1873: Lebert creates new asthma theory

Herman Lebert (1813-1878)

In 1873, Herman Lebert came up with an interesting theory about asthma that lasted for several decades, and into the 19th century.  

Lebert was born in Germany, and later became professor of pathology in Paris and Zurich.  As a pathologist he spent hours in a lab investigating tissues under the microscope.  

Steven I. Hajdu, in a 2004 article in Annals of Clinical Laboratory Science, said Lebert was one of the first clinical pathologists who often goes unrecognized by pathologists, when he should be a household name to them.  (1)

Hajdu said he sliced"fresh tissues with a razor-like knife and prepared cell samples (smears) by scraping, washing, or by squeezing the tissue slices. Samples from fluids were placed on glass slides without preservatives. Most microscopic preparations were unstained, but occasionally a drop of iodine was applied as a stain." (1)

It was by this approach that he learned about cancerous tumors.  Hajdu said:

In his text on cancer (1851), Lebert gave concise summaries and organ specific descriptions of all forms of tumors. The book consists of 885 pages and discusses the dietary, surgical, and medical treatment of cancer. In 1857, Lebert published a comprehensive pathology text in two volumes that covered everything that was known at that time about anatomic pathology, as well as discussions on clinical pathology. (1)

Hajdu said it was Lebert's work, along with fellow pathologist Julius Vogel (1814-1880) who developed the "concepts of cellular pathology.  Vogel and Lebert established the solid basis on which Rudolph Virchow, in the 1860s, built his general theory about cells."  (1)

Despite his accomplishments, Hajdu said, Lebert (and Vogel too) does not get the credit he deserves, at least as far as pathologists are concerned.  This is yet another example of how history is not always written fairly.

Along with his other accomplishments, Lebert also did research on lungs and vessels, and he used this to establish opinions about asthma.

In 1873, he supported both the spasmotic theory of asthma and the diaphragmatic theory of asthma. However, he  believed asthma was caused by dilation of the blood vessels in the lungs. (2, page 45)

In fact, this theory was still believed to be true when epinephrine was later invented in 1900, as the vasoconstricting (vasopressor) component of epinephrine was thought to increase blood flow to the lungs to make breathing easier. (3, page 38)

Lebert also offered an interesting remedy for asthma. Rene Laennec, among other asthma experts of the 19th century, observed asthmatics often developed asthma at night, or in the dark.  Based on this observation, "Lebert advised the use of as many candles as possible in the rooms of asthmatics," said Orville Brown in 1917.(3, page 38)

References: 

1. Hajdu, Steven I, "The first cellular pathologists," Annals of Clinical Laboratory Science, 2004, http://www.annclinlabsci.org/content/34/4/481.full, accessed 3/11/14
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

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1873: The Blackley Experiments, part IV

The results of a scratch test performed on a boy.

During the summer of 1865,  Charles Blackley performed perhaps his most famous experiment. He obtained pollen from Lolium Italicum and applied it to one forearm of a friend. He then scratched the skin over the pollen to introduce it to the skin. He did the same to his friends other forearm, although without applying pollen.

Soon thereafter he observed that the skin around the scratch where the pollen had been introduced to the skin tissue "raised a wheel such as is seen in uticaria or in stinging with nettles. In a few minutes, after the pollen had been applied the abraded spot began to itch intensely; the parts immediately around the abrasion began to swell, but this was not apparently due to any action on the cutis vera (skin)."(1, page 105) (2, page 818)

He observed that the rash was contained to the area around the scratch. He wrote:

The tumour increased in size until it measured two and a half inches in length, by one inch and a half in breadth, and was raised above the ordinary level of the surface nearly three quarters of an inch. No pain was felt in the limb, nor was there any heat or redness present at any time, beyond the very slight amount to which the abrading of the cuticle gave rise. The swelling attained its maximum in six hours, and then remained stationary for other eight hours; after this it gradually subsided, and in forty-eight hours it had entirely disappeared. The arm to which no pollen had been applied did not exhibit any sign of swelling or irritation.

Blackley performed this experiment to show that a rash was a specific result of pollen. This test has been modified some over the years, but it is still used to this day to test people for allergies. It is called the scratch test.

If a doctor suspects a patient has allergies, he can place a variety of allergens on the surface of the patient's skin, either on the forearm or back, and scratch the surface of the skin over each specific allergen. if a hive forms the patient is allergic to that allergen.  If no hive forms, the patient is not allergic to that allergen. The size of the hive also helps to reveal the severity of the allergy. For example, a large hive would be the result of a severe allergy to that substance.

He would continue this practice until he retired in 1894.  He passed away in 1900 at the age of 80.

References:

1. Blackley, Charles Harrison, "Experimental Researches on the Causes and Nature," 1880, 2nd edition, London, Bailliere, Tindall, and Cox
2. O'Sullivan, Dr. Stephen, "Charles Blackley and Allergy Research," New Scientist, June 28, 1973, Volume 58, No. 852, pages 818-819

1873: The Blackley experiments, part III

Plate showing an apparatus used by Blackley to collect pollen.
This design was recommended by Dr. Philipp Phoebus.
Any solid particles in the air collected on a glass plate (d),
that was exposed to a specific atmosphere for 24 hours.
The glass plate was then examined using a microscope.
The number of pollen counted.
(1, page 122)

Charles Blackley wasn't your typical hay fever patient. After suffering from its annoyingly frustrating symptoms year after year, and realizing his experiences with the disease did not match what was offered in medical literature, he began, in 1859, a series of experiments to prove the actual cause and nature of this disease. His ultimate goal was to find a remedy that actually worked.  Or, better yet, a cure.

This was probably an exciting time for Blackley.  He knew there was not much written about hay fever, and what was written was mostly speculation, so there was still a lot to learn about this newly defined disease.

By reading newspaper accounts, or perhaps by listening to his professors, he must have been well aware of all the recent investigations on microscopic substances. He most certainly would have known of recent studies on the reproduction of plants, and that it was determined plants reproduce sexually.

He must have learned about pollen, and how some plants were pollinated by bees and others by wind.  He must have been well aware that pollen was in the air around him, and that a few physicians had speculated this pollen might be a contributing cause of hay fever symptoms, although it was never proven.

The idea that diseases could be caused by microscopic substances was proven by Louis Pasteur.  Perhaps Blackley was thinking of this as he went to his bedroom one spring night.  Perhaps he was symptom free when he opened the window to enjoy the refreshing breeze, but was sniffling and sneezing upon waking up. Perhaps it was this that caused him to have an aha moment.

