Bronchial Asthma

Bronchial Asthma

Asthma from Rye Flour – Bronchial Asthma
FRED M. was out of a job again. This was the third job he had lost within a month. This in itself was hardly as important as the fact that Fred was over 50 years of age and knew no other work. He had started as a baker’s apprentice right after leaving high school and, since that time, all his life had been at this kind of work.

He was alert., he possessed a certain amount of ingenuity and he was well-versed in the art of baking, all of which had assured him of steady work throughout the years. He liked his work, and the fact that he had remained at one job for 27 years was, in itself, sufficient testimonial.

But, suddenly, striking as a bolt of lightning from behind the clouds, he was called in to see his boss. “Fred,” began the employer slowly, “I’m afraid I’ll have to let you go.”

For a moment Fred stood bewildered. Many thoughts raced through his mind. “I—I don’t quite understand,” he said.
The employer reiterated his statement. “This is your last day here. I’m giving you two weeks’ pay to hold you over until you get another job.”
“But—I like it here. Twenty-seven years I have worked here. I don’t know any other work,” Fred protested. “Where will I go? What will I do?”
“I’m sure you’ll get another job right away, Fred,” assured the other man. “Perhaps another bakery. There are several other big ones, you know.”

Fred felt that there was something more to this than appeared on the surface, but, out of respect for his employer, he accepted the facts as they were and, after choking out a brief farewell, turned and left the office.

As Fred trudged toward the door of the bakery, he made up his mind that he wasn’t through. His reputation as a baker was known by all the tradesmen. His recipe for rye bread was the envy of all the other bakeries in town.

Convinced that he had not lost his usefulness, he marched straight to the next largest bakery in town, where he was promptly employed.

This gave Fred a certain sense of satisfaction and self-reliability, and once more he felt happy. But this was not to last long, for hardly two weeks had passed when his dismissal was again requested.

A third and fourth bakery retained the man for similar periods of time, but nobody would give him a reason for his failure to hold a job.

Just before leaving his last place of employment, he accidentally overheard two of his recent co-workers discussing him.

“Damn shame about Fred,” one of them said. “Swell guy.”
“Got canned because of his cough, they tell me,” commented the other.
“Yeah. Guess the boss couldn’t take a chance. Maybe he’s got T.B. or something. Gotta be careful.”

Fred was shocked. He had never thought his cough was anything serious. Right then and there he decided that this was not the end for him. Had the employers only told him that this was the reason for his dismissal, he could have explained. They were not to blame. They only tried to avoid hurting him, he figured.

His general health was good, and this prompted him to believe that his cough was not really serious. Yet he had to do something about the situation. He had not been able to save, and the thought of charity was repugnant.

The thing foremost in his mind was the affliction that had cost him his job. His first visit to a doctor’s office convinced him of one thing. The physician assured him that he did not have a lung ailment, but that was the extent of the diagnosis. Believing that Fred was suffering from the effects of a bodily irritant, the doctor referred him to a specialist.

In a short time, the new physician learned by means of tests that Fred was highly sensitive to the thing he had handled most while he worked in the bakery—rye flour. The mere contact of this flour with the delicate membranes of his nose and throat caused him to choke and cough. His lungs had been the fuse box of his body; consequently, a rash had developed there due to his constant association with this particular food.

Fred listened with interest to the doctor’s diagnosis.
“Do you think you can convince my former employer that I am not seriously ill? Perhaps he would take me back.”
“If I thought it would do any good, I’d be happy to do so,” replied the doctor. “As a matter of fact, I don’t believe he could really be convinced, and, if he were, the job would do you more harm than good.”

Fred looked disappointed. “What am I to do? I haven’t the money to live on.”
“I’m going to handle your case,” replied the doctor. “I believe that the State Industrial Commission will pay compensation on a case of this sort.”

For several years, the Industrial Commission had been confronted by just such cases, but it had never been thoroughly convinced that these cases came under its jurisdiction. By furnishing sufficient medical facts, the physician proved that Fred’s illness and his loss of employment had originated industrially.

