1841: Romberg verifies nervous theory of asthma

Moritz Heinrich Romberg (1795-1873)

By 1841 there seemed to be quite a bit of evidence in support of the nervous theory of asthma.  It was in this year that Dr. Moritz Heinrich Romberg verified this evidence, hence proving once and for all that asthma was definitely nervous, or so many supporters of the theory believed.

In the 17th century Jean Baptiste van Helmont and Thomas Willis came up with the idea that asthma was nervous.  In the 18th century William Cullen further supported this theory. Then, in the 19th century, the experiments of various physicians seemed to provide the evidence in support of the nervous theory of asthma.  (1, page 506)

In 1835 Francis Ramadge wrote papers, in 1836 Joseph Bergson and Amedee Lefevre wrote prize essays, all of which seemed to provide support for the nervous theory of asthma.  Based on this evidence, Romberg also supported this theory, and he did experiments to put an end to any arguments once and for all. (1, page 506)

J.B. Berkart, in his 1878 book "On Asthma," said Romberg described "two affections of the vagus... of which are productive of dysponeal attacks:

• Bronchial spasm:  He generally referred to this as "bronchial cramp" or spasmus bronchialis.  (2, page 28)(3, page 4) 
• Paralysis: This was essentially paralysis of the muscles of respiration, or emphysema (2, page 28)

There were also later studies that likewise verified the works of Romberg.  Alfred Wilhelm Volkman (1801-1877) and M. M. Valentin proved that irritation of the pneumogastric, or vagus, nerve causes contraction of the air tubes, or bronchioles. (4, pages 5-6

Orville Brown, in his 1917 book, described Volkman's experiment:

Volkmann tied a tube into the trachea of an animal and set a candle before the opening and then stimulated the vagus and the flame showed that air was thereby caused to come from the lungs. (2, page 33)

These results were verified again by Ludwig Traube, Paul Bert, and others.

These men confirmed that asthma was nervous, and this influenced the remedies used to treat it, often resulting in physicians prescribing such medicines that calmed the nerves and relaxed the mind in order to prevent and treat asthma. (4, pages 5-6)

The experiments of these men helped enshrine the image of asthma as nervous for greater than the next hundred years. 

References:

1. Whitaker, James Thomas, "The theory and practice of medicine," 1893, New York, William Wood and Company
2. Berkart, J.B., "On Asthma: It's Pathology and Treatment," 1878, London, J. & A. Churchill
3. Schmiegelow, Ernest, "Asthma, considered specially in relation to nasal disease," 1890, London, H. K. Lewis; he references the following source; Bergson, Das krampf. Asthma der Erwaohsenen, Nordhausen, 1850.
4. Thorowgood, John Charles, "Notes on Asthma: It's Nature, Forms, and Treatment," 1878, London, J. & A. Churchill

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1835: Lefevre questions nervous theory of asthma

Amedee Lefevre (1798-1869) was yet another physician who believed in the spasmotic and nervous theories of asthma.  Yet while he believed asthma was nervous, he was not prepared to deny there weren't organic lesions as yet discovered in asthmatic lungs. (1, page 505)(2, page 23-24)

Orville Brown, in his 1917 book," said Lefevre was an asthmatic who observed by studying his own asthma that he expectorated large amounts of sputum. (3, page 31)

Of this, J.B. Berkart, in his 1878 book, said: 

Lefevre (in 1835)... reverted to the opinion of Laennec. Himself an asthmatic, he had watched his own case and that of a friend, and arrived at the conclusion that the dyspnoea could be produced only by a bronchial spasm. In looking thus upon asthma as a nervous affection, he still was not prepared to deny the possible existence of organic lesions; adding, however, that if such were present, they were of so fleeting a nature as to elude detection. The essence of the disease he considered to be an increased irritability of the nerves of the lungs, in consequence of which the slightest irritation applied to the bronchial surface induced spasm of the bronchial tubes. (2, page 23-24)

However, Berkart suspected that the patient's he was studying were not asthmatics, and therefore his experiments (of which he performed with  Joseph Bergson) did not support his theory that asthmatic lungs might possibly have organic lesions.  He said: (2, page 24) 

The cases, however, which he himself reported, do not confirm his views. It is difficult to recognise a nervous affection, much less a bronchial spasm, in the dyspnoeal attacks, which terminated always with the expectoration of thick masses of mucus. The expectoration was of a grey colour, very viscid, in consistency like boiled maccaroni, filamentous in shape, and, when disentangled, appeared as if moulded to the bronchi. Sputa of that kind sufficiently distinguish the preceding dyspnoea as the symptom of a fibrinous (croupous) bronchitis, and there can be no doubt that Lefevre and his friend were subject to that disease. (2, page 24)

So while he thought he was on to something with his theories, he probably added little evidence to advance either the spasmotic nor the nervous theories of asthma. The reason was mainly due to the inability to differentiate bronchitis with asthma.

Of interest is he also observed spirals in asthmatic sputum.  This would be an observation that would inspire investigations by later physicians that would ultimately lead to a new theory about asthma.  (1, page 505)

He also wrote a book called De 'lasthme , of which you can read if you can read French.  

References:

1. Sakula, Alex, "Charcot-Leyden crystals and Curschmann spirals in asthmatic sputum," Thorax, 1986, 41, pages 503-507
2. Berkart, J.B., "On Asthma: It's Pathology and Treatment," 1878, London, J. & A. Churchill; The reference used by Berkart is as followed:  "Recherches sur l'Asthme, M&noire couronne' par la Society de MfSdecine de Toulouse."—JournalHebdomad., 1835.
3. Brown, Orville Harry, "Asthma, presenting an exposition of nonpassive expiration theory," 1917, St. Louis, C.V. Mosby Company.  The above mentioned theory of vessel turgescence comes from this reference also on page 25; he refers to the same source as Berkart

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