Blackley and his friends spent many hours in enclosed rooms inhaling, sniffing, and rubbing onto their respiratory membranes and eyes and lips all the substances suspected of causing the symptoms.  When none of them caused the symptoms of hay fever, they must have gotten excited that they were on to something truly historic here.

This excitement must have become exuberant when the first experiments on pollen came back positive for hay fever symptoms.  The only frustration was when a test came back positive they had to wait for the symptoms to abate before performing the next test on himself.

However, even when he was having symptoms, he was able to study the types and quantities of pollens in the atmosphere.  To do this, he constructed an apparatus (see figure) that allowed him to collect and count pollen for 24 hour periods in various locations "to imitate some of the conditions... to which a patient may be exposed in his daily routine." (1, page 122)

As he suspected to be the case, his own hay fever symptoms appeared to be worse on the days when the quantity of pollen in the air he was studying was highest. (1, 124-125)

By using his apparatus to count pollen on both hot days and cool days he was able to conclude that the quantity of pollen was determined by the temperature of the air.

Because he failed to measure the moisture of the air, he was unable to use his experiments with the apparatus to determine the effects of humidity on the release of pollen.  So he opted to perform a separate experiment where he allowed several ears of rye to grow in a dry controlled environment, and several more to grow in a humid controlled environment.  (1, pages 126-7)

The ears exposed to dry air threw off their pollen within a few hours, and the ears exposed to high humidity threw off no pollen.  This test proved the release of pollen was greater on dry days than humid days.  (1, pages 126-7)

By using his apparatus to collect pollen on rainy days, he quickly realized that rain was not conducive to the release of pollen.  This explained why some hay fever patients observed a reprieve from hay fever when the rain was falling.  (1, page 121)

However, he concluded: (1, page 86-87)

A high temperature is in itself favorable to the generation of pollen, but a high temperature with severe drought will, in the case of the grasses, check their growth, and thus prevent the formation of pollen. In proportion as temperature and moisture are suitably combined, so will be the production of pollen, but where these happen to be unusually favorable, we may have the grass arriving at maturity rapidly, and as a consequence this may be quickly cut and converted into hay and housed. Under such circumstances, hay-fever patients may have a short season of attack, but the symptoms may be very severe whilst they last. (1, pages 86-87)

In the same manner, he proved that grass did not grow well at lower temperatures, and grass that did grow had less vigor.  Likewise, plants that flowered prematurely, such as in March, did not have the same power as when the plant flowered in the middle of summer. (2, page 87)

Because pollen counts may peek during the dog days of summer, Blackley said he could understand how such an intelligent physician as John Bostock might confuse heat as the cause of the malady. Yet Backley now understood that heat was a contributing cause more so than the exciting cause.

He learned that the amount of wind affected pollen counts too. He said:

A quiet state of the atmosphere in the height of the hay season generally gave a large amount, but a strong wind lessened the quantity. In the latter case, however, if the wind was not very strong, I found the ophthalmic (tissue around the eyes) suffering to be more severe than in a quieter state of the atmosphere. (1, page 121)

Various physicians recommended a visit to the city in order to obtain a reprieve from hay fever symptoms. While previous authors did not understand why this was so, Dr. Blackley proved by his experiments that it was because there was less pollen in the middle of a city. (1, page 121)

And, most notably, many physicians recommended hay fever vacations to the seashore at high altitudes, such as in the mountains.  Dr. Morrill Wyman recommended hay fever vacations, particularly to the White Mountains.

References:

1. Blackley, Charles Harrison, "Experimental Researches on the Causes and Nature," 1873, London, Bailliere, Tindall, and Cox

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1873: The Blackley experiments, part II

Of all the things theorized to cause hay fever, Dr. Charles Harrison Blackley put them all to the test on himself.  The following are the common agents he tested:

1.  Benzoic acid:  It's a compound used as a food preservative.  In three different experiments, he inhaled vapors and fumes of the substance, and applied a solution of it to the mucous membranes inside his nose.  His conclusion was that the substance did not cause hay fever symptoms. (2, pages 51-53) (5, page 71-73)

2.  Coumarin:  A chemical compound found naturally in some plants, and can be used as a food additive or in some perfumes.  He placed ten drops of the substance upon a plate, thus allowing it to evaporate into the air of the room.  He and a couple friends entered the room, spending a couple hours at a time on more than one occasion.  The men walked around the room as to inhale the air as if they were walking in the open air. He even performed this experiment in different years and during different seasons of the year.  The experiments did not produce hay fever symptoms. (2, pages 53-55) (5, pages 73-75)

3.  Odours: He inhaled the odours of various plants, flowers, fungi and other substances.   Some produced hay symptoms and some others didn't.  The substance that came closest to producing hay fever symptoms was Penicillium. His recommendation was for further testing in this area. (2, pages 55-59) (5, pages 76-79)

4.  Ozone: It was discovered in 1785 by Dutch physicist Martinus Van Marum (1750-1837), and is a naturally occurring substance created by the sun.  Christian Friedrich Schonbein described in 1832 how it can be produced by man. Dr. Schonbein said he observed catarrhal affections such as asthma and hay fever among those who, during experiments he performed, inhaled air highly charged with it.

During the 1850s various other physicians made similar observations, and so did Dr. Phillip Phoebus in 1862.  Blackley set out to prove if this was true.  In some experiments he spent several hours, at various seasons of the year, in locations with high levels of measurable ozone in the atmosphere, and he observed no hay fever symptoms.  He also artificially created an atmosphere high in ozone in a room, and he spend six hours in it while experiencing no ill effects.

He also observed that ozone was always present, even in the atmosphere on the seashore and out at sea, where many hay fever sufferers have reported relief of symptoms. He therefore concluded that if ozone caused hay fever, symptoms would be observed in these locations.

In this way he was able to disprove the theory that ozone caused hay fever symptoms. (2, pages 59-69) (2, page 8, pages 79-91)

5.  Dust: Blackley said many authors referred to dust as "common dust," and he said there is no such thing, as all dust contains different ingredients depending on the geological character of the district and its botanical productions. He said various germs may also appear in the dust depending on temperature and moisture of the air.

He said dust produces hay fever symptoms, but only during the hay or flowering season.  He did observe that symptoms occurred when a horse and buggy stirred up dust, but he attributed this pollen carried carried by the horse and buggy and not the dust.