Other individuals employed in industry, who, at one time or other, have developed bodily reactions against the things they work with, have benefited from this precedent.

Bronchial asthma is a frequent allergy which occurs seasonally and also the year around. It is, on occasion, associated with other allergic conditions. True allergic asthmatic attacks result from exposure to allergens either by inhalation, in-gestion, injection or by absorption of bacteria from a focus of infection. There are conditions arising from heart disease, obstruction of the bronchial tubes from within or without, which resemble allergic asthma, and, from which, true asthma must be differentiated if correct treatment is to be undertaken.

True asthma results from spasm of the bronchial muscles, swelling of the lining or mucous membrane and thickening mucus within the bronchial tubes. This produces the shortness of breath, the prolonged phase of breathing out and the wheezing or musical sounds while breathing.

At the outset, the acute attack is manifested by tightness in the chest, with cough and shortness of breath. Thickened phlegm of a gelatinous type is often present. When it is brought up, the patient feels better. This result occurs when the attack subsides or appropriate medication is given. The attack may occur suddenly, day or night, often without warning, following exposure to an allergen, or subsequent to whooping cough, pneumonia, measles, the common cold or sinus infection.

The examination may reveal nothing abnormal in the early stage of asthma between attacks. During an attack, the individual will be sitting up and leaning forward, pale, cold and sweating and extremely breathless. The neck veins appear prominent. In long-standing cases, when complications have set in and emphysema is present, the chest is shaped like a barrel. The chest on percussion or tapping has a hyper-resonant sound. Wheezing is often heard without a stethoscope. With a stethoscope, all types of musical and noisy sounds are heard. There are special crystals known as Charcot-Leyden crystals or Curschmann’s spirals in the sputum. There is also an excess of a special white blood cell, the eosinophile, in the blood stream.

The allergens are recognized from the history and special skin tests. The physical examination, food idiosyncrasies and seasonal, environmental, temperature and weather changes should be evaluated. In addition, possible emotional factors, nasal infection, foci of infection and endocrine imbalance should be carefully investigated, as they may precipitate an attack.

In some patients the attacks develop gradually, beginning with symptoms of a “cold in the head,” progressing gradually into the lungs. Many of these are mistaken for attacks of bronchitis, especially in children, in whom the attacks may be for years so mild as to mask the asthmatic nature of the condition. However, usually in these cases, one notices wheezing breath sounds which are seldom found in simple bronchitis and the presence of which usually indicates asthma.

Some patients have asthma only at certain seasons of the year, as, for example, a complication of hay fever or pollen asthma without hay fever, occurring during the latter part of August. Others may have attacks at any season of the year. Patients presenting attacks at the same time every year suffer from “seasonal” asthma; those who may develop symptoms at any time or who have continual attacks are said to have “perennial asthma.” The perennial asthmatic may suffer most severely at some one season—a characteristic of perennial asthma with the seasonal exacerbations.

In order to develop asthma, one must have (a) the allergic state and (b) contact with the specific exciting cause to which the patient is sensitive in quantities sufficient to produce either immediate allergic shock or the balanced allergic state.

The physician must determine all of the exciting causes which may enter the body from the outside (extrinsic causes), and all of the abnormal conditions in the body which may tend to disturb the allergic balance (intrinsic causes). Asthma may be divided etiologically into three groups: extrinsic, intrinsic and combined. Purely extrinsic cases are those in which there are no physical deformities or defects in the body, and in which the exciting causes enter from the outside through the air or food.

Extrinsic cases are the least difficult to diagnose and treat. These patients show seasonal variations often depending on changes of residence from one house to another, or from one community to another. A complete set of skin tests usually affords many clues to the specific exciting causes. When this information is obtained, the life of the patient is rearranged in order to exclude the exciting factors from the environment. The patient is then brought into contact with the suspected materials one at a time to see if attacks can be reproduced. If, under these circumstances, an attack occurs, it is necessary to avoid the reacting substance indefinitely in order to keep the patient free of asthma. If, in spite of all efforts to remove the suspected influences from the patient’s environment, attacks continue, it is obvious that removal has not been complete, or that other active allergens are present.

