Wednesday, September 28, 2016

1851: Reid and Bergson verify spasmotic theory of asthma

Figure 1 --
While Reid and Bergson argued that asthma was spasmotic,
Dr. Carl (Karl) Friedrich Canstatt (1807-1850), pictured here, 
was a pioneer of medicine in Germany who, in 1855,
 wrote that a differential diagnosis of asthma didn't matter 
because anti-spasmotics were equally beneficial for both diseases.
  He believed asthma was a "spasm of the breathing organs"
 as opposed to accepting the spasmotic theory of asthma. 
(1, page 32)(5, page 32)(6)
The next in a series of experiments that confirmed the spasmotic and nervous theories of asthma were performed by Dr. John Reid and Dr. Joseph Bergson. Reid performed the experiments, and later, in 1851, Bergson used these to make his argument to disprove the paralytic theory of asthma, and prove asthma was only spasmotic and nervous.

M.H. Gill, in an 1850 edition of the Dublin Quarterly Journal of Medical Science, said Bergson was a physician from Hamburg, Germany, and that he wrote a prize essay based on experiments he performed with Amedee Lefevre. (3, page 373)

Figure 2 --Bergson, among other physicians, believed signals sent
 from the brainvia the vagus to the lungs caused an asthma attack.
 You can see by this diagram that the vagus feeds the various organs
 of the body, including the heart and lungs. Vagi is singular for vagus nerve.
 The vagus is responsible for all the things your body does without
you having to think about them, such as your heart beating, your mouth
 salivating, your eyes blinking, your lungs inhaling and exhaling, etc. 
Of course at the time the two prevailing theories regarding asthma were the spasmotic and nervous theories, although another theory that was gaining steam was the paralytic theory of asthma, which basically stated that paralysis of the muscles of respiration, the muscles that make you breathe, resulted in emphysema. 

The theory, therefore, postulated that emphysema was also a part of asthma. Berkart, therefore, believed Reid's experiments proved this paralytic theory wrong.  
Of this, J.B. Berkart, in his 1878 book "On Asthma," said: 
Bergson, however, denied the existence of a paralytic asthma, because, according to the experiments of John Reid, section of both vagi (figure 2) produces no dyspnoea so long as the animals are at rest and the supply of air unlimited—a fact duly confirmed by the later experiments of Rosenthal. Bergson, therefore, admitted only the spasmodic form of the disease, consisting in paroxysmal constrictions of the bronchi and air-vesicles, in consequence of a morbid irritability of the vagus. (1, page 28)
Ernest Schmiegelow, in his 1890 book, said:
It was especially after the publication of Bergson's prize work that a decided separation was made between the idiopathic nervous asthma, characterized by its periodical attacks, which are separated by perfectly free intervals, and the numerous forms of difficulty in breathing, which appear purely symptomatic in many different complaints of the chest. To Bergson the idiopathic nervous asthma is an independent neurosis of the organs of the chest, whose origin is a cramp or spasm which like all other neuroses can be caused by a central or peripheral irritation of the nervous centre. (2, page 4)
Gill said Bergson described asthma this way:
Having detailed a number of experiments from various sources, as the result of which our author considers himself justified in the conclusion that the asthmatic fit consists in a spasmodic contraction of the bronchial and pulmonary air-cells, caused by the action of the par vagum on the muscular fibres in these structures, so that he thinks it may properly be termed spasmus bronchialis, he divides it into two kinds: the first proceeding from the brain (cerebral asthma), and the second from the spinal marrow (spinal asthma). (3, page 377) 
In other words, he believed, as with other asthma experts of his era, that asthma was both nervous and spasmotic; that irritation of the nervous center by various stimuli triggered the muscular fibers that wrap around the lungs to spasm, thus causing the various symptoms of asthma.

