-and this is a fact of current clinical observation-astonishing results; the best effect is achieved if the medication is administered in the earliest stages of the symptoms when it is a question of asthmatic crisis occurring at intervals. It is, however, necessary sometimes to resume the injection at the end of a half-hour. Where asthma with very frequent crises if concerned daily or several times a day- the use of the medication is not without inconvenience.
Adrenalin injections generally do not affect hypertony. There are patients who received several thousand injections, yet their tension remained the same. There are cases where the periods of calm following injections are progressively curtailed while the acuteness of the crises increases at the same time, and things reach a pass where adrenalin, while stifling the crisis momentarily, increases the vagosympathetic disequilibrium. The injection in the long run may cause cardiac eventualities and further the patient may become an adrenalomaniac.
Where adrenalin is inefficacious or where its use must be renounced, belladonna-the classic remedy in asthma before the discovery of adrenalin-should be substituted. Belladonna may be replaced by its alkaloid, neutral sulphate of atropin administered in 1/2 or one milligram injections. Morphine may be administered in 1/2 or one centigram, and finally, morphine- scopalamine, which should be the last resort and should not be except when the crisis resists all other means of treatment.
The basic treatment of asthma comprises a certain number of prescriptions which can be administered in all cases of asthma. The best regimen is similar to that prescribed for patients suffering from gout and consists of rationalization of albuminoids, avoidance of preserves, sausages, giblets, spiced sauces, heavy cheese; moderate use of wine, coffee, tea and alcohol. Some asthmatics will find a strictly vegetarian diet very beneficial while inversely, others will profit from and acid diet with large quantities of meats and fats. Hurst and some other english writers have recommended a diet rich in sugar: 80 to 100 grams daily in addition to the diet.
To check a recurrence of crises in an asthmatic individual, his terrain must be modified and to make it normal it is necessary:.
1. Suppress the organic irritative which by way of reflex may affect the vago-sympathetic system and precipitate the crisis (ablation of nasal vegetations; resection of hypertrophied cornets; appendectomy; salpingo-ovarian ablations; prostatectomy; treatment of chronic rhinopharyngitis) pulmonary sclerosis, where the irritative barb is of ganglion or pulmonary origin, and especially when the tubercular lesions are present, the suppressing of the irritating agent is generally impossible; the treatment must be directed toward the cause: tuberculosis or syphilis.
I can see how occasionally there may be need for the conservative drainage of an antrum empyema, the clipping of a large polyp or restoration of the necrosed cribriform plate of the ethmoid in some of these advanced pansinus conditions, but I believe this is done far too much. In the end surgery only tends to make your patient worse. Dr. Ferris Smith, of Grand Rapids, Michigan, is the only accurate operator I ever saw perform on the sinuses.
2. Reestablishment of the vago-sympathetic equilibrium by the pleuriglandular therapy with which I am not familiar. Some report good results with adrenalin and pituitary by mouth, 6x. tablets.
3. To consolidate the humoral equilibrium. In the majority of cases, we are unable to shelter the patient from the cause determining a colloido-clastic shock often anaphylactic in character (feather and wool in the manufacture of bedding; animal hair like dog, cat; furs, food, etc.; dust, flowers, etc.). The best way to avoid such a shock is to render it impossible by modifying the humors making them shock-resistant, that is by desensitization.
I have never seen desensitization, either specific or nonspecific, help a single case. Many of them are made worse and as fast as one allergen is removed two spring up to take its place. It is like the familiar old story of Hercules and the nine-headed serpent.
4. Several years ago specific desensitization was tried cutaneously and subcutaneously in respiration allergies and by the gastric route in digestive allergies. But experience has demonstrated the difficulties of achieving such specific desensitization without incidents and inconveniences and also the deceptive because temporary character of the desensitization since the patient desensitized against allergy may become sensitive to other conditions, thus bringing the entire matter again in doubt. Therefore the now preferred desensitization is nonspecific (peptonotherapy; autohemotherapy; autoserotherapy; autovaccinotherapy; vaccinotherapy with polymicrobic vaccine stock; chemotherapy; chloride of calcium, hyposulphide of soda).
Medical treatment is comprised of innumerable drugs and it is important to remember those which are definitely superior. The first place belongs to belladonna which has not been abandoned since the time of Trousseau next, gardenia, lobelia, arsenic and iodine, ephedrin used alone or in combinations not too complex. It is always wise to administer these therapeutic combinations progressively because with asthmatics we are dealing with patients who tolerate poorly one medicament or the other.
These physiological effects do not actually work out in practice. Many cases are so toxic that they cannot take any drug whatsoever.
