Wednesday, December 16, 2015

1600s: Nervous theory introduced to medical community

Perhaps the most prevalent theory regarding asthma through most of history was the nervous theory of asthma. The idea was that, since no scars were found in asthmatic lungs, that it must be caused by the mind. While this idea was tinkered with by various ancient physicians, including Galen, it wasn't taken seriously by the medical community until the 17th century.

So we understand so far that the term asthma first appeared in the ancient Greek writings of Homer, and was defined as a medical term by Hippocrates.  In Ancient Rome it was used sparingly, and it didn't find its way into English and other European languages until about 1398.

Medical wisdom in Western societies hit a wall of sorts with the fall of the once mighty Roman Empire, only to rise up in Eastern societies.  Around the 10th, 11th and 12th centuries such wisdom started to filter back West, yet it was a slow transition to say the least.

With the fall of Constantinople in 1453, the dark ages ended and the age of Renaissance began.  Old Western ideas about medicine and science started to re-emerge, and new ideas started to form.  The first Western physician during this era to investigate the term asthma was Jean Baptiste van Helmont (1579-1644).

Even during modern times physicians and scientists who become rapt in a certain disease are usually those who are affected by it, and van Helmont was no exception.  He was afflicted with asthma from a young age, and he became especially interested in it as a physician/scientist/alchemist.

He was the first to describe asthma as anything other than simply a symptom.  He was the first to propose the idea that asthma was a disease of spasms of the air passages when he wrote:  "The lungs are contracted or drawn together."

Galen mentioned something of the sort way back in the first century, yet it was van Helmont who focused attention on the subject.

Van Helmont was also the first to describe asthma as a nervous disorder. By this, he meant that irritation of the nerves triggered the asthma response.

Several years later, Thomas Willis (1621-1675) also described asthma as a nervous disorder that caused spasms of the air passages of the lungs.  Yet it was his writings that were more generally accepted by the medical community at the time, mainly because he wrote more abundantly and specifically on the subject than van Helmont.  For this reason, he it is Willis who is generally given credit for introducing the nervous theory of asthma to the medical community.  (1, page 6)

So it's important to understand that van Helmont was the first to postulate the nervous theory of asthma, yet Willis is often given credit because.  This is mainly because, if not for his writings, the theory would never have gained the attention of the medical community.

Likewise, while van Helmont also was the first to postulate the idea of the spasmotic theory of asthma, he didn't get credit for it either.  Credit here goes to John Floyer, who would dissect this disease even further than either van Helmont or Willis.  Floyer is given credit mainly due to the fact he was among the most famous physicians of his era.  (1649-1734).

Very rarely will you find an author on the subject giving credit to van Helmont. Just to give an example, in his 1835 book "Asthma, its species and complications," Francis Ramadge said Willis was "the first to observe the nervous character of complicated asthma."  (3, page 92)

While this may not be fair to van Helmont, it's just the way history was written; it's just the way it is.

For the sake of simplicity, I want to give a quick overview of the nervous and spasmotic theories of asthma.
  • The spasmotic theory of asthma; also referred to as the convulsive theory of asthma, and later the bronchospasm theory of asthma
  • The nervous theory of asthma; later called psychosomatic theory of asthma
It also should be known here that many authors on the subject believe that asthma is both nervous and spasmotic, or that one is synonymous with the other.  So as one physician is referring to the nervous theory of asthma, he is generally referring to spasmotic asthma caused by the nervous response.  Or, he is referring to irritation of the mind that causes it to send signals via nerves to start the asthma response, which is spasms of the air passages.  

Regardless, these two theories would continue to be dissected and debated for the next three centuries.  

References:
  1. Berkart, J.B., "On Asthma," 1878, page 
  2. Walter, Mmichael J, Michael J. Holzman, "Americana Journal of Respiratory Cell and Molecular Biology, "A Centennial History of Research on Asthma Pathogenesis," http://ajrcmb.atsjournals.org/content/32/6/483.full (accessed 2/22/13)
  3. 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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