1847 definition: Asthma the opposite of consumption

As noted in the writings of Dr. Francis Ramadge, a common belief around the middle of the 19th century was that asthma was the opposite of consumption. This theme was further acknowledged through the writings of Dr. Samuel Fitch in his book "Six lectures on the uses of the lungs.

He said: 

"It is a disease caused by consumption or consumptive tendency in the lungs, and always arrests the progress of consumption.  It is a vastly lesser disease given in place of a greater, and instead of being a curse, is a greater blessing.  In consumption, the lungs are too small; in asthma they are too larger.  A disease like asthma may be produced by ossification of blood vessels of the heart; but in nearly all cases, it is produced by consumptive irritation of the lungs.  It often takes place suddenly, in earliest childhood, continues until between 12 and 20, then goes off and is never seen again; but the person falls victim to consumption.  Or asthma my reappear and secure the patient from consumption.  If properly treated it is a passport to old age; but when badly treated it may terminate in dropsy of the chest." (1, pages 69-71)

Next to this description is a picture of an asthmatic rib cage and a consumptive rib cage. The asthmatic rib cage is large and expanded as thought the patient had his chest puffed out.  The consumptive rib cage is small, narrow and weak.

Thus, Fitch believed since asthma produces a larger rib cage it protects against consumption.  It's strong and mighty while consumption is weak and frail.  While both are diseases that cause discomfort, asthma is minor compared to consumption.  Asthma is temporary and goes away, and consumption is long lasting.

Yet under it all he believes consumption causes asthma in some cases, and this is good because asthma protects against the wasting effects of the underlying consumption. (1)

He wrote:

"Asthma all but always cures consumption, or what is made consumption by very bad treatment.  The asthma leaves the person, and he rapidly is overcome by the consumption that had always been on him whilst he had the asthma, and resumes it's rapid and fatal course, on asthma leaving him.  If asthma is cured without perfectly expanding the lungs, and keeping them so, the person is extremely liable to consumption."

Asthma is a blessing and masks the underlying diseases, and even protects the person from wasting or consumption. He describes a patients who had asthma, didn't take care of it not knowing he had underlying consumption, and died of consumption. (1)

"As in heart disease, woe to the person who is cured of asthma.  Without a free, and perfect, and continued expansion of the chest; as he will, in nearly all cases, sooner or later fall into consumption."

The patient must be brought up well, he proposes.  He must be exposed to outdoor occupations and he must exercise.  This is how to treat asthma and prevent it from going away so consumption doesn't show it's ugly head again, destroy him, and ultimately kill him.

So basically he's saying take care of your asthma if you have it because it's a blessing protecting you from the course of your underlying consumption.

There were other physicians who had similar beliefs about asthma and consumption.  Orville Harry Brown gives us the following quote from two physicians named Hall and Hall (further detail eludes me):  (2, page 33)

"Asthma is a spasmodic contraction of the membranous portion of the windpipe. In consumption the patient dies because there are not lungs enough to receive sufficient air for the wants of the system; that is, they cannot get enough air in; while in asthma they cannot get enough air out; hence asthma and consumption are antagonistic, the former is preventive of the latter and a consumptive is cured on the supervention of asthma."

The idea of asthma as an underlying disease, and of asthma as a blessing, is ironic to say the least.  This was not the first time in history that asthma was considered a blessing, as the ancient Greeks believed asthma was a blessing from the gods.

References:

1. Fitch, Samuel Sheldon, "Six lectures on the uses of the lungs," 1847, London, H. Carlisle
2. Brown, Orville Harry, "Asthma, presenting an exposition of nonpassive expiration theory," 1917, St. Louis, C.V. Mosby Company

RT Cave Facebook Page
RT Cave on Twitter

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

RT Cave Facebook Page
RT Cave on Twitter

1835: Ramadge's inhaling tube for consumption and asthma

Figure 1 -- Ramadge Iinhaling Pipe (1, page 93)

Respiratory therapists are well aware of insentive spirometers (IS) and positive end expiratory (PEP) therapy. You might think these are modern inventnions. You would be wrong.

Incentive Spirometers are small, hand held devices that that encourage patients who are on pain medicine, or who had recent abdominal or chest surgery, to take deep breath and cough to facilitate movement of secretions, thereby preventing or treating atelectasis and pneumonia. The incentive spirometer was invented in 1970 by R.H. Bartlett and quickly became an inexpensive mode of bedside therapy.

PEP therapy involves having the patient blow through a resistor that applies resistance, or positive pressure (usually 10-20 cwp), during expiration. The pressure acts as a splint to keep otherwise collapsible terminal airways and alveoli open. This facilitates the movement of secretions that would otherwise be trapped due to airway closure. It was invented in Denmark during the 1970s and was became popular in Scandanavia, Denmark and Canada before making its way to the United States. (5, page 1001)

So both IS and PEP therapy were invented during the 1970s and are forms of chest physiotherapy, or chest exercise through manual movement. However, the general concept was conceived of back in 1810 by a doctor by the name of Francis Ramadge.

He was a student of Rene Laennec, the inventor of the stethoscope.  The two men worked together in order to find a means of preventing people from developing consumption, the most common respiratory disease at that time.

Laennec suggested a natural cure for consumption was the formation of cicatrizations, or scar tissue, following the softening of the tubercles.  This scar tissue, he suspected, acted as a natural barrier against the disease. He suspected most people living with the disease had such scar tissue.