In other words, he attributed symptoms caused by dust not so much on the dust, but on pollen mixed with the dust. He said he would further prove this by performing experiments with pollen.  (2, pages 69-72) (5, pages 90-93)

6.  Pollen: He performed five different types of experiments with various types of fresh and dry grass and flowering pollens: he applied them to the mucous membrane inside a patient's nose, he had the patient inhale them to bring them into contact with the throat and lungs, he applied them to eyelids and lips, and he rubbed them on limbs.  (2, page 76)

Upon completion of his experiment on pollen, he said:

Almost every experiment (with pollen) is by a greater or smaller amount of definite and unmistakable effect which seems to point to pollen as the most powerful if not the only cause of the malady. (2, page 74)

In this way, he proved that, without a doubt, pollen was the main cause of hay fever, both in its catarrhal and asthmatic forms.  He also determined that even a small amount of pollen may cause these symptoms, although the severity depended on the type and the quantity of pollen. (2, page ?, 99)

7.  Animals:  Various physicians had noted that some animals, such as cats, rabbits and guinae pigs, brought about hay fever symptoms.  Blackley suspected that this was due to pollen being carried withing the fur of these animals. (2, pages 101-102)

8.  Light:  Regarding this, he said:

We have abundant evidence to show the important influence it has in aiding those changes that make up the sum total of life in the animal and vegetable kingdom, but we have no evidence to show that it has the power to produce symptoms which have even a remote resemblance to those of hay fever, and, so, as far as I am aware, no author has yet made experiments which prove that light can produce the fully developed disease." (2, page 102)

He said that until evidence shows otherwise, he cannot accept that light is the cause of hay fever. (2, page 102-103)

9.  Heat: Many credible physicians, including Dr. Bostock, postulated this to be the cause.  However, if this were true, hay fever sufferers would not get a reprieve while visiting the city or the sea side, as the weather would be the same at these locations as anywhere else.  He said the disease would equally appear in southern states as northern states, and in fact Dr. Morrill Wyman proved there are fewer cases of hay fever in the south.

Blackley essentially said John Bostock's experiments that showed hay fever was caused by heat were flawed.  Blackley said:

I have... shown that in a cool summer very little pollen is formed by grass, and I shall be able to show... that a rise in the temperature, during the hay season, will sometimes cause large quantities of pollen to be formed and thrown off... certain it is that heat and moisture favor the growth and evolution of pollen and that cold and dryness will almost completely put a stop to these processes. (2, page 104-105)

Lacking this knowledge, it must have been easy for wise physicians like John Bostock to assume that heat was the cause of the symptoms, instead of just a contributing factor.

References:

1. "Charles Harrison Blackley, 1820-1900," The University of Manchester: The John Ryland University Library: Manchester Medical Collection, http://archives.li.man.ac.uk/ead/search?operation=full&rsid=dc.title%20any%2Frelevant%2Fproxinfo%20%22William%20Charles%20Henry%22&firstrec=1621&numreq=20&highlight=1&hitposition=1638, accessed 9/13/14
2. Blackley, Charles Harrison, "Experimental Researches on the Causes and Nature," 1873, London, Bailliere, Tindall, and Cox
3. Waite, K.J., "Blackley and the development of hay fever as a disease of civilization in the nineteenth century," Medical History, April, 1995, 39 (2), pages 186-196, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1036974/?page=5, accessed 9/14/14
4. Smith, William Abbotts, "On Hay-Fever, Hay-Asthma, or Summer Catarrh," 1867, London, Henry Renshaw, pages 17-24.
5. Blackley, Charles Harrison, "Hay Fever: It's causes, treatment and effective prevention," 2nd edition, 1880, London, Bailliere, Tindall, & Cox

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1873: The Blackley experiments, part 1

Charles Harrison Blackley (1820-1900)

Dr. John Bostock defined hay-fever in 1819, and by 1840 it quickly gained ground as a common diagnosis. This was true despite physicians not understanding the true cause and nature of the disease. Yet this all changed in 1873 when Charles Harrison Blackley published his book "Experimental Researches into the Cause and Nature of Catarrhus Aestivus."

He was born in 1820, and when he was of age he became an apprentice to Bradshaw as an engraver and printer.  (3, page 190)

In 1848, at the age 28, he became ill and became a patient of Dr. David, who practiced in homeopathic medicine, or medicine that was generally shunned by the medical profession.  He was diagnosed with a newly defined disease called hay fever.  This seemed to have peeked his interest in both homeopathic medicine and hay fever. (3, page 190) (2, page 8)

He continued to work as a printer and engraver, studying chemistry, botany, electricity, and Greek on the side.  In 1855, at the age of 35, he left this career to attend Manchester School of Medicine full time.  He qualified as a doctor in 1838, and started a practice in Manchester, England, as both as a surgeon and physician, specializing in homeopathic medicine. (1) (3, page 190)

He returned to school in 1874, this time at Brussels, where he earned his doctorate (M.D.). He did not hide the fact he practiced in homeopathic medicine, in fact he was honored and even wrote papers on the subject. However, once he obtained his doctorate (M.D.) in 1874, he was more generally accepted by the medical community. (3, page 190) (1)

Through it all, and since his diagnosis with hay fever, and his constant reminder of it each fall, he constantly and "carefully read over most of the scanty bits of literature of the disease then existing," he said.   (2, page 8) (3, page 190)

He learned there were a lot of theories as to what caused hay fever, including heat from the sun on hot days, benzoic acid used as food preservatives, strong odors (such as from plants), ozone, dust, light, animals and pollen (from grass or flowering plants).  Yet he was constantly frustrated by the lack of evidence that any of these caused hay fever. (2, pages 3,7)

He was amazed at all the theorizing regarding the cause and nature of this disease. He said: "It is, however, much easier to theorise than to try experiments, and especially when these would have to be tried on the theoriser's own person. (2, page 73)

He said such theorizing resulted in "no advance towards obtaining a remedy on which we can depend as an effectual means of a cure," he said.(2, page 3, 7)

The most common theory at the time was that hay fever was caused by heat, such as heat from a hot summer's day.  However, one day he was in a hot kitchen and he did not have hay fever symptoms.  He wondered why this would not induce the symptoms, but a hot summer day would.  It made no sense.

He said:

"I was inclined to regard heat as the principle exciting cause, but my experiences did not quite coincide with the opinions of those who had written on the disorder, and this experience had, unfortunately, compelled me to come to the conclusion that until something more was known than I had learned from the writings of others, or from my own previous observations, there was no chance of escape from the annual torment. I had thus a personal interest in getting a more thorough knowledge than I then possessed of all the phenomena of hay-fever; and whilst I was in this way furnished with a good and sufficient reason for commencing the investigations, the annoyance caused by the annual attacks acted as a powerful stimulus to exertion in making these as complete as my somewhat limited time and opportunities would permit." (2, page 8-9)

It was this frustration that inspired him, in 1859, to begin a series of experiments to learn the true nature and cause of hay fever, of which he referred to as cararrhus aestivus. (2 page 7)

He initially wanted to perform these experiments on others, although he had only a few volunteers.  So he ultimately decided to perform these them on himself.  This decision was initially criticized by his peers, although they quickly rescinded their criticism as soon as they learned how well his experiments were formulated.