Further reading:
  1. 1851: Bergson describes typical asthma attack (2/23/16)
References:
  1. Berkart, J.B., "On Asthma: It's Pathology and Treatment," 1878, London, J. & A. Churchill
  2. Schmiegelow, Ernest, "Asthma, considered specially in relation to nasal disease," 1890, London, H. K. Lewis; he references the following source; Bergson, Das krampfAsthma der Erwaohsenen, Nordhausen, 1850.
  3. Gill, M. H., "Review and Bibliographic Notices: "On the spasmotic asthma of adults," by Bergson, published Gill's book, "The Dublin Quarterly Journal of Medical Science," volume X, August and November, 1850, Dublin, Hodges and Smith, pages 373-388
  4. Freudenthal, Wolff, "Bronchial Asthma," New York Medical Journal: A Weekly Review of Medicine, edited by Edward Swift Dunster, James Bradbridge Hunter, Frank Pierce Foster, Charles Euchariste de Medicis Sajous, Gregory Stragnell, Henry J. Klaunberg, Félix Martí-Ibáñez, volume CV, January-June, 1917 (Saturday, January 6, 1917), New York, A.R. Elliot Publishing, Co., pages 1-5
  5. Brown, Orville Harry, "Asthma, presenting an exposition of nonpassive expiration theory," 1917, St. Louis, C.V. Mosby Company
  6. Karl Friedrich Canstatt "Images from the history of medicine," nlm.nih.gov, http://ihm.nlm.nih.gov/luna/servlet/view/all/what/Portraits?os=18800&res=2&printerFriendly=1, the photo is in the public domain, accessed, 3/10/14
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Monday, September 26, 2016

1850: Todd says asthma disease of mind

Robert Bentley Todd (1809-1860)
He was born in Ireland in 1809, and he became known as the intoxicated physician.

He was known to roll in on his carriage "to visit patients equally intoxicated by the quantities of alcohol he had prescribed for them," said F.F. Cartwright in 1974.  (1, page 893)

Cartwright said he was known to prescribe a pint and a half a day of alcohol, his famous remedy. (1, page 893)

Cartwright said that such an exorbitant prescription for alcohol was not out of the norm for this period of time.  So we must not use this bit of wisdom in judging the famous doctor. (1, pages 893-894)

He qualified in Dublin in 1831, and then joined the Aldersgate School in London in that same year as lecturer of anatomy and physiology.  In 1836 he moved to Westminster and became elected to the Chair of Physiology and Morbid Anatomy. He was only 27-years-old at the time. (1, page 894)

Cartwright said that lectures at medical schools were a rare treat prior to Dr. Todd, although his lectures became so popular with the students that other schools adapted the practice.  Cartwright quotes his obituary, which stated:
Physiology was ill defined in those days; it was meant the study of the healthy body as opposed to morbid anatomy, the study of the deceased body.  Todd described himself as an anatomical physician.  What he meant was that the science of medicine depended upon the study of anatomy just as did the science of surgery. Naked-eye anatomy was not sufficient; with his great friend, William Bowman, Todd was largely responsible for popularizing the microscope as an essential instrument in diagnosis. He insisted the accurate diagnosis must always precede treatment, a desideratum by no means universally accepted at that time. (1, pages 894-895)
His research with the microscope lead him to some significant discoveries, such as cirrhosis of the liver, which became known as Todd's Disease.  Such discoveries ultimately lead him to publishing some significant medical books, such as "Cyclopedia of Anatomy and Physiology of Man" in 1843.

In the year 1851 he hired Dr. Henry Hyde Salter to be his assistant, even assisting him write the final two volumes of his "Cyclopaedia of Anatomy and Physiology." (4, page 887)

Dr. Salter ultimately became the preeminent expert on asthma.  Dr. Salter believed there was too much evidence to refute the argument that asthma was spasmotic, although Dr. Todd Thought otherwise.  In his book "On Asthma: Its Pathology and Treatment," which was originally published in 1860, Dr. Salter described Dr. Todd's theory regarding asthma, and gives his reasoning why, to him, it was poppycock. (3, page 26-27)

