1913: Cauterize your nose, cure your asthma

Another interesting concept of Adams is that he denied that most asthmatics had allergies, although he associated abnormalities in the nasal cavity with asthma.  He noted that Henry Hyde Salter cursorily mentioned the relevance of the nose in cases of asthma, when such knowledge was known since 1844 when Herck of Freiburg noted the association of sneezing and asthma. (1, page 89)

Later, Adams noted, Voltolini, in 1872, claimed to have "relieved eleven cases of asthma by removal of nasal polypi.  This idea received further impetus when Lazarus, Brodie and Dixon and others showed that electrical stimulation of the nasal mucosa caused bronchial spasm."

Ernst Schmiegelow explained that Voltini noted that no other asthma physicians prior to him noted the link between nasal polypi and asthma.  And while polypi are not always associated with asthma, there are noted cases where, upon removal of the polypi, the asthma disappeared. Although, if asthma has existed long enough so that it is chronic, removal of the polypi will not make the asthma disappear. Schmiegelow notes that Voltini's opinions were confirmed by Hanisch. (2, page 14)

Schmiegelow notes that "Hanisch thinks that as not all nasal polypes cause asthma, there must be a certain debility of the whole organisation or at least of the organs of breathing. In the nasal polypes themselves he finds sufficient ground for the weakened state of the organisms and lungs, as the insufficient breathing, the restless sleep, the buccal respiration, etc., must be considered capable of causing the general weakness."  (2, page 14)

B. Frankel and Weber also confirmed the findings of Voltini, and they also believed that chronic catarrh could also cause asthma. They believed irritation of the nasal mucous membrane passed a message down the pneumogastric to the pulmonary fibres, causing asthma, and "the result of the reflex was always a bronchospasm.". (2, page 15) Henry Hyde Salter previously mentioned this, and referred to is as reflex asthma.  

Schmiegelow also mentions a Dr. Wilhelm Hack, who "supported by casuistic observations, considered a number of different nervous diseases from the same point of view. Hack's principal object was to show that in the swollen cavernous mucous membrane in the foremost end of the inferior turbinated bones, different nervous states of irritation originate, and these reflex neuroses can be caused experimentally, and they disappear entirely as soon as the places in question are operatively removed. The filling of the cavernous membrane is, according to Hack, the essential in the pathogenesis of these reflex neuroses."

Adams notes that other physicians were so focused on the other theories of asthma, particularly that asthma was neurotic, that they were overlooking the true cause: that there was a problem with the patient's nasal passage causing the asthma, or that there was a toxaemia in the blood causing asthma as I discussed in this post.

Adams emphasises the following: (1, page 89-90)

"I have seen patients with noses absolutely ruined, mere shells of what they should have been—their asthma remaining the same, but promptly clearing up on simple antitoxaemic treatment, except in the case of a poor woman who owed an opium habit to her doctor. Francis cauterises the septal tubercle of all asthmatics—sometimes a valuable temporary procedure; others would also cauterise the lower turbinals—an unnecessary addition. The value of proper nasal treatment cannot be gainsaid; but that it should be subsidiary and ancillary to treatment of the toxaemia I have, where mouth breathing was absent, occasionally and successfully proved by the experiment of carrying out the latter treatment and leaving the nose alone. Apart from the experimental and therapeutical evidence just mentioned, the importance of a nasal factor in asthma can be gauged from several considerations."

Some of the ailments he observed on asthmatics, were:

• Nasal polypi
• Deviated Septum
• Hypertrophied areas in nasal passages
• Pigeon chest (due to laboring for air so frequently)
• Mouth breather
• Expanded shoulders (due to years of laboring for air)
• Expanded chest (due to emphysema if chronic)

References:

1. Adam, James, "Asthma and it's radical treatment," 1913, 
2. Schmiegelow, Ernest, "Asthma, considered specially in relation to nasal disease," 

1913: Adam: A perfect description of an asthma attack

Consider the following description of an asthma attack:

"In marked attacks not only is the struggle for breath so severe as to make the patient sit or kneel in bed, but he may even get out of bed and stand gasping at an open window, or clutching at any support that will aid the respiratory muscles of respiration. many will not go to bed at all, but sit in a chair all night, dozing when they can." (1, page 9)

If that doesn't describe one of my typical asthma attack when I was a kid I don't know what does. 