While he initially suspected the experiments would be done quickly, he said that circumstances beyond his control forced them to be done slowly over the course of many years.  He had to test pollen under various situations, and in various seasons.

Likewise, while many of the substances did not cause hay fever symptoms, some of them did cause symptoms that were quite unpleasant.  For instance, when he and his friends were sitting in a room inhaling the odors of Chamomilla metricaria, he started to feel...

...severe aching pain across the forehead, with nausea, dizziness, and pain at the epigastrium... and these became so unpleasant on the second day after the plant had been placed in the room that I was glad to have it removed.  (1, page 57)

Occasional set backs like this would delay further experimentation until he was feeling better. All in all, it took fourteen years for him to conclude his experiments and finish writing his book. (2, page 9)

Blackley was initially criticized for his work.  However, his book was so well written, and his experiments so well performed, that the criticism was not long lasting.

References:

1. "Charles Harrison Blackley, 1820-1900," The University of Manchester: The John Ryland University Library: Manchester Medical Collection, http://archives.li.man.ac.uk/ead/search?operation=full&rsid=dc.title%20any%2Frelevant%2Fproxinfo%20%22William%20Charles%20Henry%22&firstrec=1621&numreq=20&highlight=1&hitposition=1638, accessed 9/13/14
2. Blackley, Charles Harrison, "Experimental Researches on the Causes and Nature," 1873, London, Bailliere, Tindall, and Cox
3. Waite, K.J., "Blackley and the development of hay fever as a disease of civilization in the nineteenth century," Medical History, April, 1995, 39 (2), pages 186-196, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1036974/?page=5, accessed 9/14/14
4. Smith, William Abbotts, "On Hay-Fever, Hay-Asthma, or Summer Catarrh," 1867, London, Henry Renshaw, pages 17-24.
5. Blackley, Charles Harrison, "Hay Fever: It's causes, treatment and effective prevention," 2nd edition, 1880, London, Bailliere, Tindall, & Cox

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1872: Wyman recommends mountainous hay fever vacations

Morrill Wyman (1812-1903)
(6, title page)

Victims of hay fever realized early on that severity of the disease was directly proportional to certain geographic regions. And for this reason one of the original remedies recommended by hay fever physicians was to vacation during the offending season. One physician to do extensive studies on the geographic effects of hay fever was Dr. Morrill Wyman.

Wyman was born in Chelmsford, Massachusetts, in 1812, the second son of Dr. Rufus Wyman, who was chosen in 1817 to be physician and superintendant at the Mclean Asylum for the Insane at Charleston (A branch of the newly founded Massachusetts General Hospital), where he worked for 17 years.  Morril's older brother was Jeffries,who likewise became a reputable physician. He also had a younger a brother Edward. (3) (6, page 6, 84)

Morrill and his brother Jeffery entered Harvard College together, both graduating in the year 1833. (3) (6, page 52)

After receiving his Harvard degree he worked as an assistant engineer on the Boston and Worcester Railroad.  He said the "open-air life" was beneficial to his health, and after a year he had the urge to return to medicine. (6, page 52)

He studied medicine with his father, and, in 1834, he became the medical student of Dr. William Johnson Walker, a physician and surgeon at Charleston and a friend of his father. He studied the books recommended to him, and tended to patients who came to Dr. Walker's office.  Occasionally he traveled with the doctor to his see his other patients. (6, pages 52-53)

In the meantime, he also attended classes at the Medical School at Harvard University.

Beginning in 1836, Morrill served for one year as house physician of Massachusetts General Hospital.  While they he worked under Dr. James Jackson and Dr. Jacob Bigelow.  At the time anaesthetics were being experimented with, so Dr. Wyman had an opportunity to participate in these experiments. He and the other house physicians experimented on themselves by inhaling the various anaesthetics to personally observe their effects. (6, page 54)

After this assignment, he returned to the university to complete his medical degree, receiving it at the same time as his elder brother in 1837.  (3) (6, page 53)

He then started a practice at Cambridge and became a surgeon.

Among his first interests was the ventilation of sick rooms and public buildings, and he would end up publishing an essay on the subject called "A Treaties on Ventilation." In 1846, the same year the essay was expanded and published into a 400 page book, he earned the Boylston medical prize for the essay. (3) (5) (6, page 57)

He observed that methods of opening the chest to remove excess fluid from it were unchanged since the days of Hippocrates.  The operation was difficult to perform, dangerous, and offered uncertain results.  In 1850 he introduced a procedure for removing excess fluid from cavities of the body, particularly the chest cavity, that was both safer and easier to perform.  (3)

His son, Morrill Wyman Jr., described the device as consisting "essentially of an exploring trocar and canula of a very small diameter fitted to an exhausting syringe." (6, page 58)

His first demonstration of this device was on a 39-year-old lady who presented with a respiratory distress and pain.  By auscultation and percussion he diagnosed her with pleurisy with effusion (fluid or pus from infection or cancer) in the pleural sac (the cavity the surrounds the lungs). (6, page 58)

After waiting several days and allowing for traditional treatments to be trialed, the patient's condition deteriorated to the point that it appeared she was going to die and a priest was called.  It was at this point it was decided for Dr. Wyman to tap the ladies chest to draw out the fluid with his new instrument (a procedure called thoracentesis).

Dr. Wyman described the procedure:

The patient was, with Dr. Homans' aid, seated in a chair inclined to the right and the body bent a little forward. An exploring trocar and canula one-sixteenth of an inch in diameter was then passed by me through the intercostal space between the sixth and seventh ribs (counting from above) midway between the spine and the line of the axilla; it was pushed steadily on until its point moved freely in the pleural sac; withdrawing the trocar, twenty ounces of straw-colored serum were allowed to flow. The canula was taken out; the pain was slight, the patient expressed herself as much relieved, and she was laid in her bed. Two days after the operation she had occasional paroxysms of dyspnoea, and at her earnest solicitation the same trocar and canula was passed near the same place as before. This time, the canula had fitted to it a pump, so arranged that fluid was continuously drawn through it without the possibility of the entrance of air, or any septic fluid. With this, ten ounces of clear serum were drawn with immediate relief to the patient. The recovery was steady; in about three weeks after the operation she was about the house; a fortnight later she drove ten miles in a carriage, and was soon no longer under medical observation. (6, page 60)

The treatment was a success, and the lady survived.

Dr. Henry Ingersoll Bowditch (1808-1892)
He was an ardent abolitionist
who prayed for the end of slavery
and for the forgiveness of slave hunters.

