Monday, September 5, 2016

1840: Dr. Williams proves spasmotic theory of asthma

Charles J. B. Williams (1805-1889)
Healthcare workers may recognize the name Dr. Charles James Blasius Williams because he was the first person to use the terms "lub-dub" to describe the sounds emitted by the two chambers of the beating heart.  This is what history best remembers him for.

While this fact is definitely important to our history, what we are mostly interested in is the fact that Dr. Williams was the first person to effectively prove the spasmotic theory of asthma by discovering that the muscular fibers that wrap around the air passages may spasm under certain conditions.

According to his own memoirs, Williams was the youngest of nine siblings. His mother was the eldest daughter of a respected surgeon, whose name was also Williams. She died shortly before her son Charles started college at Edinburgh University in 1820.

Despite Williams proof that the certain stimuli may cause the air
passages of the lungs to spasm, some physicians continued to
argue this in no way proved this had anything to do with asthma.
Other physicians, however, believed this proved nervous asthma
caused spasms of the air passages.  The above picture shows
how far science expounded upon the experiments of Williams
in the years between the publication of his work in 1840 and
the publication of Dr. Henry Hyde Salter's 1860 book,
Asthma: It's Pathology and Treatment." The caption under
the picture read: "Diagram showing the four ways in which the bronchial tubes may be narrowed.
1. Bronchial catarrh. 2. Recent bronchitis. 3. Old bronchitis 4. Asthma.  (6, page 39)
His father was Rev. David Williams, who came from an eminent family of many teachers and scholars. Along with being a Reverend, his father was also a successful tutor, having "prepared several gentle men for the university, who have since attained distinction as scholars." He educated his son at home until he was accepted at Edinburgh University in 1820, where he began his pursuit to become a physician. (1, page 1, 6, 9)

Williams credited his father with exposing him to subjects he wouldn't have been exposed to had he attended the public schools, subjects which would help him in his later endeavors, such as "Geography, History, Biography, Natural History, and above all, Natural Science." (1, pages 2-3)

Williams would have learned about Franz Reisseissen, who discovered in 1808 that muscular fibers wrap around the air passages of the lungs.  He would have learned about Rene Laennec, who believed Reisseissen's evidence was proof enough of both the spasmotic and nervous theories of asthma.

J.B. Berkart, in his 1878 book "On Asthma: It's Pathology and Treatment," said: (2, page 17)
Laennec assumed that they, being muscles, were endowed with contractility, and therefore liable to spasm. Such a spasm, he thought, might probably have been the cause of that fatal dyspnoea; but whether this supposition were correct or not, the case itself seemed to indicate the existence of a nervous asthma. Yet, notwithstanding the negative results of physical diagnosis and post mortem examination, he had doubts on the subject. Hesitatingly he admitted spasmodic asthma, with this limitation, however, that it generally consisted of nervous and organic affections combined.(2 page 17-18)
He would have been well aware of the evidence in support of the nervous theory of asthma, that asthma is a neurosis of the respiratory organs, that came from the papers of Francis Ramadge in 1835, the essays of Joseph Bergson and Amedee Lefevre in in 1836, and the verification of this evidence by the experiments of Moritz Romberg in 1841.   (4, page 506)

Williams must have been aware of these studies, and believed this evidence was too overwhelming not to support the nervous theory of asthma.

Yet other physicians did not believe this was enough evidence to support any theory, especially Dr. William Budd, who performed experiments in 1840 that he believed disproved the spasmotic theory AND the nervous theory of asthma.

Yet our doctor Williams would have something to say about Dr. Budd's experiments.  Dr. Williams would prove them wrong, and he did it that same year: in 1840.

