Friday, February 5, 2016

1733: The English Malady: Modern living causes asthma

Dr. George Cheyne (1671-1743)
speculated that modern civilization
may be partially responsible
for many of the diseases
that plague the modern world,
including asthma. 
There are modern theories that speculate that civilization is the cause of many of the diseases that plague us, including arthritis, eczema, allergies, and asthma. Yet the idea that the civilized way of life caused disease goes all the way back to the 17th century in England. It was a mysterious ailment, simply referred to as "The English Malady."

Various English physicians observed an increase in certain nervous ailments that they blamed on the English way of life, or the English diet. According to Glen Colburn, in his introduction to "The English Malady: Enabling and Disabling Fictions," the ailments were often referred to as: (1, page 1)
  • Spleen (produced yellow bile, and therefore produced melancholia)(5)
  • Vapours (6)
  • Lowness of Spirits
  • Hypochondria (when it affected a man)
  • Hysteria (when it affected a woman) (1, page)
There were other nervous disorders as well that were included as part of the English Malady, some of these were: (4)
  • Colic
  • Gout (4, page 13)
  • Scurvy (4, page 13)
  • Leprosy (4, page 13)
  • Rheumatism
  • Dyspepsia
  • Cholera
  • Consumption (4, page 162)
  • Asthma (2, page 73)
Title page of George Cheyne's 1733 book
"The English Malady." 
The English Malady was sort of an umbrella term, a rubric, similar to our term asthma. For example, all of the following medical observations would be considered a form of asthma
  1. Dyspnea from exertion
  2. Dyspnea caused by spasms of the air passages that produced no or little fluid in lungs (dry asthma)
  3. Dyspnea caused by humors (mucus or blood) in the lungs (wet asthma)
Asthma, and all of the other ailments here, were lumped together as nervous in origin. They were all internal ailments that left behind no visible scarring, and the cause was mysterious. Such diseases were often attributed to nerves, and diagnosed as hysteria or hypochondria. The general treatment would be whatever the diagnosing physician thought appropriate for nervous disorders (opium, purge, diuretic, etc.)

The English Malady was so perplexing that it was even addressed by the most famous English physicians of the day, including Thomas Sydenham.  Colburn explains: 
In 1682, the prominent physician Thomas Sydenham described it as “so strangely various, that it resembles almost all the Diseases poor Mortals are inclinable to.” Some seventy years later, Sir Richard Manningham lamented that in trying to diagnose the disease, "both the Patient and the Physician are very liable to be deceived." (1, page 1)
While Sydenham mentioned the Malady, the first to write a book about it was George Cheyne in 1733: "The English Malady: or,  a treaties of nervous diseases of all kinds as spleen, vapours, lowness of spirits, hypochondriacal, and hysterical dystempers, etc.,"

