1913: Adam: Abnormalities Associated With Asthma

Dr. James Adam believed the most common cause of asthma was a toxin or poison in the blood.  The other cause of asthma was lesions in the respiratory tract (published 7/10/14).  While most physicians focused their attention on spasms in the lungs, he believed they should be focused more on one of these two causes of airway spasms.

He observed that many asthmatics, although not all, present with one or more of the following abnormalities along their respiratory tract or amid the chest and body:(1, page 12, 35-38)

1. Polypi
2. Septal deviations blocks air passage
3. Turgid turbinals: blocks air passage
4. Irritable turbinals (very sensitive to stimulus, causing coughing or sneezing)
5. Congestion of mucus membrane (anywhere from nose, trachea or bronchi)
6. Pigeon breast: from a lifetime of asthma the chest becomes deformed, where one sternum, or breastbone, is pushed outward
7. Emphysema during asthma attacks, becomes chronic if asthma not cured 
8. Barrel chest: rounded, bulging chest that shows little movementn with respiration.  It occus during a paroxysm, and becomes chronic if asthma not treated (sign of emphysema)
9. Rounded, almost stooped shoulders (sign of emphysema)
10. Unilateral nasal obstruction
11. Sputum at the end of the attack
12. Curschmann spirals in the sputum
13. Eosinophile cells in sputum, with Charcot-Leyden crystals
14. Heart Rate of 90-110
15. Blood pressure within normal limits: paroxysm does not raise the blood pressure, but adrenalyn used to treat asthma may
16. Blood pressure of 80-90 mmHg at end inspiration, and 120-130 at end expiration: decreased BP on inspiration may probably be due to impeded pulmonary circulation
17. Flatulence during the paroxysm
18. Asthmatics live long: In this, he agrees with other asthma physicians such as Salter and Berkart. (1, page 38) Adam notes this is true "so long as they don't become drug slaves)

While most other members of the medical community focused most of their attention on the spasmotic and nervous theories of asthma, Adam was focused on the Lesion Theory of Asthma and the Toxaemia theory of asthma, and for that reason his "radical treatment" would better help asthmatics as opposed to the more traditional treatment prescribed by other physicians.

References

1. Adam, James, "Asthma and it's radical treatment," 1913, London, Gasgow: Alexander Stenhouse