Tuesday, October 20, 2015

1940's: Dr. M. Murray Peshkin, Parentectomy, and the rise of the asthma institution

Figure 1 -- NJH patients receiving sunlight exposure treatment
Thanks to better care, improved diets and good hygiene, the number of tuberculosis patients declined significantly during the 1930s. National Jewish Hospital at Denver and National Home for Jewish Children in Denver continued to function mainly because their doors were open to people with other diseases besides just tuberculosis, particularly asthmatics having trouble managing their asthma at home.   (1, page 115)

In the 1940's, the number of tuberculosis patients was generally higher than those with other diseases, like asthma.  However, the number of asthma patients at the institution was on the rise.  And, for the most part, the goal for people with chronic lung diseases was to seek the cool, dry climate of Colorado for improved breathing.  So, both asthmatics and TB patients received open air treatment (see figure 1).

Figure 2 --Children playing on swings at the National Home
 for Jewish Children, 1936 (6)
Likewise, patients who got better were provided the "added bonus of rehabilitation, social and education programs.  The education programs were intended to equip patients, who often came from lives of poverty, to function more effectively, in the world outside of the hospital."  (5)

Now, before I get into the rise of asthma patients at these hospitals, you have to understand the common thinking about asthma in this era. First of all, asthma was a much rarer disease at this time, so it didn't get even close to the type of limelight that a deadly disease like tuberculosis got.

During most of the 19th century the two most prominent theories about asthma were that it was a neurotic disorder that resulted in airway constriction and shortness of breath.  This theory continued to be prevalent in the minds of many physicians, although it sort of took a back seat to other theories, such as the allergic theory. In fact, some researchers were so excited about the new allergic theory that they believed this would lead to a vaccine for asthma.

However, the idea that asthma was nervous was reinvigorated beginning with German and Austrian physicians (like Dr. Alexander) in the 1920's. These physicians described wheezing and asthma as a suppressed cry for the mother. So, the treatment for it, along with controlling asthma triggers, was psychotherapy. Of course it was often noted that most asthmatics were not avoiding triggers nor receiving the therapy they needed to obtain ideal control.

As these physicians migrated to the United States this information migrated with them. Do doctors here, including Dr. Murray Peshkin, medical director for the National Home for Jewish Children, must have been aware of it. This must have inspired him.

So, during the 1930's the number of tuberculosis patients were on the decline and the number of asthma patients were on the rise. Still, at this time, there weren't a lot of asthma patients. This changed after Dr. Peshkin observed a trend among asthmatic children at the hospital. He postulated a theory based on his observations that would cause a spike in the number of asthmatic admissions to National Jewish and all the other asthma hospitals around the nation.

What he observed was there were about 10 percent of asthmatic children who never got better at home, even when he personally visited their homes to make sure they were perfectly clean and antiseptic with no trace of any known allergens.  (2) He observed that as soon as being admitted to his hospital many of these children became immediately better. He observed that 99 percent of the children treated this way had 'substantial or complete relief' of symptoms, according to his own reports. (3, page 145)

He concluded the reason for this was removal from allergens and stress at home. He therefore proposed a strategy that involved abducting (with parental permission of course) these children from their homes and admitting them to asthma hospitals. A slang term for this developed: Parentectomy.

Parentectomy became a popular strategy when physicians observed severe asthma in children despite their best efforts. The children would often stay at these hospitals from 1-2 years. And they weren't like typical hospitals either: they were more like institutions. Sure there were nurses and doctors, but there were also teachers and, most certainly, there was entertainment. We can learn what it was like to live at one of these institutions by reading their stories. (4, page 170)

References:
  1. Minton, Gregg, "Breathing Space,"
  2. Wamboldt, Fredrick S. "Asthma Theory and Practice: It's Not Too Simple," April 2, 2008,
  3. Jackson, Mark, "Asthma: A Biography,"
  4. Travis, George, "Chronic Illness in Children," 1976, California, Stanford University Press
  5. "Clinical History: The Early Years," NationalJewishHealth.org, http://www.nationaljewish.org/about/whynjh/history/clinical/, accessed 11/7/12
  6. Photo from Penrose Library, http://lib-anubis.cair.du.edu/About/collections/SpecialCollections/NAC/index.cfm, accessed 11/8/12

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