Ramadge, on the other hand, believed that since consumption resulted in a small, contracted and frail rib cage, anything causing the opposite effect prevented consumption. Various other physicians agreed with Ramadge. (1, pages 91- 93)  (3, page 8-9, 37)

Two such diseases suspected as acting as natural barriers against the disease, Ramadge suspected, were catarrh (colds) and asthma. He said:

For instance, let us begin with catarrh. Here tumefaction (swelling) of the mucous membrane preventing the free egress of the air, imprisons it in the air-cells, and produces a quasi emphysematous state of the lungs, expanding their entire volume to a certain degree, and pushing outwards in every direction the walls of the chest. Asthma also acts in a similar way. (3, page 8)

They believed if patients took care of their asthma this would act as a barrier to consumption. Ramadge said that this was one of the "ulterior good" effects of having asthma. It was "a lesser evil being substituted for a greater." (6, page 37)(1, pages 91- 93) (3, page 9, 37)

Ramadge also believed that any medical condition that impeded free expiration tended to "mitigate and arrest the disease."  Such conditions included: enlarged tonsils, tumors pointing towards the pharynx, polyps in the nasal passages, aneurysms of the aorta, diseases of the heart, obstruction of the liver, hysteria and pregnancy.  (3, page 8)

It was based on these theories that he invented what was called "an inhaling pipe," which would later be referred to as the Ramadge Inhaling Pipe.  He believed that by inhaling and exhaling through the pipe the patient would develop an expanded chest. In this way, regular use of the pipe had "palliatve and prophylactic, as well as a curative, intentions." (1, page 93) (3, page 10, 59)

It was a pipe with hot tar stuffed into it that you inhaled for therapeutic means. The tar, and the narrow diameter of the tube, provided resistance to inspiration and expiration, and this was supposed to provide "gymnastics" or "exercise" for the consumptive patients.

The Ramadge Inhaling Pipe wasn't exactly PEP therapy, but the principle was similar.  He said:

The value of the tube in catarrh, which it supersedes as a curative agent, must not be overlooked. By due exercise and expansion of the bronchial ramifications, it contributes to allay, or indispose to, irritability of the lining membrane, and I have often heard patients state that after its use in the morning they have been better, and more freely able to bring up the accumulated phlegm. (3, page 59)

The inhaling pipe wasn't an IS, although it worked similarly to encourage deep breathing and coughing.

Ramadge said:

The lungs may simply and safely be kept in daily exercise, and expansion to the full amount may be effected by atmospheric inhalation, through the respiratory apparatus. (3, page 15)

Dr. Samuel Sheldon Fitch, in his 1847 book "Six lectures on the uses of the lungs," described the tube.  He said: (1, page 91-93)

This tube he at first made about four and a half feet long, with an opening through its whole length, provided with a mouth-piece to go between the lips, and the patient sucked in, or inhaled the air as long as he could, and then through the same tube, blew it out again. By this process, the chest would rapidly enlarge. Dr. Eamadge also made an inhaling tube a little like a whistle, with a valve in it so constructed that the air would go into the mouth and lungs through a large free passage, and on returning, the air would be forced to go outmof the mouth and lungs through a much smaller opening. The effect of which is, to allow the lungs to fill rapidly and without exhaustion of strength, and on leaving the lungs, it is all passed through an opening not much larger than a knitting- needle, by which the air was slowly forced out of the lungs, and by this pressure the lungs were greatly expanded, and the air every where opened the chest in the largest manner. (1, page 93)

Fitch said the tubes were made of wood or ivory, although he recommended they be made of gold, platina or silver so that they last long, and the patient can take the tube wherever he goes and can use it often to keep his lungs expanded.  (1,2)

Ramadge said he'd prefer his patients use the inhaling tube...

...but, in the absence of the inhaler, I have no hesitation in saying, on the Principle of choosing the minor of two evils, that exposure to the exciting causes of catarrh, under prudent restrictions, is an alternative that may be judiciously adopted in consumption. (3, page 15)

Surely there were other remedies for consumption, such as leeches, tonics, sedatives and relocation, but...

...The use of the inhaling tube I consider to be essential in the treatment of phthisis; indeed, all other treatment is comparatively secondary and ancillary. (3, page 10)

He said it worked even as a last ditch effort to save the life of a consmptive in the dire states of the disease.  He said:

It may be thrown out as a sheet-anchor, even at the eleventh hour. A clergyman's daughter, who had been despaired of, in phthisis, by several medical men, was induced, as a dernier ressort,to employ the inhaling apparatus for two or three months, during which period a decided retrogression of all her bad symptoms was established. Considering herself well, she left it off and died. It is not improbable that, had she gone on till her disease had been more completely brought. (3, page 59) 

While recommended for consumptive patients, he said his inhaling device also worked well for asthmatics.  He said:

In asthma the windpipe is too small for the volume of the lungs, and, though it may seem contradictory, the mechanical respiration by the tube has the effect of restoring this disturbed relation to its healthy standard. The objection to it, on the score that asthma is liable to be superinduced by its use, arises from idle prejudice. Could I but present one-tenth part of the cases which have been rescued from a premature grave, chiefly by means of using this instrument, I should force irresistible conviction on the most incredulous, or at least induce them to institute a number of experiments, patiently and judiciously, so as to satisfy themselves of the truth. (2, page 10)

Not sold yet as to the efficacy of the Ramadge inhalaing pipe?  Well, how about some endorsements that might change your mind.  Ramadge said:

This mode of treatment has many advocates, both in England and abroad. Lebeau, physician to the King of the Belgians, and senior surgeon of the Military Hospital at Brussels, as also Hohnbaum, physician to the Duke of Saxe Meiningen, and a distinguished pathologist, highly approve of it. Among the American medical men might be mentioned, the names of Drs. Pitch, Newton, and Hull, of Philadelphia, and several other distinguished practitioners of the same country, together with a great many continental physicians, all of whom have adopted its use, and are its zealous supporters. (3, page 11) 

Ramadge would go on to become a well respected physician who specialized in pulmonary disease, ultimately becoming senior physician to the Infirmary for Asthma, Consumption, and other diseases of the Lungs. He claimed to have had the advantage of over 30,000 cases of consumption in all its various stages. He said:

