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1) Eleven courses of intravenous ACTH by continuous infusion were given to 10 patients with severe bronchial asthma. 2) The total dose ranged between 10 mg. and 210 mg. given over a period of one to nine days. 3) Seven patients obtained excellent remissions lasting up to six weeks. The others obtained partial remissions only. There was no complete therapeutic failure. 4) One patient who demonstrated clinical resistance and eosinophil escape with i.m. ACTH responded promptly to i.v. ACTH. 5) Antibiotics should be administered concomitantly, particularly to those patients with bronchitic manifestations, to combat possible depressed resistance to infection produced by ACTH.

Pulmonary function studies were performed in forty-two patients with chronic bronchial asthma in the asymptomatic state after treatment which consisted of aminophyllin, 0.5 gm. intravenously, or neosuprel® bronchodilator, six inhalations by aerosol sprays. Pulmonary function studies performed after treatment gave the following results. (1) The average improvement in the vital capacity was 10.6 per cent after aminophyllin and 16.9 per cent after bronchodilator aerosols. (2) The average improvement in the maximum breathing capacity was 30.9 per cent after aminophyllin and 50.0 per cent after bronchodilator aerosols. (3) The average improvement in the index of intrapulmonary mixing was 32.7 per cent after aminophyllin and 28.8 per cent after bronchodilator aerosols. (4) The average residual volume decreased slightly. The average total lung capacity did not change appreciably after treatment. (5) The average improvement in the residual volume to total lung capacity ratio was 7.4 per cent after aminophyllin and 8.1 per cent after bronchodilator aerosols. Clinical and experimental data are discussed in relation to the possible mechanism involved in the pathologic physiology of bronchial asthma and the changes induced by treatment.

The antihistaminic and anticholinergic protective capacity in man of various combinations of diphenhydramine, ephedrine, and aminophylline is presented. Combinations of these agents retain the antihistaminic and anticholinergic activity of the most potent ingredient. Aminophylline appears to increase the antihistaminic effect of diphenhydramine, but nothing approaching arithmetic summation has been seen.

Summary A simple ruler-graph device has been described for use with single determinations of the vital capacity on a recording drum apparatus. This permits the rapid determination of the volume of air ejected during each second of the vital capacity tracing on a graphic record. The same record also affords an opportunity for analyzing the contour of the graph for evidence of trapping or change in mid-position. These time relationships enhance the value of the simple vital capacity determination. The relative efficacies of bronchodilator preparations in relieving the bronchospasm of the patient with bronchial asthma or pulmonary emphysema can be determined readily with this technique. This method was compared with the vitalometer. Both methods yield comparable values. The ruler-graph method, however, affords additional significant data, easily obtained by employing the apparatus which is generally in use in laboratories studying pulmonary function.

1.1. Eighty-two timed vital capacity measurements were studied in 36 patients with chronic bronchial asthma during (a) the symptom-free stage, (b) "spontaneous attacks," and (c) experimentally induced attacks of "asthma." 2.2. Symptom-free patients had a first second to total vital capacity ratio of 57.5 per cent. There was no significant change of the ratio after medication, although the component parts of timed vital capacity were improved. 3.3. The patients with spontaneous acute asthma had a first second to total vital capacity ratio of 58.1 per cent. This ratio decreased after the attack was relieved, because of the greater improvement of the total vital capacity rather than of the first second. 4.4. The patients with experimentally induced "asthma" had a ratio of 52 per cent. The ratio and its response to treatment showed a very close relationship to results obtained in spontaneous asthma. 5.5. Improvement in the total vital capacity, although subject to some criticism, may be employed as a guide to measure the over-all improvement of the asthmatic patient under treatment. 6.6. Timed vital capacity and all of its subdivisions represent a valuable technique for the quick estimation of the basic ventilatory disturbances. A decreased ratio of first second vital capacity to total vital capacity, in the presence of a markedly diminished total vital capacity, is a definite indication of the presence of obstructive ventilatory insufficiency. However, the ratio of first second to total vital capacity, considered alone, does not represent a valuable index of the degree of improvement of the asthmatic patient under treatment.