Friday, July 29, 2016

1820-1900: Best remedy for hay-fever may be a holiday

Map of White Mountain Region
presented by Dr. Morill Wyman
in "Autumnal Catarrh."
(4, inside cover)
Dr. John Bostock, the same man who first defined hay-fever, may also have been one of the first to leave his home and participate in what later became known as a Hay Fever Holiday.  (1, page 26-27)

He observed that when he went on vacation to the seaside he gained relief from hay fever, and when he retired to the sea-side just prior to the hay fever season the ailment was prevented altogether.

He, along with various other hay fever sufferers, found they were unable to live a normal life, which included performing their normal vocations, during the hay fever season, which generally included the summer months.

They found that when they retreated to the seaside they were afforded with relief.  If they retired to the seaside prior to the hay fever season they were often able to prevent the condition altogether.  This became such a fad that it ultimately earned the name "hay fever holiday."

By the 1870 physicians of hay fever sufferers were commonly recommending hay fever holidays as a regular preventative and treatment for the condition.  They had it down to such a science that they would even prescribe a specific region of the country for the patient to vacation to.

They learned that ideal places to get away from hay fever "exciting causes," or what we would refer to as triggers, were places of high altitudes, such as mountainous regions such as Denver, or the prairies of Nebraska, or the White Mountains of New Hampshire.

They learned that locations along the sea were also ideal, such as along the shores of Lake Michigan, in places such asMackinac Island and Petoski.

Morrell Wyman, in his 1876 book "Autumnal Catarrh," went as far to list in his book all the best regions for getting away from hay fever, or for curing the malady as it already exists, which included: (3, pages 73-89)

  •  A sea voyage, such as a voyage across the Atlantic or a cruise many miles from land
  • Sea side residence, such as permanent removal to the sea coast of Maine, or an island like Martha's Vineyard or Nantucket or the Isles of Shaols
  • City living, such as Boston brings relief for some
  • Mountainous regions, such as the White Mountain region
Wyman even included maps of the best regions to vacation to, particularly the White Mountain region.

Hay fever holidays became an important source of income for these places, benefiting local merchants and, in some cases, forming resort towns specifically for hay fever sufferers.  These resorts would be busy during the hay fever season, and barren during the off-season.

But hay fever holidays were very expensive.  This meant that the only way to participate in this prescription was to be wealthy.  Fortunately, however, it was observed that most who suffered from the condition were wealthy citizens, such as physicians and doctors.

This resulted in many theories about hay fever.  One was that it was a modern disease that only occurred in persons who grew up away from hay fields and farms associated with urban life.  People who grew up in cities and towns were not exposed to such things as hay and grass, and therefore did not develop sensitivities to them.

Another theory was that hay fever was a disease of the educated, meaning that the better educated citizens of a society are less likely to be spending time in the fields and farms, and therefore more likely to develop hay fever.

Yet another theory was that hay fever was a nervous condition just like asthma, caused by the stress of city life, or the stress of working long hours in an office all day.  It was caused by the stress of obtaining an education, and the stress of making tough decisions, and the stress of making tough decisions in order to make profit.

It was, in other words, a disease of the aristocracy; a disease of the rich; a disease of the well-off; a disease of the upper class; a disease of the most successful members of society.  

Allergy historian Gregg Mittman said, in his 2007 book, that...
...hay fever holidays enjoyed by America's well-to-do were part of an expanding nineteenth-century tourist trade.  Leisure had become both a popular pastime and a marketable commodity after the Civil War. And... hay fever began as an illness that only the wealthy could afford to treat." (2, page 12)
Like retirement resorts in Florida today, hay fever holidays became a major tourist trade, and this was significant for the economies of these areas.  Petoski was amid the towns in Michigan, like my home town of Manistee, where lumberjacks migrated to because of all the white pines in the area.

Manistee, for instance, was so prosperous during the lumbering era that it was one of a few places in Michigan to become a city before even being designated a village.  It grew that fast.  It was such a prosperous industry that by the turn of the 20th century Manistee had the third most millionaires per capita in the United States.

Yet the lumbering boom ended in the 1920s because most of the white pines were cut down without being replaced.  Manistee's economy took a significant hit, while the economy of Petosky continued to flourish, mainly because of the new market created their by hay fever vacationers.

The interesting thing is, there was really never any evidence that hay fever vacations did any good.

Although, there were many wealthy physicians, businessmen, and published authors who were convinced it worked, and who continued to vacation for the remainder of their adult lives.

It was such a popular pasttime that even up until the 1990s relocation was still prescribed by physicians of asthma and hay fever sufferers.  Even to this day there are people who relocate to prevent asthma and allergies.  Sometimes it works, although the evidence suggests they usually don't.

  1. Smith, William Abbots, ""On Hay-Fever, Hay-Asthma, or Summer Catarrh," 1867, London, Henry Renshaw, pages 17-24.  The quotations are from Smith's descriptions of Phoebus's ideas. 
  2. Mitman, Gregg, "Breathing Space: how Allergies Shape our lives and landscapes," 2007, New Haven and London, Yale University Press
  3. Wymann, Morrill, "Autumnal Catarrh," 1876, New York, Published by Hurd and Houghton
  4. Holopeter, William Clarence, "Hay fever and its successful treatment," 1898, Philadelphia, P. Blakiston's Son & Co
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Wednesday, July 27, 2016

1819: Bostock defines hay fever for medical community

Figure 1 -- John Bostock (1773-1846) (12)
Even thought hay fever had caught the fancy of the public by the turn of the 19th century, the malady was barely recognized by medical authorities. This left the task of defining it, and giving it an official name, to Dr. John Bostock Jr. of London, England.

He was born in 1773 to Dr. John Bostock Sr.  As a student at New College at Hackney he attended the lectures of Joseph Priestly (the man credited with the discovery of oxygen) on chemistry and natural philosophy. He received his medical degree from the University of Edinburgh and opened up a practice at Liverpool.

He moved to London in 1817, and two years later, on March 16, 1819, when he was 46-years-old, he presented a study to the Medical and Chirurgical Society called  "Case of a Periodical Affection of the Eyes and Chest."

It was in this report that he described a subject by the name of JB who suffered from hay fever since the age of eight, and who realized over time that there was an association with his seasonal catarrh, runny eyes, nose and scratchy throat with the appearance of the season of summer. (1, page 12)(8, page 3)(12)

In his 1878 book on hay fever, Dr. George Beard said that in the report Dr. Bostock...
...cited a number of facts from his own experience which went to show that, in his case at least, heat and direct rays of the sun had more to do with the disease than any other traceable exciting cause. He states that one season he walked out frequently among acres of hay-grass, and suffered less than usual, except when it was very hot. Dr. Bostock, however, admits that in some persons the disease was apparently brought on by hay; but he was sufficiently skeptical on the subject to suggest that possibly they might be exposed to hay and heat at the same time, and confound the effects." (5, page 12)
A little less than a decade later, in 1828, he provided another report that this time he called "Summer Catarrh" or "Catarrhus Aestivus."  He referred to the condition as such because he did not believe, as the public fancy had suspected, that the condition was caused by emanations from dry hay during the hay season.  Instead he suspected it was caused by moist heat, sunshine, dust and fatigue. (1, page 12)(5, page 11)(8, page 3)(10, page 19)

However, despite this recognition for hay fever, it should come as no surprise that the condition continued to go unrecognized by a dogmatic and proud medical profession.   It continued to go unrecognized even as King George IV of the United Kingdom was diagnosed with it.  (10, page 19)

Still, once Dr. Bostock described the disease other physicians were quick to write about it, some creating unique terms to describe it, and others their own theories as to the cause and nature of the disease.  Regardless of any confusion as to the name, cause or nature , there was a general consensus it was seasonal.