References

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

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

1913: Two types of chronic asthmatics

James Adams explains that most cases of asthma are chronic before they are seen by a physician; that these cases are usually treated as bronchitis first (airway inflammation and increased sputum production).  Bronchitis "is really the form asthma commonly takes at first."  Only as time progresses, does asthma be come chronic. (1, page 31, 33)

He describes two types of chronic asthma: (1, page 30)

1. Fat: Less common; overeating can lead to asthma; chronic bronchitis
2. Lean: More common; usually as the disease becomes more chronic, a toxaemia in the blood will cause the asthmatic to become thin, with expanded shoulders and chest due to chronic laboring and emphysema.  

Adam writes that the most common sign of chronic asthma is "dusky, sallow skin with chloasms round the eyes, sure token of toxaemia. There is no mistaking this asthmatic chachexia (fatigue, weakness, as in wasting away) and the first sign of improvement resulting from correct treatment is the clearing of the skin; it looks as though it has been washed from the inside -- as it has been... it takes prolonged, repeated and severe paroxysms to develop the other (signs of chronic asthma). (1, page 31)

What causes the signs of chronic asthma, Adam notes, is the hyperaemia that is constantly ongoing and not treated (and it's usually not treated because most physicians don't respect the toxaemia theory of asthma.).  Toxaemia that is constant acts on the "skin and bronchial mucous membrane as well as on the tissues generally, producing the cachexia and bronchitis, the stress of the dyspnea, which is the main factor in producing the other thoracic changes, is intermittent.

Other signs of chronic asthma would be your distended chest and shoulders, pigeon chest, etc. These are signs that the person has a toxaemia, and that the person has been working hard to suck in air. (You can see more signs of the toxaemic effect on asthma in this post (1913: Lesions in respiratory tract cause asthma on 7/22/17)

Bronchitis is generally caused by a metabolic disorder, and therefore, the treatment generally revolves around decreasing carbohydrates (sugary foods), such as "sweets cakes." (1, page 33, 35)(also see chapter on atypical asthma)

References:

1. Adam, James, "Asthma and its radical treatment," 

1913: Adam Toxaemic Theory of Asthma

By the turn of the 20th century, the medical profession had readily accepted both the nervous theory of asthma and that spasmodic theory of asthma. The allergic theory of asthma was in its infancy, and the old toxaemic theory of asthma was no longer written about in new editions of asthma books.

Yet it was the old theory, the toxaemic theory of asthma, that Dr. James Adam proposed as the most valid explanation of asthma.  He understood that is was no longer accepted by the medical community, and he understood treatment based on this old theory was considered radical.  This, therefore, was the reason he referred to his asthma book as "Asthma and its Radical Treatment." (1, pages 1-3)

Dr. Adam said he continued to have much respect for Dr. Henry Hyde Salter who, during a series of articles published in the 1950s, articulated support for the nervous and spasmodic theories of asthma.  Yet Dr. Salter also articulated support for the toxaemic theory of asthma.  Of Dr. Salter, Adams wrote:

Hyde Salter’s book, written before most of us were born, must not be overlooked by anyone interested in the subject; he had probably a wider experience of asthma, and a better grip of the value of the dietetic treatment, than many twentieth-century authorities." 

Dr. Salter, from our own studies, was an ardent supporter of the idea that there was a direct correlation between what one puts into his body and asthma.  He wrote that many of his patients, including himself, observed that upon eating too much or eating the wrong foods, often lead to a paroxysm of asthma.  The prevention of asthma, therefore, was to eat healthily and eat light.  The remedy was emetics and enemas.

