Monday, July 31, 2017

1913: Adam: Abnormalities Associated With Asthma

Dr. James Adam believed the most common cause of asthma was a toxin or poison in the blood.  The other cause of asthma was lesions in the respiratory tract (published 7/10/14).  While most physicians focused their attention on spasms in the lungs, he believed they should be focused more on one of these two causes of airway spasms.

He observed that many asthmatics, although not all, present with one or more of the following abnormalities along their respiratory tract or amid the chest and body:(1, page 12, 35-38)
  1. Polypi
  2. Septal deviations blocks air passage
  3. Turgid turbinals: blocks air passage
  4. Irritable turbinals (very sensitive to stimulus, causing coughing or sneezing)
  5. Congestion of mucus membrane (anywhere from nose, trachea or bronchi)
  6. Pigeon breast: from a lifetime of asthma the chest becomes deformed, where one sternum, or breastbone, is pushed outward
  7. Emphysema during asthma attacks, becomes chronic if asthma not cured 
  8. Barrel chest: rounded, bulging chest that shows little movementn with respiration.  It occus during a paroxysm, and becomes chronic if asthma not treated (sign of emphysema)
  9. Rounded, almost stooped shoulders (sign of emphysema)
  10. Unilateral nasal obstruction
  11. Sputum at the end of the attack
  12. Curschmann spirals in the sputum
  13. Eosinophile cells in sputum, with Charcot-Leyden crystals
  14. Heart Rate of 90-110
  15. Blood pressure within normal limits: paroxysm does not raise the blood pressure, but adrenalyn used to treat asthma may
  16. Blood pressure of 80-90 mmHg at end inspiration, and 120-130 at end expiration: decreased BP on inspiration may probably be due to impeded pulmonary circulation
  17. Flatulence during the paroxysm
  18. Asthmatics live long: In this, he agrees with other asthma physicians such as Salter and Berkart. (1, page 38) Adam notes this is true "so long as they don't become drug slaves)
While most other members of the medical community focused most of their attention on the spasmotic and nervous theories of asthma, Adam was focused on the Lesion Theory of Asthma and the Toxaemia theory of asthma, and for that reason his "radical treatment" would better help asthmatics as opposed to the more traditional treatment prescribed by other physicians.

  1. Adam, James, "Asthma and it's radical treatment," 1913, London, Gasgow: Alexander Stenhouse

Friday, July 28, 2017

1913: Two types of chronic asthmatics

James Adams explains that most cases of asthma are chronic before they are seen by a physician; that these cases are usually treated as bronchitis first (airway inflammation and increased sputum production).  Bronchitis "is really the form asthma commonly takes at first."  Only as time progresses, does asthma be come chronic. (1, page 31, 33)

He describes two types of chronic asthma: (1, page 30)
  1. Fat: Less common; overeating can lead to asthma; chronic bronchitis
  2. Lean: More common; usually as the disease becomes more chronic, a toxaemia in the blood will cause the asthmatic to become thin, with expanded shoulders and chest due to chronic laboring and emphysema.  
Adam writes that the most common sign of chronic asthma is "dusky, sallow skin with chloasms round the eyes, sure token of toxaemia. There is no mistaking this asthmatic chachexia (fatigue, weakness, as in wasting away) and the first sign of improvement resulting from correct treatment is the clearing of the skin; it looks as though it has been washed from the inside -- as it has been... it takes prolonged, repeated and severe paroxysms to develop the other (signs of chronic asthma). (1, page 31)

What causes the signs of chronic asthma, Adam notes, is the hyperaemia that is constantly ongoing and not treated (and it's usually not treated because most physicians don't respect the toxaemia theory of asthma.).  Toxaemia that is constant acts on the "skin and bronchial mucous membrane as well as on the tissues generally, producing the cachexia and bronchitis, the stress of the dyspnea, which is the main factor in producing the other thoracic changes, is intermittent.

Other signs of chronic asthma would be your distended chest and shoulders, pigeon chest, etc. These are signs that the person has a toxaemia, and that the person has been working hard to suck in air. (You can see more signs of the toxaemic effect on asthma in this post (1913: Lesions in respiratory tract cause asthma on 7/22/17)

Bronchitis is generally caused by a metabolic disorder, and therefore, the treatment generally revolves around decreasing carbohydrates (sugary foods), such as "sweets cakes." (1, page 33, 35)(also see chapter on atypical asthma)

  1. Adam, James, "Asthma and its radical treatment," 

Wednesday, July 26, 2017

1913: Adam Toxaemic Theory of Asthma

By the turn of the 20th century, the medical profession had readily accepted both the nervous theory of asthma and that spasmodic theory of asthma. The allergic theory of asthma was in its infancy, and the old toxaemic theory of asthma was no longer written about in new editions of asthma books.

Yet it was the old theory, the toxaemic theory of asthma, that Dr. James Adam proposed as the most valid explanation of asthma.  He understood that is was no longer accepted by the medical community, and he understood treatment based on this old theory was considered radical.  This, therefore, was the reason he referred to his asthma book as "Asthma and its Radical Treatment." (1, pages 1-3)

Dr. Adam said he continued to have much respect for Dr. Henry Hyde Salter who, during a series of articles published in the 1950s, articulated support for the nervous and spasmodic theories of asthma.  Yet Dr. Salter also articulated support for the toxaemic theory of asthma.  Of Dr. Salter, Adams wrote:
Hyde Salter’s book, written before most of us were born, must not be overlooked by anyone interested in the subject; he had probably a wider experience of asthma, and a better grip of the value of the dietetic treatment, than many twentieth-century authorities." 
Dr. Salter, from our own studies, was an ardent supporter of the idea that there was a direct correlation between what one puts into his body and asthma.  He wrote that many of his patients, including himself, observed that upon eating too much or eating the wrong foods, often lead to a paroxysm of asthma.  The prevention of asthma, therefore, was to eat healthily and eat light.  The remedy was emetics and enemas.

Salter believed the certain foods, or too much food, lead to some form of poison in the blood that leads to the nervous system causing bronchospasm.  Dr. Adam simply refined this theory as follows: (1, page 3)
Toxaemic theory of asthma:  Asthma is a disease of the nervous system, and "all neurosis are toxaemias."  A poison enters the body and this "hits the nerves of the respiratory tract."

Adam suggests that asthma is caused in this way:
This toxaemia arises partly in the bowel, partly in the tissues; it arises partly by absorption of nitrogenous poisons resulting from intestinal puttefaction under microbic action ; but mainly is due to an error in nitrogenous metabolism, the result of imperfect oxidation or enzyme action. In short, the poison arises from Proteid food or proteid tissue.
The error in proteid metabolism is closely connected with excess of carbohydrate in the diet.
The oxidation of the excess of the simpler carbohydrate molecule seems to interfere with proper oxidation of the more complex proteid molecule. In other words, the excess of energy food interferes with the metabolism of the tissues and tissue-foods; the imperfectly metabolised products so resulting set up asthma.
In other words, as Salter explained, the poison, or toxaemia, was the cause of some error in diet.  The result, according to Adams, was as followed
The toxaemia, whether arising in bowel or tissues or both, tends to show itself first as catarrh, later as spasm, in the respiratory tract. This toxaemia shows itself in conditions, catarrhal and spasmodic, other than, but closely related to, asthma.
He believed there were certain prodomata (early signs) of asthma that are often overlooked, and while these signs may not be present in all cases of asthma, if one is observed it can be a sign of an impending attack, such as:
  • Polyuria (excessive urine production)
  • Oliguria (diminished urine production)
  • Anuria (no urine production)
  • Constipation (unable to have a bowel movement)
  • Formication (sensation you have insects crawling under your skin)
  • Pruritus (sensation that results in urge to scratch; itchy sensation)
  • Urticaria (hives)
  • Erythema (redness of skin)
  • Cyanosis (Blueness of skin, representative of ischemia of tissues of hand, foot, lips, etc.)
  • Petechiae (red or purple spots on the skin caused by minor hemorrhage; local bleeding due to broken capillary vessels)
  • Embarrassed breathing (asthma)
The above will continue until something happens involving the elimination of something, which generally involves:
  • Vomiting (spitting up stomach contents)
  • Diarrhea (loose stools)
  • Polyuria (excessive urination)
  • Expectoration (sputum production)
Due to the toxaemic effect, the following are also associated with asthma (all are associated with increases of eosinophilia in sputum): (1, page 34-35)

