1717: Floyer establishes spasmotic theory of asthma

Cover page of John Floyer's
"Treaties on Asthma," 1698

In his 1698 book "A Treaties of the Asthma," Sir John Floyer because the first person to make the case for asthma as a separate disease from other pulmonary disorders.

He also lived during a time when supernatural remedies were slowly going out of favor, yet some physicians, such as Floyer, didn't like the change.  Floyer preferred to treat asthma as a disease caused by an imbalance of the four humors as opposed to some physiologic condition of the body.

Because of this, because he supported ancient theories as opposed to science, his ideas were more readily accepted, compared to the science-based ideas of men like Jan Baptiste van Helmont and Thomas Willis.

Yet while holding onto old superstitions, he was an ardent supporter of asthma being a disease of contraction of the air passages, said John Thorowgood in his 1894 book. (2. page 10)

Thorowgood provides some intriguing quotes from the second edition of Floyers's asthma book that was published in 1717.  He quotes him as saying:

"I have assigned the immediate cause of the asthma to the straitness, compression, or constriction of the bronchia; and in the continued asthma (chronic) the causes must be constant, as dropsy (edema), tuberculum, etc. The return of periodic asthma (acute) depends on the defluxion (discharge) of humours on the primae viae (bowels). Thus, the old notion of the asthma being a defluxion of serous humours (fluids) is certainly true, because evident to our senses in the evacuation of serosities (secreting serum).... Some express their feeling, during a fit of asthma, as if the lungs rose, and were drawn upwards to choke them. Contraction of the vesicuise is very probable, because the bronchia are contracted, and the vesiculae have the same muscular fibres to help expiration, by which they may be drawn so up as not to admit the air.' (2, page 11)

Thorowgood also provides a passage from Floyer's book comparing the chest with bellows.

 'We can move the bellows easily; but suppose a bladder tied within the bellows over the nozzle, so as to receive the air and suffer none to get into the cavity of the bellows, it will follow that in a perfect stoppage of all the entrances of air the bellows could not be opened; and if no more entered than may be contained in the bladder, the bellows would be opened but a little way, and would inspire difficultly. So it appears in the business of the asthma, the inspiration is difficult and laborious, because but little air can be admitted into the contracted bronchia, and the vesicular drawn up. This puts the scapular and intercostal muscles and diaphragm upon a violent endeavour to press in the air and open the lungs, which nisus (physicians trying to understand asthma) authors have mistaken, and supposed the pneumonic (lung) muscles, especially the diaphragm, to be convulsively affected; but it may easily be apprehended that the diaphragm cannot press the viscera (abdominal organs) downwards to enlarge the breast if the air cannot be admitted into the lungs to follow its depression and fill the cavity of the breast; and this is the true reason why the diaphragm cannot move in the asthmatic fit. The contraction and stiffness of the lungs during asthma causes a catalepsis (stiffness) or rigidity of the diaphragm—the part most unjustly accused of this tyrannic oppression.' (1, page 11-12)

Thorowgood said Floyer was observant of the diaphragm being "rigid and spasmodically drawn up by some contractile force within the thorax," although he did not believe, as many of his predecessors did, that the diaphragm was an "essential cause of asthma." (1, pages 10, 12)

He said the fact that the wheezing heard when an asthmatic exhales is proof of narrowed air passages, and therefore he championed for the spasmodic theory of asthma. (1, page 12)

Thorowgood also said that Floyer believed asthma associated with no other observable signs as hysterical asthma, and he refers to the "hysteric" who wheezes but produces no phlegm as proof that asthma is not caused by phlegm but by contraction of the air passages.  (1, page 12)

He said Floyer clearly rejected the nervous theory of asthma postulated by Willis and van Helmont.  Thorowgood said:

(Floyer) regarded the contraction as brought about by mechanical pressure rather than by nervous influence seems clear, from his saying that certain writers of his day, Van Helmont and Dr. Willis, were wrong in regarding asthma as a convulsion, to be treated by anti-spasmodics, hot tinctures, gums, volatile salts, and sulphur medicines. The proper method is by evacuants, and remedies calculated to promote secretion and effect the discharge of humours —anti-congestive rather than anti-spasmodic treatment. (1, page 13)

So, while Floyer was more in line with the popular view of asthma as a humoral disease, his idea that asthma was a disease associated with spasms of the air passages tended to gain more attention during his lifetime than his contemporaries. In this way, he became the father of the spasmotic theory of asthma.

References:

1. Thorowgood, John C., "Asthma and Chronic Bronchitis: A New Edition of Notes on Asthma and Bronchial Asthma," 1894, London, Bailliere, Tyndall, & Cox.  The quotes from Floyer were referenced by Thorowgood from Floyers book "A Treaties on Asthma," which was published in 1717.  Pages referred to are in the quotes above.