To determine the completeness of removal of the known allergens, the household furnishings and the wearing apparel, frequent sources of allergens, are investigated. To do this properly, the physician must have a thorough knowledge of the materials used in the manufacture of both usual and unusual clothes and furniture. Goat hair, horsehair, feathers, silk, fur, wool and cotton are present in almost every home in some form or other.

Most of the furs found in homes are derived from the common furbearing animals, which have been altered by plucking and dyeing to resemble the more expensive and rarer kinds, under which names they are often sold. Some of the furs commonly altered and sold under names of superior furs are:

NaturalAltered and Sold as
Hare, dyedSable or Fox
Hare, whiteFox
Rabbit, whiteErmine
Rabbit, white, dyedChinchilla
Sable
Rabbit, sheared and dyedFrench Seal
Electric Seal
Seal, Electric Seal
Muskrat, dyedHudson Seal
Muskrat, pulled and dyedMink, Sable
Mink, dyedSable
MarmotMink, Sable, Skunk
OpossumBeaver

To determine the presence of other and unknown allergens, samples of dust are collected from various parts of the house; these samples are extracted and skin tests are made with the extracts. The dusts are collected in the following manner.

The cloth bag is removed from a vacuum cleaner. The machine is then operated for a minute or two to free the working mechanism of any dust which may be present. A piece of muslin is tied on in place of the cloth bag, and the machine is operated directly or by means of attachments, so as to collect a tablespoonful of dust from the mattress, pillows and linen of the patient’s bed. The muslin is then removed, folded and labeled, and another clean piece is tied on in its place. A sample is obtained in a similar way from the living room rug, from the bedroom rug, from the automobile and from such other sources as might suggest themselves after a survey of the surroundings. Dust is often collected also from the working environment.

If any of these dusts give positive reactions in the patient, and negative reactions in normal individuals, the source of the dust is eliminated from the environment, and a survey is made once more to determine the effect of this change.

Sometimes, this method fails and it is then necessary to move the patient to a specially prepared room in a hospital, where the air is so free of all particles that the patient cannot possibly receive any harmful substances through the air. By means of special filters, similar conditions may be produced at home. The patient remains in the special environment until it has been determined with certainty whether inhalant factors are responsible for attacks. During all this time, the diet should be arranged in accordance with the clues derived from the history and the skin tests.

When the conditions necessary for the control of the attacks have been determined, these conditions should be maintained indefinitely. Efforts to raise the tolerance to specific allergens, although temporarily successful, are never lasting, and are of chief value when it is impossible or impractical to free the environment of the offending material.

The treatment of purely intrinsic asthma consists of the surgical eradication of all removable areas of infection, and of attempts to improve the body health by hygienic measures such as regularity in living, attention to excretory functions, simple nutritious diet and ample fresh air and exercise. In these cases, the aim is to assist temporarily in the raising of the body’s tolerance.

The combined form is relatively common. It consists of a combination of the extrinsic and intrinsic types, in which the extrinsic causes are usually the more significant, as in most instances the intrinsic causes are insufficient to produce symptoms until the body has been placed in the unbalanced allergic state by contact with doses of the specific exciting causes. Treatment consists of a combination of the methods described for the extrinsic and intrinsic types.

Heart Failure and Asthma – Bronchial Asthma

For nearly two years, Harry B. was under medical care for severe asthma. He had become almost a complete invalid, unable to do more than walk a few steps before his breath gave completely out. Upon the insistence of his wife, who had learned of a similar case “cured” by an allergist, her physician referred this man for study and care.

There was no question about the allergic history in Harry’s case, for he had had hay fever and an asthmatic cough for most of his 48 years. He had a sister with asthma and his father had hay fever. His allergy tests and blood tests certainly confirmed the fact of Harry’s strong allergic condition-but that was not the whole story.

When he was 10 years old, Harry had spent five weeks in bed with a rather prolonged illness. He had a continuous fever, nose bleeds, sore throat, enlarged glands and painful swollen joints. The family physician said he had an enlarged heart with a loud murmur. The condition was thought to be rheumatic fever.

