Friday, October 28, 2016

1860: Salter disproves ancient asthma theories

Dr. Henry Hyde Salter was among the first physicians to believe that diseases ought to be defined based on personal experiences with the diseases, observing patients, and studying autopsies, as opposed to speculation.  Later physicians said it was this technique that made him the most famous asthma doctor of his era.  

In the opening chapter of his 1960 book "Asthma: Its Pathology and Treatment" he put to rest any theories about asthma that didn't support modern evidence. While he shunned the humoral ideas of ancient writers, he also shunned the bronchitic theories of the famous Dr. Robert Bree  who's believed asthma was caused by some peccant matter entering the lungs

Salter said that Bree was so convincing, and had obtained such a large following, that he had to dedicate almost an entire chapter to disproving his theories.

However, in the end, Dr. Salter said Dr. Bree's theory was disproved simply by the invention of the stethoscope.  He said if Bree had access to a stethoscope he would have easily heard the wheezes caused by narrowed air passages due to neurosis, and would have heard that the wheezes persist even after mucus is expectorated, as opposed to before.

One of the reasons Dr. Bree's ideas were so well accepted was because they were more in line with the Hippocratic doctrine, which was still well accepted by many prominent physicians when Bree first wrote his 1798 book "A Practical Inquiry into Disordered Respiration."

Since Hippocrates, many asthma experts believed asthma was caused by an imbalance of the four humors. Salter doesn't deny...
..."that in some cases the exciting cause of the attack is humoral; but what I would deny is, that the humoral derangement has any higher place than that of an exciting cause; and what I would insist upon is, that the heart and core of the disease is nervous; that the essential peculiarity of the asthmatic is a vice in his nervous system, a peculiar morbid irritability of it, whereby a certain portion of it is thrown into a state of excitement from the application of stimuli which another person would produce no effect at all, or a very different effect." (1, page 25)
Salter disproved the idea that congestion, or phlegm, or mucus, was the cause of asthma, because the attack usually ends with the expectoration of phlegm. He wrote:
"We admit the fact to be true, but doubt very much the correctness of the inference; at least it is certain that, in ordinary bronchitis, enormously greater accumulations of mucus take place with comparatively few signs of general obstruction. We think this position must be admitted by any unbiased observer; and it is, in our opinion, fatal to this theory. (1, page 25)
Given the tools available to Salter, wasn't hard for him to disprove old asthma theories in favor of science. He went on to prove that asthma was nervous and spasmotic, and was so convincing that his ideas were referenced by nearly every author on asthma for the next 50 plus years.

  1. Salter, Henry Hyde, "Asthma: It's Pathology and Treatment," 1864, Philadelphia, Blanchard and Lea
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