Friday, June 10, 2016

1800: Lipscomb tries to discredit Bree's asthma theories

While Dr. George Lipscomb may have had nothing against fellow physician, Dr. Robert Bree,  personally, he strongly opposed his ideas regarding asthma in his 1800 book  "Observations on the history and Cause of Asthma."

I have yet to be able to obtain a copy of Lipscomb's asthma book, nor a picture of it, nor a picture of the doctor himself.  I have, however, been able to learn a bit about him and his thoughts on asthma through the writings of other authors.

According to his obituary, he was born in Quainton (Queen's Estate) in England, on January 4, 1773, which, ironically, is the same birthday as my own, only 197 years earlier.  His grandfather was Thomas Lipscomb, who was a surgeon in Hampshire County, and died in 1791 at the age of 92. (5, pages 88-89)

The eldest son of Thomas was James, and he was a surgeon in the Royal Navy, and resided in Quainton from 1764 until his death in 1794.  James was the father of George.  So you can see that he was born into a family of surgeons, and so there was a high likelihood that this was going to be his trade.  (5, page 89)

George received his elementary instruction at Quainton School and transferred to Aylesbury in 1783, and then was educated at home for his "hereditary vocation." He then studied under James Earle in London in 1791, started his own business, and in 1792 became house surgeon of St. Bartholomew's Hospital (5, page 89)

In 1799 he wrote "An Essay on the Nature and Treatment of Putrid Fevers." He also wrote various other essays. In 1800 he published his book containing all his wisdom regarding asthma, which included a history of asthma and criticism of Dr. Bree. (5, page 89)

George Lipscomb would die in 1846.

Asthma historian Mark Jackson, in his book "Asthma: The Biography," said Dr. Lipscomb, while born London, practiced, like Bree, in Birmingham.  While he admitted to not knowing Bree and having nothing personally against him, his book was an ardent attack on Bree's ideas regarding asthma.

Jackson quotes Lipscomb as saying the intent of his book was to "elucidate the history of a very prevalent and distressing disease, which has been hitherto but ill explained, and very unsuccessfully treated (1, pages 86)

Jackson said Lipscomb argued against many of the ideas of Bree, "criticizing his vague terminology, denouncing his over-reliance on ancient authorities, disputing his speculations about the irritating qualities of serum or the morbid state of the pulmonary vessels, and dismissing his classification of asthma into four species." (1, page 87)

William Cullen, our asthma expert from the 18th century, said asthma was a disease of constriction of the lungs. Bree, however, believed this theory was disproved as soon as the lungs were inspected, as no signs of constriction were found in asthmatic airways, and copious amounts of sputum were found in these airways. This was proof, he said, that asthma was bronchitic and not spasmotic.

Jackson said Lipscomb believed that Bree could no more prove Cullen's theories were wrong than Cullen could prove them right, mainly because, upon death, the lungs automatically relax (1, pages 86-87)

In this way, because the lungs automatically relax, even if asthmatic air passages were constricted, they would no longer be constricted upon death.  So Lipscomb argued that, while Bree's argument is flawed, Cullens