Cheyne noted the cause of the Malady as a nervous disorder caused by overindulgence and inactivity, and affecting nearly two thirds of the inhabitants of England. He wrote:
The Title I have chosen for this Treatise, is a Reproach universally thrown on this Island by Foreigners, and all our Neighbours on the Continent, by whom Nervous Distempers, Spleen, Vapours, and Lowness of Spirits, are, in Derision, call’d the ENGLISH MALADYAnd I wish there were not so good grounds for this Reflection. The Moisture of our Air, the Variableness of our Weather, (from our Situation amidst the Ocean) the Rankness and Fertility of our Soil, the Richness and Heaviness of our Food, the Wealth and Abundance of the Inhabitants (from their universal Trade), the Inactivity and sedentary Occupations of the better Sort (among whom this Evil mostly rages) and the Humour of living in great, populous, and consequently unhealthy Towns, have brought forth a Class and Set of Distempers, with atrocious and frightful Symptoms, scarce known to our Ancestors, and never rising to such fatal Heights, nor afflicting such Numbers in any other known Nation. These nervous Disorders being computed to make almost one third of the Complaints of the People of Condition in England. (4, page i)
So why did the rise of wealth in England cause the English Malady?  The question is answered by Cheyne as  followed:
Since our Wealth has increas'd, and our Navigation has been extended, we have ransack'd all the Parts of the Globe to bring together its whole Stock of Materials for Riot, luxury, and to provoke Excess. The Tables of the Rich and Great (and indeed of all Ranks who can afford it) are furnish'd with Provisions of Delicacy, Number, and Plenty, Sufficient to Provoke, and even gorge, the most large and Voluptuous Appetite. The whole Controversy among us, seems to lie in out-doing one another in such Kinds, of Profusion. Invention is rack'd, to furnish the Materials of our Food, the most Delicate and Savoury as Possible: Instead of the plain Simplicity of leaving the Animals to range and feed in their proper Element, with their natural Nourishment, they are physick'd almost out of their Lives, and made as great Epicures, as those that feed on them; and by Stalling, Cramming, Bleeding, Lameing, Sweating, Purging, and Thrusting down such unnatural and high-seasoned Foods into them, these Nervous Diseases are produced in the Animals themselves, even before they are admitted as Food to those who complain of such Disorders. Add to this the torturing and lingering Way of taking away the Lives of some of them, to make them more delicious: and the Dressing of them by culinary Torments while alive, for their Purchaser's Table: All which must necessarily sharpen, impoison, corrupt and putrify their natural Juices and Substances. (4, pages 49-50)
He thus believed that the modern, civilized method of living, of eating to excess, of enjoying the luxuries that are now available, caused the nervous disorders.  Along with the treatment of animals, the following were also considered by Cheyne as substances that poison the juices of the body: (4, pages 48-49)
  • Luxury
  • Laziness
  • Coffee
  • Tea
  • Chocolate
  • Alcohol
  • Spices
  • Other foods of amusement
  • Over indulgence 
Thus, he notes that the "consequence of such a Diet must be in naturally weak Habits." (4, page 51)

And to link all these disorders as nervous was normal for this day and time, as noted by Cheyne:
All Nervous Distempers whatsoever from Yawning and Stretching, up to a mortal Fit of an Apoplexy, seems to me to be but one continued Disorder, or the several Steps or Degrees of it, arifying from a Relaxation or Weakness, and the Want of a sufficient Force and Elasticity in the Solids in general, and the Nerves in particular, in Proportion of the Resistance of the Fluids in order to carry on the Circulation, remove obstructions, carry off the Recrements, and make the Secretions." (4, page 14-15)
All in all, I believe Cheyne was implying that the primitive way men and women lived prior to civilization fostered few nervous diseases.  The reason was because animals ran wild and fed off the natural elements of the land, and when eaten their meat was clean and pure and less likely to cause disease.  Also, when people were hunters and gatherers they ate natural and received plenty of exercise in the process, and thus maintained healthy minds in the process.

Once people became civilized, they started eating meat that was tainted by their fellow men, and the meat was poisoned.  Likewise, people had more time to invent materials of luxury, such as houses, beds, chairs, chariots, etc.  These items of luxury increased the tendency to be lazy.  It also provided men time to discover    and overindulge in such unnatural substances such as alcohol, coffee, tea, chocolate, spices, etc.  This, along with a hereditary disposition (a rotten and corrupt tree can produce nothing but bad fruit) (4, page 6), increased the tendency to a nervous disposition, or The English Malady.  

Cheyne used himself as an example of how the opportunities presented by modern civilization brought upon The English Malady.  He explained that he was plagued with a bout of stomach pain, and tried Dr. Taylor's Chewing Bark.  He said he knew it was a good remedy for stomach and nervous cases.  After chewing half a dram 2-3 times per day for ten days "I found so wonderful a change on my whole Man, as to Spirits, Cheerfulness, Strength and Appetite."

