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."


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

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