Sunday, October 2, 2016

1851: Bergson classifies asthma as purely nervous

Figure 2 --Bergson, among other physicians, believed signals sent
 from the brainvia the vagus to the lungs caused an asthma attack.
 You can see by this diagram that the vagus feeds the various organs
 of the body, including the heart and lungs. Vagi is singular for vagus nerve.
 The vagus is responsible for all the things your body does without
you having to think about them, such as your heart beating, your mouth
 salivating, your eyes blinking, your lungs inhaling and exhaling, etc. 
Joseph Bergson supported the nervous theory of asthma. This basically meant he also supported the spasmotic theory of asthma, considering irritation of the nerves caused asthma.

Being that asthma was purely nervous in origin, he classified it based on this theme.

So he defined two nervous types of asthma:
  1. Cerebral Asthma:  The seat of disease is the brain. Signals are sent from the brain via the vagus or recurrent nerves to the respiratory organs, thus causing respiration to become impeded. (figures 1 and 2)(3, page 378)
  2. Spinal Asthma: "The influence of the brain on the function of respiration remains undisturbed, but that of the spinal system is preternaturally excited, producing contractions in the bronchial tubes." (3, page 378)  He described two types of spinal asthma: 
    1. Centric Spinal Asthma:  Asthma is caused by the portion of the spinal marrow that is the source of the nerves of respiration.  "Any irritation applied to it may produce asthma in its most distinct form; such as wounds, acute or chronic inflammation, effusions, pressure from tumours, and other diseases, all of which have been found connected with asthma. " (3, pages 378-379)
    2. Excentric Spinal Asthma: "In this the nervous centre is free from disease, and the irritation is conveyed from without; but as this may be in three different ways, viz., in the reflex nerves or in the ganglia, or, which is the most unfrequent of all, in the motor or centrifugal nerve, we divide excentric asthma into reflex, ganglionic, and motor asthma." (3, page 379)
  3. Reflex:  Asthma is caused by a reflex action
    1. Cause #1:  Asthma caused by disturbance of the digestive system, such as dyspepsia (upset stomach), abuse of alcohol, intestinal worms, etc.  (3, page 379)
    2. Cause #2:  Irritation of the mucous surface of the bronchial tubes. Thus asthmatic fits are often excited by breathing dust, the pollen of grass in flower (hay asthma), acrid gases, vapours of lead, powdered ipecacuanha, odour of sun-flower or hyacinths, smell of heaps of apples, vapors of chlorine, etc. (3, page 380)
    3. Cause #3: Irritation of some portion of the vagus nerve itself. "When, by compression from tumours, &c., the nerve of one side is atrophied or injured, this becomes paralysed, and the nerve of the opposite side is thrown into a state of preternatural activity, and thus the phenomena of asthma ensue." In one case he described an aortic aneurism that caused atrophy of the left recurrent nerve and resulted suffocation due to croup like symptoms and edema (swelling) of the glottis. Another cause may be tumor of trachea. (3, page 380-381)
    4. Figure 3 -- Bergson believed some forms of asthma were caused
      by irritation of the recurrent nerve. You can see by this diagram that
       it branches off the vagus nerve to supply the trachea.  I would imagine
       the asthma he is referring to here is probably childhood
      ailments like croup, edema of the glottis, etc.
    5. Cause #4:  Influence of mental emotions, such as anger, terror, etc. A good example is fear that you are going to have an asthma attack, and you have an asthma attack. (3, page 381)  
  4. Ganglionic Asthma: The diagnosis of this type of asthma is diagnosed by ruling out the others.  A ganglion is a mass of nerve cells, and Bergson believed that "sensations" from this may cause asthma. (3, page 381)(4, page 3)
  5. Motor Asthma: "To this class belong all those cases in which either the muscles or the bones concerned in the motions of respiration are incapable of obeying the impulse conveyed to them from the nervous centre. Rickets, Pott's curvature, and other diseases of the bones of the thorax, are often attended with asthma." (3, pages 382-383)
So Bergson denied paralytic asthma in favor of nervous asthma, and he further came up with categories in support of his theory.

Further reading:
  1. 1851: Bergson describes typical asthma attack (2/23/16)
  1. Berkart, J.B., "On Asthma: It's Pathology and Treatment," 1878, London, J. & A. Churchill
  2. Schmiegelow, Ernest, "Asthma, considered specially in relation to nasal disease," 1890, London, H. K. Lewis; he references the following source; Bergson, Das krampfAsthma der Erwaohsenen, Nordhausen, 1850.
  3. Gill, M. H., "Review and Bibliographic Notices: "On the spasmotic asthma of adults," by Bergson, published Gill's book, "The Dublin Quarterly Journal of Medical Science," volume X, August and November, 1850, Dublin, Hodges and Smith, pages 373-388
  4. 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
  5. Brown, Orville Harry, "Asthma, presenting an exposition of nonpassive expiration theory," 1917, St. Louis, C.V. Mosby Company
  6. Karl Friedrich Canstatt "Images from the history of medicine,",, the photo is in the public domain, accessed, 3/10/14
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