Yet after a while he receded to his old habits.  He explained:
But the long and violent depuratory Fever; which I did not get over entirely... that upon my total recovery, my appetite being insatiable, I sucked up and ratain'd the juices and chyle of my food like a Sponge, and thereby suddenly grew plump, fat and hale to a wonder; but indeed too fast... I swell'd to such an enormous size, that upon my latest Weighing I exceeded 32 stone.  My breath became so short, that upon stepping into my Chariot quickly, and with some effort, I was ready to faint away, for want of breath, and my face turn'd Black... going up one pair of stairs, with high Steps, hastily, by pushing my Breath a little too violently, to make room for those that were following, I was immediately seized with a convulsive asthma, returning by repeated and strong Inspirations, Fits, and small Intervals, which lasted about a Quarter of an Hour, so that I thought I have died on the Spot; but by Evacuations and Low living, I got rid of the disorder also, in some Degree, tho' after that, I was not able to walk above one pair of stairs at a Time without extreme Pain and Blowing, being forced to ride from door to door in a Chariot... But if I had an hundred paces to walk, was oblig'd to have a Servant following me with a Stool to Rest on. (4, pages 341-343) 
Cheyne explains that some of the 'nervous distempers' caused by living in England are curable with the proper treatment, although hysterical and hypochondriacal disorders -- sush as humoral asthma (dyspnea caused by secretions or fluid in the chest), pulmonick pythisis (tuberculosis), gout, epilepsy, diabetes, etc -- are incurable.

Of these incurable ailments he writes:
I say, in these only, and only in these when they are become manifest, have resisted all other common Methods, and the Patients are rather growing worse than better under them, is a total and strict Milk, Seed and vegeatable Diet, proper or to he attempted, and that in other, more simple and slight Cases, and even in the first Stages of these mentioned Distempers, a common moderate and temperate animal Diet, and well-chosen Medicines, will be sufficient. Now if after all this, any one is disposed to be merry with me, I ought not, I shall not grudge them their diversion.  (4, pages vii and viii)
Typical treatment for the "English Malady" generally consisted of attempts at improving the quality of the patient's life, such as through diet, regimen, and even some herbal remedies.

Other physicians of his era, including William Cullen, continued this theme. (2, page 73) Cullen, for instance, believed that the muscle was a continuation of the nerve, and that life itself was a continuation of the nervous system.  (3, page 369)

References and Notes:
  1. Colburn, Glenn, "The English Malady: Enabling and Disabling Fictions," 2008, U.K., Cambridge Scholars Publishing
  2. Jackson, Mark, "Asthma: The Biography," 2009, New York, Oxford University Press.  He mentions Cheyne's idea mainly as a segue to Dr. William Cullen.  
  3. Garrison, "An introduction to the history of medicine," 1921, 3rd edition, Philadelphia and London, W.B. Saunders Company
  4. Cheyne, George, "The English Malady: or, a treaties of nervous diseases of all kinds as spleen, vapours, lowness of spirits, hypochondriacal, and hysterical dystempers, etc., " 1733, Londin, Another version of the same book can bee found here at Google Books. The book was not an easy read, and is full of  theoretical ramblings, although was very telling of the medical ideas of the era. 
  5. The ancient Greeks believed the spleen produced the humor black bile.  With an increased supply of black bile in the system, the person had a tendency to be melancholy (depressed) in nature.  Due to this belief, a depressed, gloomy, pessimistic person was generally diagnosed with Spleen or Melancholy.
  6. Vapours and Hysteria generally refer to a mental disorders in women, and hypochondria generally refers to mental disorders in men.  Lowness of spirits, melancholy, and spleen are different names for the same thing and are often used interchangeably.  Which term used was generally up to the preference of the diagnosing physician.  As you will see throughout this history, there was no uniformity on diagnostic terms for many disorders until the mid 19th century or even as late as the mid 20th century for some disorders.  This was probably due to the lack of consensus on any specific diagnosis (such as bipolar, depression, mood swings, schizophrenia, etc.  
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