For a number of years, Harry seemed to be short of breath on exertion of even the mildest degree. He could never play with the kids, and he was nicknamed “wheezy.”

It was difficult, but, upon examination, it was ascertained that his allergy alone could not account for the type of heart murmur he exhibited, nor could it account for all of his shortness of breath, cough and wheezing. With more refined techniques, X-rays of the interior of the heart revealed that the mitral valve of the left side of the heart was nearly completely obliterated, preventing normal circulation. It was further determined that all of the factors were right for Harry to undergo heart surgery in which the mitral valve would be “cracked” (as the surgeons call splitting and enlarging the opening). Harry made a dramatic recovery and his circulation was restored to nearly normal. His allergy is still being treated and controlled to keep all strain off the heart. Harry walks 25 blocks to and from work now without distress.

This case illustrates the existence of two distinct conditions, rheumatic heart disease and allergic asthma. Harry could have lived with his allergy without treatment, but he could not have lived without the recognition of his serious heart disease. Harry has certainly had 25 years added to his life.

Asthma from Peppermint – Bronchial Asthma

An exceptionally interesting case was that of John K., an important business executive in a large midwestern city. His family physician referred him to an asthma specialist only after months of unsuccessfully attempting to locate the source of his difficulty.

One of the first things Mr. K. said to his new physician was, “I hope you can find the trouble with little or no loss of time. I’m a busy man. I can’t afford to waste time, and the only reason I’m here is that my asthmatic attacks make it difficult for me to work.”

The physician convinced Mr. K. that he was not a magician, and that he could only accept the case if he had absolute cooperation. John K. agreed under protest and proceeded to give the facts concerning his ailment.
“When do you get your attacks?” asked the doctor.
“Generally twice a day,” was the reply.
“Last long?”
“The first one is fairly brief. It comes between nine and ten in the morning, and lasts for about 45 minutes. The afternoon attacks are more provoking. They generally last all afternoon.”
“Are there any days when you have no attacks?” the physician asked. John K. reflected momentarily. “Sometimes I manage to get through an entire Sunday without having much trouble. That’s probably because I spend most of the day sleeping.”
“Is there any other time when you are not bothered by these attacks?”
“Yes. When I’m away on business trips, I find that the attacks come less often,” replied the patient.
“Haven’t you ever tried to figure out why?” the doctor asked.
“I’ve been too busy to think about it,” John K. replied with an embarrassed chuckle.
“It seems to me that a thing which affects your health and, incidentally, your business activity would merit more consideration,” suggested the physician.
“You know how it is, Doctor. Most of us take our health for granted,” Mr. K. replied.
“When you are away on business trips, do you alter your living routine a great deal?” queried the doctor.
“Not at all,” said John reassuringly, “I make it a point to stick as closely as possible to my regular routine.”
“Yet your attacks come less frequently while you are away?”
“It does seem strange, but it’s true.”

After extracting considerably more history from the patient, the doctor proceeded with the routine task of making skin tests for the various foods. Nothing significant appeared in these tests.

A day-by-day record of the asthmatic attacks was given to the physician regularly. Oddly enough, the morning attacks occurred invariably between the hours of nine and ten, and the afternoon attacks usually began between one and three o’clock.

Here, at least, was something for the doctor to work with. He set himself to the task of learning precisely what Mr. K. did within the hour preceding each attack.

Very often the obvious goes unnoticed, and here was art excellent example. Several weeks passed, and John K.’s asthmatic attacks continued with their customary regularity.

The doctor traced every avenue of possibility. He even spent several days at Mr. K.’s home, watching him closely from the moment he arose in the morning until he left for the office. But all was in vain. One day the physician decided to go along to the office with John K., believing that a new clue might present itself. It was a tedious and apparently hopeless task sitting in the patient’s private office all morning, making note of every move he made, and everything he handled. It was doubly tedious because of the fact that John K. was a very busy man, and had practically no time to converse with the physician.

The morning had passed, and along with it the morning asthma. Noon arrived.

The doctor noted the time. “If you’ll pardon my intrusion, Mr. K.,” he began, “isn’t it about time for lunch?”

