CHAPTER XIII 



MISCELLANEOUS DISEASES 



ASTHMA 



The recognition that asthma and hay fever were to be grouped 

 among diseases due to sensitization of the patient in the nature of an 

 anaphylaxis, has opened a series of exceedingly valuable and interest- 

 ing investigative and clinical problems. Naturally the asthmas 

 due to cardiac impairment or anatomical alterations result- 

 ing from tuberculosis cannot be included in such a category, 

 but there is evidence accumulating that in this latter group of 

 cases we must admit certain elements of sensitization. In Wolff 

 Eisner's recent discussion one finds the admission that the tuberculous 

 individual presents a definite hypersusceptibility to a number of pro- 

 teins of nontuberculous origin so that asthmatic phenomena in tuber- 

 culous individuals are to be expected. So, too, in the true asthmatic 

 we must expect that attacks will be precipitated not only by specific 

 antigens but by a variety of metabolic alterations or shocks which 

 may bring about focal activation such as has been discussed in the 

 chapter of focal reactions. During pregnancy asthma may become 

 manifest (Hepworth, Salaberry), although as a rule the reverse is 

 more common that is, asthmatics are usually free from attacks. 

 Onset of attacks after remote trauma (Loeper and Codet) or psychic 

 disturbances are common examples of the phenomenon. 



As long as the conviction was entertained that desensitization was 

 as specific as sensitization, efforts at therapy naturally centered about 

 the determination of the particular protein that might be the cause 

 of the disease and the endeavor to bring about an increased resistance 

 or tolerance by subcutaneous injection of the antigen. Walker's 

 publications in this field are of particular importance. Walker's 

 method, which consists of desensitization by vaccination, is usually 

 followed by quite satisfactory and often permanent results. 



In recording observations on the treatment of asthmatics which 

 were sensitive to various proteins and also those in whom no specific 

 sensitization could be determined, Walker describes the therapeutic 

 result in this latter group of 150 patients who were not sensitive to 

 any protein with which they were tested. It may be well to quote 

 Walker's observations in full: 



"The following comparisons as regards treatment may be made 

 between sensitive and nonsensitive asthmatic patients. In the previous 

 article, which concerned patients sensitive to proteins, and in the 



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