Monday, February 1, 2016

1717: Floyer establishes spasmotic theory of asthma

Cover page of John Floyer's
"Treaties on Asthma," 1698
In his 1698 book "A Treaties of the Asthma," Sir John Floyer because the first person to make the case for asthma as a separate disease from other pulmonary disorders.

He also lived during a time when supernatural remedies were slowly going out of favor, yet some physicians, such as Floyer, didn't like the change.  Floyer preferred to treat asthma as a disease caused by an imbalance of the four humors as opposed to some physiologic condition of the body.

Because of this, because he supported ancient theories as opposed to science, his ideas were more readily accepted, compared to the science-based ideas of men like Jan Baptiste van Helmont and Thomas Willis.

Yet while holding onto old superstitions, he was an ardent supporter of asthma being a disease of contraction of the air passages, said John Thorowgood in his 1894 book. (2. page 10)

Thorowgood provides some intriguing quotes from the second edition of Floyers's asthma book that was published in 1717.  He quotes him as saying:
"I have assigned the immediate cause of the asthma to the straitness, compression, or constriction of the bronchia; and in the continued asthma (chronic) the causes must be constant, as dropsy (edema), tuberculum, etc. The return of periodic asthma (acute) depends on the defluxion (discharge) of humours on the primae viae (bowels). Thus, the old notion of the asthma being a defluxion of serous humours (fluids) is certainly true, because evident to our senses in the evacuation of serosities (secreting serum).... Some express their feeling, during a fit of asthma, as if the lungs rose, and were drawn upwards to choke them. Contraction of the vesicuise is very probable, because the bronchia are contracted, and the vesiculae have the same muscular fibres to help expiration, by which they may be drawn so up as not to admit the air.' (2, page 11)
Thorowgood also provides a passage from Floyer's book comparing the chest with bellows.
 'We can move the bellows easily; but suppose a bladder tied within the bellows over the nozzle, so as to receive the air and suffer none to get into the cavity of the bellows, it will follow that in a perfect stoppage of all the entrances of air the bellows could not be opened; and if no more entered than may be contained in the bladder, the bellows would be opened but a little way, and would inspire difficultly. So it appears in the business of the asthma, the inspiration is difficult and laborious, because but little air can be admitted into the contracted bronchia, and the vesicular drawn up. This puts the scapular and intercostal muscles and diaphragm upon a violent endeavour to press in the air and open the lungs, which nisus (physicians trying to understand asthma) authors have mistaken, and supposed the pneumonic (lung) muscles, especially the diaphragm, to be convulsively affected; but it may easily be apprehended that the diaphragm cannot press the viscera (abdominal organs) downwards to enlarge the breast if the air cannot be admitted into the lungs to follow its depression and fill the cavity of the breast; and this is the true reason why the diaphragm cannot move in the asthmatic fit. The contraction and stiffness of the lungs during asthma causes a catalepsis (stiffness) or rigidity of the diaphragm—the part most unjustly accused of this tyrannic oppression.' (1, page 11-12)
Thorowgood said Floyer was observant of the diaphragm being "rigid and spasmodically drawn up by some contractile force within the thorax," although he did not believe, as many of his predecessors did, that the diaphragm was an "essential cause of asthma." (1, pages 10, 12)

He said the fact that the wheezing heard when an asthmatic exhales is proof of narrowed air passages, and therefore he championed for the spasmodic theory of asthma. (1, page 12)

Thorowgood also said that Floyer believed asthma associated with no other observable signs as hysterical asthma, and he refers to the "hysteric" who wheezes but produces no phlegm as proof that asthma is not caused by phlegm but by contraction of the air passages.  (1, page 12)

He said Floyer clearly rejected the nervous theory of asthma postulated by Willis and van Helmont.  Thorowgood said:
(Floyer) regarded the contraction as brought about by mechanical pressure rather than by nervous influence seems clear, from his saying that certain writers of his day, Van Helmont and Dr. Willis, were wrong in regarding asthma as a convulsion, to be treated by anti-spasmodics, hot tinctures, gums, volatile salts, and sulphur medicines. The proper method is by evacuants, and remedies calculated to promote secretion and effect the discharge of humours —anti-congestive rather than anti-spasmodic treatment. (1, page 13)
So, while Floyer was more in line with the popular view of asthma as a humoral disease, his idea that asthma was a disease associated with spasms of the air passages tended to gain more attention during his lifetime than his contemporaries. In this way, he became the father of the spasmotic theory of asthma.

  1. Thorowgood, John C., "Asthma and Chronic Bronchitis: A New Edition of Notes on Asthma and Bronchial Asthma," 1894, London, Bailliere, Tyndall, & Cox.  The quotes from Floyer were referenced by Thorowgood from Floyers book "A Treaties on Asthma," which was published in 1717.  Pages referred to are in the quotes above.
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