I have no hesitation in asserting -- in contradiction to the opinion of many medical practitioners -- that this disease when properly, judiciously, and skillfully treated, is a curable as any other disease, the curability of which is not dispute. (1, page iv)

The Ramadge Tube was recommended by physicians for pulmonary gymnastics and as a prophylactic therapy for consumption until better devices were invented at the turn of the next century. (4, page 228)

Further reading:

• 1819: Laennec says consumption can be cured
• 1910: Early PEP and Incentive Spirometers

References:

1. Fitch, Samuel Sheldon, "Six lectures on the uses of the lungs," 1847, New York, H. Carlisle, pages 91-93, 
2. Laennec, Rene, "On Mediate Auscultation," 1827, London, T and G Underwood.  
3. Ramadge, Francis Hopkins, "The Curability of Consumption: the reprint of a series of papers, presenting its most prominent and important practical points in the diagnosis, prognosis, and treatment of the disease," 1850, London, Printed by W. Clowes and Sons
4. Tissier,Paul Lewis Alexandre, edited by Solomon Solis Cohen, "Pneumotherapy: Including Aerotherapy and inhalation methods," volume X, 1903, Philadelphia, P. Blakiston's Sons and Co., pages 227-230.  If the profession of respiratory therapy existed in their era, we would be reading their books.  However, as it was, their books were written for the medical profession.  For a more detailed description of any of the devices mentioned on this blog click on the links provided. Unless otherwise indicated, all material from this post was from Tissier's book. 
5. Sehlin, et al, "Physiological Responses to Positive Expiratory Pressure Breathing:A Comparison of the PEP Bottle and the PEP Mask,"  Respiratory Care, August, 2007, Vol. 52, No. 8, pages 1000-1005

RT Cave Facebook Page
RT Cave on Twitter

1835: Ramadge renews interest in nervous asthma

A fit of asthma is like the suffocation caused by a noose.
Francis Ramadge said: "As the respiration becomes more 
difficult the pain at the chest increases, and the constriction
is at last so intense as to be compared by the sufferer,
to what might be supposed to arise from cords bound tightly
 around it. It heaves and dilates as if striving to burst these
 imaginary bonds, and is again compressed, as it were,
by their violent re-action.. after retiring early to bed...
the patient is suddenly awakened in a few hours 
by a feeling of strangulation, and finds that the fit has
seized him with all its violence. When fully awake,
 he finds an oppression of the chest, weighing him down 
like an incubus, and is constrained to sit up, 
or to quit his bed at once, if, as he imagines, 
he would escape suffocation." (6, page 43, 45)

By the end of the 18th century nervous asthma had gone out of fashion, becoming once again merely a form of dyspnea or a symptom of some other disease, such as bronchitis.   The idea that asthma was nervous in origin was not revived until the writings of Dr. Francis Hopkins Ramadge in 1835.  (1, page 599)

Ramadge was born in 1793 in Dublin, and was educated at Dublin college in London.  He received his bachelor's degree in 1816 and a master's degree in 1819 at Dublin.  He earned his medical degree at Oxford in 1821.  (3)

He was a student of Rene Laennec, the inventor of the stethoscope.  So he would have been well acclimated to this new tool.

He went on to become a well established physician in London, developing an "extensive" and "lucrative' practice that focused "chiefly" on diseases of the chest. (7, page 92)

He became senior physician to the Royal Infirmary for asthma, consumption, and other diseases of the lungs.  He as lecturer on the principles and practice of medicine and chemistry.  (3) (6, page iv, 64)

Ramadge published a book on consumption that was well received, and this inspired him to write a book on asthma called"Asthma, its species and complications, " which was published in 1835.  (6, page v)

He wrote that asthma was "less fatal (than consumption), it is true; but, when of an aggravated character, as exquisitely painful to the sufferer, as it is alarming to the beholder." (6, page v)

He said his book on asthma was necessary because...

...little has yet been done to put either the pathology, or the therapeutics of Asthma on a satisfactory basis. The few works of our English medical writers on the subject propose little beyond theory in the one, and palliation in the other. Nor have the labours of the continental physicians been much more successful. The views put forward, in this country at least, have been chiefly traced from the limited opportunities of private practice, for the most extensive are circumscribed, when compared with those afforded by a public institution. (6, page v-vi)

Of asthma, he observed what we already know:

Its Greek etymology (difficult respiration) is so comprehensive in its signification, that numerous disorders, distinctly separated from each other by their causes, and differing in their effects, have been classed under the name of Asthma, as a generic term, from then. agreeing in one general character—difficulty of breathing. This has not only produced much confusion among medical writers, but, as a necessary consequence, has led to a similar result in practice.

These are important statements made by Ramadge, because they show, as a pioneering physician of the scientific era, how vigilant he was of the theoretical basis of most conclusions regarding asthma prior to his era, and even during his era.

So he aimed to end this confusion, and he aimed to do it by using the one advantage he had over them: the stethoscope.

By using this new tool he was able to prove that bronchitis followed and did not precede a fit of asthma, and this, he believed, should disprove the bronchitis and humoral theories of asthma that postulated it was the result of inflammation and secretions in the lungs caused by organic lesions or, as Robert Bree speculated, some peccant matter that made its way into the lungs.