During a second second case Dr. Wyman performed his procedure on a patient of Dr. Henry Ingersoll. Bowditch, which was also successful.  In 1851 Dr. Wyman and Dr. Bowditch read papers to the Massachusettes Medical Society on the successful results of 39 successful operations they both performed using Wyman's new method of thoracentesis.  (6, pages 64-65)

These two physicians proved the simplicity and safety of the new method, and soon thereafter gained the confidence of the rest of the medical community.

Wyman became particularly interested in hay fever, which he referred to as "autumnal catarrh" in 1833 when he first had a severe attack of hay fever, the same ailment his father, brothers, and later his son (Morril Wyman Jr.) suffered.  So he had ample reason to partake in a study of the aliment and, ultimately, publish a book on the subject.  (1, page 174)(2, page 18) (6, page 82)

Yet such research would be delayed due to his busy career and the Civil war. Prior to the ware he was a strong supporter of President Abraham Lincoln, and did whatever he could to support the Union.  (6, page 75)

He offered his services as a surgeon, but governor Andrew said his was needed at home.  A short while later, however, he was requested to serve on the U.S. Sanitary Commission, and his role was to inspect army medical facilities to make sure they were sanitary. (6, page 77)

It was only after the war that his interests in hay fever peeked.  Yet he didn't have to start from scratch, as his father had gathered some data on the subject.  (1, page 174)(2, page 18)

He was determined that "autumnal catarrh" was caused by the pollen from ragweed, and so he collected data from various correspondence to determine where the disease was most common. He published the results of his findings and his opinions on autumnal catarrh in his most famous book in 1972 book aptly titled "Autumnal Catarrh."

He wrote that the results of his studies proved that hay fever was both seasonal and geographical.  

Dr. Wyman interviewed patients who noted they had no symptoms
of hay fever while vacationing at resorts in the White Mounntains.
Partly due to Wyman writing about it in his 1872 book "Autumnal
Catarrh," the White Mountains became an elite hay fever resort area.

For instance, he noted that people who suffered from hay fever in May in the United States may have no symptoms while vacationing during May in Great Britain, and vice versal.
This, he said, was ample evidence that different geographic regions have unique causes of hay fever.

This is a map of the White Mountain region from Dr. Wyman's book.
 The uncolored areas represent regions safe from Catarrh.

So, for this reason, he suspected a vacation to the opposite country may actually provide a remedy for the hay fever. (1, page 58-61, see also pages 1-6)

Wyman said: 

It may be assumed, therefore, with a good degree of certainty, that the Autumnal Catarrh of the northern portion of the United States does not exist in Great Britain, nor in those countries on the Continent above mentioned. To this we may add, that although Dr. Phoebus makes mention of asthmatic and catarrhal attacks occuring in these countries annually, at other seasons than early summer, he makes no mention of a regularly recurring catarrh in September. He gives the average duration of the June Cold as about eight weeks. (1, page 61)

Wyman also observed that hay fever...

...does not exist over the whole United States. It is a matter of difficulty to give the exact limits the number of cases not being sufficient for that purpose. We can, however, arrive at proximate results which further observations may render more definite. We have no other evidence of its non-existence in the indicated places than this, that certain persons who have suffered elsewhere have ceased to suffer on removing to them. (2, page 61)

Using data he collected, he was able to create various pollen maps of the United States showing hay fever sufferers the best places to plan their hay fever vacations.  (You can view the maps here, click and scroll up one or two pages).

He believed places with low pollen counts would end an attack within 24 hours, or prevent one from occurring altogether.  Such locations were:  (1, page 73)

1. Along the shores of Lake Michigan
2. Canada
3. Latitude 35°
4. Extreme east of the continent
5. Pacific coast.
6. In the sea

The best methods of escaping the pollen, and the hay fever, were: 

1. Sea voyage: symptoms do not seem to occur out at sea (1, page 73-4)
2. Sea side:  Sea air seems to provide relief from hay fever symptoms.  If symptoms occur they are generally milder, and the cooler air is soothing and provides better ability to deal with symptoms. (1, page 74-9)
3. Islands: They are protected by sea air, which seems to provide relief (1, page 74-9)
4. City residence: It provides relief, but it is never complete, especially if there are fields nearby, or if there is a wind.  Although, for the most part, there is less vegetation in the city.(1, page 80) 
5. Mountains:   Generally, the disease does not exist in places that are 800 feet above sea level. (1, page 81-95)

The only time the above may result in hay fever symptoms was when, as noted, the wind was blowing.  When this occurred, pollen from fields would waft to these regions, thus increasing the risk of hay fever symptoms.  

To further explain this, Dr. Wyman quoted Dr. Phoebus:

"Moist air brings to many, probably to most, great relief. Many praise the sea air. It brings a quick and lasting amelioration during the whole attack, even without sea bathing, which is also useful. Dr. Bostock proved this in his own case. Many reside at the sea-shore, or cruise about in yachts during the critical period. The asthma is immediately relieved at the sea-coast; but if the wind blows from the land, even for a single hour, the disease immediately returns." (1, page 79)

Dr. Wyman was not the first physician to propose the benefits of mountainous air for treating diseases, as tuberculosis had long been treated this way.  Likewise, for many years hay fever sufferers had noted to their physicians that they felt better when they traveled into mountainous regions. Dr. Wyman was, however, probably the first to make light of this observation, thus inspiring him to further question his patients.

The Glenn house was one of the earliest resorts in the White
Mountain region.  The original hotel was built in 1851, an expansion
 of an old farm house.  The name Glenn House was established in 1852
after the hotel was sold to J.M. Thompson (see this link for more).
Wyman notes in his own biography that he too found that staying
at the Glenn house offered him the most relief.  (1, page 173)

One of the hay fever sufferers he talked to was a lady from Lynn, Massachusetts. Wyman said:

She had suffered severely, especially in the asthmatic stage. She accidentally noticed, in 1853, while traveling in the White Mountain region, that her catarrh, which for twelve years had commenced in August 20th, had failed to make its appearance. The following year she visited the same region before the usual time of attack, with the hope of escaping it. She did escape it. During the remaining ten years of her life, until 1864, she was at the Franconia Notch, White Mountain Notch, or at the Glen House (a White Mountain resort established in 1851.  You can read about it here), — most of the time at the latter place. During this whole period she,obtained complete relief. (1, page 81)

Image of Wyman used in his obituaries in 1903. 

Another patient he talked to was Jacob Horton.  Wyman said:

In 1860, Jacob Horton, Esq. of Newburyport, Mass., who bad suffered so severely that he was obliged to keep his room during much of the attack, to answers to my inquiries replied: "The only relief for me is at the White Mountains."  (1, page 81-82)

So, it was by questioning his patients that he realized mountainous regions worked to the benefit of hay fever sufferers, and his further investigations verified his theory.