Dr. Berkart explained:
As the bronchial contractility was denied as often as asserted, Dr. C. J. B. Williams again took the question in order to settle the matter in dispute. He, indeed, succeeded in showing, by experiments conducted with all necessary precautions, that mechanical, as well as chemical and electrical stimuli do produce contraction of the air-tubes. Thus the theory of a bronchial spasm obtained the support of experimental physiology. And even those who until then wavered in their opinions as to the possibility of such a spasm saw now no reason for doubting, but readily accepted that doctrine.  (2, page 26)
Still, while Reisseissen discovered that muscular fibers wrap around the air passages, and while Williams proved that they may spasm under certain circumstances, this did not prove that they spasmed during an asthma attack. (3, pages 193-194)

Berkart said:
Yet one link was wanted to complete the chain of evidence in favour of a bronchial spasm. As yet nothing was known of the innervation of the bronchi. Irritation of the vagus had produced no effect upon their calibres, and Dr. Williams was therefore led to conclude that "the muscular fibres seem not to be excitable through the nerves of the lungs."(2, page 26)
This evidence would also come in 1840 by the experiments of Dr. Francois Achille Longet.  

Williams was among the physicians of his era to support that idea that the definition of asthma was too vague, including too many ailments that cause symptoms similar to asthma yet have nothing to do with the lungs.  He therefore wanted to simplify the definition. 

Berkart said:
Dr. Williams himself, assuming a plus and minus state of contractility, described two forms of asthma—the one spasmodic, the other paralytic. The former was supposed to be represented by the isolated attacks of dyspnoea which generally accompany emphysema; the latter by those which appear in connection with chronic pituitous catarrh. (2, page 26)
Wolff Freudenthal, in his 1917 article in A Weekly Review of Medicine titled "Bronchial Asthma, said:
In 1841, Doctor (J. B.) Williams, in Tweedie’s Dissertations of Diseases of the Organs of Respiration, describes two forms of asthma—a spasmodic and an atonic or paralytic form. He found “that defect of these properties (excessive contractibility of the bronchial tubes) would disorder the process of breathing, and is led to believe that there may perhaps be a nervous asthmaor dyspnea “from weakness or paralysis of the circular fibres, or of the. nerves which regulate their contractions.” (5, page 2)
Williams was correct that asthma needed to be redefined, yet his most impressive contribution to the history of asthma was his experiment proving that the muscular fibers that wrap around the lungs may contract when irritated by certain stimuli.

Surely his experiment didn't prove the spasmotic thoery of asthma, yet it made this theory look highly probable.  His experiment met with little opposition for the next 14 years (Wintrich, 1854), and would be noted by nearly every physician writing on the subject of asthma for the rest of the century.   

  1. Williams, Charles J. B., "Memoirs of Life and Work," 1884, London, Smith, Elder, & Co. 
  2. Berkart, J.B., "On Asthma: It's Pathology and Treatment," 1878, London, J. & A. Churchill
  3. Geddings, W.H., author of the chapter on "Bronchial Asthma," in the book  "A System of Practical Medicine," edited by William Pepper and Louis Star,Volume 3, 1885, Philadelphia, Lea Brothers and Co.
  4. Whitaker, James Thomas, "The theory and practice of medicine," 1893, New York, William Wood and Company
  5. Freudenthal, Wolff, "Bronchial Asthma," New York Medical Journal: A Weekly Review of Medicine, edited by Edward Swift Dunster, James Bradbridge Hunter, Frank Pierce Foster, Charles Euchariste de Medicis Sajous, Gregory Stragnell, Henry J. Klaunberg, Félix Martí-Ibáñez, volume CV, January-June, 1917 (Saturday, January 6, 1917), New York, A.R. Elliot Publishing, Co., pages 1-5
  6. Salter, Henry Hyde, "Asthma: It's Pathology and Treatment," 1864, Philadelphia, Blanchard and Lea
Further reading:
  1. Geddings, W.H., author of the chapter on "Bronchial Asthma," in the book  "A System of Practical Medicine," edited by William Pepper and Louis Star,Volume 3, 1885, Philadelphia, Lea Brothers and Co.
  2. Biermer, Anton., "On Bronchial Asthma," in the book, " Clinical Lectures on Subjects Connected with Medicine Connected with Medicine, Surgery, and Obstetrics," by various German authors, 1866, London, New Sydenham Society,  pages 171-194
  3. Williams, Charles James Blasius, Alexander Tweedie, William Wood Gerhard, "Tweedies dissertations of diseases of the organs of respiration," 1841, London, Lea and Blanchard
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