Later in 1828, Dr. MacCulloch wrote an essay titled "An Essay on the Remittent and Intermittent Diseases."  He said hay fever was caused by hot houses and green houses, and that it was caused by hay fields. (5, page 11)(also see 8, page 4) (11, page 14)(13, page 603)

Despite the diagnosis, MacCulloch advocated nothing new about the disease. (10, page 19)

A year later, in 1829, Dr. W. Gordon, of Welton, in Yorkshire, published a paper in the London Medical Gazette (volume IV) titled "Observations on the Nature, Causes, and Treatment of Hay Fever."  He said it was caused by the aroma of the flowers of grass, particularly anthoranthum odoratum, and suggested it be called grass asthma. (6) (13, page 603) (14, page 962)

He said he observed the disease usually appeared when this plant flowered and disappeared when the plant disappeared.  He said that after the death of this plant grass asthma sufferers could go through meadows without suffering. (6)

Gordon recommended a tincture of lobelia inflata as the remedy, and also recommended the cold shower as the best preventative for the malady. (14, page 962)

In 1831, Dr. Elliotson of England described hay-fever, and two years later agreed with Dr. Bostock that the disease was not caused by hay, but opposed Dr. Bostock's claim the disease was caused by heat.  Instead, he insisted it was caused by grass, similar to Gordon.  (10, page 19) (13, page 603)

In 1837, any patient seeing Dr. J.J. Cazenave of Bordeaux, and who complained of hay-fever-like symptoms, were encouraged to wear goggles to protect their eyes from irritating matter.  It's possible this was the first time a physician recommended protection to prevent allergies. (11, page 15)

Dr. Morell Mackenzie, in writing a history of hay fever, would write that Cazenave also...
...attempted to prepare the nasal mucous membrane for the enemy's attack by hardening it with nitrate of silver.  Cazenave attributed the complaint to the effect of light, and does not seem to have known that it had been described before. (11, page 15, 16)
In 1841 Dr. Francis Hopkins Ramadge referred to it as hay asthma and viewed it as just another form of asthma.  Although in this form he suspected it to be caused by an effluvia from flowers, and that avoidance of such would prevent the condition from occurring.  (10, page 19)(8,page 20)

In 1850, Dr. Gream published a paper in the London Lancet (volume I, page 692) in which he described his observation that asthma was relieved after a fall of rain.  He said this was true because the causative agent was not grass or even the flowers of grass, but dust that fell on the grass.  He said house dust was just as much an exciting cause as outdoor dust.  (7) (13, page 603)

In 1852, Dr. Swell of New York may have been the first to observe a difference between summer fever and hay fever.  (11, page 15)

In 1859, asthma expert Dr. Henry Hyde Salter referred to "hay asthma" as "periodic asthma," meaning that it comes and goes with the hay season and lasts about 4-6 weeks. He said the cause was heat, dust, and "bright, hot, dusty sunshine." He also suspected laughter, eating too much, and hay. (5, page 14) (13, page 603)

Also in 1859, Laforque of Toulouse described two patients he diagnosed with hay fever, and he believed the cause in both cases was nervous in origin and that it was excited by heat.  Various other physicians would likewise conclude hay fever, like asthma, was a nervous condition.  (11, page 15)

In 1860 Dechambere was convinced that "'an occult atmospheric influence' was the cause." (11, page 15)

So mainly thanks to the efforts of John Bostock, hay fever had gained the interest of the medical community, inspiring various physicians to further study the condition for the benefit of hay fever sufferers worldwide.

  1. Mittman, Gregg, "Breathing Space," 2007, New Haven and London, Yale University Press
  2. Taylor, C.F., editor, "The Medical World," volume 16, 1898, Philadelphia, 
  3. Fry, John, "The Natural History of Hay Fever," J. Coll. Gen. Practi1, 1963, 6, page 260
  4. Ehrlich, Paul M., Elizabeth Shimer Bowers, "Living with Allergies," 2008
  5. Beard, George, "Hay-Fever; or Summer Catarrh: It's Nature And Treatment," 1876, New York, Harper & Brothers
  6. Beard, ibid, pages 12 and 13, referenced by Beard from Dr. Mr. W. Gordon's paper "Observations on the Nature, Cause, and Treatment of Hay-Asthma," London Medical Gazette, 1829, vol. iv, page p. 266
  7. Beard, ibid, pages 13 and 14, referenced from "On the use of Nux Vomica as a Remedy in Hay Fever, Lancet1850, vol. 1, page 692
  8. Blackely, Charles Harrison, "Hay-fever: its causes, treatment, and effective prevention," 1873, 1880 2nd edition, London, Bailliere
  9. Smith, William Abbotts, "On Hay-Fever, Hay-Asthma, or Summer Catarrh," 1867, London, Henry Renshaw
  10. Hollopeter, William Clarence, "Hay-fever and it's successful treatment," 1898, Philadelphia, Blakiston's Sons & Co.
  11. Mackenzie, Morell, "Hay fever and paroxysmal sneezing," 5th ed., 1889, London, J&A Churchill
  12. Parkinson, Justin, "John Bostock: The Man Who 'Discovered' Hay Fever,",, accessed 7/24/14
  13. Rumbold, Thomas F., "A Practical Treaties on the Medical, Surgical, and Hygienic Treatment of Catarrhal Diseases of the Nose, Throat, and Ears; Including Anatomy, Physiology, Pathology, Etiology, and Symptomatology...," 1888, St. Louis, Medical Journal Publishing Company, Chapter XV: "Pleuritic Rhinitis Catarrhalis -- Pleuritic Rhinitis  (Hay Fever, June Fever, Summer Catarrh, Autumnal Catarrh, etc, etc, etc.," pages 596-654
  14. Watson, Dr., "Lectures On the Principles and Practice of Physic: Hay Asthma, Chronic Bronchitis. It's varieties. Morbid anatomy of these affections," London Medical Gazeette, volume 28, Friday, September 17, 1841, London, 
  15. Ergonul, Onder, Chris A. Whitehouse, editors, "Crimeon-Congo Hemorrhagic Fever: A Global Perspective," 2007, Netherlands, Springer
  16. Heberden, William, "Commentaries on the History and Cure of Disease," 4th edition, 1816, London, Printed for Payne and Foss - Pall Mall
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Monday, July 25, 2016

1820-1850: Race to define asthma

In the year 1840 Dr. Charles J.B. Williams proved the bronchospasm theory of asthma, and Dr. William Budd rejected this proof by performing experiments of his own.  This theory was debated for the rest of the century.

Likewise, from this year on you had one physician after another come up with his own theory as to the cause of asthma, with each being convinced he was right, and each offering proof.  Historians can argue whether this slowed down or sped up search for better asthma wisdom.

Dr. Franz Daniel Reisseissen:  He was a German physician who studied the lungs, and concluded "there is another apparatus appointed for contracting the bronchi, which consists of transverse muscular fibres.  As far as the cartilaginous rows extend, these fibres are inserted...." (1, page 186)

Reissiessen proved muscle fibres wrap around the air passages of the lungs almost all the way to the alveoli.  His writings are published in Berlin in 1822. You can check out his 1835 book by clicking here.

Charles J.B. Williams later proved that certain irritants cause contraction of the muscular fibres that Reisseissen proved wrap around the air passages in the lungs.

