Wednesday, August 17, 2016

1835: Lefevre questions nervous theory of asthma

Amedee Lefevre (1798-1869) was yet another physician who believed in the spasmotic and nervous theories of asthma.  Yet while he believed asthma was nervous, he was not prepared to deny there weren't organic lesions as yet discovered in asthmatic lungs. (1, page 505)(2, page 23-24)

Orville Brown, in his 1917 book," said Lefevre was an asthmatic who observed by studying his own asthma that he expectorated large amounts of sputum. (3, page 31)

Of this, J.B. Berkart, in his 1878 book, said: 
Lefevre (in 1835)... reverted to the opinion of Laennec. Himself an asthmatic, he had watched his own case and that of a friend, and arrived at the conclusion that the dyspnoea could be produced only by a bronchial spasm. In looking thus upon asthma as a nervous affection, he still was not prepared to deny the possible existence of organic lesions; adding, however, that if such were present, they were of so fleeting a nature as to elude detection. The essence of the disease he considered to be an increased irritability of the nerves of the lungs, in consequence of which the slightest irritation applied to the bronchial surface induced spasm of the bronchial tubes. (2, page 23-24)
However, Berkart suspected that the patient's he was studying were not asthmatics, and therefore his experiments (of which he performed with  Joseph Bergson) did not support his theory that asthmatic lungs might possibly have organic lesions.  He said: (2, page 24) 
The cases, however, which he himself reported, do not confirm his views. It is difficult to recognise a nervous affection, much less a bronchial spasm, in the dyspnoeal attacks, which terminated always with the expectoration of thick masses of mucus. The expectoration was of a grey colour, very viscid, in consistency like boiled maccaroni, filamentous in shape, and, when disentangled, appeared as if moulded to the bronchi. Sputa of that kind sufficiently distinguish the preceding dyspnoea as the symptom of a fibrinous (croupous) bronchitis, and there can be no doubt that Lefevre and his friend were subject to that disease. (2, page 24)
So while he thought he was on to something with his theories, he probably added little evidence to advance either the spasmotic nor the nervous theories of asthma. The reason was mainly due to the inability to differentiate bronchitis with asthma.

Of interest is he also observed spirals in asthmatic sputum.  This would be an observation that would inspire investigations by later physicians that would ultimately lead to a new theory about asthma.  (1, page 505)

He also wrote a book called De 'lasthme , of which you can read if you can read French.  

References:
  1. Sakula, Alex, "Charcot-Leyden crystals and Curschmann spirals in asthmatic sputum," Thorax, 1986, 41, pages 503-507
  2. Berkart, J.B., "On Asthma: It's Pathology and Treatment," 1878, London, J. & A. Churchill; The reference used by Berkart is as followed:  "Recherches sur l'Asthme, M&noire couronne' par la Society de MfSdecine de Toulouse."—JournalHebdomad., 1835.
  3. Brown, Orville Harry, "Asthma, presenting an exposition of nonpassive expiration theory," 1917, St. Louis, C.V. Mosby Company.  The above mentioned theory of vessel turgescence comes from this reference also on page 25; he refers to the same source as Berkart
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