Places that he recommended were: (1, pages 85-89)

1. White Mountains in New Hampshire
2. Mount Mansfield in Vermont, one of the Green Mountains
3. Slow Village near the foot of the Green Mountains
4. Adirondack Mountains in northeastern New York State, including St. Lawrence and Chateaugay ranges
5. The great Pennsylvania and Ohio plateaus (proves to be a good refuge)
6. Catskill Mountain House 
7. Alleghany Holds (only in certain plaes)
8. Other, including regions not necessarily of high altitude (1, pages 85-89)

He said:

The large number of persons, who have visited these regions successfully, demonstrates their safety. But we have other evidence: persons who have left them before the end of the critical period, have been at once attacked, and the attack has ceased immediately on their return. (1, page 89)

The change in a sufferer fully under the influence of this malady, on arriving at the mountains is sudden and striking. His first night's sleep is refreshing, and in the morning his most annoying symptoms — the itching and watering of the eyes, the sneezing and nose-blowing, or the asthma — have much diminished. A second night gives still more relief and usually in the course of the following day most of the symptoms disappear. Besides this relief of the local symptoms, a still greater change takes place in the spirits. Activity of mind and body replaces discouragement and weakness, the usual flesh and strength are regained, and the sufferer feels assured that he has at last shaken off his enemy. 
(1, page 90)

The number of cases obtaining this relief in certain regions is too great to be explained by coincidence; the repetition, year after year, of the same relief at the time of arrival in such regions, is conclusive that the relief is connected closely with the arrival; that the causes of the disease, whatever they may be, have ceased to be efficient. We have no evidence that persons, residents of these regions, suffer.1 We have also the still further evidence that it is not dependent upon simple change of residence, for very many of those who are relieved in these regions have tried various other places without success; and yet these places, by their distance from their usual residence, and different physical conditions, should have afforded relief, provided ordinary changes alone were required. They have also tried various kinds of drugs, and different methods of medical treatment, with as little success. 

And he concluded by saying:

We are forced to the conclusion, then, that the causes of a paroxysm of disease which exist elsewhere, are less active, or entirely wanting in the places above mentioned; and that those who visit these places in due season, are for the much larger part greatly relieved, or entirely free. (1, page 92) 

Dr. Wyman was not the first to recommend mountainous regions as the cure for maladies, but he was the first to recommend them for hay fever sufferers.  He was the first to create maps showing ideal places of refuge for hay fever sufferers.

Still, his favorite place to recommend was the White Mountains. Partly due to the publication of his book  "Autumnal Catarrh" in 1872, the While Mountains became a prime location for hay fever vacations, thus becoming a prestigious mountain resort.

In fact, it was partially, if not significantly, because of his studies that the White Mountains became one of the most sought after vacation spots for hay fever sufferers, especially for those with money (such as hay fever doctors with the affection).

After serving as a physician in Cambridge for greater than 60 years, he announced in 1902 that he was no longer fit to see patients.  He passed away in Cambridge at the age of 91 in 1903. During the course of his life he saw Cambridge grow from a small town to a city, while himself becoming one of the most famous physicians in the United States. (3) (5)

Further reading:

1. 1872: Wyman's two types of hay fever
2. 1872: Good times for hay fever sufferers

References:

1. Wyman, Morrill, "Autumnal catarrh," 1876 (first edition 1872), New York, Hurd and Houghton
2. Mitman, Gregg, "Breathing Space," 2007,
3. Walcott, H.P., "Fruitful career: sketch of the late Dr. Wyman by Dr. H.P. Walcott-- his professional and public service," The Cambridge Tribute, Saturday, June 27, 1903, page 9, accessed from Cambridge Public Library, http://cambridge.dlconsulting.com/cgi-bin/cambridge?a=d&d=Tribune19030627-01.2.93#, accessed 9/12/14
4. "Morrill Wyman, M.D.", 1863, Cambridge Historical Society, https://www.flickr.com/photos/38861678@N03/3781219724/, accessed 9/12/14
5. "Dr. Morrill Wyman Dead: One of the Most Famous Physicians in the United States Passed Away in Cambridge Aged 90," Boston Daily Globe, 1903, January 31, http://omeka.lts.brandeis.edu/items/show/885, accessed 9/12/14
6. Wyman, Morrill Jr., "A brief history of the lives of Rufus Wyman (1778-1842) and his son Morrill Wyman (1812-1903)," Cambridge, Fourth March, 1913, privately printed

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1872: George Catlin describes Native American Respiratory Therapists

George Catlin (1796-1872)

There are many people we can thank for preserving the history of respiratory therapy, and among them is Georgy Catlin.  He was a painter who traveled to North and South America taking portraits of Native Americans.

By living among them between the years of 1832 to 1839, he became an expert of sorts on their way of life.  Included among his wisdom was knowledge on their view on air and breathing. 

Along with making portraits of them, he recorded their habits and their rituals.  He noted that their view on medicine was not the same as ours, as the Indians essentially thought of medicine as a mystery.  So as they used the term medicine pipe, they were essentially saying mystery pipe, meaning they didn't know how it worked.

Catlin, in "Notes of Travels Amongst the North American Indians," said he observed that the Indians, in their savage state, were healthier and had fewer diseases  --- including weakness of the lungs, bronchitis, and asthma -- than people who lived in the civilized world.  He made a similar observation in his book "The breath of life, or mal-respiration."   (3, page 3, 73) John D. Hunter (3, page 342) and John Lawson (4, page 151)

Georege Catlin oil on canvas
portrait of native american
See-non-ty-a,
an Iowa Medicine Man
1844-45 (Wikepedia)

He said he decided to write "breath of life" because...

...I have visited 150 Tribes, containing more than two million souls; and therefore have had, in all probability, more extensive opportunities than any other man living, of examining their sanitary system; and if from those examinations I have arrived at results of importance to their health and existence of mankind, I shall have achieved a double object in a devoted and toilsome life, and shall enjoy a twofold satisfaction in making them known to the world; and particularly to the Medical Faculty, who may perhaps turn them to good account." (2, page 3-4)

Along with diseases being rare, he observed that fatal conditions of the lungs were rare among the savages and the animals that lived amid the wild -- dog, ox, horse, etc.  This was not true among civilized man.  Lung ailments, along with ailments of the spine and abdomen, were rarely heard of among savage people, while civilized people had an amalgamate of ailments, including a variety of diseases, and aches and pains.
  