Francis Hopkins Ramadge:  In 1835 he described food as an asthma trigger, recommends moving from the city to country,  and of asthma being mostly a nocturnal disease. He discourages use of opiates because they impede respirations that are already impeded. He mainly recommends strammonium because it "produces a grateful forgetfulness and a balmy oblivion like opiates." (2, page 7)

He regarded asthma as a neurosis of the respiratory organs.

Prize essays of Bergson and Lefevre:  This occurred in 1836.  They regarded, as did Ramadge, asthma as a neurosis of the respiratory organs (3).

Lefevre observed his own asthma and that of a friend and concluded asthma could only be caused by bronchospasm, and that this bronchospasm was caused by the mind, according to J.B Berkart. (4)

Berkart said that ant "in essence of the disease he (Lefevre) considered to be an increased irritability of the nerves of the lungs, in consequence of which the slightest irritation applies to the bronchial surface induced spasm of the bronchial tubes." (4)

Romberg:  He further established the view of asthma as a nervous disorder in 1841, and based his conception of the disease as a spasmus bronchialis, upon the discovery by Reiseissen (1808) of muscular tissue in the finer bronchial tubes, and the contraction of these tubes under galvanization of the lungs by Charles J.B. Williams (1840), and irritation of the vagus (nerve) by Dr. Francois Achille Longet (1842)." (3)

Dr. Francois Achille Longet:  According to a brief history of asthma by W.H. Geddings, "It was ascertained by (Charles J.B.) Williams that by irritating the lung he could cause contraction of these fibres, and Longet subsequently proved that the same effect could be produced by galvanizing the pneumogastric nerve."  (5, page 184)

Berkart said that in 1842 Longet performed experiments to prove "irritation of the pneumogastric nerve always produced spasmodic contraction of the bronchi, whereas section of the nerve led to emphysema, which was described as distention of the air vesicles."  (4, page 27)

Longet also believed bronchospasm and emphysema were both parts of asthma.

Rudolph A. von Killiker:  In the 18th century William Cullen believed the muscle was just a continuation of a nerve.  Von Killiker was a histologist who proved this was not true.  He basically confirmed the works of Williams and Reisseissen when he isolated smooth muscles in the lungs  (6, page 422)

This essentially proved Cullen wrong, that the muscle was not just a continuation of a nerve.  Yet since nerves still connected to muscles, van Killiker's discovery was unable to stop the fallacy of the nervous theory of asthma. (6, page 422)

Interesting notes:  Williams must have agreed with Rene Laennec and J.B. Berkart that asthma was an abused term. James Thomas Whitaker noted that in 1768 there were 17 different types of asthma (as described by Savage) and in 1822 this was reduced to 11 (by Richter). This was confusing. Williams wanted to simplify the definition of asthma.(3)

The thing to note about most of these experts is that even while they believed in the bronchospasm theory of asthma, they continued to believe in the nervouse theory of asthma, and their experiments proved the two co-existed  -- or so they thought.

During the 1850s, asthma was described by Dr Henry Hyde Salter as a disease of bronchospasm caused by an exciting cause that triggers the nervous system.

  1. Floyer, John, ed., "The Cyclopaedia of practical medicine," 1833, volume 1, page 186
  2. Brenner, Barry E, ed, "Emergency Asthma" 1998, page 7 (chapter one is a history of asthma written by Brenner)
  3. Whitaker, James Thomas, "The theory and practice of medicine," 1893
  4. Berkart, J.B.,"On Asthma:  It's Pathology and Treatment, 18xx, volume 1878, London, J. & A. ChurchillI, page 23 (Berkart started his book with a good history of asthma up to his time.
  5. Geddings, W.H., writer, "Bronchial Asthma," in the book, "A System of Practical Medicine," edited by William Pepper and William and Louis Star, Volume 3, Philadelphia, Lea Brothers & Co., pages 184-209
  6. Daintith, John, editor, "Biographical encyclopedia of scientists." 2009, 3rd edition, Florida, CRC Press
  7. Ramadge, Francis Hopkins, "Asthma, its species and comications, 1835, London
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Friday, July 22, 2016

1819: Laennec says consumption can be cured

Dr. Rene Laennec might have become interested in diseases of the lungs because his own mother died of tuberculosis when he was only five-years-old.  Of course it may simply have been his desire to help people who lived under the gloomy cloud created by the grim diagnosis of the disease.

While he specialized in diseases of the chest, he would end up spending more time studying consumption than any other disease, perhaps becoming the first to describe the disease as curable. (1, page 6)

He referred to it as pthhisis pulmonalis in his 1919 book "Mediate Auscultation," dedicating three full chapters to the disease.  He said it results in the development of "species of accidental production" called the tubercle in the lungs. (2, page 283)

He said the ancients described an "accidental production" as any abnormality, and used the term "tubercle" to describe an accidental production in the lungs, such as a cyst or cancerous growth, that resulted in phthisis or wasting away.  (2, page 283, 310)

Laennec, however, recommended tubercle only be used to describe tubercles of consumptive patients. (2, page 283)

He described the tubercle:
Whatever be the form under which the tuberculous matter is developed, it presents at first the appearance of a grey semi-transparent substance, which gradually becomes yellow, opaque, and very dense. Afterwards it softens, and gradually acquires a fluidity nearly equal to that of pus; it being then expelled through the bronchi, cavities are left, vulgarly known by the name of ulcers of the lungs, but which I shall designate tuberculous excavations. (2, page 285)
He said in most cases the disease results in extreme emaciation, which is why the ancient Greeks referred to it as phthisis, wasting away.  (2, page 304)

He said the internal organs other than the lungs are usually of normal length, but of lessor diameter.  The chest is "usually narrow and sometimes evidently contracted." The skin is usually very pallid and pale.  (2, page 306)

He said:
"The emaciation then makes rapid progress toward complete marasmus (severe malnutrition).... The nose becomes sharp and drawn; the cheeks are prominent and red, -- and appear redder by contrast with the surrounding paleness; the conjunctiva of the eyes is of a shining white or with a shade of pearl blue; the cheeks are hollow; the lips are retracted, and seem moulded into a bitter smile; the neck is oblique and impeded in its movements; the shoulder blades are projecting and winged; the ribs become prominent, and the intercostal spaces sink in, particularly on the upper and fore parts of the chest. Sometimes even the whole chest seems contracted...; and this may actually be the case, particularly when the disease is very chronic, owing to the contraction and tendency to cicatrization of large tuberculous excavations. The belly is flat and retracted; the larger joints and those of the fingers, appear enlarged from the falling away of the neighboring soft parts; and even the nails become incurvated, in consequence of the absorption of the pulpy extremities of the fingers. No other disease gives rise to so complete emaciation as phthisis,—except cancer and continued fever of long duration. (2 page 372)
The patient sometimes complains of a "guggling sound," which Laennec attributes to the softening the the tubercles.  This is often expectorated, resulting in sputum similar to that produced during a fit of common catarrh. (2, pages 375-377)

The disease generally presented with obvious signs and symptoms.  The earliest symptom was a dry cough, which may be confused with dry catarrh. Haemoptysis, fever, chills and night sweats are other prominent symptoms. Some patients are known to require a change of sheets several times in a night. (2, pages 369-272)

Most people, including most physicians, during the early 19th century had a very gloomy view of this disease, as most who were diagnosed with it perished as a result of it.  The medical prognosis, therefore, was not very good.  (2, pages 319-320)

However, Laennec explained that the ancients believed "phthisis" started as a result of chronic inflammation, and they probably came to this conclusion because an early symptom of the disease is a slight dry cough that could easily be contributed to a dry catarrh (common cold). (2, page 319, 320, 369)