He did not deny asthma was humoral, yet he believed organic lesions were more likely to cause asthma in the extremes of life, such as in childhood from congenital abnormalities, and in adulthood from lesions of the large vessels and heart.  He said humoral asthma, when it did occur, was most likely in old age. (6, pages 9-10)

By using his stethoscope, he believed the following should not be considered forms of asthma, but disease entities of their own.  (6, page 10)

• Structural impediment of the larynx that narrow the airway (6, page 10,33)
• Structural impediments of the trachea that narrow the airway (6, page 10,33)
• Extensive adhesion (6, page 10)
• Emphysema of the lungs  (6, pages 10, 35-36)
• Bronchitis, dyspnea with inflammation (6, pages 10,33)
• Hydrothorax, edema of the lungs  (6, page 10)
• Glandular or calcareous obstructions at the root of the lungs  (6, page 10)
• Various organic lesions of the heart or aorta  (6, page 10)
• Valvular irregularity of the heart or aorta  (6, page 10)
• Ossification of the coronary arteries  (6, page 10)
• Chronic pericarditis, (6, page 10)
• Angina Pectoris, Darwin's asthma, Laennec's Neuralgia, chest pain, cardiac asthma (6, pages 18-33)
• Pulmonary apoplexy (6, page 34)
• Acute Catarrh, swelling of the air passages, nasal passages, etc. 
• Etc. (6, page 10)

He believed that all of these could be distinguished from asthma simply by means of auscultation with a stethoscope and thorough assessment and questioning of the patient.  For example, when a patient complains of chest pain, or is yelling things like "My arm!  Oh, my arm!" a physician might think angina, not asthma, is the cause of the person's agony.  (6, pages 18-19)

He did, however, believe that any of these may lead to asthma.  He also beleived that asthma, when "long continued" may result in organic lesions that seriously affect a person later in life.   (6, page 36)

So, instead of thinking that asthma was humoral or bronchitic in nature, and in the absence of organic lesions, Ramadge postulated that asthma must be nervous in origin.

In order to allay some of the confusion regarding the term asthma, he decided that he needed to come up with a new term.  He therefore decided that nervous asthma was asthma in its pure form, was nervous or spasmotic or convulsive or idiopathic asthma.  Yet he preferred to refer to it as pure or essential asthma.  (6, pages 65-66, 92)

He believed a paroxysm of asthma occurred when some exciting cause, either internal or external, irritated the nerves, resulting in the brain sending messages along nerves supplying airway and pulmonary tissue, including the bronchi.  This message causes spasms of the trachea and bronchial tubes. (4, page 3)(5, page 193)(6, page 12)

He believed that essential asthma was caused by "some injury done to the nerves of the chest, by cold or other means.  He described a case of asthma that he suspected arose after a case of the hooping cough.  When this happens, the pneumogastric nerve, which supplies nerves to the throat and lungs, becomes damaged or irritated. (4, page 60-61)

Other exciting causes might include: 

• Troubled mind or passions of the mind(6, page 19, 59)
• Passions of the mind (such as fear, excitement)(6, page 86)
• Irritable temperament (6, page 59)
• Gusts of passion (6, page 19)
• Excessive eating (6, page 11)
• Excessive drinking (6, page 11)
• Excessive anything (6, page 11)
• Inhalation of occupational particles, metals, or dust (6, page 11)
• Nervous temperament (6, page 11)
• External irritants, such as strong smells like the smell of tea (5, page 193)(6, page 11)
• Internal irritants, such as a visceral (organ) irritation, sympathetically affecting the brain, or a tumor in the lungs, or adhesions in the lungs.  (6, page 11)
• Atmospheric influences, such as changes in weather; excessive heat at end of May, or  (6, pages 14-16)
• Particular period of the year, such as winter or summer (this would be the most common in the purely nervous asthma; the most violent asthma occurs after the summer solstices) (6, page 46)
• Stomach ailments (caused by food ingested, indigestion, dyspepsis, etc.)(6, page 83, 86)

He said pure or essential asthma caused morbidity, but did not, as a general rule, cause mortality.  He said:

The prognosis of asthma is seldom difficult.  Doubt can arise only in cases severely complicated. When asthma wears the purely nervous form, danger is rarely to be apprehended." (6, page 36)

However, he added:

"To sum up prognosis in a few words, asthma is seldom productive of present danger, but often betokens much future inconvenience."

He believed asthma was periodic, the episodes were generally short lived, and the intervals in between the fits were of varying lengths.  He also believed the person would experience perfect health between episodes. (6, page 17)

It was only when asthma was prolonged, or continued for a long time, that it might cause organic lesions resulting in such conditions as emphysema of the lungs, bronchitis, heart disease, or other diseases often confused as asthma.

Symptoms of essential asthma were: (6, page 45)

• Difficulty in breathing (6, page 18)
• A sense of suffocation (6, page 18, 43)
• Pain across chest (6, page 43)
• Flatulent uneasiness in the stomach and bowels (6, page 16, 46)
• Undefined oppression and constriction of the chest (6, page 16)
• Dry cough (6, page 16, 43)
• General irritability (6, page 16)
• General impatience (6, page 16)
• Headache (6, page 16)
• Dejection (6, page 16)
• Langour (6, page 16)
• Thirst and dryness of the mouth (6, page 17, 43)
• Dry and cold skin (6, page 17, 43)
• Copious flow of clear urine (6, page 17, 45)
• Drowsy (6, page 42)
• Disinclined to exertion (6, page 42)
• Apt to fall into disturbed and uneasy slumber (6, page 42)
• Wheezing on expiration (6, page 43)
• Wheezing accompanies exertion, and is audible (6, page 43)
• The sufferer literally gasps for breath (6, page 43)

Similar to those who support the humoral or bronchitic theory of asthma, such as Bree, Ramadge believed the fit of asthma usually ended with the expectoration of sputum. (6, page 17, 46)

He believed that pure asthma was a rare condition.  (6, page 103) 

He even speculated as to which folks were most likely to acquire disease:

The predisposition to asthma is very generally apparent, in individuals of a defective constitution, and morbid temperament. In numerous instances, it may be traced to the transmission of the nervous susceptibility of receiving impressions, injurious to the respiratory functions, from parent to child. How frequently indeed do we see a kind of general disposition handed down, from one generation to another; sometimes immediately, at others with the intermission of one, or more generations. And we frequently find that the more intimate the moral, no less than the physical organization of two individuals, the one in the ascending, the other in the descending line; the more probable is it, that the latter will inherit the morbid peculiarities of the former. (6, pages 101-102)

He suspected asthma to be be hereditary.  He said he observed its occurrence in n four generations of one family.  He said the father had asthma, and three of his four children also had asthma. He said one of the daughters married, and, of her two children, one had asthma. The one who had asthma also had a child with asthma.  (5, page 190)(6, pages 56, 101-102, 104)

Ramadge wondered why the nervous theory of asthma fell out of favor among the medical community.  He blamed it on the fact that...