The natives believed that breathing was essential to life, and of this Catlin said:

Per Catlin: "Shut—your—mouth. " (2, page 71

Man's cares and fatigues of the day become a daily disease, for which quiet sleep is the cure; and the All-wise Creator has so constructed him that his breathing lungs support him through that sleep, like a perfect machine, regulating the digestion of the stomach and the circulation of the blood, and carrying repose and rest to the utmost extremity of every limb; and for the protection and healthy working of this machine through the hours of repose, He has formed him with nostrils intended for measuring and tempering the air that feeds this moving principle and fountain of life; and in proportion as the quieting and restoring influence of the lungs in natural repose, is carried to every limb and every organ, so in unnatural and abused repose, do they send their complaints to the extremities of the system, in various diseases; and under continued abuse, fall to pieces themselves, carrying inevitable destruction of the fabric with them in their decay.... The two great and primary phases in life and mutually dependant on each other, are waking and sleeping; and the abuse of either is sure to interfere with the other. For the first of these there needs a lifetime of teaching and practice; but for the enjoyment of the latter, man needs no teaching, provided the regulations of the All-wise Maker and Teacher can have their way, and are not contravened by pernicious habits or erroneous teaching... If man's unconscious existence for nearly one-third of the hours of his breathing life depends from one moment to another, upon the air that passes through his nostrils; and his repose during those hours, and his bodily health and enjoyment between them, depend upon the soothed and tempered character of the currents that are
passed through his nose to his lungs, how mysteriously intricate in its construction and important in its functions is that feature, and how disastrous may be the omission in education which sanctions a departure from the full and natural use of this wise arrangement? (2, page 15-16)

He observed that native American mothers closely watched the breathing of their infants, of whom rarely, if ever, passed from this life (In fact, Catlin quotes an Indian Chief as saying that it is rare that a child under the age of ten passes away.)  Catlin explained:

When I have seen a poor Indian woman in the wilderness, lowering her infant from the breast, and pressing its lips together as it falls asleep in its cradle in the open air, and afterwards looked into the Indian multitude for the results of such a practice, I have said to myself, "glorious education! such a Mother deserves to be the nurse of Emperors." And when I have seen the careful, tender mothers in civilized life, covering the faces of their infants sleeping in overheated rooms, with their little mouths open and gasping for breath; and afterwards looked into the multitude, I have been struck with the evident evil and lasting results of this incipient stage of education; and have been more forcibly struck, and shocked, when I have looked into the Bills of Mortality*, which I believe to be so frightfully swelled by the results of this habit, thus contracted, and practised in contravention to Nature's design

There is no animal in nature excepting Man, that sleeps with the mouth open; and with mankind, I believe the habit, which is not natural, is generally confined to civilized communities, where he is nurtured and raised amidst enervating luxuries and unnatural warmth, where the habit is easily contracted, but carried and practised with great danger to life in different latitudes and different climates; and, in sudden changes of temperature, even in his own house... The physical conformation of man alone affords sufficient proof that this is a habit against instinct, and that he was made, like the other animals, to sleep with his mouth shut—supplying the lungs with vital air through the nostrils, the natural channels; and a strong corroboration of this fact is to be met with amongst the North American Indians, who strictly adhere to Nature's law in this respect, and show the beneficial results in their fine and manly forms, and exemption from mental and physical diseases, as has been stated.

The Savage infant, like the offspring of the brute, breathing the natural and wholesome air, generally from instinct, closes its mouth during its sleep; and in all cases of exception the mother rigidly (and cruelly, if necessary) enforces Nature's Law in the manner explained, until the habit is fixed for life, of the importance of which she seems to be perfectly well aware. But when we turn to civilized life, with all its comforts, its luxuries, its science, and its Medical skill, our pity is enlisted for the tender germs of humanity, brought forth and caressed in smothered atmospheres which they can only breathe with their mouths wide open, and nurtured with too much thoughtlessness to prevent their contracting a habit which is to shorten their days with the croup in infancy, or to turn their brains to Idiocy or Lunacy, and their spines to curvatures—or in manhood, their sleep to fatigue and the nightmare, and their lungs and their lives to premature decay.

If the habit of sleeping with the mouth open is so destructive to the human constitution, and is caused by sleeping in confined and overheated air, and this under the imprudent sanction of mothers, they become the primary causes of the misery of their own offspring; and to them, chiefly, the world must look for the correction of the error, and, consequently, the benefaction of mankind. They should first be made acquainted with the fact that their infants don't require heated air, and that they had better sleep with their heads out of the window than under their mother's arms—that middle-aged and old people require more warmth than children, and that to embrace their infants in their arms in their sleep during the night, is to subject them to the heat of their own bodies; added to that of feather beds and overheated rooms, the relaxing effects of which have been mentioned, with their pitiable and fatal consequences. (2, pages 16-19)

He was actually onto something here that may have been proved in the modern world.  Many of the diseases and plagues that ail civilizations are of our own doing.  By taking children away from nature, their immune systems aren't exposed to microscopic forces necessary for maturation.  This results in diseases such as asthma, or so states the Hygiene Hypothesis and the Micro Flora Hypothesis.  Yet these are modern theories. Catlin came to this realization by his own observations, without ever having done any studies.


"Who ever waked out of a fit of the Nightmare in the middle of the night
with his mouth strained open and dried to a husk, not knowing when or
 from where, the saliva was coming to moisten it again,without being
willing to admit the mischief that such a habit might be doing to the lungs,
 and consequently to the stomach, the brain, the nerves, and every
 other organ of the system?"  It requires no more than common sense
to perceive that Mankind, like all the Brute creations, should close their
mouths when they close their eyes in sleep, and breathe through their
nostrils, which were evidently made for that purpose, instead of dropping
the under jaw and drawing an over draught of cold air directly on the lungs,
through the mouth; and that in the middle of the night, when the fires
have gone down and the air is at its coldest temperature—the system at rest,
 and the lungs the least able to withstand the shock. (2, page 21-22)

Like John D. Hunter, Catlin observed that sleep was essential to resting the lungs and the limbs from the labors of life.  While one is sleeping the breathing and the pulse is slowed.  Yet too much sleep is also bad. Catlin explained:

In natural and refreshing sleep, man breathes but little air; his pulse is low; and in the most perfect state of repose he almost ceases to exist. This is necessary, and most wisely ordered, that his lungs, as well as his limbs, may rest from the labour and excitements of the day.

Too much sleep is often said to be destructive to health; but very few persons will sleep too much for their health, provided they sleep in the right way. Unnatural sleep (due to sleep inducing drugs?), which is irritating to the lungs and the nervous system, fails to afford that rest which sleep was intended to give, and the longer one lies in it, the less will be the enjoyment and length of his life. Any one waking in the morning at his usual hour of rising, and finding  by the dryness of his mouth, that he has been sleeping with the mouth open, feels fatigued, and a wish to go to sleep again; and, convinced that his rest has not been good, he is ready to admit the truth of the statement above made.