Dr. Salter said:
In an interesting clinical lecture, published in the Medical Gazette for December, 1850, Dr. Todd advances the opinion that asthma depends upon a poisoning of the nerves of respiration, or those portions of the nervous centres with which they are connected, by a particular materies morbi, by which their function is so perverted, that a spurious and morbid sense of want of breath is engendered; that this central or subjective breathlessness is the first step in the morbid phenomena; that it need have no real objective cause in the lungs themselves; that bronchial spasm is an accompaniment, not a cause, of the dyspnoea of asthma; and that you may have asthma without any bronchial contraction whatever.
Dr. Todd's argument is this—In many points asthma resembles gout; gout is humoral; therefore asthma is humoral. Again—you may have asthma with puerile breathing; with puerile breathing the bronchi cannot be contracted; therefore asthma may co-exist with uncontracted bronchial tubes.
But let me give in his own words the views of one whose opinions always carry with them so much weight.
"Like asthma," says Dr. Todd, "gout comes on quite suddenly; there is no warning. A man may go to bed quite or nearly well, and may wake up early in the morning with a fit of the gout in his great toe. There is another disease, epilepsy, in which we have exactly the same phenomenon. A patient, with or without warning, falls down foaming, livid, and convulsed; the paroxysm goes off and leaves him in his ordinary good health, and he may go on for years and not have another. Again—we know a fit of the gout leaves no organic lesion if it occurs once or twice, but, if it is often repeated, it leaves permanent injury in the joints it attacks. The same of asthma; the organic changes are all secondary, and a few attacks leave no traces behind them.
"The theory at present most in favour with regard to gout is, that it is a disease of assimilation, and that this defective or vitiated assimilation gives rise to some materies morbi. When this matter is eliminated from the system the attack passes off; when it accumulates the attack comes on. In asthma defective assimilative power is a frequent coincident. Gout, too, and rheumatism, and all humoral diseases, resemble asthma in being inherited.
"When the materies morbi of asthma has been generated, its effect is to irritate the nervous system, not generally, but certain parts of it, those parts being the nerves concerned in the function of respiration, viz., the pneumogastric, and the nerves that supply the respiratory muscles, either at their peripheral extremities or at their central termination in the medulla oblongata and spinal cord; extreme difficulty of breathing is the result, and, as a consequence of this, ultimate disease of the lungs.
"Many pathologists ascribe all the phenomena of asthma to spasm of the circular muscular fibres of the bronchi. The first link in the chain of effects of the immediate exciting cause of asthma would be, according to them, spasm of the bronchial tubes, then dyspnoea. Undoubtedly, a state of spasm of the bronchial tubes would produce a great deal of dyspnoea; but what I want to point out to you is, that this state of spasm of the bronchial tubes ought rather to be regarded as one of the accompaniments, one of the phenomena, of asthma, than as its cause. The feeling of breathlessness, or, in other words, a peculiar state of certain nerves, or of a certain nervous centre, the centre of respiration, is the first link in this chain of asthmatic phenomena. The spasm of the bronchi follows sooner or later upon this, and often it follows so quickly upon it as to appear to come simultaneously with it. Does it ever precede it? I doubt this.
"Undoubtedly you may have severe asthma without severe spasm of the bronchial tubes. I remember a well-marked instance of this in a gentleman whom I attended for a chronic disease—cancer, as I thought, of the liver. For nearly a week before his death he suffered from the most frightfully distressing asthma, which nothing could control, and which lasted without interruption till he died. I examined his chest repeatedly at all parts, and could hear nothing but the most perfect, loud, and puerile breathing, which is quite inconsistent with a state of spasm.
"Again, a section of the vagi nerves of animals produces phenomena exactly like those of asthma. Whatever be the cause of the dyspnoea in these cases, it is clear it cannot be bronchial spasm, as the muscles of the bronchi would be paralyzed after a section of their nerves."
With regard to the first part of Dr. Todd's theory, founded on the supposed analogy of asthma to gout—that you have in asthma a specific materies morbi—I do not think that the existence of points of analogy in the clinical history of the two diseases in any way implies identity of pathology. To how many diseases are headache, shivering, Joss of appetite, thirst, an accelerated pulse, and loaded tongue common, between the pathology of which there is no affinity whatever? With regard to the second part of his theory—the coexistence of asthma with uncontracted bronchial tubes—I believe that the case that he quotes is one of that subjective dyspnoea, not asthma at all, to which I have already referred. In the anhelitus consequent upon the division of the vagi, I can see nothing resembling asthma. Altogether, I cannot but think that the arguments brought forward by Dr. Todd are inadequate to meet the mass of evidence that can be adduced in proof of the necessity of bronchial spasm and the non-necessity of humoral disturbance in asthma. (3, page 26-67)
Dr. Todd made some significant contributions to medical profession, yet his theory regarding asthma was not one of them.  Still, we don't hold this against him, because it shows, once again, the variety of theories about this disease even into the middle of the 19th century.