Salter believed the certain foods, or too much food, lead to some form of poison in the blood that leads to the nervous system causing bronchospasm.  Dr. Adam simply refined this theory as follows: (1, page 3)
Toxaemic theory of asthma:  Asthma is a disease of the nervous system, and "all neurosis are toxaemias."  A poison enters the body and this "hits the nerves of the respiratory tract."

Adam suggests that asthma is caused in this way:

This toxaemia arises partly in the bowel, partly in the tissues; it arises partly by absorption of nitrogenous poisons resulting from intestinal puttefaction under microbic action ; but mainly is due to an error in nitrogenous metabolism, the result of imperfect oxidation or enzyme action. In short, the poison arises from Proteid food or proteid tissue.

The error in proteid metabolism is closely connected with excess of carbohydrate in the diet.

The oxidation of the excess of the simpler carbohydrate molecule seems to interfere with proper oxidation of the more complex proteid molecule. In other words, the excess of energy food interferes with the metabolism of the tissues and tissue-foods; the imperfectly metabolised products so resulting set up asthma.

In other words, as Salter explained, the poison, or toxaemia, was the cause of some error in diet.  The result, according to Adams, was as followed

The toxaemia, whether arising in bowel or tissues or both, tends to show itself first as catarrh, later as spasm, in the respiratory tract. This toxaemia shows itself in conditions, catarrhal and spasmodic, other than, but closely related to, asthma.

He believed there were certain prodomata (early signs) of asthma that are often overlooked, and while these signs may not be present in all cases of asthma, if one is observed it can be a sign of an impending attack, such as:

• Polyuria (excessive urine production)
• Oliguria (diminished urine production)
• Anuria (no urine production)
• Constipation (unable to have a bowel movement)
• Formication (sensation you have insects crawling under your skin)
• Pruritus (sensation that results in urge to scratch; itchy sensation)
• Urticaria (hives)
• Erythema (redness of skin)
• Cyanosis (Blueness of skin, representative of ischemia of tissues of hand, foot, lips, etc.)
• Petechiae (red or purple spots on the skin caused by minor hemorrhage; local bleeding due to broken capillary vessels)
• Embarrassed breathing (asthma)

The above will continue until something happens involving the elimination of something, which generally involves:

• Vomiting (spitting up stomach contents)
• Diarrhea (loose stools)
• Polyuria (excessive urination)
• Expectoration (sputum production)

Due to the toxaemic effect, the following are also associated with asthma (all are associated with increases of eosinophilia in sputum): (1, page 34-35)

• Eczema: Commonest and most likely to occur in children with bronchitis. It usually shows up before asthma and disappears.  Although will continue to "dog" the patient if the asthma is not "cleared up." Cause is same as asthma, and treatment therefore same too (see treatment for both asthma and eczema is generally to restrict carbohydrates)
• Ichthyosis: Probably caused by metabolic disorder
• Psoriasis: Adams notes it's "said to be associated with asthma, but I have never seen the combination." Restricting carbohydrates generally doesn't work, but restricting "nitrogenous intake does." The difference in treatment may prove the non-association of psoriasis with asthma.
• Dermatitis Herpetiformis:  Also associated with asthma. 

One of the reasons that he published his book was because he believed that "far too much attention has been paid (by the general practitioner) to the most striking feature of asthma, the asthmatic spasm; too little to the conditions that precede and cause the spasm, and those by which Nature cures it." Of course, the toxaemic theory of asthma provides the answer to why the spasm occurs, and thus its radical treatments would prevent and treat asthma.

Adams also noted that his theory came at a time when other theories were more readily accepted by the medical profession.  However, his idea are "put forward with the hope that it will be useful not only in the treatment of asthma but also in those other diseased states whose kinship with asthma is too."

References

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