Friday, April 29, 2016

1793: Ryan likes cold baths for asthma

Michael Ryan was an18th century physician who strongly supported the idea of taking cold baths as the best treatment for asthma.  He was so in love with the idea that wrote an entire book on the subject 1793 called "Observations on the history and cure of asthma."

In the preface he explained:
Among the various chronic complaints to which the human frame is liable, very few can be considered of a more formidable nature than a confirmed asthma. The idea of its being an incurable disorder, its threatening instant suffocation at every attack, are circumstances altogether so alarming to a patient, as must necessarily weaken and depress a mind endowed with the utmost fortitude and resignation. Any remedy then that could be found capable of administering permanent relief, to a person in such an afflicting situation, must be looked upon as of the utmost importance to mankind... Unhappily, however, the efforts of physicians hitherto, in the asthma, have generally failed in that respect. (1, page v)
He said cold bathing was recommended as the cure of "chronic complaints, particularly in the nervous and spasmotic, experience has stamped a value on it superior to that of any medicine yet discovered.  In the asthma, however, this practice has been rarely recommened." (1, page 131)

He said that Caelius Aurelianus was the only ancient physician to recommend it. Of this, Ryan wrote:
Caelius Aurelianus says, that residing at the sea-coast, and bathing in the water, are highly useful to asthmatics; though he produces no instance of its success to support his assertion. (1, page 132)
Of this, Sir John Floyer said:
Celius Aurelianus commends... washing the Head is certainly useful against it. (2, page 121) 
The next authority to recommend it was Sir John Floyer. Ryan quotes him from his Treaties on Cold-Bathing as saying the following: (1, page 131)
I have discoursed with an asthmatic person, who has had an habitual asthma for many years, and she informed me that she went into St, Winifred's Well at Holywell, and that her asthmatic dry cough went off for some time, but at last returned again. (2, page 121)
Then he quoted him again as saying:
I have had several accounts of people being much relieved, and some perfectly cured by the use of cold immersion, in asthmas, and other difficulties of breathings especially if the infirmity is taken in the beginning, and not confirmed by time: yet an old gentleman, of sixty years lately told me that, having had a convulsive asthma for at least seven years, he was so cured by three times bathing, that he had not the least fit for three months after; and believes that, had he lived temperate, and continued bathing sometimes, it would not have returned."  (1, page 132-133) (2 page 314)
Floyer also wrote the following about cold water and asthma:
I am certain no Hot Regimen can be proper for tde Asthma, but the Cld is very useful, viz. to drink Water in the Morning, to have oft, and wash the Head every Morning, and a Cold Bath once in a Month or Fourteen Days." (2, page 174)
Ryan states that "in all the late publications on the asthma, cold-bathing is not even mentioned as a remedy, except in one work (Thomas Withers wrote about it in his 1876 book "A Treaties on the Asthma).  (1, page 144)

However, he concludes that all of the other physicians who recommended cold bathing offered little evidence of its usefulness. He said that even Floyer, while he recommended it in his writings, rarely recommended it for his patients. And, although he had asthma of greater than 30 years, he rarely used it on himself.

Ryan was probably biased about bathing as a remedy before he ever tried it.  Yet when he recommended the remedy to a 25-year-old lady, it worked.  When he returned home he described the case in his journal, and later transcribed the account in his book.  He wrote:
The first instance of the good effects of cold-bathing in asthma that happened to come within my knowledge, was that of a woman, about twenty-five years of age, who had borne several children. From her first pregnancy onwards, she was subject to spasmodic complaints of the stomach and bowels, both during the periods of gestation, and the intervals thereof; without the smallest tendency, however, to any disorder of the lungs. But on exposing herself to cold shortly after a lying-in, she began to feel an uneasiness in her breathing, attended with a short teasing cough, which, in a few days, terminated in a confirmed spasmodic asthma. In no case whatsoever were the pathognomonic symptoms of idiopathic asthma better marked than in the present: the fits returned most commonly late in the evenings, preceded by flatulence, continued through the night, and ended towards morning with a free and plentiful expectoration. In fact, all those symptoms were present that usually characterise the most violent and alarming state of this disease.
Blisters, asafeetida, camphor, and the rest of the usual remedies in those cases were tried ; but all to no purpose, for the fits still returned every night with very little abatement of their violence. At length recourse was had to cold-bathing, and the success that attended its use far exceeded any expectations that were formed of it. In less than a week from the first immersion, the patient found herself very sensibly relieved ; and by continuing the practice for the space of six weeks, she obtained a complete and lasting recovery.

If a single fact can authorise a particular mode of treatment in any disease, we are certainly warranted in recommending the cold bath in asthma from the precedent before us, especially as the utmost precaution was taken to guard against any deception about it. I was altogether so exact, that I even intermitted the bath for a few days, after some change for the better had taken place, in order to satisfy myself of its efficacy: but the patient began to relapse so suddenly into her former situation, that an immediate repetition of the bath was found absolutely necessary.

