Asthma, due to digestive disturbances, was first described by Henoch1 under the name of asthma dyspepticum. The original communication of this clinician referred to its occurrence during acute digestive disturbances in children. His cases all ran their course under alarming symptoms - the dyspnoea being of a high degree and attended with cyanosis and cold extremities - and failed to improve under the ordinary stimulants, but entirely recovered after a treatment directed against the disturbances of the digestive tract.

Silbermann,2 Barie,3 Lauterbach,4 Oppler,5 Boas,6

1 Henoch: "Ueber Asthma dyspepticum." Berl. klin. Wochensehr., 1876, No. 18, p. 241.

2 Oscar Silbermann: "Zur Lehre vom Asthma dyspepticum der Kinder." Berl. klin. Wochenschr., 1882, No. 23, p. 848.

3E. Barrie: "Recherches cliniques sur les accidents cardiopulmo-naires eonsecutifs aux troubles gastroh6patiques." Revue de Medecine,. iii., 1888.

4M. Lauterbach: "Asthma dyspepticum in Folge atonischer Ver-dauungsschwache." Wiener med. Presse, 1894, No. 48, p. 1841.

5B. Opplcr: "Ueber Asthma dyspepticum." Allgem. med. Central-Zeit., 1896, No. 71, p. 849.

6.T. Boas: "Ueber Asthma dyspepticum." Arch. f. Verdauunga-kmnkh.. Bd. ii., 1896. p. 444.

Ehrlich,1 Murdoch,2 and myself3 have written on this subject.

Cases of dyspeptic asthma can conveniently be classed into two main groups: (1) Cases in which dyspeptic asthma appears in an acute form, periodically; (2) cases in which dyspeptic asthma assumes a more chronic type.

The first group is characterized by the occurrence of attacks of asthma at more or less prolonged intervals, either without an apparently preceding cause or after distinct excesses in eating, drinking, smoking, or after undue excitement. The attack is usually of a very severe type, often assuming alarming symptoms - extreme dyspnoea, cyanosis, almost collapse.

The second group, that of chronic dyspeptic asthma, embraces the larger number of cases, and may again be divided into two separate categories: (a) cases in which the attacks of asthma appear quite soon after meals, either without any particular provocation or after some slight exertion; (6) cases in which the attacks usually occur two or three hours after meals, either spontaneously or again after some exertion - walking, etc. In a certain number of the latter category the attacks can be checked by partaking of a small amount of food.

Cases belonging to category (a), of group 2, resemble very much true angina pectoris, which is so often encountered in arteriosclerosis of the coronary arteries. Their differentiation from the latter is often very difficult. For even in true angina pectoris at the beginning there will be attacks without any discoverable lesions of the heart or blood-vessels. Such cases may for a long time appear as dyspeptic asthma until all of a sudden there are distinct signs indicating the heart involvement, as, for instance, a sudden appearance of albumin in the urine or irregularity of the pulse, etc.

1 F. Ehrlich: "Casuistisehcr Beitrag zum Asthma dyspepticum." Arch. f. Verdauuugskrankh., Bd. v., 1899, p. 120.

2F. H. Murdoch: "Dyspeptic Asthma." New York Medical Journal. January 12th, 1901, p. 58.

3Max Einhorn: "Dyspeptic Asthma." The Journal of the American Medical Association, February 1st, 1902.

The differentiation between dyspeptic asthma belonging to this category and true angina pectoris is not always easy. As a rule, however, cases of dyspeptic asthma are amenable to treatment; that means that a rational regime with regard to the digestive apparatus is followed by good results. These cases also are often capable of a permanent cure. Cases of angina pectoris, however, caused by cardiac lesions - if the latter are not manifest - are much less amenable to treatment, and if improved, the amelioration is only transient.

A great many of my cases of dyspeptic asthma have been examined with regard to the secretory condition of the stomach. Although no constant anomalies were found, it is noteworthy that a considerable number of the patients suffered from achylia gastrica; hyperchlorhydria likewise was often encountered. In both these conditions a rational treatment of the gastric affection was frequently crowned with favorable results as far as the disappearance of asthma was concerned. The explanation why two such contrary conditions may produce the same phenomenon may be found in the fact that in both probably an undue irritation of the gastric mucosa takes place. In hyper-chlorhydria it is the hyperacid gastric juice, in achylia the mechanically unchanged coarse particles of food, which irritate the mucous membrane of the stomach and thus reflexly the vagus fibres.

In those cases in which the gastric secretion is more or less normal it will be necessary to assume a condition of hyperaesthesia of the stomach in order to explain the cause of the asthma. This was already done by Boas.

Floating liver was noted in a considerable number (five) of these cases. There is hardly any doubt in my mind but that the abnormal position of the liver, dragging the diaphragm downward, is the cause of the existing dyspeptic asthma in these cases.

The treatment must be directed first toward relieving any existing disorders of the digestive tract; second, toward correcting any abnormal position of the abdominal organs, principally the liver. A regular mode of life, avoidance of too much tobacco and alcoholic drinks, also of too much mental worry and strain, is always of importance. By paying attention to these points the majority of cases of dyspeptic asthma will not only be temporarily relieved, but often radically cured.