Wednesday, February 10, 2016

1757: Boerhaave lectures about asthma

By reading the lectures of Dr. Herman Boerhaave we gather he had a very impressive understanding of the causes of difficult respiration, although his understanding of asthma is no better than that of the ancients. While he did have a better grasp on the anatomical changes that cause disease, he continued to believe in the humoral theory of medicine.

Yet, while he adds nothing new to our disease, he does give us a great view of what the medical community was taught about our disease.

It must be understood before we delve into the lectures of Boerhaave, is that he tailored them to his medical student, who were well educated in the medical terminology of the time. His sentences are often long winded, and he makes little effort to simplify complicated thoughts.  Two-hundred seventy six years after his death, that became my job.  Below you will find Boerhave's thoughts on asthma made easy.  

He wrote the following about symptoms attending on injured respiration:

1.  Apnoea:  "In which respiration is entirely suppressed... diminished or suppressed pulse..a state of the body approaching nearer to Death, and absolutely terminates in Death if it continues for Two minutes together."  (5, page 47)

2.  Dyspnoea:  "A dyspnoea is when the respiration is performed with Pain, Difficulty, and Fatigue.

3.  Asthma:  "An Asthma, which is a quick,  difficult and noisy or wheezing Respiration, arising generally from stronger causes than a Dyspnoea, but more especially as it would seem, from a spasmotic Constriction of the muscular Fibres in the lungs." (5, page 48)

He also said:
In this Disorder then the Patients erect their Body, raise the Shoulders, and draw them nearer to each other, and fixing their Elbows in some Window, they draw in their Breath with great Violence and Wheesing, by dilating the Thorax as much as lies in their Power. When the Fit is run to 'such a Height' that the Patient seems to be near to Suffocation, as the Blood now cannot pass thro' the Lungs, the jugular Veins appear turgid and ready to burst; neither the left Ventricle of the Heart nor the Aorta, and consequently the Encephalon and Lungs themselves receive no Supplies (5, page 49)
As was typical of the day he described asthma as either moist (with secretions) or dry (without secretions)

4.  Orthopnoea:  "Short, difficult, and wheezing Respiration, that can only be performed when the Patient's Neck and Thorax is in the erect posture. An orthopneoa is a Respiration with a kind of stertor, performed with the action of the Neck and Shoulders; Hippocrates calls it an exalted or high Respiration... more especially an empyema, a Dropsy of the Paricardium, and other Disorders of the like kind, from which an exalted respiration may follow; and it may also arise from the Lungs being over charged with Moisture or with Water." (5, page 50)

5.  Suffocating Catarrh:  "Which seems to be a sudden and fatal apneoa, or total suppression of the Breath

The causes of all the above are: (5, page 47)
  • Vitiated air
  • Poisonous vapours
  • Air that is caustic, acid, or austere (5, page 47)
Suffocating Catarrh may also be caused by "sudden Distillation of the fluid Matter into the Fauces and Lungs, or great Disorders of the Nerves, as in hysteric cases; or lastly, a large polypus in the heart suddenly protruded into the lungs."   A violent effort to take in a breath often causes a "Vomica" to suddenly burst, and this causes "a bloody, purulent, or phlegmatic Matter" to be discharged from the mouth and nose. The patient does not have an opportunity to speak one word, and death quickly ensues. (5, page 50-51)

The inhalation of these cause "palsy or spasm of the organs subservient to respiration, as also other diseases which are capable of totally destroying the Functions of these parts." (4, page 47-48)

Surely there is no cure to suffocating catarrh, although the other ailments (apnoea, dyspnoea, asthma, and orthopnoea) may be cured by "discharge of the offending Matter.  (5, page 52)

The offending matter may result in the following, which causes difficult respiration:
(Caused) chiefly (by) a filling of the Thorax with extravasated Lymph, Matter, or Blood, an Inflammation of the Larynx, Wind-pipe, Bronchia, Lungs, Pleura, Mediastinum, Diaphragm, Pericardium, and Muscles of the Thorax and Abdomen subservient to Respiration; as also offending matter of various kinds, whether polypose, chalky, phlegmatic, stony, or purulent; and likewise a tumor formed about or within the Larynx; or in the Lungs themselves, or in the Thorax, whether the Tumor be Inflammatory, Supperating... cancerous: finally, we may add to these a very bad Adhesion of the Lungs to the Pleura. " (5, page 52-53)
He said he has seen cases of asthma whereby the patient was "tortured incessant coughing without intermission, till after some Weeks they brought up Calculi from the Wind-pipe, and then the Respiration has been free for some time, till the Calculi were again formed. I have seen other Patients who have kept by them large Cups full of these Stones, which had been brought up from the Lungs. Such People as these generally die with a spitting of Blood ; for the tender Fabric of the Lungs is destroyed by the violent Coughing used to bring up these Stones." (5, page 5)