  • Eczema: Commonest and most likely to occur in children with bronchitis. It usually shows up before asthma and disappears.  Although will continue to "dog" the patient if the asthma is not "cleared up." Cause is same as asthma, and treatment therefore same too (see treatment for both asthma and eczema is generally to restrict carbohydrates)
  • Ichthyosis: Probably caused by metabolic disorder
  • Psoriasis: Adams notes it's "said to be associated with asthma, but I have never seen the combination." Restricting carbohydrates generally doesn't work, but restricting "nitrogenous intake does." The difference in treatment may prove the non-association of psoriasis with asthma.
  • Dermatitis Herpetiformis:  Also associated with asthma. 
One of the reasons that he published his book was because he believed that "far too much attention has been paid (by the general practitioner) to the most striking feature of asthma, the asthmatic spasm; too little to the conditions that precede and cause the spasm, and those by which Nature cures it." Of course, the toxaemic theory of asthma provides the answer to why the spasm occurs, and thus its radical treatments would prevent and treat asthma.

Adams also noted that his theory came at a time when other theories were more readily accepted by the medical profession.  However, his idea are "put forward with the hope that it will be useful not only in the treatment of asthma but also in those other diseased states whose kinship with asthma is too."

  1. Adam, James, "Asthma and it's radical treatment," 1913, London, Glasgow: Alexander Stenhouse

Monday, July 24, 2017

1851-1913: The history of asthma sputum

Ernst Victor von Leyden (1832-1910 discovered
crystals in asthmatic sputum, and suspected these
to be the cause of asthma. During his era, he was
the closest supporter of Dr. Robert Bree's
bronchitic theory of asthma. (9, pages 14-15)
He believed these crystals somehow irritated the
"vagus in the mucus membrane of the bronchials,
and hereby caused by reflex action a spasm
of the muscles of the small bronchial tubes."
(10, page 8)
Most people find sputum disgusting, and so will have nothing to do with it. But as far back as 400 B.C. the medical significance of it was observed by ancient Greek physicians, and probably even earlier than that.

If you mention it at the dinner table your mother might smack your hand. But for the sake of gaining a complete grasp on the history of asthma and respiratory disease, we must delve into the topic of sputum.  Sorry, but we must.

It must have been observed at an early date in history that people with breathing issues produce sputum, sometimes consisting of a putrid smell, often consisting of many varied colors such as red, yellow, brown and white.

Yet rather than being petrified by the grossness of the substance, Greek philosophers became fascinated by it. They even gave it its own classification as one of the four humors that, along with determining ones personality, also determined whether was healthy or sick.

Prior to the philosophical medicine of the ancient Greeks, other ancient societies, and the primitive clans and families that roamed the lands before them, believed sputum was the production of some evil spirit, demon or god. When a person expectorated the substance, they were in essence expectorating an evil substance that caused the symptoms they were suffering from.

From the ancient world to the scientific revolution there were few changes in the way physicians viewed diseases and treated their patients.  In 1799 Dr. Robert Bree speculated that sputum contained a poison that it was trying to get out of the body, and asthma was the result.  This theory wasn't much different than any idea Hippocrates might have postulated.

Since the sputum preceded the asthmatic fit, Bree essentially speculated that asthma was essentially bronchitis, and thus created the bronchitic theory of asthma.  Others, without much more evidence, speculated sputum was the effect of asthma rather than the cause.

Such speculation gradually tapered off, but never really came to an end, during the scientific revolution, and mainly due to the inventions of the microscope, which allowed physicians to see that the human body was made up of substances too small to be seen by the unassisted eye, and the stethoscope, which allowed physicians to hear changes that occurred inside the chest and to diagnose diseases with accuracy prior to autopsy.

The microscope allowed physicians to learn that air passages were surrounded by smooth muscle, and that it was capable of spasming when stimulated.  The stethoscope allowed them to hear when sputum accumulated in the chest, and learn that it was the effect and not the cause of asthma.

So, pretty much, prior to the 1850s asthma was basically considered to be a disease of excess sputum, mainly because this was all physicians could observe with the unaided eye and ear.

Yet by the 1850s it was looking pretty clear that asthma was also a disease associated with spasms of the air passages, particularly by the wheezes heard by air flowing through narrowed air passages, and rhonchi heard as air flowed through sputum lined air passages.  (1, pages 592-595)

In 1851, Dr. Beau, along with his assistant Cozart, observed that fits of asthma usually ended with a wad of sputum being coughed up. Beau used this observation as evidence to support his theory that asthma was a disease of chronic catarrh, and that asthma was caused by increased sputum in the air passages.  (3, page 31)

When this sputum dried out mucus plugs formed that were capable of blocking the air passages, thus resulting in dyspnea and other symptoms of asthma, including the "sonorous and sibilant rhonchi -- their 'rales vibrants' heard upon auscultation with a stethoscope."  (3, page 31)

The fit, therefore, was resolved when mucus plugs were broken up with a fit of coughing.  (3, page 31)

Then, in 1878, at a time when most physicians had accepted the nervous and spasmotic theories,  J.B. Berkart used Beau's research as evidence of the bronchitic theory of asthma.

Berkart said:
With the displacement of the mucous plug into the larger bronchus, or on its expulsion by means of a fit of coughing, the dyspnea ceases, and with it also the rales disappear.  This form of bronchitis is, in their (Beau and Crozant's) opinion, due partly to an idiosyncrasy of the patient, partly to exciting causes, which greatly vary in different individuals."
Tiny crystals were first observed in sputum in 1851 by Jean Martin Charcot, but it wasn't until 1872 that these crystals were linked to asthma by Ernst Victor von Leyden. So history has given credit for this discovery to both men by calling the crystals Charcot-Leyden crystals.

Leyden, whose asthma theories were similar to Dr Bree's bronchitic theory, believed Charcot-Leyden crystals caused asthma by irritating...
...the peripheral extremities of the vagus nerve, and produce reflex spasm of the bronchial muscle."  
The asthma attack, as Bree and Beau observed, ended when a wad of sputum was coughed up during a fit of coughing. (4, page 14-15

However, it was the discovery of these Charcot-Leyden crystals that would ultimately put an end to the bronchitic theory of asthma.  This was noted by Dr. John Charles Thorowgood in 1878.  He said that these crystals were found in sputum obtained from patients with "ordinary catarrh and croupus bronchitis."  (4, page 15)

Thorowgood said:
The asthmatic patient while in a fit presents abundance of symptoms distressing enough to endure or to witness; and yet, when things seem to be at their worse, and the patient well-nigh at his last gasp, a remission comes on, the spasm yields, air enters the lungs, and the attack subsides, coincidentally often with access of cough and mucous expectoration." (4, page 16)(9, page 1,2)
In 1879, bacteriologist Paul Erlich discovered the eosinophil, and it was soon discovered that elevated levels of eosinophils (eosinophilia) was commonly found in asthmatics. (5)

In 1882 Heinrich Curshmann observed other spirals in asthma sputum and believed they were associated with causing asthma. He believed since Leyden's crystals didn't cause asthma, perhaps his crystals did. (5)

Later Curshmann's crystals were determined to be fragments of mucus plugs associated with asthma, and Leyden crystals were determined to be fragments of eosinophils. Eosinophils were later learned to be a type of white blood cell that, along with mast cells, are involved in the allergic reaction.

