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ASTHMA,

INTRODUCTION.

Asthma is a complaint which is mentioned in the oldest writings, but the name of Asthma was given to all kinds of diseases, if accompanied by difficulty in breathing; this caused a great confusion of ideas, which it took centuries to correct.

According to Bergson,* the Bible (Exodus) mentions a disease which must be looked upon as Asthma. According to the same author, Homer and Herodotus also knew the complaint, and advised those who suffered from Asthma to use warm sand baths. In the works of Hippocrates Asthma is mentioned several times, and he gives the name of Asthma to all respiratory difficulties that are accompanied by accelerated breathing. Celsus distinguishes between dyspnea, asthma and orthopnea; dyspnea being the milder form of the complaint, orthopnæa the more

Aretæus gives an exact description of asthmatic attacks, and separates only asthma and dyspnea, regarding orthopnea as a symptom of asthma. From this time up to the middle ages Galen's opinions were in this case, as everywhere else in medicine, predominant. He knew only dyspnea, whose subordinates are orthopnæa and apnea.

It was only towards the end of the 17th century, that Willisius established the category of nervous spastic asthma, t

severe.

Bergson, Das krampfhafte Asthma der Erwachsenen, Nordhausen, 1850. † See Ramadge, Asthma, London, 1835, p. 86.

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which had already been indicated by v. Helmont.* The characteristics of this form of Asthma were, that the patient's lungs were perfectly healthy (viscera omnia sana, præsertim pulmones), and that Asthma, therefore, was now placed as an independent disease, in contrast to earlier authors who looked upon it as a symptom.

Floyer, I who himself suffered from asthma for 30 years, wrote a capital work on the subject, he considers a convulsive contraction of the bronchial tubes to be the cause of the asthmatic attacks, whereas dyspnoa, which is distinctly separated from asthma, is caused by a compression of the lungs. He makes a sharp distinction between the asthma that has a visible cause, and the one that has no distinct origin, and where no pathological change is to be found. This last, the essential asthma of the present day, he calls Asthma periodicum flatulentum, whereas Willis has named it, A. convulsivum et spasmodico-flatulentum or A. spasmodicum. This theory of Floyer as regards the bronchial spasms was later on acknowledged by Cullen g. Darwin in his Zoonomia declares that Asthma convulsivum has the same character as all other cramps and epilepsies, and that it can originate from nearly all distant parts of the body. Already in former times numerous observations have appeared, which endeavoured to prove that asthma could originate from pathological conditions in other organs. Willis and Hoffmann mention cases, where the presence of bilious stone has been the cause of asthmatic attacks, Ruysch has observed the same thing in cases of renal stone. Floyer has seen asthma in women suffering from uterine diseases. Wainwright knew a lady who contracted asthma every time she

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* See Floyer, A treatise of the Asthma, London, 1717, Dedication, p. 7. + See Ramadge, Ibid, p. 94.

Floyer, Ibid. § Cullen, Practice of Physick, 1777, referred to by Bree, Recherches prati. ques sur les disordres de la respiration, traduit de l'anglais, 1819, p. 108.

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