Monday, December 12, 2016

1865: Dr. See supports diaphragmatic theory of asthma

Germain See (1818-1896) was a German physician wrote several articles on asthma and other lungs diseases in the various medical publications of his era, and he is referenced more than once in this asthma history.  It is obvious, that through his writings, he was well acquainted with respiratory disease, including our asthma.

In 1865 he gave his support to the ideas of Alton Wintrich and Heinrich Bamberger that asthma was not caused by spasms of the muscular fibres in the lungs, and instead was caused by spasms of the diaphragm. (1, page 5) (2, page 2) 

In his 1890 book, Ernest Shmiegelow said See reviewed all the theories of the day.  He quotes See:
"Asthma is a neurosis in the medulla oblongata, that is to say in the centre of respiration, caused by an acquired or native elevated reflex irritability in this organ. The cause of the attacks must be sought for in irritations, which originate in pneumogastric nerves or other peripheral nerves. The effect of the reflex exhibits itself in the motory nerves of the inspiratory muscles, specially those of the diaphragm. We have, therefore, before us a permanent neurosis, whose attacks are caused by an irritation especially of the pneumogastric nerves, and which is always concluded by a tetaniform contraction of diaphragm, this theory only (in contrast to the bronchial spasm) can explain the dilatation of the lungs... The principal factor in the asthmatic attacks is therefore not (as in the bronchial spasm) a direct motor effect of the pneumogastric nerve, only the sensitive pneumogastric fibres take a part in this respect as they lead the irritation up to the noeud vital of the spine, whence the irritation spreads through the nervi phrenici to the diaphragm. " (1, page 9-10)
Joseph Berkart, in his 1878 book, said See divided asthma into three elements: (2,page 2)
  1. Dyspnoea
  2. Bronchial exudation
  3. Emphysema of the lungs (2, page 2)
See believed asthma was always accompanied by organic lesions, and diseases such as chronic bronchitis and emphysema, but never caused by them. (2, page 37)

While others, such as George Kidd, believed asthma was a symptom of emphysema or chronic bronchitis, See believed it was, according to Berkart: (2, page 37)
...always a substantive disease, accompanied, but never produced by organic lesions. He recognised, however, only one form of it. In his opinion, asthma was essentially a neurosis of the vagus and its branches, and manifested itself by a tetanus of all the respiratory muscles, and by a bronchial exudation. The presence of these two "elements" combined was alone characteristic of the affection, whereas emphysema of the lungs was only their constant attendant. Emphysema, he maintained, was not an essential, but merely the consequence of the inspiratory traction during, and the bronchial exudation after, the attack.
Berkart said a goal of German experts, such as See, was, to...
"...maintain that, to warrant a diagnosis of pure bronchial asthma, the bronchial mucous membrane should appear healthy, nor should any other cause for the dyspnoea be discoverable. Still, not all supporters of this definition adhere to it throughout. They admit that asthma may be complicated 'with' or 'grafted on' other cardiac and pulmonary affections. But, as these affections are themselves capable of producing asthmatic seizures, the distinction in a given case between this symptom and the supposed complication would be purely arbitrary." (2, page 3)
In other words, according to Berkart, pure bronchial asthma was only diagnosed when there were no other scars found upon the lungs or the heart, at least according to the Germans. (2, page 3)

References:
  1. Shmiegelow, Ernst, "Asthma, considered specially in relation to nasal disease," 1890, London, H.K. Lewis
  2. Berkart, J.B., "On Asthma: It's pathology and treatment," 1878, London, J. & A. Churchill
  3. Brown, Orville Harry, "Asthma, presenting an exposition of nonpassive expiration theory," 1917, St. Louis, C.V. Mosby Company; reference used: ee, Germain: Nouv. Diet, de Med. et de Chir. Practiques, 1865, iii, p. 585, pages 36, 89
  4. Gee, Samuel, A lecture on permanent asthma, delivered at the Hotel Dieuj, by Prof. Germain See, translated from the Union Medicale, by H. McS. Gamble, "Gailard's Medical Journal," volume 37, edited by Edward Samuel Galliard, 1884, New York
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