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 Britannica.com:

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. 

References: 

1. "Erasmus Darwin", ucmp.berkley.edu, "http://www.ucmp.berkeley.edu/history/Edarwin.html, 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," encyclopedia.com, http://www.britannica.com/EBchecked/topic/151960/Erasmus-Darwin, 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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