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1698: Floyer's asthma symptoms, triggers, treatment

Floyer's A Treaties on Asthma (1698)

John Floyer's A Treaties on Asthma provides a neat description of asthma, which probably comes from his own experiences with the the disease.   (4, page 374)

He described himself as having periodic asthma, which is probably more in line with our modern definition of the disease.

About a century after the first edition of his book was published a fellow asthmatic and asthma physician by the name of Robert Bree would quote Floyer's description of an asthma attack as such:

"I have found, that by late sitting up I have put by the fit for a night or two; and I have found it commonly necessary to rise out of bed, especially in the summer time, and to sleep in a chair the first night of the fit.  Two nights before the fit asthmatics want sleep frequently." (2, pages 123-124)

Perhaps it's from his own experience that Floyer decided asthma into four parts, which are basically broken down as: (1)

1.  Symptoms:  A history of the fits or the asthmatic attack. It's generally based on his scientific description of bronchospasm: (1)

• The attack usually begins at one or two of the Clock in the Night
• The breath if very slow (early sign)
• Fullness of stomach (early sign)
• A slight headache (early sign)
• Sleepiness (early sign)
• Feeling rigid
• Feeling stiff
• Feeling inflated (head seems to be filled with Fumes or Serous Humour)
• Began to suck in breath
• Straitness of breath, seems to be for want of an easie Inspiration
• Urge to sit in an erect Posture, that the weight of the viscera may pull down the diaphragm
• Enlarging of the breast during inspiration
• Muscles of inspiration strive and labour more vehemtly
• Muscles of expiration cannot easily perform the Contraction of the Thorax, being hindered by the Stiffness or Inflation of the Membranes in the Thorax
• Expriation is easier than inspiration
• Expriation is very slow, and leisurely (and wheezing)
• The patient can not cough, sneeze, spit or speak freely
• The diaphragm cannot contract itself to move downward
• Bronchi and trachea has its membranes and nervous fibres contracted which results in wheezing (mainly expiratory)
• Muscular Fibres of the Bronchia and Vesiculae of the Lungs are contracted adn that produces the Wheezing noise, which is most observable on expiration
• Convulsive cough before fit (inconsiderable)
• Phlegm is spit up (inconsiderable) 

2. The nature of asthma as he saw it: Basically based on Galanic principles: (1)

• A flatulent slimy Caccochymia which is bred in the stomach, and creates inflation there, and gives an effervescence in the blood and an inflation in the membranes in the lungs
• At 2 a.m. the Chyle is more plentiful in the blood.. and the viscid Chyle and Lymph will not easily circulate through the lungs of the asthmatics
• The Asthma is a High, Slow, Rare and Laborious Respiration, which depends immediately on the inflation of the Membranes of the Lungs by Windy Spirits, rarefied or propelled through the Glands of the Brain, either by external Accidents or periodic Febrile Effervescence (bubbling) of the Blood. 

3.  Triggers: (Accidental causes) or lifestyle causes or factors that precipitate an asthma attack: (1)

• Great heats or cold
• violent motions of the body or mind
• Excess in eating and drinking
• Venereal Pleasures
• Heat of the bed
• Changes of the weather to rain
• Snow
• Change in weather from frost to thaw
• Alteration of clothes
• Changes of the air at spring and fall (change in barometric pressure)
• Moist air (dry air is good for the asthmatic)
• Heat and smoke of from fires
• Fumes
• Perfumes
• dust
• Strong liquors and food
• Exercise
• Anger (makes humours more viscid)
• Fear
• Shouting
• Excessive study (upset the spirits)
• Any strong smells (candles put out, Smoak of tobacco, winie fermenting, soap making, burnign metals, etc.)
• Sadness makes humours more viscid 

4.  Treatment: (The cure of the fit) and preventative measures.  These are probably things he tried out on himself: (1)

• Light diet (fasting on day of attack with a light diet thereafter)
• Gentle Exercise
• Bleeding (performed in small quantities, but only in extreme cases)
• Blisters (Applied to limbs and shoulders)
• Narcotics/ opiates (if induced by sleep 'when nerves are filled with windy spirits'/ induce sleep)
• Abstinance of anger or shouting
• Emetics (to induce vomiting/  if excessive may bring on asthma/ monthly vomiting recommended)
• Feather in throat (another option to promote expectoration of viscid sputum
• Oxymel of squills (to induce expectoration)
• Clysters (laxitives) or Purges (violent purging should be avoided, but regular purges are recommended)
• Late sitting up (staying up late)
• Avoid extreme climate changes
• Febrifuges and Sudorifics to help fevers that accompany the asthma
• Diuretics such as millipedes and woodlice
• Cold water bathing (4, page 110)
• Apple water (4, page 110)