This chronic inflammation resulted in the gradual formation of pus in pulmonary tissue.  They believed this was curable, especially in the early stages. (2, pages 319-320)

This was pretty much the common perception of phthisis all the way up to the late 19th century when pathological anatomists discovered tubercles in the lungs of patients with phthisis.  (2, page 369)

Yet once physicians started studying pathological anatomy, they learned that this was not true, that once one developed tubercles (like cancer) the prognosis was poor, with death almost certainly imminent. (2, pages 319-320)

Laennec seemed to disagree with this notion, believing instead that, while the disease was not curable during the early stages of the disease, it was curable in the latter stages, that is, he said, "after the softening of the tubercles and the formation of an ulcerous excavation."  (2, page 321)

He said:
The formation of the semi-cartilaginous membrane on the surface of tuberculous excavations, must be considered, in my opinion, as a curative effort of nature. When completely formed, it constitutes a sort of internal cicatrix (a scar of a healed wound) analogous to a fistula, and is, in many cases, not more injurious to health than this species of morbid affection. All the persons whose cases I noticed above, died of diseases not referable to the pulmonary organs. They had all lived a greater or less number of years in a very supportable state of health, being merely subject to chronic catarrh. Some indeed had more or less of dyspnoea, but without any fever or emaciation. (2, pages 321-322)
Essentially, he believed that early on in the disease the tubercles were soft, and these were not curable. However, later in the disease scar tissue formed, either by fistula or cicatrix.  This hardened tissue acts as a natural barrier against the disease. (2, page 336)

While essentially cured, the patient may still present with symptoms. Generally, he believed those cured by fistula developed a chronic catarrh occasioned with sputum production that was sometimes copious; and those cured by cicatrix developed a dry cough that was not frequent, not severe, and not much of an inconvenience to the patient. (3, page 337)

He even gave examples of patients cured of consumption.
In a lady, formerly a patient of M. Bayle, fourteen years since, and whose case was decidedly consumption, (as appears from M. Bayle's notes in her possession,) the sign of pectoriloquy (particular lung sound made by a tubercle) is most distinct. This lady recovered beyond all expectation; she is now stout, and the only symptom she has at all referable to the lungs, is a slight cough. I have no doubt that the cartilaginous excavations above described exist in this person's lungs.
In July of 1817 he attended to a lady of 48 who had been in good health until the age of 30 when she became subject to severe attacks of catarrh and became quite emaciated.  Upon assessment he observed her breathing was diminished over the upper right chest.  By this, and by the appearance of her sputum, he diagnosed her with tubercles in the early stages.  As the treatment he applied leeches and more.  (2, pages 325-326)

Her symptoms were unchanged until February of 1818 when her cough increasingly distressing with thick yellow sputum.  He said:
I did not see the patient during this attack, which she looked upon as a cold; but I visited her in the beginning of April, and upon examining her chest I found most distinct pectoriloquy at the anterior and upper part of the right side. I was convinced by this that the supposed catarrh (the cold) had been the discharge of the softened tuberculous matter. The sound of respiration was good over the whole chest; and even in the vicinity of the pectoriloquous spot; the pulse was not frequent and the heat moderate. On this account I entertained hopes of her recovery, and prescribed ass's milk. The cough and expectoration progressively lessened, the flesh and strength returned; and, in the beginning of July, my patient had regained every appearance of the most perfect health. (2, page 326)
The pectoriloquy continued, although he suspected that it would, offering proof that she had suffered and survived a bout of consumption.  (2, page 322)

Laennec listed hundreds of various remedies used by the ancients and moderns, and he said any of these are worthy of trying, so long as the patient tolerates them, and this included bleeding with leeches and cautery by the application of caustic potass on several locations of the body.

The medicinal list also included a long list of expectorants, purgatives, etc.  It also included the inhalation of fumes, air of cow houses, oxygen, hydrogen, etc. (for a longer list of Laennec's remedies check out my post 1819: Laennec remedies for consumption.

The remedy he was most fond of, however, was change of situation.  (2, page 392)

Laennec said that the ancients observed that consumption was sometimes cured by the seaside, and that they often recommended sailing to their phthisical patients. He said Areteaus recommended sailing and the air of the seashore, Celsus recommended a voyage to Egypt.  (2, pages 243-394)

This was an idea recently picked up by English physicians, who often sent their phthisis patients to Maderia.   (2, page 343)

There was one case early on in his career, long before he had invented the stethoscope, whereby a patient of his was diagnosed by both himself and Dr. Bayle as having chronic catarrh.  However, upon a change of air, or a move to the seaside, he was cured.

Several years later, and after he had use of the stethoscope, he had another opportunity to assess this patient.  He said:
Since then I have had an opportunity of satisfying myself, by means of the stethoscope, that our patient had had more than a mere catarrh. His respiration is quite perfect throughout the whole chest, except at the top of the right lung, in which point it is totally wanting. On this account, I am certain that this portion of lung had been the seat of an ulcerous excavation, and that this had been replaced by a complete and solid cicatrice. The health of this gentleman continues good, although he has often occasion to speak in public. He has sometimes a little dry cough, on the change of weather, but takes cold very seldom. (2, page 340)
Yet while medicine may offer benefits to the consumptive, it does not offer a cure. The only means to a cure, he said, was nature.  (2, page 396)

So while he began his career under the belief there was no cure for consumption, his own experience and assessment skills proved that this was not always the case. He learned that there was a cure for consumption...
...or at least, for such a suspension of their symptoms as may be deemed almost equal to a cure, as the individuals may enjoy such a state of health as may enable them to fulfill all the duties of civil life, for several years, or until a fresh development of tubercles produces a fresh and final seizure. (2, page 337-338)
Patients who were thus "cured" might still have some symptoms, such as episodes of catarrh or a cough, but may otherwise "live in a supportable state of health." Others may have dyspnea, but without the fever and emaciation. (2, page 322)

As one final note to this discussion, Laennec said:
My experience leads me to deem such cases to be extremely common: those related above occurred to me in the course of some months: and I have since met with many others. (2, page 340)
Laennec was, therefore, among the first physicians of his era to speculate that consumption was a curable disease.  This subject would be further investigated by his pupil, Francis Ramadge.

It was perhaps due to his passion to learn about this disease that cost him his own life.  He would end up one of the many victims of consumption at the young age of 45.

  1. Ramadge, Francis Hopkins, "The Curability of Consumption: the reprint of a series of papers, presenting its most prominent and important practical points in the diagnosis, prognosis, and treatment of the disease," 1850, London, Printed by W. Clowes and Sons
  2. Laennec, Rene, "Mediate Auscultation," translated by John Forbes, Notes by professor Andral, 4th edition, 1838, New York, Samuel S. and William Wood
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Friday, July 15, 2016

1819: Laennec defines pneumonia

By the year 1819, when Rene Laennec invented the stethoscope, little had changed regarding pneumonia since it was described by Hippocrates.  Treatment was also unchanged, as many physicians still recommended bleeding as a general treatment.