In 1911 Hermann Sahli described eosinophils in asthmatic sputum. Yet Sahli noted another author from 1891 who described eosinophils in asthmatic blood, and he concluded that these must be pathological with asthma. Yet he also noted that neither the cause of the eosinophils nor their origin was known. (7)

Sahli could isolate the area where the sputum came from based on epithelial cells in it, yet he did not understand the mechanisms of its production as we do today. (7)

Dr. James Adams describes asthma sputum in 1913: (8)
"Asthmatic sputum varies. Often there is none till the end of the attack; then it is in the typical form of small, tough pellets expelled by laborious coughing. The attack may then cease, or it may go on till a more free and profuse expectoration occurs."
He also wrote:  (8)
"The sputum does not readily decompose, and is said to be wonderfully free from microbes; but this is not always so, as I have occasionally found it teeming with them."
The true purpose of sputum is to ball up microbes inside the lungs and haul them out, and in this way the lungs stay sterile.  Surely asthma can be caused by inhaling a microbe, such as a bacteria, but it's also caused by asthma triggers (dust mites, smoke, fumes, chemicals, pollution, animal dander) that are innocuous to most people, and non infecting agents.

So this might explain why Adams most often found asthmatic sputum without an infecting agent, and sometimes "teeming with them."

Backing up a moment to 1906, Australian pediatrician Clemons van Pirquet coined the term allergy when he observed that some of his patients were hypersensitive to substances that did not bother other people (what we now refer to as allergens, or asthma triggers).  This was the first time asthma was linked with allergies.

By 1910 Histamine was discovered and found to be a major component in the allergic response.  So some went on to speculate that finding a way to block histamine would cure both allergies and asthma.

By 1946 antihystamines hit the market, and within a decade they were among the most commonly prescribed medicines.

Yet as time went by, it was learned that there was more to asthma and allergies than just histamine.  It was learned that asthmatic and allergic immune systems respond irrationally to allergens and asthma triggers by increasing production of eosinophils and this spearheads inflammation of the bronchial muscles.

Another weapon of the immune system is mast cells that line the respiratory tract and eyes, and these were discovered in 1953.  .

In 1967 Immunoglobulin E antibodies (IgE) were discovered.  It was later learned IgE has a significant role in the asthmatic and the allergic response.  The first time asthmatics are exposed to asthma triggers (allergens), say dust mites, their immune systems develop dust mite IgE antibodies that attach to mast cells that line the epithelial layer of the skin or respiratory tract.

The second time that person is exposed to that allergen (dust mites in this case), a mast cell that has a dust mite IgE antibody attached to it explodes and releases its contents:  the mediators of inflammation.  A mediator of inflammation called histamine was discovered in 1910, and others called cytokines and leukotrienes were discovered in the 1970s.

These mediators, when released into the blood stream, cause inflammation of the respiratory tract, thus causing the allergic and asthmatic responses.

In the allergic person, they can also cause inflammation of the upper respiratory tract, which includes the back of the throat and nose.  The offending substance (dust in our case) is recognized by the immune system, trapped in the mucus layer, absorbed by the mucus, balled up by the mucus, and sent on it's way up the respiratory track to be coughed up.

So this would explain what Dr. Bree, Beau, and Berkart observed. While hacking up a wad of sputum may have been related to the fit of asthma, it was not the cause, and had nothing to do with the cure.

Later it was learned that asthmatic lungs tended to produce an abnormal number of goblet cells, this results in an abnormal increase in mucus production during an asthma attack.  While some of this sputum may be coughed up, some becomes trapped in obstructed air passages, dries out to form mucus plugs, and this further blocks the air passages, thus compounding the asthma response.

When the fit ends, when the air passages relax and dilate, which may be a result of time or medications, the asthmatic will probably expectorate this sputum, which will usually be, if no bacteria or virus is balled up within it, white and sterile.  It will also have IgE and eosinophils in it, hence your Charcot-Leyden and Curshmann crystals.

So it's easy to understand how this production of sputum at the end of an attack could easily be misinterpreted as the cause, rather than the effect, of asthma.

  1. Lotval, J., "Contractility of Lungs and air tubes: experiments performed in 1840 by Charles J.B. Williams, European Respiratory Journal, 1994, (7) pages 592-595
  2. Bree, Robert, "A Practical Inquiry into Disordered Respiration Distinguishing the Species of Convulsive Asthma, their Causes and Indication for a Cure," 4th ed, 1810, London, page pages 117-118
  3. Berkart, J.B., "On Asthma: Its Pathology and Treatment," 1878
  4. Thorowgood, John C., "Asthma and Chronic Bronchitis: A New Edition of Notes on Asthma and Bronchial Asthma," 1894, London, Bailliere, Tyndall, & Cox
  5. Lipkowitz, Myron, Tova Navarra, "Encyclopedia of Allergies," 2001
  6. Brenner, Barry E, "Emergency Medicine, 1998, page 10
  7. Sahli, Hermann, "A treatise on diagnostic methods of examination," 1911
  8. Adams, James, Asthma and it's Radical Treatment, 1913
  9. Thorowgood, John C., "Notes on Asthma," 1878, 3rd edition, London, J & A Churchill
  10. Shmiegelow, Ernst, "Asthma, considered specially in relation to nasal disease," 1890, London, H.K. Lewis

Friday, July 21, 2017

1913: Speculation about asthma continues

My mom once said that house wives today probably know more than physicians in the 19th century. As I study the history of medicine and lung diseases, I have learned this is somewhat true to a certain extent, mainly because housewives like my mom had access to greater wisdom.

However, there are still an amalgamate of wive's tales, excuse the pun, that wives still use to treat their children when they are sick.  One of these was to place their asthmatic child in a hot and steamy bathroom.  We now know this may work to make breathing easier if the diagnosis was croup, but not asthma.  In fact, steam may make asthma worse because it makes the air thicker.  

Yet as the old saying goes: we do the best given the knowledge we know today, and as we learn better we do better. So by this saying, we cannot fault our parents for trying.  And as we have sick kids, we must do better.

So this brings me to the topic that caught my interest today, and that is that as I read case histories the various physicians wrote in old asthma books, I realize how much more knowledge I have as an asthmatic, asthma dad, respiratory therapist, and amateur historian.  

One of the neat things about reading an asthma history is I read a lot of case histories written by the various physicians knowing I know more than that doctor. A good example is here noted by Dr. James Adam in his 1913 book "Asthma and its radical treatment." (1, page 33-34)
'' A boy of 26 months was sent to me by Dr Alex. Morton. He had cured him of bad generalised eczema; but asthma occurred almost every night in spite of the fact that the dietetic regimen laid down by Dr Morton was what I myself would have set for the asthma. This boy was the subject of hay fever and ichthyosis; his urine showed persistent deposit of uric acid and increased indigogens. His maternal aunt had eczema in childhood, and now has asthma; his paternal aunt has eczema and asthma; there is a history of gout and uric acid on the mother's side. Treatment freed him fromasthma for a year. He then went to stay with his grandmother who coddled him, gave him the forbidden thing, sweets and cakes, and soon brought back both eczema and asthma. Not only so, but interesting etiologically is the fact that adenoids and chronic rhinitis have developed, for which treatment has been declined; but although this injures the prognosis, the asthma has never been so bad as at first. A boy, whose father was long asthmatic but has remained well for many years, was much troubled during the first two years of life with eczema, the result largely of overfeeding. He is now five, and during the last two years he has developed 'bronchitis,' which is now taking the more typical asthmatic form."
Adams further notes that: "The association, bad feeding, eczema, bronchitis, asthma, is too frequent and too plain for anyone to doubt that a metabolic error, or at least a toxic condition, is in play."