Asthma may be so severe that the circulation of the blood becomes obstructed in the lungs, and this affects the constitution of the whole body.  A sign of this occurring is a short respiration.  This is a sign that "the Lungs are stuffed up with Blood or some other Matter to which they are not previous but rigid; or else or else that the Wind-pipe, or its Branches, being compressed or obstructed with some Sort of Homour or Matter, are scarce capable of admitting the Air; whence it is a very bad sign."  (5, pages 205- 206)

Regarding shallow breaths that occur with difficult respiration, he said:
The Lungs transmit a greater Quantity of Blood by acting in Respiration, than if they were at rest. lf now a greater Quantity of Blood is to be moved through the Lungs in a given time, the Respiration must necessarily become quicker, in order to transmit such a greater Quantity, and on the other hand, if the quantity of Blood 'remains the same, and the Respiration becomes twice as small, it must also become twice as quick, since without that, one half of the Blood will stagnate in the Lungs, and by degrees more compress the Air-Vessels, till they are at length wholly oppressed  the Consequence of which, if not timely removed, must be Death. (5, page 208)
He adds:
A suffocative Respiration, in which the Patient perceives a Sense of choaking, bespeaks that the Lungs are inflamed, obstructed, owrzsilled' or disordered by Stiffness'and Driness, also that the Blood is impervious ; hence it proves fatal in a little time, unless when it proceeds from aflightconvulsive Cause in hysterical 1 and hypochondriacal People, or in those who have been accustomed to an Asthma. (5, pages 208-209)
He also observed that "This is a kind of Death which generally terminates acute Diseases; namely, the arteries of the lungs are so distended with Blood, that they can transmit none to the Veins and left Ventricle of the Heart; whence the Pulse intermits, cold Sweats break out, and after Death the Lungs are found heavy and full of black Blood in their arterial system, while their venal system is empty, and whereas the Lungs of a healthy person are usually light and spongy." (5, page 209)

As typical for the day, he also describes nervous asthma:
It is true, that hysterical Women, hypochondriacal Men, and especially those who are troubled with an Asthma, are sometimes invaded with a suffocating Respiration, perfectly like that of adying Person : but these When they seem to be about expiring, are commonly relieved of a sudden -, for the Convulsive Spasm, which suppressed the Respiration, is removed when the Patient is thereby render'd extremely weak. Such a strangling arises from' the Fumes of burning Sulphur, which by excitinga Convulsion of the Musculi Mesachondriaci suppresIZ-s the Inspiration. (5, page 209)
As for his antidotes particular to asthma he noted but a few.  He said dry asthma was "cured by riding on horseback, with a mild diet."  He said that a lady who presented with "Disorders of the Nerves, with Anxiety, Pains, Asthma, etc. I ordered her Acids with a plentiful Use of Vinegar, by which the pulverized Lead was dissolved and her Maladies relieved (5, page 49-15, 348)

Other than the remedies mentioned in this post, he mentions few that were specific to asthma or other respiratory ailments.  He did prescribe the use of inhalers, such as inhaling fumes vinegar in a sponge, or fumigations, although there is no evidence he recommended these for breathing disorders.

If he thought though it was indicated, there were a variety of other things he might recommend to improve your asthma, such as an improved diet, bleeding, cupping, various herbal remedies prepared as draughts, baths, or the application of warm blankets or sitting by a warm fire.

Although there is no evidence by reading his complicated lectures that any of these remedies were specific to any one disease.  They were mor or less prescribed based on the signs presented by the patient and his surroundings, and prescribed in order to remove the poisons that entered the body to cause disease, and somehow disturbed the flow of humours through the body.

So as you can see, there was not much added to the definition of asthma by Boerhaave.  His definition here, however, is typical of the view of asthma during his generation. What is impressive is that he does seem to be quite aware of the anatomical changes that occur withing the body that cause difficult respiration.

  1. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey
  2. Johnson, Samuel, "Herman Boerhaave," 1739, as printed in the book" "The Works of Samuel Johnson, with an essay on his life and genius," by Arthur Murphy, volume II, 1837, New York, George Dearborn Publisher, pages 307-314; (This biography of Boerhaave by Johnson was first published in January, February, March, and April of 1739 in subsequent issues of The Gentleman's Magazine. To view a version with section titles added for simplicity, you can click here
  3. "Hermann Boerhaave", Encyclopedia Britannica,, accessed 11/12/13
  4. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1921, 
  5. Boerhaave, Herman, "Academical Lectures on the theoryof physic being a genuine translation of his institutes and explanatory comment, collated and adjusted to each other, as they were dictated to his students at the University of Leyden, 1757, Volume II, London, 
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