...from the time of Willis, who was the first to observe the nervous character of uncomplicated asthma, down to the publications of Laennec and Andral, no light has been thrown on the seemingly inexplicable disease from morbid anatomy.  All agree that it is impossible to discover any lesion; or from post-mortem examination to assign any cause for the presence of the disease. (1, page 92)

He added:

It is deeply to be regretted that our own writers on this disease should not have been more anxious to investigate its pathology, than their works would evidence. From many circumstances in cases detailed by them, I am induced to believe that many important states have been either overlooked, or misunderstood. Had due attention been given to the subject from Willis's time to the present, we should have had a rich harvest of facts on which to reason. As it is, we are presented with innumerable details, gleaned from the works of men who wrote at a period, when the art of minute dissection was in its infancy; and when, consequently, many appearances of consequence to a full understanding of the case must have escaped notice. (1, page 96)

Despite this work by Ramadge, it wasn't until 1851, through the prize winning work of Bergson and Lefevre , that nervous theory of asthma would be fully accepted by the medical community, and that asthma would be "recognized as an independent affection."  (1, page 599)(2, page 596)

He died 31 years later in 1867. (3)

References: 

1. West, Samuel Hatch, "Diseases of the organs of respiration," volume II, 1902, London, Charles Griffin & Company, Limited 
2. Whitaker, James Thomas, "The theory and practice of medicine," 1893, New York, William Wood and Company
3. Gordon, Goodwin, "Ramadge, Francis Hopkins," from the "Oxford Dictionary of National Biography: 1885-1900," volume 47, Matthew, H.C.G., Brian Harrison, Lawrence Goldman, editors, http://en.wikisource.org/wiki/Ramadge,_Francis_Hopkins_(DNB00), accessed 2/10/14
4. Schmiegelow, Ernest, "Asthma, considered specially in relation to nasal disease," 1890, London, H. K. Lewis
5. Geddings, W.H., author of the chapter on "Bronchial Asthma," in the book  "A System of Practical Medicine," edited by William Pepper and Louis Star,Volume 3, 1885, Philadelphia, Lea Brothers and Co.
6. Ramadge, Francis Hopkins, "Asthma, its species and complications, or researches into pathology or disordered respiration; with remarks on the remedial treatment applicable to each variety; being a practical and theoretical review of this malady, considered in its simple form, and in connection with disease of the heart, catarrh, indigestion, etc." 1835, London,  Longman, Rees, Orge, Brown, Green, and Longman
7. Fitch, Samuel Sheldon, "Six lectures on the uses of the lungs," 1847, New York, H. Carlisle, pages 91-93, 

RT Cave Facebook Page
RT Cave on Twitter

1835: Ramadge questions that Dr. Bree had asthma?

So we know that Dr. Robert Bree published a book called "A Practical Inquiry into Disordered Respiration" that became the principle authority on asthma during the first half of the 19th century. Yet his book did not come without criticism.  

George Lipscomb, a fellow British physician, had the nerve to criticize Dr. Bree's ideas regarding asthma even as the book was first published.

Then, in 1935, Dr. Francis Hopkins Ramadge, in his 1835 book "Asthma, its species and complications," went almost as far as to suggest that Dr. Bree did not have asthma at all, and, therefore, was probably describing some other disease.  

He said: 

Dr. Bree delineated the early stages of his disorder, as distinctly as the latter, I have no doubt it would be found, that his asthma supervened upon latent consumption. Thus he gives no account of the symptoms preceding dyspepsia, which would have indicated, at once, the origin of his complaint. But, it is evident that some ailment of the chest was early at work, from his alluding to pain of the intercostal muscles, which could hardly have existed without; or, the reverse might have happened, and the dyspepsia impairing his health, have thus indirectly originated the pulmonary affection. (1, pages 135-136)

Some remarks of Laennec coincide wonderfully with this view of the case. He observes, "that nervous symptoms may mask phthisis for a long period; and that he has known it concealed for years by habitual dyspepsia, and other symptoms of hypochondria." (1, page 136)

This, in fact, is giving in other words the commencement of Dr. Bree's case, as stated by himself. So strongly, indeed, am I convinced that one or other of these explanations will apply to the learned Doctor's case, and elucidate what has been omitted by him, that, could he be induced to summon up his recollections, and retrace minutely the precursory symptoms of his disease, it would, I have little doubt, appear that either before, or during his dyspeptic condition, he had had attacks, slight ones perhaps, of haemoptysis. However, for an author to retrace his steps, crossexamine himself, and confess his views to be erroneous, would be an effort of candour above the powers of poor humanity! (1, pages 136-137)

I would not be supposed to insinuate, that any thing was purposely omitted by him. On the contrary, I believe he has detailed, and fully too, every symptom he conceived to be of importance; and that, supposing he had laboured under slight spitting of blood, he would have deemed it too irrelevant for notice. The course, therefore, of his complaint, on the supposition of the correctness of the views above taken, would be that on the appearance of the dry form of asthma, which did not exhibit itself for several years after the first manifestation of dyspnoea, his lungs became emphysematous, and the cavity, which I conjecture to have previously existed, was gradually healed up. The care he appears subsequently to have taken of himself put a stop to the bronchial affection, and with it of the asthma,which at one period seems to have been habitual with him. (1, pages 137-138)

Dr. Ramadge, along with other physicians who came to the same conclusion about Dr. Brees ideas regarding asthma, said that Dr. Bree was a smart man who, if he had had access to the stethoscope of Dr. Rene Laennec, would have easily seen his mistake.  