Given modern wisdom, I know that there was a major flaw in the analysis of Adam, and that was his decision to treat asthma and all the other maladies associated with it as a toxaemia. Surely it's a bad idea for a child to eat too many cakes, yet what might more likely cause the hay fever, asthma and eczema are allergies. The child was probably exposed to allergens near birth and at his paternal aunts. The remedy would be to not let the child go to his paternal aunts.  

The fact the parents were courageous enough, and perhaps wise enough, to decline treatment for adenoids and rhonitis, which may have involved surgical treatment, was impressive.Adam said himself that other asthma experts were so intent on focusing on the nervous theory of asthma and the spasmodic theory of asthma that they didn't see the true cause: toxaemia in the blood. He called his theory the toxaemic theory of asthma.

To his credit he did acknowledge his ideas would be seen as radical, of which they were. Plus, in a time when the trend was to generate theories about asthma based on science, Adam took the route of speculation.

As my asthma history continues, I will delve in later posts more into the theories and treatments of Adams that he describes himself as radical. They would not be radical if they were proposed 100 years earlier, but, given the era he was born in, yes he was quite radical.

  1. Adam, James, "Asthma and it's radical treatment," 1913, London, Gasgow: Alexander Stenhouse

Wednesday, July 19, 2017

1910-1950: Antihistamines to treat allergies

While some scientists and physicians studied the effects of decensitization for the treatment of hay fever (er, allergy) sufferers, others were working on other angles.  This was a good thing, because one of the best selling medicines of all time was the result. 

In 1910 British scientists discovered a chemical called histamine that was released during an allergic reaction, and they determined it was this substance that was responsible for causing tissues to become inflamed.  A year later Henry Dale proved that injecting histamine into guinea pigs and dogs would instigate the allergic response.

This discovery gave scientists a lot of hope.  Originally they beleived histamine was the only cause of allergies and that finding a treatment for histamine would mean allergies would be eliminated.  Yet later scientists learned this was not true, that allergies were a series of complex reactions.

In 2007 Gregg A. Minton explains how "in 1921 Carl Pransnitz attempted to further understand allergies by injecting into his abdomen the serum from his colleague Heinz Kustner, who had a severe allergy to fish.  Prausnitz had no such allergy, but when he sat down to a fish dinner, he found that a case of the hives appeared on his body at the injection site. The experiment demonstrated that a specific immune body -- later known as an antibody -- was present in the serum of allergic patients.  The substance could be passively transferred to nonallergic individuals, and it played a crucial role in the allergic reaction." (1, page 215)

This experiment lead researchers to think that if they could figure out what this "antibody" was they could unlock the mystery of allergies and eliminate this annoying malady from existence. (1, page 215) So the hunt was on. 

In the meantime, Daniel Bovet introduced a medicine that blocked the effects of histamine in 1937, and he called this new medicine an antihistamine.  It was the first truly effective medicine to treat the symptoms of allergies.  By blocking the effects of histamine it therefore prevented an allergen from causing a stuffy and runny nose, itchy eyes, nose and throat, and sneezing.
The next discovery was Benadryl.  Minton explains it was discovered by 21 year old professor at Cincinnati University named George Rieveschi.  He was trying to create an antispasmotic drug when he inadvertently discovered the "new compound in his laboratory." (1, page 216)

In 1946 the first two antihistamines hit the market:  Benadryl and Pryibenzamine. Minton describes how "antihistamines became, next to antibiotics and barbituates, the third most commonly prescribed class of drugs in America." (1, page 213)

Minton explains that other antihistamines hit the market in 1947, but Benadryl and Prybenzamine made up the bulk of the sales.  In 1947 Hydrillin hit the market, which was a product that had both an antihistamine and a bronchodilator called theophylline. This relieved allergy symptoms and made breathing easier, an ideal remedy for people suffering from allergic asthma (which, as it turns out, includes about 75 percent of all asthmatics)

Theophylline is a medicine that was first introduced to the world in 1930 as another antispasmotic medicine for asthma.  It was a medicine that relaxed the smooth muscles that lined the air passages of the lungs and made breathing easier.  This new medicine provided another over the counter option for allergy and asthma sufferers. (I wrote about theophylline here.)

In 1949 Neohetramine was the first antihistamine approved by the Food and Drug Administration (FDA) as an over the counter medicine.  Other antihistamines soon followed.  Minton notes that "by 1950, more than 21 antihistamine compounds packaged under one hundred different trade names in tablets, nasal sprays, eye drops, and creams on the market in the United States." (1, page 216-217)


  1. Mittman, Gregg, "Breathing Space," 2007, New Haven and London, Yale University Press

Monday, July 17, 2017

1909: Pituitrin tried for asthma and hay fever

Pituitrini was an extract of the bovine pituitary gland.  Along with other uses,
it was trialed for asthma by various physicians, and with success, around
1909 and 1910. The medicine was provided by Park-Davis & Co. out
of Detroit, Michigan in one-ounce glass stopper bottles and glaseptic
  ampoules (ready for immediate hypodermic injection) as seen here. (2)
Another medicine that was trialed for asthmatics around the 1910s was a medicine called Pituitrin. It was an extract of bovine pituitary gland containing oxytocin and vasopressin, and being a relatively new medicine it garnered much attention among the medical community. As with other new medicines, it was trialed for various purposes, including asthma. 

The medicine "has been somewhat extensively used for the past two or three years," by European physicians for its Oxycontin effect on some pregnant women to help strengthen labor and reduce bleeding.  (1) It does this by constricting blood vessels.  It also is a bronchodilator, and for this reason, it was trialed on asthmatics.

In 1919 the Therapeutic Notes reported the following:
The fact that Pituitrin has an Adrenalin-like action, and the fact that this action is more prolonged than that of the suprarenal active principle, has suggested its utility in the treatment of asthma and hay-fever. It has been tested clinically by leading practitioners, who pronounce it a valuable drug in these diseases. Some opinions are here given:
 "One of my asthmatic patients has experienced great relief from the use of Pituitrin.""I have used Pituitrin in two cases of hay-fever with satisfactory results. While ischemia is accomplished less slowly it seems to last much longer; one patient who experienced great irritation from the use of Adrenalin says that the Pituitrin is almost without any irritating effect.'' 
"I have one case of asthma which was relieved by the use of Pituitrin; it is also of a great deal of use in the treatment of hay-fever." 
"A case of hay-fever treated with Pituitrin in normal salt solution (1:3) showed decided relief. I found that its. action was slower, more prolonged and less irritating than Adrenalin, and no after-congestion resulted as in the case of the latter." 
"I used Pituitrin daily in one case of hay-fever, employing the undiluted solution so as to give the hardest possible test as to its irritation. There was no irritation and the relief was perfect.'
"When used in a 10-per-cent normal saline solution the results were very satisfactory."
 It's very common throughout human history to find a medicine experimented with in this fashion, and this continues to this day.  Also, in the 1970s a medicine called terbutaline was approved for asthma as a rescue medicine, and it was ultimately more commonly used to delay pregnancies.

Probably due to the success of adrenaline, pituitrin never caught on as an asthma medicine.  Yet it provided another option for physicians and asthmatics when such an option was necessary.