He lived only 50 years, yet he accomplished an "enormous amount of constructive work," said Cartwright. (1, pages 893-894)

References:
  1. Cartwright, F. F., "Section of the History of Medicine: Robert Bentley Todd's Contributions to Medicine," Proceedings of the Royal Society of Medicine, September 6, 1974, 67 (9), 893-897
  2. Brown, Orville Harry, "Asthma, presenting an exposition of nonpassive expiration theory," 1917, St. Louis, C.V. Mosby Company, page 33
  3. Salter, Henry Hyde, "On Asthma: It's Pathology and Treatment" 1864, London, Blanchard and Lea, pages 24-25
  4. Sakula, Alex, "Henry Hyde Salter (1823-71): a biographical sketch," Thorax, 1985, 40, pages 887-888 (Henry Hyde Salter)

Friday, September 23, 2016

1849: Great inventors at the dawn of modern medicine

The man who would become the father of modern medicine was born in Canada on July 12, 1849.  His parents would name him William Henry Osler. He was born into an era where medicine was changing for the better, and he would grow to become a significant part of it.

Yet a post about the life and times of the infamous Dr. Osler won't come on this blog for another few months.  First we must consider medical significance of the era to which he was born into.

It was an era, they say, where physicians were just starting to adapt to new equipment, such as the stethoscope, laryngoscope, thermometer and microscope.  Students were just starting to learn about them, and physicians just starting to adapt them into their daily practice.

The incorporation and use of these devices would allow physicians to learn what went on inside the body that affected what went on outside the body.  It was by knowledge obtained by their investigations with these tools that antiquated medical theories about medicine were being reviewed.  Those proven true were further substantiated, and those proven false were cast away.  

The following are some of the significant contributions that affected the medical community at this time:

Oliver Wendell Holmes (1809-1894)
was among the first to realize
fevers may spread by unclean hands.
 (4, page 457)
1843:  Oliver Wendell Holmes announced to the medical community that women in child bed should not be attended by physicians who had been studying the victims of perpetual fever. He was concerned the causative agent might be spread to the mothers and their babies. He recommended that physicians and medical caregivers wash their hands and change their clothing after leaving patients infected with perpetual fever. He received harsh criticism from his fellow physicians who were in harsh opposition to change. (4, page 457)

Ignaz Semmelweis (1818-1865)
proved hand washing between patients
 reduced the spread of sickness.
He was mocked and ignored.
(4, page 458)
1846:    Ignaz Philipp Semmelweis became an assistant in an obstetric ward in Vienna where there was such a high death rate from child bed fever that women feared to go there. Semmelweis observed the death rate was higher in the 1st ward where he and his fellow male physicians worked compared to the 2nd ward where female mid wives worked. Upon investigation he learned the women were much cleaner in appearance than the physicians, who often walked proudly around with blood stained hands and aprons. The physicians also were more likely to perform postmortem investigations just prior to checking the vagina. The women, on the other hand, did not have blood stained clothes and washed their hands in calcium chloride solution between patients. When he insisted his physicians likewise wash their hands and put on clean clothes prior to checking women in child bed, the death rate fell from 9.92% to 3.8%. The following year it was down to 1.27%. The proud physicians were unhappy, and eventually rejected Semmelweis. After they went back to their old poor habits, the death rare once again duly rose. (4, pages 457-8)
Charles Darwin (1809-1882)
His theory of evolution
may have been controversial,
yet it helped transform medicine.