Hence we see that very little room is left for supposing that nature was in any degree entitled to the merit of this recovery; and this will be the more readily acceded to, if people consider how feeble and deficient her endeavours must be, when engaged in combat with such a formidable adversary as the asthma.
River water was the bath made use of on this occasion, from its vicinity to the patient's habitation, and as a preparatory step to bathing in the sea; but as the former answered every purpose that could be expected, the latter was neglected, and the cure went on equally well without its assistance, This, however, is the only instance in which I have seen a cure obtained without sea-bathing; its powerful stimulus being in most cases necessary for restoring to the lungs their lost elasticity and tone. (1, pages 147-151)
 Yet this wasn't the only instance where the remedy worked, because upon traveling to the home of Richard dunphy, he applied the same remedy with equal success.  He wrote:
Richard Dunphy, of whom some account is to be given in this place, was about the age of forty when first attacked with the asthma. During the winter season, in particular, he was subject to frequent fits of his disorder ; and, in the intervals of them, was affected with more or less of difficult breathing. He laboured under his disorder twelve months and more, when he first applied to me in April 1785. Several remedies were tried, such as antispasmodics, blisters, expectorants and others, with little or no alleviation of the symptoms: indeed the disorder seemed to gain ground, notwithstanding the repeated use of them for the space of seven weeks.
Finding very little probability of gaining any advantage by the medicines of the Materia Medica, I thought myself bound to recommend a trial of the cold bath, from the glaring proofs of its efficacy in the case just now related; nor had I any cause to repent of my rashness, as the patient soon experienced the happiness of getting rid of a disorder which must have inevitably terminated in his death. By his own account, it appears that he had not bathed above six days, when he found a very sensible change for the better; and by continuing the practice once a day for seven weeks only, the asthmatic fits were totally removed.
On this occasion sea-bathing was made use of, and nothing was done previous to the course, except the taking of a mild purgative: the precautions to be mentioned hereafter were not attended to in this, or in the case immediately following: both patients were constantly employed in bodily labour; and on this account they probably did not stand much in need of a preparation for sea-bathing, by having first bathed in water of a warmer temperature. (1, 151-153)
Dr. Ryan offered several other similar cases, all of which, according him, proved that cold bathing was a viable cure for asthma.

Perhaps to allay the minds of the skeptics, Dr. Ryan lists a few contraindications for cold bathing in the treatment of asthma, all of which were capable of being exciting causes of asthma.  (1, pages 200-220)
  • Ulcers of the lungs: 
  • Tubercles (consumption)
  • Inflammation of the lungs
  • Catarrh recent (colds)
  • Catarrh, long lasting, with phlegm (humoral asthma)
  • Dropsy of the chest (water in the chest)
  • Malconformation of the chest (abnormal formation that may lead to plethora)
  • Plethora (Accumulation of blood in the vessels of the lungs that may rupture with cold bathing) (1, pages 200-220)
While these were all reasons to hold off on cold bathing, they were not always absolute reasons for abstaining from the treatment.  Ryan believed that in many instances they could be treated and resolved, and then the patient could jump in a cold bath, thus receiving the benefits thereof.

Other conditions that should be treated prior to cold bathing were:
  • Humoral asthma: The accumulation of phlegm should be expectorated with emetics, blisters, or other expectorants, prior to cold bathing. 
  • Plethora: Should be treated with bleeding and blistering.  
  • Plethora caused by malformation of the chest: Treated with bleeding, blistering, emptying stomach and bowels, or blisters to the chest. (1, page 207, 210, 214)
  • Dropsy of the chest:  The "characteristic symptoms of water in th chest are on many occasions very obscure," although, "as the reigning symptoms will clearly point out the danger that must attend cold-bathing in such a situation." (2, page 215)
  • Difficult breathing:  Bathing should ideally be "entertained" when the patient is breathing easy between paroxysms.  However, should the patient have "uninterrupted difficult breathing," the bath may be "dangerous" and "the more cautious we should be in making use of it."  However, so long as the difficult breathing is caused by the "spasmotic affection" and not by plethora or tubercles, it can be tried. An antispasmotic may be tried to make the breathing easier prior to bathing.  (2, page 216-218)
Ryan also noted that he, along with Floyer, observed that the elderly respond well to cold water bathing whether they are breathing normal or are breathing with difficulty.  He said it's difficult to know at what age one is considered elder, although he said: (2, page 219-220)
If we can rely upon the authority of Sir John Floyer, an asthmatic of sixty not only escaped with impunity, but obtained great benefit from cold-bathing. However, it is much to be dreaded that, at such an advanced period of life as this, the remedy would prove a greater evil than the disease, not merely from the debility that attends old age, but more especially from this circumstance, that the asthma of old people seldom appears in a simple form, but is generally complicated with obstruct tions of the internal parts, or such an affection of the lungs as must render cold-bathing highly pernicious.
So, when cold water bathing is to be attempted as a preventative or as a remedy for asthma, the following remedies should be applied prior to submersion into the water.
  • Empty the stomach and bowel in order to give the lungs as much room as possible to expand. 
  • A small bleeding may be beneficial to those of full habit.
  • Blistering plaster should be applied if any stricture is felt on the chest 
The water should not be fresh water, but impregnated with salt.  This is done because fresh water seldom agrees with the asthmatic lungs.  

Regardless, Ryan said cold water bathing should be found useful both as a treatment and preventative measure for most types of asthma.  

References:
  1. Ryan, Michael, "Observations on the history of asthma, in which the propriety of using the cold bath in that disorder is fully considered," 1793, London, printed by G.G. J. and J. Robinson of Paternoster-Row
  2. Floyer, John, "History of cold bathing: both ancient and modern," 5th edition, 1722, London, Printed for William and John Innys at West-End of St. Paul's Church-yard 

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