  1. "Pituitin in difficult parturition," Medial Review, June, 1912, Volume 61, Issue 6, Picture is from an advertisement that follows the article paid for by Park-Davis & Co.
  2. "Pituitrin in Hay fever and asthma," Therapeutic Notes, Volumes 17 and 18, Park-Davis & Co., 1909 and 1910, page 70.
Further reading

  1. article on pollen and hay fever

Friday, July 14, 2017

1904: The first remedy for hay fever is Pollantin

There must have been a lot of excitement in the early part of the 20th century as scientists were finally honing in on the cause of the strange malady most often referred to as hay fever.  In 1901 Portier and Richet cointed the term Aniphylaxis, and by 1904 Dr. William Dunbar was working on a serum he probably suspected would be a cure for hay fever. 

The serum was written about in an editorial in the Journal of the American Mecial Association in October of 1904.  The authors noted that there were a lot of theories as to the cause of hay fever: the heat theory, the light theory, the nervous theory, the pollen theory and the bacteria theory were just a few.  Yet all that was known for sure about the disease was (1):
  • You had to have a have a predisposition to suffer from it
  • There had to be an exciting cause to trigger it. 
Dunham was a supporter of both the pollen theory and the bacteria theory.  When his initial experiments found no bacteria, he ruled out the bacteria theory.  His new focus was on the pollen thoery, and it was by his experiments with pollen that he would hit pay dirt. (1)

He learned that when a pollen was inserted into the eyes of hay fever sufferers it caused inflammation and redness of the mucous layers around the eyes.  He later discovered that it was not the pollen itself that caused this reaction, but a protein (toxalbumin) produced by pollen.  When exposed to that protein, the symptoms of hay fever were present.  (1)

His studies were interesting in that he discovered that "as little as 1/40,000 of a milligram of the rye-pollen toxin placed in the conjunctival sac (around the eyes) will call forth in certain individuals a paroxysm of hay fever lasting several hours." (1) 

The serum only caused hay fever symptoms in those people with a susceptibility (or predisposition), and had no effect on any one else.  His research basically confirmed the theories of Blackley, that pollen was a cause of hay fever.  He, thus, proved the pollen theory of hay fever.  (1)

Yet Dunbar didn't stop there.  By further experiments:
"Dunbar found on mixing the toxalbumin with the serum of animals which had been previously treated with pollen or the extracted poison that the former was rendered innocuous. Unlike diphtheria antitoxin, the hay-fever serum is not to be used subcutaneously, for subcutaneous injections give rise to unpleasant symptoms—itching, swelling and erythema. Experiments have shown that the local application of the serum to the irritated mucous membrane is more effective than its introduction hypodermically.
The technique he used was called passive immunization.  He "injected young thoroughgbred horses with pollen toxin in increasingly large doses, (and) produced what he believed to be an antitoxin in the horse's blood that neutralized the pollen's effects," writes historian Gregg Mittman in 2007. (2, page 56)

In one study 222 hay fever sufferers were treated with the serum, and 127 found it to be effective.  The medicine was believed to be most effective if given every morning during the hay fever season, and it lasted for several hours to an entire day, even when the patient spends the day "in the open air." (1)

Dunbar patented his serum in Germany, England and the United States as Pollantin.  To treat hay fever patients the serum, a liquid or powder, must be administered frequently, such as every morning, to the mucus layers of the nasal passages and around the eyes.  

It was soon realized that Pollantin wasn't what it was cracked up to be.  Not only did it not really work, it caused aniphylactic shock in some patients exposed to it.  (2, page 56) So the quest was on to find a better remedy.  This research would ultimately lead to the discovery of desensitization and antihistamines

  1. "The situation in regards the serum treatment of hay fever," The Journal of the American Medical Association, Editorial, Saturday, October 15, 1904, page
  2. Mittman, Gregg, "Breathing Space," 2007, New Haven and London, Yale University Press

Wednesday, July 12, 2017

1901: Treatment for Asthma

Marcous Proust was a writer and a lifetime asthmatic.  The year 1901 was the dawn of modern asthma treatment and wisdom.  That was the year adrenaline and cortisone were just being discovered.

According to Mark Jackson the following are the medicines Proust used during his lifetime:
  1. Strammonium cigarettes (same type of medicine as atrovent and spiriva)
  2. Legras powders
  3. Espic powders
  4. Epinepherine (adrenaline)
  5. Caffeine (same family of medicine as bronchodilator theophylline, not as strong
  6. Carbolic acid fumigations
  7. Escouflaire powder fumigations
  8. Isolation -- cork lined bedroom (staying away from allergens)
  9. Opium (relaxes breathing, mild bronchodilator)
  10. Morphine (relaxes, mild bronchidilator)
  11. Sea, lakeside and mountain resorts  (getting away from allergens, relax)
Jackson quotes Proust's journal entry to his mother:
"Yesterday after I wrote to you I had an asthma attack and incessent running of the nose, which obliged me to walk all doubled up and light asthma cigarettes at every tobacconist's as I passed, etc.  And what's worse, I haven't been able to go to bed until midnight, after endless fumigations..."  (August 31, 1901)
If the Internet were available to Mr. Proust I bet he'd be involved in an online asthma community as this blog is a part of.  While he didn't have the ability to blog, at least he wrote of his asthma experience in letters. 

Mr. Jackson is a professor at the Center for Medical History at the University of Exeter in England.  He's written books on asthma and articles on asthma and allergies and COPD.  I will link to some below so you can check them out at your liking.

Click here for more asthma history.
  1. Divine Strammonium:  The rise and fall of smoking for asthma
  2. Marcus Proust and the global history of asthma (slide show)
  3. On Asthma:  A Biography
  4. Allergies:  A history of the malady
  5. The Oxford handbook of the history of medicine
  6. Asthma timeline

Monday, July 10, 2017

1898: Dr. Hollopeter: What Causes Asthma?

According to William Hollopeter in his 1898 book "Hay-fever and its successful treatment, there were essentially two causes of hay fever: (1, page 47)
  1. An exciting cause (heat, pollen, dust, sunlight, etc.)
  2. A preexisting, underlying condition 
Provided statistics of the era, Hollopeter said that relatively few people have hay fever, which verifies that some "underlying condition, predisposition, or idiosyncrasy can hardly be doubted. Exactly what this is, or on what it depends, is unknown." (1, page 47)

