Wednesday, December 4, 2013

1700-1940: "The asthmatic pants into old age."

There is a stunning array of evidence that prior to the 1950s, and even into the 1980s, physicians had a view of asthma as a benign disease; that morbidity (severity) and mortality (the death rate) from asthma was negligible.  The evidence comes in the form of quotes from the physicians themselves.

Dr. William Cullen (1710-1790), who wrote extensively on asthma, said:
"The asthma, though often threatening immediate death, seldom occasions it; and many persons have long lived under this disease. In many cases, however, it does prove fatal; sometimes very quickly, and perhaps always at length." (6, page 451)
Dr. William Withering (1741-1799), who recommended the diuretic digitalis for asthma, said:
  "The disease does not cut short the usual period of life." (4)
Dr. Rene Laenec(1781-1826) , the inventor of the stethoscope, said:
Asthma gives the patient the best hope of a long life. (9)
An attack of purely nervous asthma is rarely fatal. (17, page 443
Dr. Armand Trousseau (1801-1867)said:
Asthma was "the certificate of a long life."  (9) 
Dr. Francis Hopkins Ramadge, in his 1835 book "Asthma, its species and complications," said:
The prognosis of asthma is seldom difficult.  Doubt can arise only in cases severely complicated. When asthma wears the purely nervous form, danger is rarely to be apprehended." (18, page 36)
 Dr. Henry Hyde Salter, in his 1882 book "On Asthma: It's Pathology and Treatment, said:
"Asthma never kills; at least I have never seen a case in which a paroxysm proved fatal." 
(2, page 82)
Salter also said this:
"If death did take place from asthma it would by by slow asphyxia -- by circulation of imperfectly decarbonized blood; and before this occurred I think the spasm would yield."
Dr. J.B. Berkart, in his 1878 book "On Asthma: It's Pathology and Treatment," said:
"The prognosis of life is generally favorable.. the patient lives to the age of seventy and beyond, in spite of the intercurrent attacks of dyspnea." (10, pages 204-205)
Dr. John Thorowgood, in his 1878 book "Notes on Asthma," said:
During the intervals between his attacks the patient probably enjoys fair health, and, as a rule, lives to a good age; should he, however, be cut off prematurely by death; should he, however, be cut off prematurely by death, what do we find as the morbid anatomy to explain the wel marked symptoms seen during life? (16, page 2)  
Thorowgood also notes the following:
The prognosis in asthma is generally good, and asthmatics are well known to be, as a rule, long-lived; so that invalids who may have been for some time suffering in the chest are wont to feel much satisfaction and comfort when they are assured that their complaint is " only asthma," or is likely to " turn into asthma."  (16, page 35)
Dr. William Aitken, in his book "The Science and Practice of Medicine, said:
"Asthmatic patients generally live to a good old age." (5, page 489)
Osler also wrote in his 1892 medical textbook "The Principles and Practice of Medicine:
"We have no knowledge of the morbid anatomy of true asthma.  Death during the attack is unknown." (8, page 4)
Dr. Anthony Rebuck and Dr. Kenneth R. Chapman said in 1987:
It is now general knowledge that asthma can be fatal and that in some countries with a sophisticated level of medical care the death rates appear to have been increasing. Yet as recently as 1983 an editorialist in the Lancet found it necessary to point out that some physicians still considered the disease "a benign nuisance related mainly to emotional problems" (14, page 353
Dr. William Osler (1849-1919), the father of modern medicine, said in 1901:
 "The asthmatic pants into old age." (4)(7, page 3 and 11)
Dr. Lawrence K. Altman, in the 1990s, said the following:
In 1963, Dr. H.L. Alexander of St. Louis concluded that, prior to 1930, "death during an asthmatic attack was almost unknown." 
Altman also said:
"It (this belief) persisted well into this century.  A textbook in 1935, for example, said that the life of an asthmatic is not endangered. (8, page 4)
  1. Garrison, Fielding Hudson, "Introduciton to the history of medicine," 1922, London, W.B. Saunders Company
  2. Salter, Henry Hyde, "On Asthma: It's Pathology and Treatment," 1882, New York, William Wood and Company
  3. Brenner, Barry, editor, "Emergency Medicine," 1999, New York, Marcel Dekker;  Brenner writes in his forward that "Osler though asthma never caused mortality." 
  4. Christennsen, Alan, Michael Antoni, editors, "Chronic Physical Disorders: Behavioral Medicine's Perspective," 2002, United Kingdom, Blackwell Publishers LTD., page 247
  5.  Aitken, William, "The science and practice of medicine," volume II, 1872, Philadelphia, Lindsay and Blakiston
  6. Cullen, William, "The works of William Cullen, M.D.," Volume II, London, 1827 (also see his book "First Lines of the Practice of the Phsych," 1784, Edinburgh, Vol. 3, 4th ed., page 399)
  7. Altman, Lawrence K., "The Public Perception of Asthma," Chapter one of the book "Fatal Asthma," edited by Albert L. Sheffer, New York, Marcel Dekker, Inc, pages 3 and 11. Lawrence notes the following about this quotation by Osler: "The origin of this statement is obscure.  Many authors have said it was one of Osler's aphorisms.  However, it is not included in the book of aphorisms." Other notable authors credit the following: William Henry Osler, "Principles and Practice of Medicine," 4th ed, 1901, Pentland, Edinburgh,
  8. Altman, ibid, page 4. Lawrence notes the following reference: "Osler W. The Principles and Practice of Medicine. Edinburgh: Petland, 1892
  9. Quoted in a variety of sources
  10. Berkart, J.B., "On Asthma: It's Pathology and Treatment," 1878, London, J&A Churchill
  11. Altmon, op cit, page 4.  The reference Altmon is referring to comes from an article by Speizer and Doll (see reference 12 below)
  12. Speizer, F.E., R. Doll, "A Century of Asthma Deaths in Young People,British Medical Journal, 1968, 3, 245-246
  13. Altman, ibid, page 2
  14. Rebuck, Anthony S. Kenneth R. Chapman, "Asthma: 1. Pathophysiologic features and evaluation of severity," Canadian Medical Association Journal, February 15, 1987, volume 136, pages 351-354.  The reference here referred to by the authors is "Childhood asthma", Lancet, September, 1983, volume 322, issue 8351, pages 659-660
  15. Speizer, F.E., R. Doll, P. Heaf, "Observations on recent increase in mortality from asthma," British Medical Journal, February 10, 1968, 1, pages 335-339
  16. Thorowgood, John Charles, "Notes on Asthma," 1878, 3rd edition, London, J and A Churchill
  17. Laennec, Rene Theophile Hyacinthe, "A treaties on the diseases of the chest, and on mediate auscultation," tranlated by John Forbes, 1838, New York, Philadelphia, Samuel S. and William Wood, Thomas Cowperthwaite and Company
  18. Ramadge, Francis Hopkins, "Asthma, its species and complications, or researches into pathology or disordered respiration; with remarks on the remedial treatment applicable to each variety; being a practical and theoretical review of this malady, considered in its simple form, and in connection with disease of the heart, catarrh, indigestion, etc." 1835, London,  Longman, Rees, Orme, Brown, Green, and Longman

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