Monday, October 10, 2016

1854: Dr. Wintrich almost disproves spasmotic theory of astma

After Charles J. B. Williams and Francois Longet performed experiments that seemed to prove the spasmotic theory of asthma, the theory "met with little opposition" until, in 1854, M. Alton Wintrich performed experiments of his own aiming to prove it wrong, said W.H. Geddings, in an 1885 article.  (1, page 194

Geddings wrote: 
The theory that asthma is due to spasm of the bronchial muscles met with but little opposition until 1854, when Wintrich, after a series of experiments, arrived at conclusions directly opposed to those of Williams and Longet in regard to the contractility of the muscular fibres of the bronchi, and refused to accept the spasm theory on the ground that it afforded no rational explanation of the phenomena of asthma. He believed that the various symptoms of that disease were due to tonic spasm (tetanus) either of the diaphragm alone or of the diaphragm and the other muscles of respiration. These experiments of Wintrich were so carefully conducted, and his standing as a specialist in respiratory diseases so high, that his theory found many supporters, and might perhaps have been generally accepted had it not been for the distinguished French physiologist, Paul Bert, who in 1870, with improved methods of scientific research, succeeded in demonstrating that Williams and Longet were after all correct in their statements as to the contractility of the bronchial muscles. (1, page 194)
While Wintrich tried hard to reproduce spasm of the bronchial tubes by irritation of the vagus, he never succeeded.  He therefore concluded that his studies disproved the spasmotic theory of asthma, and therefore the nervous theory of asthma. (3, page 34)(4, page 4)

Wintrich, however, does not deny completely that bronchial muscles are a part of the asthma response, simply not the the extent that other physicians claim. When broncospasm occurred, it was secondary to tonic spasm of the diaphragm, that bronchospasm was due to "disturbance of innervation," said Dr. J.B. Berkart in his 1878 book.

In other words, when bronchospasm occurred, it occurred as a result of irritation of one part of the body (such as the diaphragm) effecting the nerves that lead to another organ (such as the lungs or glottis). So, he concluded, the underlying cause of asthma was not bronchospasm, but diaphragmatic spasm.  (3, page 34)(4, page 4-5)

Ernest Shmiegelow, in his 1890 book, summed up the theory of Wintrich best:
Wintrich...thinks that asthma can be explained by a tonic spasm of the diaphragm alone or combined with the respiratory muscles... Only a tonic contraction of the diaphragm can explain the deep immovable position it occupies in many cases of nervous asthma. (4, page 5)
The ideas of Wintrich were later confirmed in 1870 by the experiments of Heinrich von Bamberger (1822-1888).  

Berkart explained: 
In a case of fatal dyspnoea he had occasion to observe the tetanus of the diaphragm, and to convince himself by post mortem examination of the absence also of structural lesions. Although the symptoms of that case by no means resembled those usually assigned to asthma, he, nevertheless, regarded them as characteristic of the disease. " (3, page 36) 
Guillaume-Benjamin-Amand Duchenne was a French neurologist who seemed to support the diaphragmatic theory by his own experiments.  Of this, Berkart said:
Duchenne demonstrated that faradisation of the phrenic nerve caused tetanus of the diaphragm. In the animals experimented upon, that operation was followed by distension of the lower half of the thorax, projection of the epigastrium, and extreme dyspnoea, the frequency of respiration being at the same time considerably diminished. Death, however, invariably followed when the electrical irritation of the nerve was continued for more than a few minutes. Unacquainted with the opinions of Budd and Wintrich, Duchenne was at first inclined to attach no importance to his discovery, because he thought a tetanus of the diaphragm was not as yet known to occur in man.. Duchenne thereby concluded that a tonic spasm of this muscle was the main cause of the asthmatic paroxysm. (3, page 35)
Wintrich wasn't the first asthma expert to consider the idea that the diaphragm might be responsible for asthma, as Dr. Thomas Willis considered this idea back in the 17th century. (4, page 4)

Another physician to consider the idea (which we refer to as the diaphragmatic theory of asthma) was William Budd.  He performed experiments in the 1840s that he believed disproved the spasmotic theory, and instead proved the diaphragmatic theory.

So the diaphragmatic theory of asthma stayed alive for a few more years, although it would ultimately be disproved once and for all by the experiments of M. Alton Biermer in 1870.

Note:  Other physicians who supported the diaphragmatic theory of asthma were Dr. Neuman (4, page 4) and Dr. Vallette.  (3, page 35)

  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. Brown, Orville Harry, "Asthma, presenting an exposition of nonpassive expiration theory," 1917, St. Louis, C.V. Mosby Company
  3. Berkart, J.B., "On Asthma: It's pathology and treatment," 1878, London, J. & A. Churchill
  4. Shmiegelow, Ernst, "Asthma, considered specially in relation to nasal disease," 1890, London, H.K. Lewis
  5. Thorowgood, John Charles, "Notes on Asthma," 1878, 3rd edition, London, J and A Churchill
You can view the 1865 book of M. Alton Wintrich, "Ueber asthma nervosum" by clicking here.

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