In his 1819 book, Mediate Auscultation, Laennec used his stethoscope to distinguish pneumonia from other pulmonary diseases.  He said that first it had to be separated from pleurisy, as calling it peripneumony as added to "confounded" descriptions of it. (1, page 512)

However Laennec continues to use the terom peripnumony.  He described three types of peripneumony. (1, pages 512-516)
  1. Pneumonia complicated with slight pleurisy: It can be accurately diagnosed by crepitous rhonchus (fine inspiratory crackles) being heard over the part of the lung affected, which is usually the "roots of the lungs"
  2. Pleurisy complicated with slight pneumonia: Crepitous rhonchus only at the roots of the lungs and the large bronchi
  3. Pleuro-pneumonia: Pleurisy with severe pneumonia (1, pages 512-516)
The following are the recommended options: (1, pages 504-508)
  1. Venesection, either general or local (to reduce congestion)
  2. Cupping
  3. No food for a few days
  4. Getting out of bed several hours a day
  5. Tartar emetic in large doses
  6. Antimonials as an emetic
  7. Kermes as an emetic
  8. Mercury to treat inflammation 
  9. Hot wine, brandy, and aromatics to treat fever
  10. Blisters to the affected side to treat chronic pleuropneumony
  11. Purgatives and diuretics, particularly when dropsy or hydrothorax occurs
  12. Acetate of potass
  13. Extract of squills
  14. Watery infusion of digitalis
  15. Nitre as a diuretic (1, pages 504-508)
Which of the above remedies is used, and the dosage, depends on the stage of the disease, and what comorbidities exist with it: does it present with a fever? Is it aucte or chornic? 

Pleurisy and pneumonia were pretty much treated the same, basically because they both present with inflammation.

  1. Laennec, Rene, "Mediate Auscultation," translated by John Forbes, Notes by professor Andral, 4th edition, 1838, New York, Samuel S. and William Wood, pages 84-87 for bronchitis treatment, and 175-177 for emphysema treatment
  2. Andras, author of the notes in the book, "Mediate Auscultation, by Rene Laennec," ibid
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Wednesday, July 13, 2016

1819: Laennec describes causes of consumption

In 1819, when he wrote his book, "Mediate Auscultation," Dr. Rene Laennec, of France, had no idea that consumption, or what he referred to as phthisis pulmonalis and what we refer to as tuberculosis, was caused by a bacteria.  So, as with other physicians of his era, he was force to speculate based on his studies and own observations.

Some things he suspected as causing tuberculosis were:

1.  Cold:  It was more common in northern Europe and America where the temperature has a tendency to become cold.  It is less common in southern Europe and between the tropics.  In places where it is cold year long, such as high up in the Alps, people tend to prepare for cold weather better with warm clothing and houses. (1, page 341)

2.  Too light clothing:  This may give the impression of cold, particularly in young women whose disease typically begins with pulmonary catarrh, pneumony, or pleurisy.  (1, page 342-343)

3.  Locality: It is more common in large cities than in small ones, and more frequent in small cities than in the country. It was less common on the seashore than inland.  Sailing, or a long voyage at sea, tends to offer as a cure.  (1, page 343-344)

4.  Haemoptysis:  Many physicians suspected this cause inflammation that resulted in congestion of the vessels, leading to blood in the lungs.  However, Laennec wasn't convinced, suspecting the blood was a result of the tubercles in the lungs.  (1, pages 345-347)

5.  Depressing passions: Strong and long lasting passions, such as grief, tend to not only cause consumption, but cancers and other accidental productions as well.  He said people in the city are likely to come into contact with more people, "and is in itself a cause of more frequent and deeper vexation." Plus, in the city, people are more prone to be witness "the greater prevalence of immortality... a constant source of disappointment and misery." (1, page 347)

6.  Fevers:  Severe continue or intermittent fevers are a common cause of phthisis.

7.  Infected people:  A question Laennec postulated was: is consumption contagious?  He said it had long been suspected to be contagious, although he had seen many cases of people living together with a consumptive who did not themselves succumb to the disease.  Still, he said, the common people still suspect it is a contagious disease

While the exact cause may have eluded him, he was aware that, while Hippocrates suspected phthisis attacked people between the ages of 18-35, and Bayle suspected it attacked people between the ages of 40-40, Laennec believed that "no age was exempt from it." (1, page 352)

He did, however, believe women were more subject to it than men.  (1, page 353)

  1. Laennec, Rene Theophile Hyacinthe, "A treaties on the diseases of the chest, and on mediate auscultation," tranlated by John Forbes, 1838, New York, Philadelphia, Samuel S. and William Wood, Thomas Cowperthwaite and Company
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Monday, July 11, 2016

1819: Laennec's treatment for emphysema and bronchitis

Laennec admitted himself to have been the first to accurately describe emphysema and bronchitis, and to note that they generally occur together.  While he offered no new remedies, he does offer an idea of how you would have been treated if you had COPD in the 1820s.

He referred to chronic bronchitis as chronic mucous catarrh.  If you were diagnosed with this, these would be your possible remedies.

In old persons:
  • Permanent drain in the arm or thigh
  • Use of aromatic bitters, such as hyssop, horehound, ground ivy, sage, veronica, &c.
If the expectoration suspended:
  • Oxymel of squills, or kermes mineral, in small doses
If cough becomes hard and returns by fits:
  • Peregorics are ordered
For long continuance of the disease
  • Emetics, repeated according to the patient's strength and his power in supporting their action
  • Tonics given in small doses after the emetic, such as barks and other bitters
  • Preparations of iron take away the complaint or greatly moderate it
  • Spirituous preparations particularly punch
  • Balsam of tulu and capaiba
  • Turpentine in 18-30 drops daily
  • Internal use of tar water 
  • Inhalation of fumes of tar water defused in the patient's chamber
When acute catarrh supervenes the chronic
  • Blisters
  • Cupping
When dyspnea becomes extreme
  • Narcotics, particularly the powder of belladonna or strammonium in doses of half a grain to a grain
  • Emetic of Squill, epecacuan, and kermes in small doses

He referred to emphysema as vesicular emphysema.  If you were diagnosed with this, these would be your possible remedies.

When caused by dry catarrh:

  • Friction with oil lessons catarrh
In cachectic subjects:
  • Subcarbonate of iron lessons catarrh, diminishes congestion of mucous membrane and diminishes spasmotic stricture of the bronchi
In severe asthmatic paroxysm:
  • Venesection to relieve congestion of blood in the lungs
  • Narcotics to diminish the necessary of respiration
If you became short of breath with either of these conditions, you would still be referred to as having a fit of asthma.  However, the cause, if your physician was observant enough, would be different.  Even the treatment might be different, at least to a slight degree

  1. Laennec, Rene, "Mediate Auscultation," translated by John Forbes, Notes by professor Andral, 4th edition, 1838, New York, Samuel S. and William Wood, pages 84-87 for bronchitis treatment, and 175-177 for emphysema treatment
  2. Andras, author of the notes in the book, "Mediate Auscultation, by Rene Laennec," ibid
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Friday, July 8, 2016

1819: Laennec accurately groups emphysema and bronchitis

Laennec accurately described emphysema (13)
Dr. Rene Laennec was known as the father of chest medicine, and this is mainly due to the fact he was the first to have the tools necessary to compare what he learned upon assessment of the chest during life, with what he saw when inspecting the lungs during autopsy after life.

The tools he had access to were chest percussion and the monaural stethoscope he invented. He used these to perform complete assessments of the chest on any of his patients who complained of asthma or asthma-like symptoms, such as dyspnea, chest tightness, chest pain, increased phlegm, and coughing. By doing this he became the first physician to accurately distinguish asthma from chronic bronchitis and emphysema.

That said, here is how he described bronchitis and emphysema.

Bronchitis:  He defined it as "Chronic Mucous Catarrh."

