Wednesday, September 14, 2016

1844: Dr. Andral writes about asthma

Gabriel Andraw (1797-1876)
Gabriel Andral, in the 1857 edition (the 4th edition) of his book, "Clinique Medicale," described asthma as nervous, and "in one instance at least," wrote Orville Brown, "he expressed his opinion that it might have come from a 'metastasis of rheumatism to the lungs.'" (1, page 34)(2, page 99)

Dr. Andral was a French physicians who became known as the father of "analytical and inductive pathology. (4, pages 186-187).

He is likewise known as the first person to use the terms anaemia and hyperaemia to describe the presence of too few and too many red blood cells in the body.  He is likewise referred to as the father of haemotology (the study of blood).

In the 1844 edition of "Clinique Medicale," he said that people with air passages that are chronically inflamed are diagnosed with chronic bronchitis.  This chronic inflammation often results in the walls of the air passages becoming "thickened," which results in "a diminution in the size of the cavities through which the air is to pass..." and these patients "have ordinarily a certain degree of dyspnoea, which from time to time assumes all at once a much greater intensity, and becomes changed into a real attack of asthma." (2, page 86)

Andral also described another  form of asthma that occasionally formed by "engorgement of the bronchial mucous membrane.  He referred to it as bronchial asthma:
There are persons who ordinarily present no sign of bronchitis, who do not cough, who have no shortness of breath, and who at certain intervals, are suddenly seized with the following symptoms: oppression, which rapidly becomes most intense; imminent suffocation; violet injection of the face, as in persons in a state of asphyxia; pulse small, hard, and rather frequent; cough at first dry, but afterwards accompanied with a copious expectoration, the appearance of which .coincides with the dyspnoea. These different symptoms set in suddenly; they very quickly attain their highest degree of intensity; then they diminish, and at the end of a few days they disappear, without leaving any trace behind them. What is the cause of this frightful dyspnoea, which thus seizes an individual in the midst of the most perfect health, which throws him all at once into unspeakable anguish, and threatens to kill him by asphyxia? (2, page 86
The patient will probably also present with emphysema of the lung, and palpation of the heart due to "temporary embarrassment of the pulmonary circulation."  The embarrassed circulation may ultimately "become modified in its texture, and in a later period become really diseased." (2, page 87)

There are a variety of causes for an attack of asthma in an otherwise healthy individual.  In one example a child has "tumefaction (swelling) which momentarily affects the mucous membrane of the bronchi, most frequently after a new cold contracted by the patient." (2, page 87)

When sudden onset dyspnea causes with no signs of organic lesions, when no other causes can be found, "either in young or plethoric persons, or in persons remarkably nervous. Young persons of both sexes, women affected with irregular menstruation, present frequent examples of "nervous asthma." (2, page 112)

He wrote:
Intense dyspnoea, genuine fits of asthma, have been sometimes seen to come on all at once, after a violent mental emotion, in persons whose breathing had been till then perfectly free. (2, page 112)
In such cases of nervous asthma he wondered if "the best remedy for them is often intense distraction." (2, page 112)

He does describe one case (as noted above) where there were no lesions, and nervous asthma was suspected.  However, upon "close inspection of the bronchi... metastasis of rheumatism to the lungs" was discovered. (2, page 112)

Such cases as this show the inexplicable nature of asthma for this era.  

Generally, however, his treatment for asthma included "blood letting, both local and general, blisters applied to the chest and extremities, repeated purgatives, antimonials, such are the means which have appeared to us to afford most relief under such circumstances." . (21, page 87)

It is of his opinion that purgatives work best, "but it is on the condition of their producing copious evacuations." (21, page 87)

Along with being associated with emphysema and bronchitis, and along with describing cases of nervous asthma, he likewise believed it was spasmotic in nature.  (2, page 250)(3, page 14)

This places him in line with many of the other asthma experts of his era.

  1. Brown, Orville Harry, "Asthma, presenting an exposition of nonpassive expiration theory," 1917, St. Louis, C.V. Mosby Company
  2. Andral, Gabriel, "Medical Clinic: Diseases of the Chest," Volume II, Diseases of the Chest, 1843, Philadelphia, Ed Barrington and Geo D. Haswell
  3. Thorowgood, John C., "Asthma and Chronic Bronchitis: A New Edition of Notes on Asthma and Bronchial Asthma," 1894, London, Bailliere, Tyndall, & Cox
  4. Kellog, Day Otis, editor, " The Encyclopedia Britannica," volume XXV, 1902, New York, Ohio, Chicago, The Werner Company 
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