References:

1. Floyers, John, "A Treaties on Asthma," 1698, London
2. Bree, Robert, "A Practical Inquiry into Disordered Respiration Distinguishing the Species of Convulsive Asthma, their Causes and Indication for a Cure," 1810, London, pages 123-124
3. Floyer, John, "History of cold water bathing," 1722, 5th edition, London, Printod form William and John, Innys, at West-end of St. Paul's Church-yard
4. Gill, M. H., "Review and Bibliographic Notices: "On the spasmotic asthma of adults," by Bergson, published Gill's book, "The Dublin Quarterly Journal of Medical Science," volume X, August and November, 1850, Dublin, Hodges and Smith, pages 373-388

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1698: Floyer redefines asthma, upholds supernatural

Sir John Floyer

The early 17th century centered around a struggle by Western men who were losing their enchantment with the old world in favor of truths obtained by scientific progress and thought. John Floyer was born into this world in 1649 and he rejected it.

In fact, it was because he rejected it that he became one of the most interesting and popular personalities of his generation. He put forth a defense against modern logic and a defense for Ancient ideas, yet at the same time he provided a stunningly accurate description of asthma based on his own experience and experimentation

Floyer lived at about the same time as Jean Baptiste van Helmont and Thomas Willis, yet it was Floyer's ideas regarding asthma that were more readily accepted by his generation. The reason was partly because Floyer had asthma and he used his own experiences to describe the disease.  Yet more likely because he disregarded science and accepted old superstitions that were popular, while the other two endorsed science.

Floyer rejected the ideas of van Helmont and Wilson and other "quacks" because they "know little of Anatomy, and the Nature of Animal Humours."

He also accepted the ideas of Hippocrates and Galen that all diseases were caused by some external poison that caused an imbalance of the humors:  black bile, yellow bile, phlegm and blood.

Floyer's Treaties of the Asthma (a)

Since this was the accepted dogma of the day -- a paradigm that medicine was still stuck in at the time -- Floyer's ideas were much easier for other physicians to accept.  

Floyer was born in 1649 in the small town of Staffordshire, England, the same year as the execution of Charles I.  He suffered from asthma as a child and through much of his adulthood, and it was because of this he would later take up the study of asthma. (2, page 248)

He received his medical degree from Oxford in 1680.  Shortly thereafter he returned to Lichfield which was only a few short miles from his birthplace and became an important member of the British society, and he was even knighted by James II in 1686. (2, page 248)


He was an ardent supporter of cold water bathing, and in n 1701 he published "A History of Cold Bathing: Both Ancient and Modern." He would often recommend this book to his patients, including those with asthma.

In 1682 Andreas Cleyer's Specimen medicinae Sinicae introduced the West to the ancient Chinese method of counting a pulse to diagnose diseases.  Floyer liked this idea, and he expanded it and made taking a pulse a routine task when assessing a patient.

To make the task easier he invented a "pulse watch" that had a second hand that ran for one minute.  Alex Sakula, "Sir John Floyer's A Treatise on Asthma (1698)," said that one of the reasons this "pulse watch" was so important for his study was because he believed that each disease was associated with a specific pulse. (1, page 248)

Floyer wrote about his watch in "The Physician's Pulse Watch" volume 1, in 1707.  You can read about it in more detail here.  The pulse watch was advanced many times even during Floyer's own life, and it soon became a popular site to see your neighborhood physician with a pocket watch. The practice of taking vitals, a pulse and respiratory rate, became commonplace.

The art of watching the hands of a watch revolve is often attributed to Sir John Floyer.

When it came to asthma, Floyer was not a fan of modern remedies that were prescribed by other physicians of his day, such as Van Helmont and Wilson. In fact, he flat out rejected many of them, and instead preferred the more supernatural remedies of Hippocrates and Galen.

Yet while he preferred the supernatural, he was also the first asthma expert to make the case for asthma as a separate disease, as compared to the common rubric term for all that is short of breath.  He made this case in his 1698 book "A Treatise of the Asthma."

In this book, Floyer described respiration as...

...preparing the blood or air vessels by tumours or by injury to the muscles of respiration or to the 'spirits, moving those Muscles.'

He described asthma this way:

When the Muscles labour much for Inspiration and Expiration, through some Obstruction, or compression of the Bronchia, &c. we properly call this a Difficulty of Breath: But if this difficulty be by the Constriction of the Bronchia, 'tis properly the periodic Asthma: And if the Constriction be great, it is with Wheezing; but if less, the Wheezing is not so evident; the Pulse being stopt in the Asthma Fit, the Respiration is Rare."