He said bronchitic airways are sometimes present with a "general or partial dilation of the bronchi.  Pulmonary vessels are often congested, and this can often be diagnosed by sputum that is tinged with blood. In fact, while the amount expectorated varies from day to day, colorful sputum is almost always produced. However, when the person becomes weak, expectoration may become difficult. (2, page 81)

He said bronchitis usually occurs in the aging, and usually after a severe acute attack, and as it worsens often produces dyspnea.  (2, page 83)

He said if it does occur in the young, however, it usually disappears in a year or two.  However, the only time it disappears in the aging is during the summer months, only to return during the winter months. In such cases it usually returns with a fever and copious expectoration.  After a few times of this happening... (2, page 83) terminates in a continual mucous catarrh... the great expectoration of which weakens and emaciates the patient." (2, page 83)
Since he had access to his stethoscope, he would use it to help him diagnose chronic mucous catarrh.  He would generally hear "mucous rhonchus, sometimes indeed pretty loud and abundant, but very rarely continuous, and still rarely general over the chest." (2, page 83-84)

Laennec said emphysema has been described by some previous authors -- Bonetus, Morgagni, and Floyer,  who observed emphysema in a "broken winded mare" --although "none of these various authors appear to have been acquainted with the real character of the affection, viz -- dilation of the bronchial cells." (2, pages 161,165)

So he said it had never been accurately described. There were two exceptions to this, and these include Ruysh and Valsalva. (2, page 165)

Some might say that Dr. Ballie accurately described emphysema, but Laennec disagrees.  He said:
Dr. Baillie, author of the Morbid Anatomy, has correctly observed the three principal circumstances which constitute emphysema of the lungs, namely—the great size of these organs,—the dilatation of the cells,—and the vesicles formed by the extravasation of air under the pleura; but he does not appear to have been acquainted with the mutual dependence of these three states, and describes them as three different affections. (2, page 166)
In fact, he said that even he thought it was a rare disease until he started making use of the stethoscope.  Since then he said he has verified it in the living as well as the dead.  In fact, he became so adept at diagnosing it that he figured that many cases previously defined as asthma were actually emphysema.  (2, page 161, 163, 165)

He defined it simply as...
...dilation of the air cells... the cavity of these dilated cells descends some little way into the substance of the viscus, and there its walls do not collapse... the bronchial tubes, especially those of the small calibre, are sometimes very evidently dilated in those portions of the lung where the emphysema exists. (2, page 161-163)
He observed that while many of the cells were dilated, some were ruptured. Interestingly, Laennec said:
When we blow into an emphysematous lung, the dilated and projecting cells seem to become flatter the more they are distended, and fall down to the general level of the surface. This is owing to the greater relative extensibility and elasticity of the healthy cells, which in the first instance rise to the level of the dilated cells, and then fall below them, to their natural level. The continued projection of the dilated cells may be partly owing, also, to the difficulty with which the air escapes from them, more especially when the exciting cause of the emphysema is the dry catarrh. (2, page 163)
He also said:
On placing an emphysematous lung in a vessel of water, it sinks much less than a healthy lung; sometimes it floats on the surface with scarcely any obvious immersion."  (2, page 164) 
Laennec became the first to describe emphysema due to aging, and he was the first to define emphysema as tissue damage in the peripheral air passages. He further defined emphysema as a breakdown of tissue in the parynchema of the lungs as opposed to air trapped in the alveoli due to an obstruction such as occurs in asthma and bronchitis.

He said the disease could be diagnosed upon autopsy, although he further stated it could be diagnosed in life by using the stethoscope. He said:
The respiratory sound is inaudible over the greater parts of the chest, and is very feeble in the points where it is audible... from time to time, while exploring the respiration or cough, a slight sibilous rhonchus... by the displacement of the pearly sputa. (2, page 172)
He also noted other signs that emphysema should be diagnosed over asthma: (2, page 172)
  • Diminished lung sounds
  • The long continuance of the disorder (chronic)
  • The severity of the habitual (chronic) dyspnea
  • The asthmatic paroxysm occasionally occurring
  • The cylindrical form of the chest (barrel chest)
  • The slight lividity of the skin
  • Occasional dry crepitous rhonchus on inspiration or with cough (inspiratory crackles due to secretions)
  • Occasional crackle where the rhonchus is heard
  • When the complaint is of long standing and the patient far advanced in life, the paroxysms become more frequent and severe
M. Andral suggests that the dry crepitous rhonchus described by Laennec was the first description of crackles "at the moment of rupture of the air cells."  In modern medical language, this would be crackles on inspiration due to the alveolar cells popping open.  This may have been the first description of this commonly heard lungsound. (3, page 173)

Interestingly, Laennec offers the following about the prognosis of this disease.
Pulmonary emphysema.  is not a disease of great severity.  Of all the varieties of asthma it is unquestionably that which affords to the patient the best prospect of long life. The long continuance and slow progress of the disease and the nature of its causes, render it possible to struggle against the organic lesion, and permit the functional disorders resulting from it to be kept within tolerable bounds (3, page 174)
In this way, it was Laennec who became the first to distinguish chronic bronchitis and emphysema as separate entities from asthma.  He was the first to speculate that they ought to be extricated from the umbrella term asthma, to become disease entities of their own with their own treatments.

  1. Petty, Thomas L, "The History of COPD,"Int. J. Chron. Obstruct. Pulmon. Dis., 2006, March; 1(1): 3-14
  2. Laennec, Rene, "Mediate Auscultation," translated by John Forbes, Notes by professor Andral, 4th edition, 1838, New York, Samuel S. and William Wood
  3. Andras, author of the notes in the book, "Mediate Auscultation, by Rene Laennec," ibid
  4. Laennec, Rene, "A Treaties on the Diseases of the Chest and on Mediate Auscultation, " 1834, London (copius notes by John Forbes)
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Wednesday, July 6, 2016

1819: Laennec is first to describe lung sounds

After he invented the stethoscope in 1819, it was then next task of him to perform experiments with it.  As he was the first to auscultate with this device, he would also be the first to describe lung sounds.

He noted first normal lung sounds, although he did not refer to them as clear as we do today.  He also noted an array of adventitious noises in the lungs among those who were not healthy, and for this he needed a name.  He said:
For want of a better or more generic term I use the word rhonchus* to express all the sounds, besides those of health, which the act of respiration gives rise to, from the passage of the air through fluids in the bronchi or lungs, or by its transmission through any of the air passages partially contracted. (1, page 55)
M. Andrus said Laennec chose the term rhonchus because...
...It was desirable that some name might be found for this phenomenon which would prove generally acceptable to British physicians.  In the former edition of this translation, the nearest English synonym, rattle, was used, but this word has been adapted by few.  The original French term rale appears to be most generally employed in this country, but there are several objections to its use. (1, page 55)
Today, the term rhonchi is used to describe the sound of air moving through secretions, and the term wheeze is used to describe the sound of air moving through air passages partially contracted.  Rhonchi is generally heard as a coarse sound, is continuous, and is often times confused as a wheeze.

Laennec avoided this confusion simply by calling all continuous sounds rhonchi. Today, many medical caregivers avoid the confusion by calling all continuous lung sounds a wheeze.  So there really is not much difference here other than the term used.