About twenty years later Dr. Henry Hyde Salter, who we will come to know as the author of the most famous asthma book of the second half of the 19th century, also criticized Dr. Brees ideas regarding asthma. 

Dr. Bree argued in favor of the bronchitic theory of asthma.  He believed the spasms or convulsions associated with a fit of asthma are all a part of the bodies effort to get rid of some irritating or peccant matter that was inhaled into the air tubes.  

I know I quote Dr. Salter's criticism of Dr .Bree in another post, yet I think it's worth repeating here.  Dr. Salter said: 

Dr. Bree maintains his argument with a great deal of ingenuity, and presses many facts into the service of his theory; but the most superficial reflection would suffice nowadays to show that it is utterly untenable ; and had Dr. Bree enjoyed the light that now shines on us from those two important points, the stethoscope and our acquaintance with excito-motory action, he would never have broached the doctrine he did: the one would have shown him the fallacy of his views, the other would have opened to him a solution of his difficulty—the stethoscope would have shown him that the conditions of an extraordinary discharging power are not present in an asthmatic attack ; indeed, that the power of getting rid of anything in the lungs is very much diminished by it; and the knowledge of reflex nervous action would, in connection with anatomy, have displayed the true nature of the disease, and made all its discrepant and scattered phenomena conspire to the production of its true and simple theory. (2, page 5)

With all due respect to Dr. Bree, the same argument about "if he had access to the stethoscope" could have been made regarding any of the physicians who studied lung diseases during their careers.  

Still, the argument that Dr. Bree never had asthma at all, and that his book did not describe convulsive asthma but some other disorder of the lungs, was quite impelling.  

References: 

1. Ramadge, Francis Hopkins, "Asthma, its species and complications, or researches into pathology or disordered respiration; with remarks on the remedial treatment applicable to each variety; being a practical and theoretical review of this malady, considered in its simple form, and in connection with disease of the heart, catarrh, indigestion, etc." 1835, London,  Longman, Rees, Orme, Brown, Green, and Longman
2. Salter, Henry Hyde, "On Asthma: It's Pathology and Treatment," 1882, New York, William Wood & Company; Dr. Salter's book was originally published in 1860, and was previously released as a series of articles during the course of the 1850s

RT Cave Facebook Page
RT Cave on Twitter

1820-1850: Race to define asthma

In the year 1840 Dr. Charles J.B. Williams proved the bronchospasm theory of asthma, and Dr. William Budd rejected this proof by performing experiments of his own.  This theory was debated for the rest of the century.

Likewise, from this year on you had one physician after another come up with his own theory as to the cause of asthma, with each being convinced he was right, and each offering proof.  Historians can argue whether this slowed down or sped up search for better asthma wisdom.

Dr. Franz Daniel Reisseissen:  He was a German physician who studied the lungs, and concluded "there is another apparatus appointed for contracting the bronchi, which consists of transverse muscular fibres.  As far as the cartilaginous rows extend, these fibres are inserted...." (1, page 186)

Reissiessen proved muscle fibres wrap around the air passages of the lungs almost all the way to the alveoli.  His writings are published in Berlin in 1822. You can check out his 1835 book by clicking here.

Charles J.B. Williams later proved that certain irritants cause contraction of the muscular fibres that Reisseissen proved wrap around the air passages in the lungs.

Francis Hopkins Ramadge:  In 1835 he described food as an asthma trigger, recommends moving from the city to country,  and of asthma being mostly a nocturnal disease. He discourages use of opiates because they impede respirations that are already impeded. He mainly recommends strammonium because it "produces a grateful forgetfulness and a balmy oblivion like opiates." (2, page 7)

He regarded asthma as a neurosis of the respiratory organs.

Prize essays of Bergson and Lefevre:  This occurred in 1836.  They regarded, as did Ramadge, asthma as a neurosis of the respiratory organs (3).

Lefevre observed his own asthma and that of a friend and concluded asthma could only be caused by bronchospasm, and that this bronchospasm was caused by the mind, according to J.B Berkart. (4)

Berkart said that ant "in essence of the disease he (Lefevre) considered to be an increased irritability of the nerves of the lungs, in consequence of which the slightest irritation applies to the bronchial surface induced spasm of the bronchial tubes." (4)

Romberg:  He further established the view of asthma as a nervous disorder in 1841, and based his conception of the disease as a spasmus bronchialis, upon the discovery by Reiseissen (1808) of muscular tissue in the finer bronchial tubes, and the contraction of these tubes under galvanization of the lungs by Charles J.B. Williams (1840), and irritation of the vagus (nerve) by Dr. Francois Achille Longet (1842)." (3)

Dr. Francois Achille Longet:  According to a brief history of asthma by W.H. Geddings, "It was ascertained by (Charles J.B.) Williams that by irritating the lung he could cause contraction of these fibres, and Longet subsequently proved that the same effect could be produced by galvanizing the pneumogastric nerve."  (5, page 184)

Berkart said that in 1842 Longet performed experiments to prove "irritation of the pneumogastric nerve always produced spasmodic contraction of the bronchi, whereas section of the nerve led to emphysema, which was described as distention of the air vesicles."  (4, page 27)

Longet also believed bronchospasm and emphysema were both parts of asthma.

Rudolph A. von Killiker:  In the 18th century William Cullen believed the muscle was just a continuation of a nerve.  Von Killiker was a histologist who proved this was not true.  He basically confirmed the works of Williams and Reisseissen when he isolated smooth muscles in the lungs  (6, page 422)

This essentially proved Cullen wrong, that the muscle was not just a continuation of a nerve.  Yet since nerves still connected to muscles, van Killiker's discovery was unable to stop the fallacy of the nervous theory of asthma. (6, page 422)

Interesting notes:  Williams must have agreed with Rene Laennec and J.B. Berkart that asthma was an abused term. James Thomas Whitaker noted that in 1768 there were 17 different types of asthma (as described by Savage) and in 1822 this was reduced to 11 (by Richter). This was confusing. Williams wanted to simplify the definition of asthma.(3)

The thing to note about most of these experts is that even while they believed in the bronchospasm theory of asthma, they continued to believe in the nervouse theory of asthma, and their experiments proved the two co-existed  -- or so they thought.