1859:  Charles Darwin, the grandson of Erasmus Darwin, published his "Origin of Species" in which he introduced his theory of evolution. Surely it resulted in much scrutiny and controversy, but this may have been one of the key publications that helped to spark the scientific revolution, of which the medical profession was one of the main beneficiaries. However, and to be expected, many proud and stubborn medical professors and physicians refused to let go of old theories. Yet the few who did continued investigating, and scientific evidence would ultimately force change, and change for the better.
Louis Pasteur (1882-1895)
His Germ theory of Medicine
Revolutionized medicine 

1865:  Louis Pasteur discovered that microbes were the cause of diseases. He invented vaccinations for anthrax, cholera, consumption and smallpox." (3)
Joseph Lister (1827-1912)
invented a rinse to disinfect wounds.
It was also useful for cleaning mouths.

1870s:  Joseph Lister discovered that antiseptic use reduced post surgical infections.  He was a British scientist and physician who observed that about 50 percent of amputation patients survived the surgery but died later of septic fevers, or what was known as "ward fevers."   With knowledge of the works of men like Pasteur and Semmelweiz, Lister surmised microbes in the air were infecting wounds, and so he used phenol as an antimicrobial to reduce the death rate by 15 percent. (4)  He recommended the antimicrobial carbolic acid to be placed on bandages to keep the wounds clean, and he invented a machine to pump carbolic acid into the air in the rooms where surgeries were being performed.  Post operative mortality rates plummeted. (5)

Listerine bottle from the 1920s
1879:  While working with Jordan Wheat Lambert (1851-1889), Lister invented an antiseptic to use during surgeries.  In honor of Lister's discovery, Lambert insisted the product be named "Listerine," introducing it to surgeons in 1879.  The product was so successful that it was ultimately marketed to dentists as an oral rinse in 1895, and to the public as a mouthwash in 1914.  The product is still available on the market to this day (although the taste has been improved).

A young William Osler must have been inspired by all this wisdom, becoming so rapt that he cast aside his father's dream that he go into the ministry, and instead studied medicine.

References:
  1. "Sir William Osler At Seventy -- A Retrospect," The Journal of the American medical Association," 1919, Saturday, July 12, pages 106-108
  2. Osler, William, "The Principles and Practice of Medicine," 1892, New York, pages 497-501
  3. Bliss, Micheal, "William Osler:  A Life in Medicine," 1999, New York
  4. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1921, London and Philadelphia, 
Further readings:
  1. Jackson, Mark, "Asthma: The Biography," 2009, New York, pages 211-12
  2. Brenner, Barry E, ed., "Emergency Asthma," 1998, New York, pages 212-14
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Wednesday, September 21, 2016

1848: The Chambers dry powdered inhaler

Surely there were powders that were inhaled since the beginning of time.  People would sun dry and crush herbs, and then inhale the powder.  Sometimes they'd use a funnel.  One of my patients said he used to inhale asthma powder in the 1950s with a funnel he made with a magazine.

Thomas K. Chambers, in 1848, announced that he believed the inhalation of powder would allow for the direct application of medicine to the lungs, which are otherwise "inaccessible." (1) (2)

For doing this he introduced a glass funnel of his own design specifically made to inhale a very fine powder of pollen of lycopodium or club moss with nitrate of silver or sulphate of copper, or both. (1) (2)

The device and how to use it was described by Chambers in the Boston Medical and Surgical Journal in February of 1849:
The patient should introduce into his mouth, as far as he can without choking, a well-dried glass funnel, and draw in his breath strongly, whilst he himself, or a second parly, dusts the powder in a dense cloud into the large end with an ordinary nursery puff-ball. If the dust is raised by an attendant, the patient can indicate the moment he inspires by raising his hand. 
To obviate the necessity for withdrawing the funnel after each inhalation, to prevent the dust being blown about the room, an apparatus with a double valve and a closed powder-box may be used, which allows the dust to pass inwards only; but the necessary employment of metal makes the machine less agreeable than the more awkward but cleaner looking and less formidable glass.
Chambers describes that inhaling such a "dust" is an "inconvenience" and often induces coughing, yet it's better than "introducing a sponge to the larynx, as has been recommended."

While Chambers said his inhaler was nice for inhaling medicine, it was far more complicated to use than inhaling fumes from a sponge or other such devices.

