Friday, August 19, 2016

1835: Ramadge questions that Dr. Bree had asthma?

So we know that Dr. Robert Bree published a book called "A Practical Inquiry into Disordered Respiration" that became the principle authority on asthma during the first half of the 19th century. Yet his book did not come without criticism.  

George Lipscomb, a fellow British physician, had the nerve to criticize Dr. Bree's ideas regarding asthma even as the book was first published.

Then, in 1935, Dr. Francis Hopkins Ramadge, in his 1835 book "Asthma, its species and complications," went almost as far as to suggest that Dr. Bree did not have asthma at all, and, therefore, was probably describing some other disease.  

He said: 
Dr. Bree delineated the early stages of his disorder, as distinctly as the latter, I have no doubt it would be found, that his asthma supervened upon latent consumption. Thus he gives no account of the symptoms preceding dyspepsia, which would have indicated, at once, the origin of his complaint. But, it is evident that some ailment of the chest was early at work, from his alluding to pain of the intercostal muscles, which could hardly have existed without; or, the reverse might have happened, and the dyspepsia impairing his health, have thus indirectly originated the pulmonary affection. (1, pages 135-136)
Some remarks of Laennec coincide wonderfully with this view of the case. He observes, "that nervous symptoms may mask phthisis for a long period; and that he has known it concealed for years by habitual dyspepsia, and other symptoms of hypochondria." (1, page 136)
This, in fact, is giving in other words the commencement of Dr. Bree's case, as stated by himself. So strongly, indeed, am I convinced that one or other of these explanations will apply to the learned Doctor's case, and elucidate what has been omitted by him, that, could he be induced to summon up his recollections, and retrace minutely the precursory symptoms of his disease, it would, I have little doubt, appear that either before, or during his dyspeptic condition, he had had attacks, slight ones perhaps, of haemoptysis. However, for an author to retrace his steps, crossexamine himself, and confess his views to be erroneous, would be an effort of candour above the powers of poor humanity! (1, pages 136-137)
I would not be supposed to insinuate, that any thing was purposely omitted by him. On the contrary, I believe he has detailed, and fully too, every symptom he conceived to be of importance; and that, supposing he had laboured under slight spitting of blood, he would have deemed it too irrelevant for notice. The course, therefore, of his complaint, on the supposition of the correctness of the views above taken, would be that on the appearance of the dry form of asthma, which did not exhibit itself for several years after the first manifestation of dyspnoea, his lungs became emphysematous, and the cavity, which I conjecture to have previously existed, was gradually healed up. The care he appears subsequently to have taken of himself put a stop to the bronchial affection, and with it of the asthma,which at one period seems to have been habitual with him. (1, pages 137-138)
Dr. Ramadge, along with other physicians who came to the same conclusion about Dr. Brees ideas regarding asthma, said that Dr. Bree was a smart man who, if he had had access to the stethoscope of Dr. Rene Laennec, would have easily seen his mistake.  

About twenty years later Dr. Henry Hyde Salter, who we will come to know as the author of the most famous asthma book of the second half of the 19th century, also criticized Dr. Brees ideas regarding asthma. 

Dr. Bree argued in favor of the bronchitic theory of asthma.  He believed the spasms or convulsions associated with a fit of asthma are all a part of the bodies effort to get rid of some irritating or peccant matter that was inhaled into the air tubes.  

I know I quote Dr. Salter's criticism of Dr .Bree in another post, yet I think it's worth repeating here.  Dr. Salter said: 
Dr. Bree maintains his argument with a great deal of ingenuity, and presses many facts into the service of his theory; but the most superficial reflection would suffice nowadays to show that it is utterly untenable ; and had Dr. Bree enjoyed the light that now shines on us from those two important points, the stethoscope and our acquaintance with excito-motory action, he would never have broached the doctrine he did: the one would have shown him the fallacy of his views, the other would have opened to him a solution of his difficulty—the stethoscope would have shown him that the conditions of an extraordinary discharging power are not present in an asthmatic attack ; indeed, that the power of getting rid of anything in the lungs is very much diminished by it; and the knowledge of reflex nervous action would, in connection with anatomy, have displayed the true nature of the disease, and made all its discrepant and scattered phenomena conspire to the production of its true and simple theory. (2, page 5)
With all due respect to Dr. Bree, the same argument about "if he had access to the stethoscope" could have been made regarding any of the physicians who studied lung diseases during their careers.  

Still, the argument that Dr. Bree never had asthma at all, and that his book did not describe convulsive asthma but some other disorder of the lungs, was quite impelling.  

  1. 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
  2. Salter, Henry Hyde, "On Asthma: It's Pathology and Treatment," 1882, New York, William Wood & Company; Dr. Salter's book was originally published in 1860, and was previously released as a series of articles during the course of the 1850s
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