Mr. K. smiled. “Lunch? That’s something I have no time for.” With this, he slid open his desk drawer and removed a small, round package.
“This is my lunch,” explained John K. with a chuckle, indicating the small package.

The doctor learned that these were dextrose wafers.

“Not the best way to eat lunch,” apologized Mr. K., “but, when you’re busy, a few pieces of dextrose candy go a long way toward replenishing your energy.”

The doctor agreed, but at the same time wondered whether this was the clue he had been waiting for. He reflected that the patient hadn’t eaten any of those wafers in the morning, and, furthermore, that there was nothing in pure dextrose that might have such an effect.

He returned the candy to Mr. K., who promptly opened the end of the package, offered it to the doctor and took one himself.

The candy was good, thought the doctor as he chewed it. Suddenly an idea came to him.
“Of course!” he exclaimed. “Why didn’t I see it before?”
“See what?” said John K.
“It was so obvious that I overlooked it. Mr. K., what flavor is this candy?”
“Why—peppermint. Helps the digestion they say.”
“It’s also a spice,” reminded the doctor, “and some people can’t eat peppermint, just as others can’t eat black pepper.”
John K. reflected for a moment. “But I only eat these at noon. How would that account for the morning attacks?”
“Your toothpaste—what flavor is it?”
“Holy smoke!” said John K. slowly. “Peppermint.”
“And you eat these dextrose wafers every day except Sunday?”
“Right.”
“And on Sundays you don’t have more than one attack,” explained the doctor. “That attack is from toothpaste.”

John K. sat silently in amazement for several moments.

It was a mere matter of routine detail to check the doctor’s diagnosis. An extract of peppermint injected into the patient’s arm confirmed the fact.

Needless to say, John K. no longer suffers from asthmatic attacks for he carefully avoids peppermint-flavored foods.

Food Allergens – Bronchial Asthma Continued

The food allergens encountered in our practice are listed in the Appendix not for the purpose of alarming the reader, but rather to open his eyes and mind to facts.

Each of these foods has the potentiality of altering one’s health to the point at which a physical or mental breakdown is inevitable.

If this list makes you aware of the fact that even the most trivial quantities of the most common foodstuffs become poison when reacting with certain human bodies, then it serves its purpose.

One person cannot eat English walnuts without losing his wind. An infant sensitive to cow’s milk is no longer troubled with bodily rashes when changed to goat’s milk. The gum-chewing stenographer who punctuates her typing with 30-second sneezing finds that, by eliminating chicle from her diet, she is no longer afflicted with this reflex. The sweet-toothed housewife, who intends to surprise hubby with a nice, rich devil’s food cake and samples about half of it herself, often finds that the chocolate flavoring has been the cause of gastric disturbances. And the corpulent gentleman with a lust for starch foods learns that potatoes, not business worries, have been bringing on those dizzy spells by indirectly affecting the semicircular canals in his ears.

Some persons have tongues which resemble the topography of a relief map because of the elevations and depressions caused by some particular food allergen.

The greater number of food sensitivities occur in mild and apparently harmless, but annoying, forms. Headaches are common, yet they signify that something is not functioning properly. When they occur with regularity, it is time to investigate the underlying cause. The same can be said for any other apparently minor ailment, for it is the constant weakening of one part of the body that evokes serious complications.