Holopeter said that the first person to talk about a predisposition to developing hay fever was Dr. Abbots Smith in 1865.  Likewise, Holopeter said: (1, page 47)
This predisposition or idiosyncrasy has generally suddenly developed without apparent reason. It has been argued that it is systematic or central, and that it is due to some local abnormality of the mucous membrane, the capillaries, or the periphery of nerves. Once acquired, however, it is seldom lost, and it apparently increases with each successive year.
The following are the major predisposing factors:
  1. Race: English and Americans are the most susceptible.  One physician went as far to suspect that sine Americans and English were the most likely to drink tea, that perhaps tea somehow affected the nervous system causing hay fever. Although the Chinese and Japanese drink tea as well, and there's a low incidence of the disease in those nations. 
  2. Geographic distribution:  It is rarely found in northern regions, such as Canada, Norway, Sweden and Denmark.  It is most commonly seen in the U.S., Europe, and to some degree New Zealand and Australia. Even in the U.S. and England is is not commonly found along the seashore and at high elevations.  It is difficult to know exactly where it's most likely to occur. (Dr. Wyman published maps for where it's most likely to occur in his 1872 book "Autumnal Catarrh." (1, pages 49-52
  3. Heredity:  George Beard was the first to postulate a nervous origin of hay fever, and that it was acquired through inheritance. Various physicians have shown evidence of the malady among the various generations of the family tree (Morill Wyman, F.H. Bosworth, Morell Mackenzie) (1, page 53)  
  4. Sex:  Generally, "of the 433 cases cited by Phoebus, Wyman and Beard, only 143, about one-third, were females." So the tendency is that it affects males more so than females.  Morell Mackenzie also noted the trend, noting he had 38 male patients with hay fever, and only 23 females. The theory is that "men are more exposed to the exciting causes such as dust, heat, pollen, etc., although females are more neurotic."(1, page 54)(2, page 96-7)
  5. Age: While occasionally occurring in people over the age of 60, it generally first appears in people under the age of 40. (1, page 55)  In many cases of childhood onset hay fever, many cases are regarded as the common cold, unless the parents were also afflicted with it (hence suggesting the hereditary component). 
  6. Education: Holopeter notes pretty much the same as every other author on the subject, that: "Most all writers on this subject have observed that the disease attacks the better educated classes and those of fair social position. It is rarely met with among the laboring classes. This would seem to emphasize the view that the disease is essentially a neurosis. From the notes of sixty-one cases of hay-fever in private practice, and the sight of many others of which no record was kept, Morell Mackenzie found all the patients persons of some education, and recalled having seen none among his hospital patients. Of fortyeight cases of Blackley, all were educated, and Wyman made the same observation. Edmund W. Holmes has shown that the ignorant classes are not so likely to recognize the disease as a distinct affection, and apply for medical aid." (1, page 55)(3, page 204)
  7. Occupation and Mode of life: The "rustic" and farmers are much more exposed to exciting causes and therefore are less susceptible to developing hay fever. Others suggest it only effects the wealthy because they have a higher intelligence.  (1, page 56)  Wyman observed, among the occupations he observed, those most likely to have hay fever have "indoor jobs requiring but little manual labor," such as merchants and manufacturers. Wyman notes that only three farmers in his little study had hay fever, and this was of interest to him.  He surmised that they probably did have hay fever, "  (2, page 99-100) 
Of this observation regarding the low number of farmers with hay fever and the high number of merchants and manufacturers, Wyman writes the following: (2, page 100)
"It is not a little remarkable that of those who must make up the largest class in the community, so few should be reported as subjects. It may be that the disease with them is light, and therefore overlooked entirely, or not thought of sufficient importance to apply for medical aid. This, to a certain degree, is not improbable, for we find that physicians to whom application is made, do not all recognize it sufficiently to ask whether the disease has recurred annually, nor do the patients think it worth mentioning, even if it has been observed and remembered. It is by no- means infrequent for a person to experience several pretty severe annual attacks before it occurs to him that probably these are returns of one and the same disease. Still, the mechanics and farmers of New England are too intelligent and too well educated to allow the disease to escape their observation entirely. If many applied for treatment at the dispensaries of the large cities, the fact would appear in their annual reports. No such disease is mentioned.
I am inclined to think, therefore, that the disease is less severe or less frequent with those that labor, than with those whose employments are attended with less muscular exertion. The result, perhaps, of a life more in accordance with the rules of health, in this respect, for the mechanics and farmers of New England, as a general rule, are as well housed, clothed, and fed, so far as health is concerned, as those who are among the richer and in some respects more favored classes. This question, however, can only be satisfactorily settled when a knowledge of the disease becomes more general."
The following are theories as to what might cause hay fever:
1.  Pollen Theory:  It is the most generally recognized as the cause of hay fever, and while it was a speculated cause prior to the 1860s, experiments by Dr. Charles Blackley proved it during experiments he performed between 1866 and 1878.  He proved that contact with pollen to the mucus membrane causes inflammation and redness, and hay fever symptoms. He wrote that there is a direct relationship between the amount of pollen in the air and hay fever symptoms. For more on Blackley's pollen theory of hay fever you can click here. 

2.  The Neurotic Theory: Holopeter basically refers to George Beard, who in 1876 postulated the nervous  theory of hay fever, and made light to allay the "misconception" that nervous meant "debility and emaciation." Holopeter notes that Beard explains the truth to be more along the lines that the nervous system is full of full of "great strength and endurane." In those with hay fever, some exciting cause "excites" the nervous system to cause the symptoms of hay fever.  Beard explains that the the disease and the tendency to be transferred from one generation to another was all based on this nervous theory.  No evidence has yet been shown of how the nervous system causes the hay fever symptoms. (You can read more about Beard's Nervous Theory of Hay Fever by clicking here)(1, page 57-60) 
  • Vasomotor susceptibility:  Vasomotor refers to the nervous systems ability to regulate dilation and contraction of blood vessels.  In hay fever it has a tendency to cause dilation of the blood vessels lining the respiratory tract and eyes, hence hyperaemia and inflammation (catarrh) and your hay fever symptoms. That this happens "indicates a neurotic tendency." Some suspect it may or may not be due to lesions. A similar event occurs with asthma, only the dilation and hyperaemia occurs in among the air passages of the lungs.  (Hyperaemia refers to increased blood flow to a certain region of the body) Hollopeter notes that "Bosworth is inclined to think a peculiar lack of vasomotor control characterizes the neurotic manifestations." (1, page 57-60)
  • Idiosyncracy:  The fact hay fever has idiosyncratic means it's neurotic.  By this, the body of the hay fever sufferer is oversensitive to some exciting cause. 
3.  Local Disease Theory: Some sort of local disease (polyp, deviated septum, rhinitis, obstructed nasal passages, etc.) may be the cause of the disease. When the polyp is removed, the hay fever may be cured. Hollopeter quotes Mackenzie:  "there exists in the nose a well-defined sensitive area whose stimulation through a local pathologic process, or through an extra irritation, is capable of producing an excitation which finds its expression in a reflex act or in a series of reflected phenomena."  Bosworth suggested these were generally the effect rather than the cause of hay fever. Some physicians propose such local agents cause both hay fever and asthma. (1, page 62-64)

4.  The Uric Acid Theory:   In 1893, Dr. Seth S. Bishop, as quoted by Hollopeter, wrote: "an excess of uric acid in the blood causes hay fever, or nervous catarrh."  Hollopeter notes that excess uric acid in the blood "causes certain disturbances of a vascular and neurotic character. Haig wrote that excess uric acid causes contraction of arterioles and capillaries, and this opinion was verified by Thomas J. Mays. Murchison, Conklin, Ebstein, Quinquad, and others. Bishop in 1894 speculated that regulation of uric acid should be regarded as a treatment for hay fever. Mays believed that while uric acid was the cause, hay fever was still nervous and, therefore, still hereditary. Although Dr. Capp suggests that the presence of excess uric acid may actually cause "a central nervous irritation." This results in "nerve currents" that are uncontrolled by the normal functions of the body, and result in the abnormal response of hay fever.  (1, pages 64-71)

  1. Hollopeter, William Clarence, "Hay-fever and its successful treatment," 1898, Philadelphia, P. Blakiston's Son and Co.
  2. Wyman, Morill, "Summer Catarrh," 1876 (first edition was published in 1872), New York, Hurd and Houghton
  3. Holmes,

Friday, July 7, 2017

1898: Hollopeter's remedies for hay fever

By the late 19th century there was an increase in the number of patients calling their physician with complaints like, "I feel miserable. My face, throat and eyes feel like I want to scratch the heck out of them.  I feel like I'm going to explode.  I will do anything to feel better."

