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.

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

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