Then he described two forms of asthma:

1.  Continued:  Dyspnea was the result of other diseases such as dropsy, empyema, tubercles in the lungs, thoracic tumors, abdominal tumors, and spinal conditions such as scoliosis.  He used continued the way we use chronic, meaning that the condition is always present.  Chronic bronchitis and emphysema might also be categorized under this category if they were known diseases at the time.

Eighteenth century physician Michael Ryan quoted Floyer:

When the asthma continues for some months, it is a true pulmonic asthma, and depends on some disease in the breast, as dropsy, tubercle, absess, which compress the bronchia; and till that evident cause be removed, it is impossible to cure the asthma fits."  (3, page 8)

2.  Periodic:  This is bronchial constriction due to "windy spirits" occurring after fevers, catarrh (colds), and hypochondriacal fits (nerves) or as what he referred to as "flatulent slimey cacochymia, which is bred in the Stomach."

Floyer described his own asthma as periodic, and it is this type of asthma that covers the majority of his Treaties on Asthma.  Floyer noted that continued asthma is known to take the life of the asthmatic, yet most people with periodic asthma lived a normal life span.  However, periodic asthma did take a life from time to time.

A little less than 100 years later, Dr. Henry Hyde Salter would further refine Floyer's asthma definition using empirical knowledge known to him, and he referred to pure asthma as periodic in nature, and continued asthma as asthma associated with some type of organic changes, such as chronic bronchitis or enlarged heart.

Floyer became the first to describe seasonal asthma.  Floyer wrote how he kept a "diary of his disease, out of what I can give a more true Account than if I had now recollected what has long since passed."

He observed that he never had any problem with his asthma while he was at Oxford, yet when he returned to Staffordshire he...

...usually visited with a severe Fit or two.  The air of a Town makes the Fits more severe when they happen; but I do not think the Asthmatic so much expos'd to the Accident of the Weather in a City, as in the Country.

He noted that his asthma was worse in the summer than winter, and worse during "the change of the moon."

Barometric pressure can also affect asthma, he proposed, and that is why he recommended changes in weather as a probable cause of asthma.

So he may have been the first to notice the benefits of certain types of air in causing asthma, an idea Salter would later embellish upon.  Such observations may have lead to the later recommendation for asthmatics to move to other areas in order to treat and cure it.

He may also have been the first to describe how tobacco fumes from smoking cigarettes may trigger an asthma attack, yet his reasoning for this was quite supernatural:

"During the Fit of the Asthma, the Smoak of Tobacco is so offensive that it very much straitens the Breath, if it be smoaked the first Day of theFit, and much endangers a Suffocation. There are many Asthmatics that cannot bear the smell of it; therefore its Foetor is injurious any time, its Heat thickens the Phlegm and rerefies their aerial Spirits, making them restless; all the good it can do is to discuss the Windiness after the Fit abates, and to help the coughing up of Phlegm."

Floyer may have been among the first to note that very few people die of an asthma attack, and that between such attacks the asthmatic can live a relatively normal life.  He wrote:

"I have met with some Asthmatics who have been so for Fifty years, as they informed me, and yet in tolerable Health without any considerable Decay of their Lungs, or Disability to perform their usual Employments; which I oft reflect on to encourage my patients, and myself, who yet can study, walk, ride, and follow my Employment, eat, drink, and sleep, as well as ever I could; neither am I yet sensible of any Decay in my Lungs."

Alex Sakula noted that while Floyer's acceptance of Galanic principles would later be proven false, "his treatise shows that he was familiar with the multifactorial basis of asthma -- heredity, occupation, atmospheric pollution, hypersensitivity, infection, exercise, and psychological influences."

Because his theories about medicine were more readily accepted by society in the 17th century, Floyers is often given credit as the first to define asthma as a disease of it's own, more specifically as a disease of bronchospasm, even while this wasn't true.  Regardless, he did play a significant part in defining asthma.

Floyers would die on February 1, 1734, yet his teachings would be studied by physicians for the next hundred years, and his practice of measuring a pulse and respiratory rate became a common medical practice that is still used to this day.

Further reading:

1. Floyer's asthma symptoms, triggers and remedies by clicking here. 
2. Floyer establishes spasmotic theory of asthma (will be published 4/17/14)

Click here for more asthma history.

References:

1. Sakula, Alex "John Floyer:  A Treaties on Asthma," Thorax, 1984, 39: 248-254
2. Floyers, John, "A Treaties on Asthma," 1698, London, pages
3. Ryan, Michael, "Observations on the history of asthma, in which the propriety of using the cold bath in that disorder is fully considered," 1793, London, printed by G.G. J. and J. Robinson of Paternoster-Rowe

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