References:
  1. Sanders, Mark, "Pioneers of Inhalation," Inhalatorium.com, a slideshow by Mark Sanders, http://www.ddl-conference.org.uk/files/DDL20presentations/19.Sanders.pdf
  2. Chambers, Thomas, "Inhalation of Nitrate of Silver,"Boston Medical and Surgical Journal, February to August, 1849, Edited by J.V.C. Smith, Volume XL, Boston, David Clapp,  pages 394-5
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Monday, September 19, 2016

1848: Rudolf von Kolliker strengthens convulsive theory of asthma

Rudolf Albert von Kolliker (1817-1905) (5, page 489)
In the 18th century William Cullen believed muscle was a continuation of a nerve, and he used this as his proof that asthma was a nervous disorder.  In 1848, a Swiss histologist by the name of Rudolf Albert von
Kolliker proved Cullen's claim to be wrong.

Kolliker was born on July 6, 1817, in Zurich, Switzerland  He began his secondary education at the University of Zurich in 1836, and then the University of Bonn in 1838.  He later studied at the University of Berlin where he became a pupil of two great physicians by the names of Friedrich Gustav Jakob Henle and Johannes Muller.  From these men he learned about the microscope and microscopic anatomy.  (1, page 422)(2, page 194)(3)(4)

Friedrich Gustav Jakob Henle (1809-1885) was
one of Johannes Muller's pupils, one of his prosectors,
and later one of von Kolliker's professors.
 He became the greatest histologist of his time,
and one of the greatest anatomists of all time.
 (5, pages 483-486)(6)
He received his medical degree from Heidelberg in 1842, and became Henle's prosector in 1843 (that means that he prepared a dissection for demonstration). This set him up nicely to become professor of anatomy and physiology at Zurich in 1844.  In 1847 he became professor of anatomy and physiologyat Wuzburg, where he was offered an opportunity to specialize in microscopic anatomy, and where he spent the rest of his active life. (1, page 422)(2, page 194)(3)(4)

He was among the first physicians to study the microscopic structures of the body, and he proved that cells did not just form on their own, only by existing cells.  He also was the first to isolate and observe minute cells called smooth muscle cells (unstriated muscle cells), and advanced scientific knowledge of nerve cells, nerve fibers, and red blood cells. (1, page 422) (2, page 194)(3)(4)

Johannes Muller (1801-1858) was one
of the first physicians to use the microscope
to study the microscopic structures
of the body.  (5, pages 475-478)
Upon further inspection, he discovered that smooth muscle cells lined the bronchiolar air passages all the way down to bronchioles as small as 0.18 milimeters in diameter. (2, page 194)

By his study of such minute structures of the human body he became one of the fathers of histology, or the study of tissues.

His research helped strengthen the convulsive or spasmotic theory of asthma in that he confirmed both the studies of Franz Daniel Reisseissen, who proved muscular fibers wrap around the air passages, and J.B. Williams, who proved these fibers constrict when stimulated.

He resisted all offers to take him away from the "quiet academic life of the Bavarian town, where he died on the 2nd of November 1905. (4)

References:
  1. Daintith, John, editor, "Biographical encyclopedia of scientists." 2009, 3rd edition, Florida, CRC Press
  2. Geddings, W.H., author of the chapter on "Bronchial Asthma," in the book  "A System of Practical Medicine," edited by William Pepper and Louis Star,Volume 3, 1885, Philadelphia, Lea Brothers and Co.
  3. "Rudolf Albert von Kolliker," britannica.com, http://www.britannica.com/EBchecked/topic/321429/Rudolf-Albert-von-Kolliker, accessed 4/4/14
  4. "Rudolf Albert von Kolliker," 1911 Encyclopedia Britannica, http://www.studylight.org/enc/bri/view.cgi?n=28434&search=span, accessed 4/4/14
  5. Garrison, Fielding Hudson, "An introduction to the history of medicine," 3rd edition, 1821, Philadelphia and London, W.B. Saunders Company
  6. "Friedrich Gustav Jacob Henle," britannica.com, http://www.britannica.com/EBchecked/topic/261245/Friedrich-Gustav-Jacob-Henle, accessed 4/4/14
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Friday, September 16, 2016

1847 definition: Asthma the opposite of consumption

As noted in the writings of Dr. Francis Ramadge, a common belief around the middle of the 19th century was that asthma was the opposite of consumption. This theme was further acknowledged through the writings of Dr. Samuel Fitch in his book "Six lectures on the uses of the lungs.

