Wednesday, January 18, 2017

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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