During the 1850s, asthma was described by Dr Henry Hyde Salter as a disease of bronchospasm caused by an exciting cause that triggers the nervous system.

References:

1. Floyer, John, ed., "The Cyclopaedia of practical medicine," 1833, volume 1, page 186
2. Brenner, Barry E, ed, "Emergency Asthma" 1998, page 7 (chapter one is a history of asthma written by Brenner)
3. Whitaker, James Thomas, "The theory and practice of medicine," 1893
4. Berkart, J.B.,"On Asthma:  It's Pathology and Treatment, 18xx, volume 1878, London, J. & A. ChurchillI, page 23 (Berkart started his book with a good history of asthma up to his time.
5. Geddings, W.H., writer, "Bronchial Asthma," in the book, "A System of Practical Medicine," edited by William Pepper and William and Louis Star, Volume 3, Philadelphia, Lea Brothers & Co., pages 184-209
6. Daintith, John, editor, "Biographical encyclopedia of scientists." 2009, 3rd edition, Florida, CRC Press
7. Ramadge, Francis Hopkins, "Asthma, its species and comications, 1835, London

RT Cave Facebook Page
RT Cave on Twitter

1819: Laennec says consumption can be cured

Dr. Rene Laennec might have become interested in diseases of the lungs because his own mother died of tuberculosis when he was only five-years-old.  Of course it may simply have been his desire to help people who lived under the gloomy cloud created by the grim diagnosis of the disease.

While he specialized in diseases of the chest, he would end up spending more time studying consumption than any other disease, perhaps becoming the first to describe the disease as curable. (1, page 6)

He referred to it as pthhisis pulmonalis in his 1919 book "Mediate Auscultation," dedicating three full chapters to the disease.  He said it results in the development of "species of accidental production" called the tubercle in the lungs. (2, page 283)

He said the ancients described an "accidental production" as any abnormality, and used the term "tubercle" to describe an accidental production in the lungs, such as a cyst or cancerous growth, that resulted in phthisis or wasting away.  (2, page 283, 310)

Laennec, however, recommended tubercle only be used to describe tubercles of consumptive patients. (2, page 283)

He described the tubercle:

Whatever be the form under which the tuberculous matter is developed, it presents at first the appearance of a grey semi-transparent substance, which gradually becomes yellow, opaque, and very dense. Afterwards it softens, and gradually acquires a fluidity nearly equal to that of pus; it being then expelled through the bronchi, cavities are left, vulgarly known by the name of ulcers of the lungs, but which I shall designate tuberculous excavations. (2, page 285)

He said in most cases the disease results in extreme emaciation, which is why the ancient Greeks referred to it as phthisis, wasting away.  (2, page 304)

He said the internal organs other than the lungs are usually of normal length, but of lessor diameter.  The chest is "usually narrow and sometimes evidently contracted." The skin is usually very pallid and pale.  (2, page 306)

He said:

"The emaciation then makes rapid progress toward complete marasmus (severe malnutrition).... The nose becomes sharp and drawn; the cheeks are prominent and red, -- and appear redder by contrast with the surrounding paleness; the conjunctiva of the eyes is of a shining white or with a shade of pearl blue; the cheeks are hollow; the lips are retracted, and seem moulded into a bitter smile; the neck is oblique and impeded in its movements; the shoulder blades are projecting and winged; the ribs become prominent, and the intercostal spaces sink in, particularly on the upper and fore parts of the chest. Sometimes even the whole chest seems contracted...; and this may actually be the case, particularly when the disease is very chronic, owing to the contraction and tendency to cicatrization of large tuberculous excavations. The belly is flat and retracted; the larger joints and those of the fingers, appear enlarged from the falling away of the neighboring soft parts; and even the nails become incurvated, in consequence of the absorption of the pulpy extremities of the fingers. No other disease gives rise to so complete emaciation as phthisis,—except cancer and continued fever of long duration. (2 page 372)

The patient sometimes complains of a "guggling sound," which Laennec attributes to the softening the the tubercles.  This is often expectorated, resulting in sputum similar to that produced during a fit of common catarrh. (2, pages 375-377)

The disease generally presented with obvious signs and symptoms.  The earliest symptom was a dry cough, which may be confused with dry catarrh. Haemoptysis, fever, chills and night sweats are other prominent symptoms. Some patients are known to require a change of sheets several times in a night. (2, pages 369-272)

Most people, including most physicians, during the early 19th century had a very gloomy view of this disease, as most who were diagnosed with it perished as a result of it.  The medical prognosis, therefore, was not very good.  (2, pages 319-320)

However, Laennec explained that the ancients believed "phthisis" started as a result of chronic inflammation, and they probably came to this conclusion because an early symptom of the disease is a slight dry cough that could easily be contributed to a dry catarrh (common cold). (2, page 319, 320, 369)

This chronic inflammation resulted in the gradual formation of pus in pulmonary tissue.  They believed this was curable, especially in the early stages. (2, pages 319-320)

This was pretty much the common perception of phthisis all the way up to the late 19th century when pathological anatomists discovered tubercles in the lungs of patients with phthisis.  (2, page 369)

Yet once physicians started studying pathological anatomy, they learned that this was not true, that once one developed tubercles (like cancer) the prognosis was poor, with death almost certainly imminent. (2, pages 319-320)