So physicians eager to help such "desperate" patients were willing to try just about anything in their pharmacopoeia, according to W.C. Hollopeter's 1898 book "Hay fever and it's successful treatment."  Some of the things tried were: (1, page 101);
  • Antiseptics: Substance that prevents growth of microorganizms
  • Antispasmotics:  Substances that relieves spasms, such as bronchospasms (i.e. atropine)
  • Escharotics: Substances that causes scabs or burns on the skin
  • Astrigents:  Shrinks body tissues
Dr. William Hollopeter says he himself tried everything under the sun. Then, finally, "during the last ten years I have had under my care over 200 well marked cases of hay fever, of which I possess, in nearly all, complete histories, and I have not failed to relieve a single patient who has persisted in the treatment."

The following is the treatment regimen that worked for him, and that he recommends to his faithful readers:

A.  Simple Local Treatment:

1.  Removal from the source of irritation:  The more wealthy among us have the luxury of vacationing to an area that is not conducive to causing hay fever.  This is the same remedy that pretty much every other physician has recommended since John Bostock made light of the ailment in his 1819 lectures.  This has been proven to be the best prophylactic means available at this time, although not always practical for sufferers who do not have the finances and, or, cannot leave their work. (1, page 105) Morril Wyman notes that the only true "unfailing remedy" for hay fever is removal of the source, or removal of the person from the source -- i.e., vacationing to the mountainous regions, or the sea shore, or an island, etc. (2, page 160-1)

2.  Daily Sterilization:  It was a technique established by Joseph Lister that entails antiseptics or surgical cleanliness to cleanse out the nose and throat.  By doing this daily, this will allow the person to live a normal life, even when surrounded by exciting causes such as dust or blooming flowers without fear of having symptoms. This will wipe out any and all offending matter that harbors in these passages. (1, page 102-5)  (Read more about this in my post to be published 11/22/13)

3.  Stay indoors during season:  Morell Mackenzie recommends for those who cannot "flee to the mountains or the mid ocean they should remain indoors." (1, page 105)

4.  Nose Plugs when go outdoors:  Again, Mackenzie recommends that when you have to go outside during hay fever season that you plug your nose with cotton wool and wear "spectacles with large frames.".  This will keep exciting causes (pollen, dust, etc.) from entering the air passages and eyes. (1, page 105)  Many patients had been employing this technique, or something similar, for years.

5.  Identify anything that might irritate nasal mucosa:  This would include things that might make the mucosa hyper-responsive to exciting factors by causing a "permanent turgescence (swelling) of the whole nasal chamber," such as: (1, page 106)
  • Germs
  • Polypi 
  • Deviated Septums 
  • Hypertrophies (enlarged tissue)
  • Chronic rhinitis (nasal infection)
  • Any other marked defects
These irritations also make it easy for irritating matter and germs to become trapped inside the nasal passages, and they make sterilization "difficult if not impossible. So they must be remedied as best as possible, and weakens the normal resistence of the mucus membrane, thus inviting periodic infection." (1, page 106)

Removal of polypi, hypertrophies and deviated septums cause too much pain and inflammation for the patient, so he simply recommended daily sterilization and nasal washes as noted in this post. (see above link)  Treatment may take a while, although over time the hay fever should be resolved. (1, page 106)

  1. Hollopeter, William Clarence, "Hay-fever and its successful treatment," 1898, Philadelphia, P. Blakiston's Son and Co.
  2. Wyman, Morill, "Summer Catarrh," 1876 (first edition was published in 1872), New York, Hurd and Houghton

Wednesday, July 5, 2017

1898: Yearning for help for asthma patient

So it's the year 1898 and you are a physician. One of your patient's has intractable asthma, where everything you had prescribed has failed.  What do you prescribe now?  Well, why not submit a letter to the editor to medical magazine asking for help. Here's one example of a doctor doing just that.
Editor Medical World :—I ask help for a case of simple but intractable bronchial asthma. I can find no complications. The patient is a lady, about 40 years old, weight 200 pounds, ruddy complexion, red hair. There is no hereditary taint. She is now five months pregnant, but the asthma does not seem to be much worse than before she became so. I have given her a good many remedies with only temporary relief. J. R. Mclaurin, M.D. Toomsuba, Miss. ,

A humble submission on the part of a doctor who had the best interest of his patient at hand. 

  1. Taylor, C.F., editor, "The Medical World," volume 16, 1898, Philadelphia, page 251

Monday, July 3, 2017

1898: Interesting remedy for hay fever

One of the first doctors to recommend nasal rinses, or nasal washes, was Dr. William Hollopeter in his 1898 book "Hay-fever and its successful treatment." He believed that by washing the nasal passages you'd also be washing out the exciting factors that might contribute to hay fever or other diseases.

Hollopeter said he conducted a study of the sputum of children waiting treatment for hay fever, and he found the bacteria of: (1, page 103)
  • Diphtheria
  • Scarlet fever
  • Measles 
  • Whooping Cough
  • Tuberculosis
So he concluded that while these children showed "no constitutional indication of the disease whatever," the following bacteria, or some other substance (such as dust or pollen) may be in the sputum to cause hay fever. So a rational treatment here was washing the nasal passages. (1, page 103)

He said that in order for a disease to occur, some weakness has to occur within the body, such as a decrease in vitality or resistance. So, an "overwhelming exposure" to an "unhygienic environment" would result in hay fever or some other disease.

Hollopeter said:(1, page 104):
Conceded that an external irritant is necessary to cause the disease, to prevent or cure it we must either prevent the irritant from reaching the points of exposure, fortify these vulnerable spots, or remove or render inert the irritant when already lodged. In hay-fever the vulnerable spot is undoubtedly somewhere within the nasopharynx (nose and throat). It is now conceded that the nose and throat are entrances for the bacteria of many infectious diseases; and I feel sure that as I have limited the extension of house-epidemics of scarlet fever, diphtheria, whooping-cough, and measles by a carefully conducted antiseptic toilet of the nose and throat, in the same manner I have prevented the dreaded paroxysms in cases of hay-fever.
So it is for this reason the he tried a daily sterilization of his hay fever patients, and, lo and behold, it was successful. The idea behind daily sterilization is this: (1, page 103)
By a daily sterilization of the nares and postnasal spaces the victims of hay-fever may remain in the city attending to their usual duties, surrounded by dust, or in the country amid blooming flowers, without any fear of the distressing symptoms—a consummation devoutly to be wished for by the great army of hay-fever sufferers.
Therefore, he recommended the following daily treatment:
  1. Cleansing the nasopharynx with a hand ball atomizer containing a warm solution of boric acid (10 grains to an ounce of water) or Dorbell's solution. Afterwords, wipe the mucous membrane and apply menthol and liquid cosmolin freely to the parts (this would have to be done by the doctor) (1, page 107)
  2. Removal of hypertrophy or polypi he no longer recommended because it causes pain and increased inflammation. He therefore recommended Debell's solution applied first with a hand ball atomizer and then with a curved aluminum applicator or Harrison Allen's cotton carrier. Very carefully swab the whole nasopharynx . Dry membranes with clean cotton, followed by free use of blandine comp. (a solution of menthol in albolene). 
  3. Surgery only when absolutely necessary, and always followed by 1 and 2 above
When I first stumbled upon this remedy in this book, I thought it sounded very interesting and odd. However, upon further review, it was't far removed from the nasal washes I was forced to endure daily when I was a kid, and what is still recommended to this day for many sufferers of nasal rhinitis.  

So, he said:  "I believe that acute infective disease, particularly in children, may be prevented by most thorough and repeated sterilization of the nasopharynx, and just as house epidemics are never excusable evils so I claim the same to be true of hay fever." (1, page 106)

Here is a recipe for making a nasal rinse.

Dobell's Solution:
  •   R. Sodii bicarb
  •   Sodii boratis
  •   Acidi carbolici
  •   Glycerini
  •   Aqua? rosae, 25 per cent
  •   SlG.—Teaspoonful to one ounce of warm water.