He said: 
"It is a disease caused by consumption or consumptive tendency in the lungs, and always arrests the progress of consumption.  It is a vastly lesser disease given in place of a greater, and instead of being a curse, is a greater blessing.  In consumption, the lungs are too small; in asthma they are too larger.  A disease like asthma may be produced by ossification of blood vessels of the heart; but in nearly all cases, it is produced by consumptive irritation of the lungs.  It often takes place suddenly, in earliest childhood, continues until between 12 and 20, then goes off and is never seen again; but the person falls victim to consumption.  Or asthma my reappear and secure the patient from consumption.  If properly treated it is a passport to old age; but when badly treated it may terminate in dropsy of the chest." (1, pages 69-71)
Next to this description is a picture of an asthmatic rib cage and a consumptive rib cage. The asthmatic rib cage is large and expanded as thought the patient had his chest puffed out.  The consumptive rib cage is small, narrow and weak.

Thus, Fitch believed since asthma produces a larger rib cage it protects against consumption.  It's strong and mighty while consumption is weak and frail.  While both are diseases that cause discomfort, asthma is minor compared to consumption.  Asthma is temporary and goes away, and consumption is long lasting.

Yet under it all he believes consumption causes asthma in some cases, and this is good because asthma protects against the wasting effects of the underlying consumption. (1)

He wrote:
"Asthma all but always cures consumption, or what is made consumption by very bad treatment.  The asthma leaves the person, and he rapidly is overcome by the consumption that had always been on him whilst he had the asthma, and resumes it's rapid and fatal course, on asthma leaving him.  If asthma is cured without perfectly expanding the lungs, and keeping them so, the person is extremely liable to consumption."
Asthma is a blessing and masks the underlying diseases, and even protects the person from wasting or consumption. He describes a patients who had asthma, didn't take care of it not knowing he had underlying consumption, and died of consumption. (1)
"As in heart disease, woe to the person who is cured of asthma.  Without a free, and perfect, and continued expansion of the chest; as he will, in nearly all cases, sooner or later fall into consumption."
The patient must be brought up well, he proposes.  He must be exposed to outdoor occupations and he must exercise.  This is how to treat asthma and prevent it from going away so consumption doesn't show it's ugly head again, destroy him, and ultimately kill him.

So basically he's saying take care of your asthma if you have it because it's a blessing protecting you from the course of your underlying consumption.

There were other physicians who had similar beliefs about asthma and consumption.  Orville Harry Brown gives us the following quote from two physicians named Hall and Hall (further detail eludes me):  (2, page 33)
"Asthma is a spasmodic contraction of the membranous portion of the windpipe. In consumption the patient dies because there are not lungs enough to receive sufficient air for the wants of the system; that is, they cannot get enough air in; while in asthma they cannot get enough air out; hence asthma and consumption are antagonistic, the former is preventive of the latter and a consumptive is cured on the supervention of asthma."
The idea of asthma as an underlying disease, and of asthma as a blessing, is ironic to say the least.  This was not the first time in history that asthma was considered a blessing, as the ancient Greeks believed asthma was a blessing from the gods.

References:
  1. Fitch, Samuel Sheldon, "Six lectures on the uses of the lungs," 1847, London, H. Carlisle
  2. Brown, Orville Harry, "Asthma, presenting an exposition of nonpassive expiration theory," 1917, St. Louis, C.V. Mosby Company
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Wednesday, September 14, 2016

1844: Dr. Andral writes about asthma

Gabriel Andraw (1797-1876)
Gabriel Andral, in the 1857 edition (the 4th edition) of his book, "Clinique Medicale," described asthma as nervous, and "in one instance at least," wrote Orville Brown, "he expressed his opinion that it might have come from a 'metastasis of rheumatism to the lungs.'" (1, page 34)(2, page 99)

Dr. Andral was a French physicians who became known as the father of "analytical and inductive pathology. (4, pages 186-187).