While we generally describe the various lung sounds as clear, diminished, rhonchi, wheeze and crackles, Laennec basically described five types of rhonchi, as follows (modern term I think he is referring to is in parenthesis): (1, pages 55-62)
  1. Moist crepitous rhonchus, or crepitation:, similar to the sound of blowing into a dried bladder, or the sound made by rubbing between the finger and thumb a piece of hair, or the noise of boiling butter.  This is a sign of the early stage of peripneumony and edema of the lungs and pulmonary apoplexy (crackles)
  2. Mucous rhonchus, or guggling: Formed by the passages of air through sputa in the bronchi, and sounds like bubbles, or blowing through a pipe into soapy waters. The sound of the bubbles can be described as middling, small, large, or very large, and is a sign of peripneumony or suffocative catarrh in old people near death (the death rattle) or those dying of phthisis, or hemoptysis, or phthisis, or diseases of the heart, or tuberculosis excavations, and may be regarded as an evil omen (tracheal Rhonchi, large airways, or upper airway rhonchi, and may be audible, as in a death rattle)
  3. Dry sonorous rhonchus, or snoring: Crackling rhonchus; Flat grave sound, sometimes extremely loud, sounding like a person snoring, and may be diagnostic of pulmonary fistula, or dilated bronchi, and may be caused by temporary inflammation or contraction of the bronchi (rhonchi or sonorous wheeze, )
  4. Dry sibilous rhonchus, or whistling: Prolonged whistle flat or sharp, dull or loud, and may sound like the chirping of birds, and may be caused by thick secretions obstructing the airway or local contraction of the smaller bronchi (wheeze)
  5. Dry crepitous rhonchus, with large bubles or crackling: The sound of air entering lungs that had been dried, or air cells or vesicles (alveoli) that had been unevenly dilated, may make noise similar to that produced when blowing into a dried bladder.  May be indicative of emphysema  (fine inspiratory crackles heard upon the opening of previously collapsed alveoli) (1, pages 55-62, 98)
Andral said he would differentiate the rhonchi based on whether the cause was in the air cells (alveoli), the air passages (bronchi) or some morbid excavations formed in the substance of the lungs (secretions). He would break the sounds down this way: (2, page 55)
  • Vesicular Rhonchi: Originating from the vesicles or air cells (alveoli)
  • Bronchial Rhonchi: Originating from the bronchial tubves
  • Cavernous rhonchi: Originating from morbid excavations
He further noted that lung sounds are either humid or dry.  (2, page 55)

He would then break them down this way: (2, pages 55-56)
  1. Humid vesicular rhonchus: Moist crepitous rhonchus, Rale crepitant of Laennec (coarse crackles or rhales)
  2. Dry vesicular rhonchus: Dry crepitous rhonchus, rale crepitant  (fine inspiratory crackles)
  3. Humid bronchial rhonchus: Mucous rhonchus (Rhonchi)
  4. Dry bronchial rhonchus: Sibilous rhonchi, rale sibilant (wheeze)
  5. Humid cavernous rhonchus: May be caused by abscess or gangrene of the lungs or the later stages of tubercle or phthisis, and may sound like mucous rhonchus or guggling, and is usually over a small spot (as in just over the area affected, and is usually heard with deep inspiration or while coughing)
  6. Dry cavernous rhonchus: described because it is possible, not that it has ever been described by any author (2, page 55-56)
Andral said that little was added to the description of rhonchus between the time of the first edition of his book in 1819 and the 4th edition in 1838.  He noted that a flaw in Laennec's description of the various lung sounds was that he did not mention at what point during the respiratory phase the sounds were heard. (2, page 62)

Andral said this was an important thing left out, because some sounds are heard only on inspiration, or only on expiration, and sometimes both.  So he added the following:
  • Crepitous rhonchi or vesicular rhonchi: heard only on inspiration because it is a noise produced by the air vesicles cracking open
  • Humid Bronchial rhoncus: heard during inspiration and expiration, and mostly during expiration because it is the sound of air moving through secretions, and the secretions are there at all stages of respiration
  • Sibilous and sonorous rhonchi, or dry bronchial rhonchus: Heard oftener during expiration more so than inspiration
  • Mucous rhonchus: Heard during both inspiration or expiration
So you can see that little has changed regarding the description of lung sounds other than the terms used.  The terms often varied from one author to the next, and this is true even to this day.

  1. Laennec, Rene, "Mediate Auscultation," translated by John Forbes, Notes by professor Andral, 4th edition, 1838, New York, Samuel S. and William Wood
  2. Andras, author of the notes in the book, "Mediate Auscultation, by Rene Laennec," ibid 
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Friday, July 1, 2016

1818: Erasmus Darwin: The father of psychosomatic medicine

Erasmus Darwin (1718-1802) 
The man who created the theory of evolution was not Charles Darwin, believe it or not, it was his grandfather, Erasmus Darwin. Surely Charles made the theory famous, yet it was Erasmus who first proposed the idea through his poetry. Inspired by his grandfather's work, Darwin took this theory to new heights, thus forcing many scientists to accept it as fact.  

Yet Erasmus was more than just another Enlightenment mind who postulated a new theory, he was also a famous physician who wrote quite a bit about our disease asthma, and for these contributions we must include him here in this history. 

As was the case with most educated people in the during the course of the 18th century, Darwin (Erasmus, that is) pursued many of the things he was interested in, including medicine, poetry, philosophy, botany, and, of course, nature.  He made quite an impression regardless of which path he followed.  At times he even shared his theories about the world through his impressive poetic voice. (1)(5)

Darwin (again, we're talking about Erasmus here), was born in 1731 in Nottingham shire, England, the son of a lawyer. He attended St. John's College, Cambridge (where he studied natural science, and the University of Edinburgh (where he studied medicine).  In 1756 he opened a "flourishing medical practice" in Lichfield, Stafford shire.  (5)

While perhaps best known as the father of Charles Darwin, and for his revolutionary ideas about the beginnings of mankind, his greatest interests through the course of the majority of his life were medicine and invention. It was not until later in his life that he became interested in botany. (4)

As a naturalist he came up with one of the first theories of evolution, which he shared with the world in his 1808 book "The Temple of Nature," which was subtitled (and originally titled) "The origin of society.  This book was a compilation of theories he devised about the origin of mankind. Unlike other books of it's nature, it was written in prose. (1)(5)

He published a variety of other books, although it's "Zoonomia, or the laws of organic life," which was published in 1818, that we are interested in.  It was in this book that he categorized diseases with their treatment, and among these diseases was our disease: asthma. So it is on this book that we will focus our attention.  (5)

In volume I of the two part series, he gave a basic description of asthma.  He said:
Another disease, the periods of which generally commence during our sleep, is the asthma. Whatever may be the remote cause of paroxysms of asthma, the immediate cause of the convulsive respiration, whether in the common asthma, or in what is termed the convulsive asthma, which are perhaps only different degrees of the same disease, must be owing to violent voluntary exertions to relieve pain, as in other convulsions; and the increase of irritability to internal stimuli, or of sensibility, during sleep must occasion them to commence at I his time. (3, page 163-164)
In volume II Darwin described two kinds of asthma, which were summed up nicely by Samuel Hatch West in his 1902 book "Diseases of the organs of the chest:" :
  • Convulsive asthma: Having the same characters as all other cramps and epilepsies, and originating, like them, from nearly all distant parts of the body.  
  • Humoral or hydropic asthma: Temporary anascara (swelling, congestion) of (blood in) the lung (2, page 599)
Darwin also noted the causes of these two types:  
  • Convulsive asthma: The bodies effort to relieve pain in remote parts of the system. The most common cause is pain of the liver or biliary ducts. Another common cause is pain caused when children are gaining teeth (this pain in some is relieved by sobbing or sobbing and screaming; but in others a laborious respiration.  It may also be caused by worms, or by acidity of the stomachs of children, and by other painful situations in adults, in whom it is generally called nervous asthma. (1, page 291-292)
  • Humoral or hydropic asthma: Torpor (slowing way down) of the blood flow through the pulmonary vessels, like that which occurs on going into the cold bath.  This causes congestion of the blood in the pulmonary vessels. (4, page 291)
Darwin said that it's often difficult to distinguish between these two types, although the vigilant physician should be able to distinguish between the two by observing key symptoms: 
  • Convulsive asthma:  The absence of sweat on the head and breast. Convulsions of the limbs, as is common in epilepsy.  These are efforts of the body to relieve pain. These patients are also more likely to run to the cold air for relief, and are more subject to cold extremities, and experience the return of it more frequently after their first sleep, as compared patients with humoral asthma. It is distinguished from peripneumony and croup in that these conditions presents with a fever, and it is distinguished from hydrops thoracis in that convulsive asthma is intermittent and hydrops is continuous. Hydrops patients also sit upright, and the breath is colder, and when the pericardium (heart) is affected, the pulse is quick and unequal.  (4, page 291-292)
  • Humoral or hydropic asthma:  Copious sweating of the head and breast, swollen legs, and other signs of anascara.  These are caused by sensitive exertions of the pulmonary vessels to relieve the pain occassioned by the anascaroius congestion in the air cells.  (4, page 291)
Darwin said both convulsive and humoral asthma are "more liable to return in hot weather; which may be occasioned by the less quantity of oxygen existing in a given quantity of warm air, than of cold, which can be taken into the lungs at one inspiration. They are both most liable to occur after the first sleep, which is therefore a general criterion of asthma." 