If you are so inclined, try it and let us know if it works.
  1. Hollopeter, William Clarence, "Hay-fever and its successful treatment," 1898, Philadelphia, P. Blakiston's Son and Co.

Saturday, July 1, 2017

The Nervous Theory Of Asthma: A Review

Earlier, I wrote that “Occupational Asthma” was “one of the oldest asthma subgroups.” I would like to make the case here that the oldest of oldest of oldest asthma subgroups is none other than “Nervous Asthma.” To help me make my case I thought a little history of nervous asthma would prove helpful. 

400 B.C. Hippocrates (400 B.C.) referred to asthma as epilepsy of the lungs. This is because he believed it was caused by phlegm draining down from the brain. He, therefore, believed asthma was caused by airway spasms similar to the body spasms of epilepsy. He also alluded to asthma as a nervous disorder when he said, "the asthmatic should guard himself against his own anger." 

1st Century. Galen (120-200 A.D.) is a physician who created theories about medicine that were well respected by physicians all the way up to the 19th century, and even into the 20th century. He performed one experiment (and probably on a stolen body) where he severed the spinal cord to produce asthma symptoms artificially. (1)
2nd Century.
 Maimonides (1138-1204) said nervousness makes one prone to illness and may have been the first to describe how illness can contribute to diseases. He did describe asthma, but he did not link the two.

1550. Felix Platerus (1536-1614) observed asthma symptoms when nothing wrong could be seen with the lungs. He believed asthma was caused by an obstructed pulmonary artery, although he also believed it was caused fluid flowing down from the larger nerves from the brain.

17th century. Jean Baptiste van Helmont (1579-1644) was the first physician to focus on the idea that asthma was caused by airway spasms. However, he believed this was the result of nerve irritation due to stress. He thought this was the case because no scars were observed in the lungs of asthmatic patients. He gave examples of how stress could induce asthma. In one case he described how a woman developed it just by being exposed to flowers, and in a second case, he described how a man developed it and died just after being exposed to stress.

17th century.  Thomas Willis (1621-1675) also described asthma as having occurred despite any observable changes in the person. Paul Ammann (1634-1691) described in a book of law cases how asthmatics should be absolved from crimes because the fear that resulted could result in an asthmatic attack. This meant that all asthmatics must be kept out of stressful situations.

1850’s. Dr. Henry Hyde Salter published a series of articles that were eventually published in 1960 as “On Asthma: Its Pathology and Treatment.” In these articles, later published as chapters, he proved for the medical community that asthma was due to spasms of the air passages caused by irritation of nerves. Salter’s asthma theories are frequently cited in medical texts regarding asthma for the next 50 years. Those physicians who accepted Salter’s theories -- and this consisted of most physicians -- referred to Salter’s nervous theory as the “Nervous Theory of Asthma.”

1899. Dr. Henry Osler, the Father of Modern Medicine, referred to asthma as a "neurotic affection" in his medical texts, "The Principles And Practice Of Medicine." This book would be the main textbook used by medical students much of the next century, and so would have a significant impact on shaping the views of the medical profession.

1900. The discovery of epinephrine created a lot of buzz among the medical community, and it was trialed for a variety of diseases, including asthma. This worked to confirm an old theory, that asthma was due to airway spasms, and a new theory, that asthma was due to dilated blood vessels resulting in pulmonary congestion. These theories spawned from the fact that epinephrine both dilates airways and constricts blood vessels. So, for the first time in many years, the nervous theory becomes less significant among asthma physicians.

1910. This was the year that allergies were linked with asthma. This revelation would have no immediate impact on our history, but it will within the next 20 years. 

1920’s. German physicians became infatuated with psychosomatic medicine, and out of this infatuation grew an increasing interest in the idea that asthma was a psychosomatic disorder. Among these physicians was Dr. Franz Alexander, who will make a significant contribution to our history about 30 years later.

1930’s and 1940’s. Most American physicians continued to believe that asthma was triggered by emotions. However, their main emphasis now was attempting to control allergies. Also, as researchers started learning more about allergies, they realized that asthma symptoms were the result of an abnormal immune response to allergens. Spearheading the idea that allergies caused asthma was the germ theory of asthma. At this time it was believed that most diseases were caused by bacteria or some similar substance, so this theory sort of spearheaded the idea of allergies as a contributing cause of asthma. So, the nervous theory of asthma takes a back seat to this new thinking about asthma.

At the same time that was going on, German physicians, lead by Dr. Franz Alexander, were beginning to study the relationship between asthma and psychosomatic disorders like stress, anxiety, and depression. This sort of was a rebirth of the old theory of asthma as a nervous disorder. The main theme here was that strong emotions caused by an asthmatics separation, or threat of separation, from his mother were one of the main contributing causes of asthma. One treatment for this was psychological therapy. 

1951.  By now, Dr. Franz Alexander had migrated to the United States, and here he wrote a paper listing asthma as one of the seven psychosomatic disorders. This, in turn, re-established credibility of the nervous theory of asthma for physicians in the developed world. This was also the decade that corticosteroids were first used to reduce airway inflammation that was present during acute asthma attacks.

1957. The first metered dose inhalers enter the market. They were the Medihaler Epi and the Medihaler Iso. This was a great revelation for asthmatics as it gave them a lightweight, portable, and easy to use means for obtaining quick asthma relief.

1960s.   It was also discovered that corticosteroids come with side effects. So, by the end of the 1950's, steroids were soon reserved for only the severest asthma attacks that responded poorly to other treatments. However, researchers began a quest to see if they could develop an inhaled corticosteroid steroid to reduce the risks for systemic side effects. So, this was the decade where researchers started studying the benefits of inhaled corticosteroids on asthma.

1980’s.  By 1982 two inhaled corticosteroids were on the market. Studies showed they seemed to work very well for asthmatics. Research to learn how they worked lead to the discovery that asthma was an inflammatory disorder, where all asthmatics have some degree of underlying airway inflammation. It was now well accepted that asthma symptoms occurred due to exposure to asthma triggers, which may include strong emotions and stress, but also allergens, respiratory viruses, certain foods, exercise, etc. Researchers now understood that asthma was a respiratory disease consisting of chronic underlying airway inflammation and that this inflammation worsened when exposed to asthma triggers resulting in bronchospasm, increased mucus production, and asthma symptoms. This spearheaded the quest to understanding the exact genes, cells, and biological processes responsible for asthma. Rather than focusing on asthma as a nervous disorder, asthma was considered a disease associated with an overactive immune response to innocuous substances in the air inhaled. So, this new theory set aside any notions of asthma as a nervous disorder caused by stress, anxiety, and depression. That said, nervous disorders were still thought contribute to asthma by triggering it, maybe even making it worse, but it was no longer suspected to be the causative agent. 

1990’s. You might hear things like: “While stress and anxiety are no longer thought to cause asthma, both may act as asthma triggers.” I'm not sure who came up with this line, but I have heard it over and over by various asthma experts, often without citation. This may have acted as a relief, of sorts, for asthmatics, who were tired of hearing about asthma being all in their heads. However, it offered no advantage to the many asthmatics who continued to deal with both anxiety and asthma. 

2017. Modern evidence has brought upon a resurgence, of sorts, of the nervous theory of asthma. Studies seem to show that asthma might contribute to anxiety and depressive disorders, and that anxiety and depressive disorders might contribute to asthma. This new evidence comes with a modern twist, which includes the idea that not all asthma is nervous in origin. However, knowledge of a possible link should make physicians better armed to both diagnose and treat anxiety and depressive disorders in asthmatics in an effort to help them obtain ideal asthma control.