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

References:
  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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