Wednesday, June 22, 2016

1815: Parry Shares his wisdom of asthma

Dr. Caleb Hillier Parry, in his 1815 book "Elements of Pathology and Therapeutics," gives us an excellent idea of what physicians knew about asthma at that time.  Through his thoughts relayed through this book we gather answers to all our questions on the subject.  

1.  What leads to a fit of asthma?  In patients who are subject to spasmodic asthma, fits of that disorder often begin with a violent coryza, in which the eyes become red and watery, and all the symptoms of a cold in the head are observable. After a few days, or sometimes even only hours, these symptoms suffer some degree ofalleviation, and the malady proceeds to the bronchia, occasioning all the well-known signs of spasmodic asthma. What, then, is this state in the bronchia, but an affection of the mucous membrane of those cells, exactly similar to that which had previously existed in the same membrane in the nose?  (1, page 196)

2.  Is asthma spasmotic in nature? It may, however, be said, that asthma is a spasmodic affection, depending on causes acting on the mind, etc, and returning at regular periods. (1, page 197)

3.  What are the exciting causes of asthma? The disease called spasmodic asthma is brought on by almost every thing which increases the action of the heart, and which stimulates and fills the vessels of the mucous membrane itself. Thus it is produced by intense heat, by lightness of air, by exercise, by full meals, by stimulating drinks, and by certain effluvia, as those of hay, whether new or old, of sealing wax, and other burning substances, and of ipecacoanha, while powdering, or even sometimes when a paper or bottle of it is opened in the same room with the patient. Of the operation of all these causes I have seen several examples; and similar cases might doubtless be found in the writings or experience of other medical men.   (1, pages 197-198)

4.  What specifically is asthma? These facts are convincing proofs of such a preternatural fulness of the vessels of the mucous membrane of the bronchia, as to impede free inspiration, and to produce all the symptoms of spasmodic asthma. (1, page 198)

5.  How is asthma relieved?  Asthma is relieved by gently open bowels, by heavy air, by inhaling that which is cold, and by cooling drinks. It diminishes, as soon as mucous secretion begins to take place; and is more speedily and effectually relieved by spitting of blood. (1, page 198)

6.  Is asthma nervous? We see the absurdity of assuming asthma to be a nervous disease, produced by a spasmodic constriction of tubes, in the parietes of which no muscular fibres have ever been demonstrated, and no equivalent power of producing such an effect has ever been proved. (1, page 200)

7.  What exactly occurs during an asthma attack? Spasmodic asthma is rarely accompanied with much preternatural heat, though the pulse is sometimes quick. The oppression of breathing consists of a general sense of constriction rather than pain, which resists inspiration, and which the patient in vain attempts to overcome, by employing all the muscles which assist in elevating the ribs, and therefore expanding the thorax. It is, however, apposite to remark, that, in patients in whom the disease is habitual, it sometimes runs into the state of bronchitis, and has all the marks of an acute affection of that kind. (1, pages 200-201)

8.  Can the cure of other ailments cause asthma? Fits of spasmodic asthma are not uncommon after the cessation of gouty paroxysms! I have often seen various thoracic affections, as pulmonary consumption, asthma, inflammation of the heart, or hydrothorax, arise from the spontaneous or artificial cure of ulcers, perpetual blisters, or fistula? (1, page 383, 386)

9.  Can asthma kill? A gentleman, formerly affected with frequent fits of epilepsy, ceased to suffer them on the appearance of gout, which often recurred, and a paroxysm of which was immediately followed by a sudden attack of spasmodic asthma, which, in twenty minutes, proved fatal.

10.  Can other ailments lead to a cure of asthma? That kind of chronic bronchitis, which is often called asthma humidum, is frequently relieved by the coming on of oedema in the lower extremities. I have also known dyspnoea and cough, of long standing, entirely cease on the appearance of ascites.

Bottom line:  Parry believed that asthma was essentially inflammation of the air passages of the lungs that lead to spasms of these passages.  In other words, he was a proponent of the bronchitic theory of asthma. 

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