He is likewise known as the first person to use the terms anaemia and hyperaemia to describe the presence of too few and too many red blood cells in the body.  He is likewise referred to as the father of haemotology (the study of blood).

In the 1844 edition of "Clinique Medicale," he said that people with air passages that are chronically inflamed are diagnosed with chronic bronchitis.  This chronic inflammation often results in the walls of the air passages becoming "thickened," which results in "a diminution in the size of the cavities through which the air is to pass..." and these patients "have ordinarily a certain degree of dyspnoea, which from time to time assumes all at once a much greater intensity, and becomes changed into a real attack of asthma." (2, page 86)

Andral also described another  form of asthma that occasionally formed by "engorgement of the bronchial mucous membrane.  He referred to it as bronchial asthma:
There are persons who ordinarily present no sign of bronchitis, who do not cough, who have no shortness of breath, and who at certain intervals, are suddenly seized with the following symptoms: oppression, which rapidly becomes most intense; imminent suffocation; violet injection of the face, as in persons in a state of asphyxia; pulse small, hard, and rather frequent; cough at first dry, but afterwards accompanied with a copious expectoration, the appearance of which .coincides with the dyspnoea. These different symptoms set in suddenly; they very quickly attain their highest degree of intensity; then they diminish, and at the end of a few days they disappear, without leaving any trace behind them. What is the cause of this frightful dyspnoea, which thus seizes an individual in the midst of the most perfect health, which throws him all at once into unspeakable anguish, and threatens to kill him by asphyxia? (2, page 86
The patient will probably also present with emphysema of the lung, and palpation of the heart due to "temporary embarrassment of the pulmonary circulation."  The embarrassed circulation may ultimately "become modified in its texture, and in a later period become really diseased." (2, page 87)

There are a variety of causes for an attack of asthma in an otherwise healthy individual.  In one example a child has "tumefaction (swelling) which momentarily affects the mucous membrane of the bronchi, most frequently after a new cold contracted by the patient." (2, page 87)

When sudden onset dyspnea causes with no signs of organic lesions, when no other causes can be found, "either in young or plethoric persons, or in persons remarkably nervous. Young persons of both sexes, women affected with irregular menstruation, present frequent examples of "nervous asthma." (2, page 112)

He wrote:
Intense dyspnoea, genuine fits of asthma, have been sometimes seen to come on all at once, after a violent mental emotion, in persons whose breathing had been till then perfectly free. (2, page 112)
In such cases of nervous asthma he wondered if "the best remedy for them is often intense distraction." (2, page 112)

He does describe one case (as noted above) where there were no lesions, and nervous asthma was suspected.  However, upon "close inspection of the bronchi... metastasis of rheumatism to the lungs" was discovered. (2, page 112)

Such cases as this show the inexplicable nature of asthma for this era.  

Generally, however, his treatment for asthma included "blood letting, both local and general, blisters applied to the chest and extremities, repeated purgatives, antimonials, such are the means which have appeared to us to afford most relief under such circumstances." . (21, page 87)

It is of his opinion that purgatives work best, "but it is on the condition of their producing copious evacuations." (21, page 87)

Along with being associated with emphysema and bronchitis, and along with describing cases of nervous asthma, he likewise believed it was spasmotic in nature.  (2, page 250)(3, page 14)

This places him in line with many of the other asthma experts of his era.

References:
  1. Brown, Orville Harry, "Asthma, presenting an exposition of nonpassive expiration theory," 1917, St. Louis, C.V. Mosby Company
  2. Andral, Gabriel, "Medical Clinic: Diseases of the Chest," Volume II, Diseases of the Chest, 1843, Philadelphia, Ed Barrington and Geo D. Haswell
  3. Thorowgood, John C., "Asthma and Chronic Bronchitis: A New Edition of Notes on Asthma and Bronchial Asthma," 1894, London, Bailliere, Tyndall, & Cox
  4. Kellog, Day Otis, editor, " The Encyclopedia Britannica," volume XXV, 1902, New York, Ohio, Chicago, The Werner Company 
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