While Lipscomb argued against Brees theories, he postulated some flawed theories of his own.  Jackson said:
Lipscomb replaced the theories of Cullen and Bee with speculations of his own. Accepting the primary role of mucus obstructing the air passages, Lipscomb argued that any bronchial effusion must have originated in the arteries of the lungs. However, in asthmatics, the accumulation of serum in the bronchi was not the result of weakened capillaries, as Bree had assumed, but the product of some irritating, acidic, 'acrid matter' in the blood, which induced the rapid pulse and dyspepsia characteristic of early asthma as well as the paradigmatic shortness of breath. Although Lipscomb admitted that the mechanism by which acids produced irritation remained to be elucidated, he nevertheless insisted that the formation of acid in the blood constituted 'the real cause of asthma': 'If, then, a definition of Asthma be required, I have no objection to call it, an excessive contraction of the respiratory muscles, excited by the irritation of acid serum effused from the pulmonary vessels into the vesiculae and bronchia.' 1, pages 87-88) (2, page 86) 
In the year 1800 a review of Dr. Lipscomb's book appeared in the Monthly Review or Literary Journal:  (17, page 310)
This publication, notwithstanding its promise, contains merely an attack on Dr. Bree's Enquiry. Some of the observations may be just, but they are so minute as to assume a captious appearance; and the strictures on Dr. Bree's language are certainly conveyed with an unnecessary degree of severity. After our large account of the Doctor's work in the Review for May last, it is needless to repeat our opinion concerning the style and arrangement of it: but we, should not have expressed ourselves in the manner of Mr. Lipscomb. In p. 89, Mr. L. sneers at Dr. Bree's account of acid perspirationbut, if he will consult Dr. Wilson's book on febrile diseases on the subject of sediment in the urine, he will find ample proof of the fact. It is not indeed peculiar to asthma, nor to any morbid state of the body.  We are sorry to learn, from Mr. Lipscomb's preface, that he has enemies, who have succeeded in lessening his professional engagements. Lest we should be deemed desirous of adding to his uneasiness, we shall decline any farther examination of his criticisms. (17, page 310)
Another similar criticism occurred in the British Critic:
In his Preface, this author complains heavily of a combination of' persons or circumstances, which has occasioned him much uneasiness, and obliged him, as he seems to say, to quit his profession; hence leisure has been afforded him to examine Dr. Bree's book on Asthma, which he criticizes with a considerable degree of acuteness, and, we will add, of asperity too; although he positively disclaims bearing any ill will to the author, or even knowing him, he says, either as a gentleman or as a physician. The points however on which he disagrees with Dr. Bree, are principally speculative, and relate rather to the supposed cause, than to the mode of treating Asthma; and as it will never be demonstrably proved, whether the asthmatic paroxysm is occasioned by the'mere weight or bulk of the serum effused into the cellular termination of the bronchial vessels, as Dr. Bree seems to think; or by the acrid, or rather acid, quality of the aforesaid serum, as Mr. L. believes, the public will not think itself much interested in the dispute; we shall therefore dismiss this article, earnestly hoping, for the fake of Dr.Bree, as well as the author, that the cause of his present chagrin may cease, although we much doubt whether the production before us will at all contribute to that desirable end. (4, page 559-560) 
So you can see that Dr. Bree's arguments were rather strongly accepted by the medical community, and this was mainly because it was easier for the medical community to hang on to antiquated theories than science.  In fact, Dr. Bree was so well respected, little Lipscomb had to say would hold much sway.

However, this would change in 1819 when the stethoscope was invented, allowing physicians to hear constricted airways by a procedure called mediate auscultation.
  1. Jackson, Mark, "Asthma: A Biography," 
  2. Griffiths, Ralph, editor, "The Monthly Review or Literary Journal, Enlarged: from May to August, inclusive, M,DCCC," 1800, Volume XXXII, London, Printed by A. Strahan for R. Griffiths, and sold by T. Becket, "Article 25: Observations on the history and cause of asthma; and a brief review of 'A practical enquiry on disordered respiration:' in a letter to Robert Bree, M.D., the author of that work. By George Lipscomb, surgeon, at Birmingham."
  3. Lipscomb, George, "Observations on the History and Cause of Asthma," 1800, Birmingham
  4. "The British Critic, for July, August, September, October, November, and December, MDCCC," Volume XVII, 1800, London, Printed by J. Rickaby, "Art. 26:  "Observation on the History and Cause of Asthma, and a Review of a Practical Enquiry on disordered Respiration, in a Letter to Robert Bree, M.D., the Author of that Work, By George Lipscomb, Surgeon at Birmingham
  5. Urban Sylvanus, "The Gentleman's Magazine," January to June inclusive, volume XXVII, 1847, London, John Bowyer Nichol's and Son, "Obituary: George Lipscomb"
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