Breathing with mouth closed is ideal  (2, page 22)

There is no perfect sleep for man or brute, with the mouth open; it is unnatural, and a strain upon the lungs which the expression of the countenance and the nervous excitement plainly slow. (2, pages 20-21)

So the Indians, at least according to Catlin, were very conscious of the importance of breathing and sleeping.  They must, in a sense, be considered among the first true respiratory therapists.

*Bills of Mortality are a means of keeping death statistics in the 16th, 17th and 18th centuries, and mainly started after the plague of London in 1592.  Statistics were generally taken every week in order to keep track of how many people died, along with the cause of death. Sometimes they also included the age of the deceased.  See figure here and here.  Bills of Mortality are believed to have originated due to the ideas published by John Gaunt of England in his 1662 publication "Natural and Political Observations upon the Bills of Mortality." The book is considered the "first book of vital statistics."  He learned that more boys were born than girls, and that by creating an accurate death count he could estimate the population.  This was, therefore, the "first step in the application of mathematical methods to the interpretation of statistics." Truly, however, the first people to keep track of such statistics were the ancient Hebrews and Romans. (5, page 273)

References:

1. Catlin, George, "Manners, Customs, and Condition of the North American Indians," 1841,
2. Catlin, George, "Breath of life, or mal-respiration and its effects upon the enjoyments and life of man," 1872, New York, John Wiley and Sons, Publishers
3. Hunter, John D., "Memoirs of a Captivity Among the Indians of North America," 1823, London, Paternoster-Row
4. Vogel, Virgil J., "American Indian Medicine," 1970, London, Oklahoma University Press
5. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1922, Philadelphia, W.B. Saunders Company

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1871: Walshe creates new asthma theory

Dr. Walshe described paralysis of the bronchial
musculature, which was essentially emphysema.
 Other physicians also observed this, one such
physician being Dr Friedrich Gustav Jakob Henle
(1809-1885).  Dr. Orville Brown said that
Henle believed  "imperfect expiration
and stenotic sounds as evidence of a paralysis
of bronchial muscles."  (2, page 33)

After Henry Hyde Salter wrote his famous asthma book "Asthma: It's Pathology and Treatment," the medical community was all but convinced as to the validity of the nervous and spasmotic theories of asthma. So when Dr. Walter Hayle Walsh came up with a third theory, he faced an uphill battle to convince the medical community, and he knew it.  

Dr. Walshe was well aware of the writings of Dr. Salter, and he supported the great asthma doctor's asthma theories.  Yet after studying the work of Rene Laennec and other physicians, he believed there was enough evidence to suggest that asthma was sometimes caused by paralysis of the bronchial musculature.  

In his book 1871 book, "A Practical Treaties on the Diseases of the Lungs," Walsh explained how he formed his theory. 

Laennec ascribed the peculiar air-distension of the lungs, found in persons asphyxiated by the mephitic gases of cesspools, to paralysis of the vagi nerves; Mr. Swan noticed similar distension in animals whose eighth pair had been divided in the neck (tide Nervous Apnosa). In both cases the contractile force of the bronchial muscles, concerned in expiration, is more or less completely annulled.  (1, pages 555)

Dr. Friedrich Gustav Jakob Henle
(1809-1885) was another physician
who supported the idea of paralysis
of bronchial muscles. He believed
 imperfect expiration and stenotic sounds
were his proof.    (2, page 33)

Vagus is Latin for wandering.  Early Roman physicians must have been amazed how this long nerve wanders throughout the body, from the brain stem all the way down to the abdomen.  In between, it branches to various viscera, or organs, including the ears, heart, lungs, diaphragm, and stomach. For this reason they referred to it as the vagus nerve.

Today it's still referred to as the vagus nerve, although it's also known as the 10th cranial nerve, the pneumogastric nerve, nerve X, or the wandering nerve.  It's responsible for many of the involuntary functions of the body, including breathing.
This refresher in mind, let's allow Walshe to continue:

If then, as we have seen, there be motive to believe that true dynamic asthma depends, as a rule, on spasmodic action of the bronchial muscular apparatus, here are speculative reasons for presuming that paralysis of the apparatus (vagus nerve) may cause an exceptional variety of the affection. Clinically, too, we meet with examples of asthma in which the comparative facility of inspiration, and difficulty of expiration, coupled with the deficiency of the usual amount of dry rhonchi (wheeze), suggest of themselves the probable existence of a minus, rather than a plus, state of power in bronchial contractility. Possibly such cases are those habitually most benefited by strychnia and galvanism. (1, pages 555-556)

Of course, upon making this observation, Walshe was aware that Dr. Salter had already succeeded in convincing the medical profession of another asthma theory. He therefore knew it would be very difficult to change the mind of a dogmatic medical profession.  He said:

This view is, however, far from being unopposed. Dr. Salter, for instance, adopting the prevailing theory that the bronchial muscles "are not, because they can not be, muscles of respiration," refuses to admit a paralytic variety of asthma. There are many clinical facts, now taking rank as accepted truths, which were once said "not to be, because they could not be," on the assumption that the conventional physiology of the hour was true. It seems to be a law of nature, that, where circular fibres embrace a tube, they are designed to influence the movement of its contents; why should the bronchial muscles have been created on a different principle? Experientia Falax! Dr. Salter may urge. True; but experimenta fallaciora.  (1, page 556)

He is not saying that all cases of asthma are paralytic in nature, just some.  As Dr. Orville Brown reminds us in his 1917 book on asthma, Walshe "adhered... to the bronchiolar muscle spasm theory to explain most cases of the disease."  (2, page 33)

So he wasn't totally opposed to the conventional wisdom regarding asthma at the time.  (16, page 33) (20, pages 13-14) (25, page 11)

References:

1. Walshe, Walter Hyde," A Practical Treaties on the Diseases of the Lungs," 1871, 4th edition, London, Smith, Elder & Company
2. Brown, Orville Harry, "Asthma, presenting an exposition of nonpassive expiration theory," 1917, St. Louis, C.V. Mosby Company
3. Thorowgood, John C., "Asthma and Chronic Bronchitis: A New Edition of Notes on Asthma and Bronchial Asthma," 1894, London, Bailliere, Tyndall, & Cox, pages 13-14)
4. Thorowgood, John C., "Asthma and Chronic Bronchitis: A New Edition of Notes on Asthma and Bronchial Asthma," 1894, London, Bailliere, Tyndall, & Cox, page 11

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