His remedies for convulsive and humoral asthma are noted as follows: 
Venesection once. A cathartic with calomel once. Opium. Asafaztida. Warm bath. If the cause can be detected, as in toothing or worms, it should be removed. As this species of asthma is so liable to recur during sleep, like epileptic fits... there was reason to believe, that the respiration of an atmosphere mixed with hydrogen, or any other innocuous air, which might dilute the oxygen, would be useful in preventing the paroxysms by decreasing the sensibility of the system. This, I am informed by Dr. Beddoes, has been used with decided success by Dr. Ferriar.  (2, page 292-293)
As noted by West: 
He mentions a case in which asthma disapeared with the development of gout, and another in which the attack followed the retrocession of an eruption on the face. (2, page 599)(4, page 292)
Darwin also mentions a third type of asthma, which was referred to by Dr. Francis Hopkins Ramadge, in his 1835 book "Asthma, its species and complications" as Darwin's asthma.  Ramadge said this was nothing more than some exciting cause affecting the nerves, and interfering with the natural functions of the heart. (6, page 18)

Darwin described this type of asthma as follows: 
  • Asthma dolorificum or Angina pectoris:  The painful asthma was first described by Dr. Heberden in the Transactions of the College; its principal symptoms consist in a pain about the middle of the sternum, or rather lower, on every increase of pulmonary or muscular exertion, as in walking faster than usual, or going quick up a hill, or even up stairs; with great difliculty of breathing, so as to occasion the patient instantly to stop. A pain in the arms about the insertion of the tendon of the pectoral muscle generally attends, and a desire of resting by hanging on a door or branch of a tree by the arms is sometimes observed. (4, page 293)
Darwin described the following case of asthma dolorificum or Angina pectoris: 
Mr. W , an elderly gentleman, was seized with asthma during the hot part of last summer; he always waked from his first sleep with diflicult respiration, and pain in the middle of his sternum, and after about an hour was enabled to sleep again. As this had returned for about a fortnight, it appeared to me to be an asthma complicated with the disease, which Dr. Heberden has called angina pectoris. It was treated by venesection, a cathartic, and then by a grain of opium given at going to bed, with ether and tincture of opium when the pain or asthma recurred, and lastly with the bark, but was several days before it was perfectly subdued. (4, page 193)
So it appears the treatment of all three types of asthma is relatively the same. However, he described four patients...
"...all of whom I believed to labour under the angina pectoris in a great degree; which have all recovered, and have continued well three or four years, by the use, as Ibelieve, of issues on the inside of each thigh; which were at first large enough to contain two peas each, and afterwards but one. They took besides some slight antimonial medicine for a while, and were reduced to half the quantity or strength of their usual potation of fermented liquor." (4, page 194)
Yet while these four were able to survive, most patient's diagnosed with asthma dolorificum or angina pectoris are so inclined to an early death.
This led me to conceive, that in this painful asthma the diaphragm, as well as the other muscles of respiration, was thrown into convulsive action, and that the libres ofthis muscle not having proper antagonists, a painful fixed spasm of it, like that of the muscles in the calf of the leg in the cramp, might be the cause of death in the angina pectoris, which I have thence arranged under the name of painful asthma, and leave for further investigation. (4, pages 193-194)
He said the reason issues sometimes worked for angina pectoris, and also for humoral asthma, was...
...perhaps the absorption of a small quantity of areated purulent matter, stimulate the whole system into greater energy of action and thus prevent the torpor which is the beginning of so many diseases. (4, page 194-195)
In other words, the pain from the issues counteracts the causative pain (whatever it may be) and also absorbs some of the congested fluid in the vessels in order to allow the blood to flow more freely.

So the remedies for asthma dolorificum or angina pectoris are as follows:
Issues in the thighs. Five grains of rhubarb, and one sixth of a grain of emetic tartar every night for some months, with or without half a grain of opium. No stronger liquor than small beer or wine diluted with twice its quantity of water. Since I wrote the above I have seen two cases of hydrops thoracis attended with pain in the left arm, so as to be mistaken for asthma dolorificum, in which femoral issues, though applied early in the disease, had no effect.
He added the following about the cause of asthma dolorificum or angina pectoris: 
The remote cause seems to have arisen from ossifications of the coronary arteries, and the immediate cause of his death from fixed spasm of the heart. (4, page 294)
To his credit he did say that "other histories and dissections are still required to put this matter out of doubt." He likewise surmised that the fact asthma dolorificum causes both spasms of the diaphragm and the heart may indicate that "these may constitute two distinct diseases."  (4,page 294)

Another interesting thing about Darwin's book is best summed up by the authors of
Darwin endorsed active intervention with drugs and mechanical apparatus; some historians trace modern psychosomatic (emotional, mental, nervous) therapeutic approaches to his insistence on integrating mind and body. (5)
It is because of this that he is often referred to as the father of psychosomatic medicine.

As with other physicians of his era, he likewise perceived asthma as a  nervous disorder. He said:
The insensibility of the lungs to cold is observable on going into frosty air from a warm room; the hands and face become painfully cold, but no such sensation is excited in the lungs; which is another argument in favour of the existence of a peculiar set of nerves for the purpose of perceiving the universal fluid (4, page 290) 
That's pretty much all we need to know about Erasmus Darwin for the purposes of our asthma history.

Note:  Since the telling of any history is best told through the words of the original authors, you may read specifically what Darwin wrote about asthma by checking out my post: 1818: Erasmus Darwin defines asthma. 

  1. "Erasmus Darwin",, ", accessed 2/11/14
  2. West, Samuel Hatch, "Diseases of the organs of respiration," volume II, 1902, London, Charles Griffin & Company, Limited , page 599
  3. Darwin, Erasmus, "Zoonomia, or the laws of organic life," volume I, 1818, Philadelphia, Published by Edward Earle
  4. Darwin, Erasmus, "Zoonomia, or the laws of organic life," volume II, 1818, Philadelphia, Published by Edward Earle
  5. "Erasmus Darwin (British Physician,",, accessd 2/12/14
  6. Ramadge, Francis Hopkins, "Asthma, its species and complications, or researches into pathology or disordered respiration; with remarks on the remedial treatment applicable to each variety; being a practical and theoretical review of this malady, considered in its simple form, and in connection with disease of the heart, catarrh, indigestion, etc." 1835, London,  Longman, Rees, Orme, Brown, Green, and Longman
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