A woman and her two young boys entered the office.
“I’d like to see the doctor, please,” she announced to the receptionist.
The girl at the desk smiled. “Do you have an appointment?” she asked.
“No. I was sent here by another doctor. I’d like to see him about my two boys,” replied the woman curtly.
“What is your name, please?” asked the girl.
“Mrs. T.,” was the brief reply.
In a moment, the girl was in and out of the physician’s private office. “The doctor can see you now,” she said, gesturing toward the open doorway.
In the private office, the woman seated herself opposite the physician, while the two boys proceeded to familiarize themselves with various objects about the room.
“I was sent here by Dr. R.,” began the woman. “He’s a nerve specialist, you know.”
The doctor assured her that he knew this.
“It’s about the boys that I came to see you,” she resumed. “But I’ll tell you this—I still think it’s a nerve specialist I need for them.”
“Let’s start at the beginning,” suggested the physician. “You may be correct, but I’ll be better able to tell when I know all the facts.”
“Well, they both have nervous stomachs,” the woman began.
“Are they subject to particularly rigid discipline at home?” asked the doctor.
“No. They get their own way most of the time. They’re pretty good boys for that age. They’re eight and ten. Of course, they aren’t angels, you understand, but then what boys are at that age?”
“Just how does this nervous stomach come about?” asked the doctor.
“That’s what I want to know,” the mother replied. “All I know is that they both wake up coughing in the middle of the night. At first I thought they had colds, but I soon found out that I was wrong.  Then,  they complained that their stomachs were jumping up and down.” “How long has this been going on?”
“Nearly a year,” answered the woman. “I first took them to Dr. L., a nerve specialist, but, when he wasn’t able to help them, he called in Dr. R. for a consultation.”
“Many physicians refer their patients to us when they come up against stone walls,” said the doctor. “I don’t say this egotistically; I say it so that you might realize how many ailments are due to specific bodily sensitivity.”
“I can’t think of anything the boys might be sensitive to, but, if you believe there is a chance of discovering something of that nature, I’m willing to have you try,” offered the woman.

The boys were energetic and somewhat difficult to work with. They could ask more questions in five minutes than a dozen quiz programs. These details were all recorded by the physician, for they convinced him that a certain amount of nervous energy was being burned constantly, and he knew that individuals! of this type were generally subject to the development of sensitivities.

The ordeal of running the regular food tests was finally completed after several weeks, and the boys were fortunate. There wasn’t a thing that had to be eliminated from their diet.

The contact tests were a bit easier since the boys were already accustomed to the procedure, although they still asked a lot of questions. Again there were no indications of sensitivity, so the bacterial tests were made. The results were the same.
By now, the mother was growing more and more skeptical. “It does look as though we have hit a stone wall again,” she offered.

“I don’t give up that easily,” the doctor replied. At the same time, he observed the two youngsters through the open doorway to the reception room. They had begun to amuse themselves by playing catch with one of the soft pillow seats of a reception room chair.
As the physician meditated on the next avenue of examination, he noted that the smaller boy, having been hit in the face by the pillow, began to sneeze.
“I’m going to make a strange request,” the doctor began.
“If it’s something to do with curing the boys, all you have to do is name it,” replied the mother.
“I’m coming to your home tonight; I have a theory that I want to check before making my further tests.”

Since this was agreeable, the woman and her children left the office.

That night, after the boys were supposed to be asleep, the doctor stood by their door. For a time, all was still. Then he heard soft sounds of restlessness within the boys’ room. Several words were mumbled, then there was a muffled giggle and, presently, the doctor heard strange sounds, as of a rug being beaten.

After several minutes of this, the doctor took the boys by surprise. He came into the room and switched on the lights. The parents followed in time to see the boys battering each other with their pillows. The boys were as sheepish as a couple of puppies caught doing something they knew was forbidden.

Turning to the parents, the physician laughed. “This is one time I’d rather you didn’t scold them,” he said. “They solved their problem for us.”
“What effect would a pillow fight have on their stomachs?” asked the father.
“Sensitivity toward the stuffing in those pillows. From the odor in the air, I’d say they were pine-filled,” replied the doctor. “The reaction could have appeared anywhere, but their point of least resistance is their stomachs. If you’ll bring the boys to my office tomorrow, I shall verify what I’ve told you.”
“But how can they be cured?” asked the mother anxiously.
“The treatment? That depends upon the degree of cooperation we can get from the boys. There will be two steps. We must have their faithful promise that there will be no more pillow fights,  and, at the same time, we must cover their pillows with a dust-proof casing.”

A suitable degree of cooperation between the physician and his patients over a period of several months brought fruitful results. The nocturnal coughing eventually disappeared, and so did the “jumping stomachs. ” Bronchial Asthma Written By: Jack A. Rudolph, M.D. & Burton M. Rudolph. M.D., Continue Reading, Hay Fever

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