Laennec seemed to disagree with this notion, believing instead that, while the disease was not curable during the early stages of the disease, it was curable in the latter stages, that is, he said, "after the softening of the tubercles and the formation of an ulcerous excavation."  (2, page 321)

He said:

The formation of the semi-cartilaginous membrane on the surface of tuberculous excavations, must be considered, in my opinion, as a curative effort of nature. When completely formed, it constitutes a sort of internal cicatrix (a scar of a healed wound) analogous to a fistula, and is, in many cases, not more injurious to health than this species of morbid affection. All the persons whose cases I noticed above, died of diseases not referable to the pulmonary organs. They had all lived a greater or less number of years in a very supportable state of health, being merely subject to chronic catarrh. Some indeed had more or less of dyspnoea, but without any fever or emaciation. (2, pages 321-322)

Essentially, he believed that early on in the disease the tubercles were soft, and these were not curable. However, later in the disease scar tissue formed, either by fistula or cicatrix.  This hardened tissue acts as a natural barrier against the disease. (2, page 336)

While essentially cured, the patient may still present with symptoms. Generally, he believed those cured by fistula developed a chronic catarrh occasioned with sputum production that was sometimes copious; and those cured by cicatrix developed a dry cough that was not frequent, not severe, and not much of an inconvenience to the patient. (3, page 337)

He even gave examples of patients cured of consumption.

In a lady, formerly a patient of M. Bayle, fourteen years since, and whose case was decidedly consumption, (as appears from M. Bayle's notes in her possession,) the sign of pectoriloquy (particular lung sound made by a tubercle) is most distinct. This lady recovered beyond all expectation; she is now stout, and the only symptom she has at all referable to the lungs, is a slight cough. I have no doubt that the cartilaginous excavations above described exist in this person's lungs.

In July of 1817 he attended to a lady of 48 who had been in good health until the age of 30 when she became subject to severe attacks of catarrh and became quite emaciated.  Upon assessment he observed her breathing was diminished over the upper right chest.  By this, and by the appearance of her sputum, he diagnosed her with tubercles in the early stages.  As the treatment he applied leeches and more.  (2, pages 325-326)

Her symptoms were unchanged until February of 1818 when her cough increasingly distressing with thick yellow sputum.  He said:

I did not see the patient during this attack, which she looked upon as a cold; but I visited her in the beginning of April, and upon examining her chest I found most distinct pectoriloquy at the anterior and upper part of the right side. I was convinced by this that the supposed catarrh (the cold) had been the discharge of the softened tuberculous matter. The sound of respiration was good over the whole chest; and even in the vicinity of the pectoriloquous spot; the pulse was not frequent and the heat moderate. On this account I entertained hopes of her recovery, and prescribed ass's milk. The cough and expectoration progressively lessened, the flesh and strength returned; and, in the beginning of July, my patient had regained every appearance of the most perfect health. (2, page 326)

The pectoriloquy continued, although he suspected that it would, offering proof that she had suffered and survived a bout of consumption.  (2, page 322)

Laennec listed hundreds of various remedies used by the ancients and moderns, and he said any of these are worthy of trying, so long as the patient tolerates them, and this included bleeding with leeches and cautery by the application of caustic potass on several locations of the body.

The medicinal list also included a long list of expectorants, purgatives, etc.  It also included the inhalation of fumes, air of cow houses, oxygen, hydrogen, etc. (for a longer list of Laennec's remedies check out my post 1819: Laennec remedies for consumption.

The remedy he was most fond of, however, was change of situation.  (2, page 392)

Laennec said that the ancients observed that consumption was sometimes cured by the seaside, and that they often recommended sailing to their phthisical patients. He said Areteaus recommended sailing and the air of the seashore, Celsus recommended a voyage to Egypt.  (2, pages 243-394)

This was an idea recently picked up by English physicians, who often sent their phthisis patients to Maderia.   (2, page 343)

There was one case early on in his career, long before he had invented the stethoscope, whereby a patient of his was diagnosed by both himself and Dr. Bayle as having chronic catarrh.  However, upon a change of air, or a move to the seaside, he was cured.

Several years later, and after he had use of the stethoscope, he had another opportunity to assess this patient.  He said:

Since then I have had an opportunity of satisfying myself, by means of the stethoscope, that our patient had had more than a mere catarrh. His respiration is quite perfect throughout the whole chest, except at the top of the right lung, in which point it is totally wanting. On this account, I am certain that this portion of lung had been the seat of an ulcerous excavation, and that this had been replaced by a complete and solid cicatrice. The health of this gentleman continues good, although he has often occasion to speak in public. He has sometimes a little dry cough, on the change of weather, but takes cold very seldom. (2, page 340)

Yet while medicine may offer benefits to the consumptive, it does not offer a cure. The only means to a cure, he said, was nature.  (2, page 396)

So while he began his career under the belief there was no cure for consumption, his own experience and assessment skills proved that this was not always the case. He learned that there was a cure for consumption...

...or at least, for such a suspension of their symptoms as may be deemed almost equal to a cure, as the individuals may enjoy such a state of health as may enable them to fulfill all the duties of civil life, for several years, or until a fresh development of tubercles produces a fresh and final seizure. (2, page 337-338)

Patients who were thus "cured" might still have some symptoms, such as episodes of catarrh or a cough, but may otherwise "live in a supportable state of health." Others may have dyspnea, but without the fever and emaciation. (2, page 322)

As one final note to this discussion, Laennec said:

My experience leads me to deem such cases to be extremely common: those related above occurred to me in the course of some months: and I have since met with many others. (2, page 340)

Laennec was, therefore, among the first physicians of his era to speculate that consumption was a curable disease.  This subject would be further investigated by his pupil, Francis Ramadge.

It was perhaps due to his passion to learn about this disease that cost him his own life.  He would end up one of the many victims of consumption at the young age of 45.

References:

1. Ramadge, Francis Hopkins, "The Curability of Consumption: the reprint of a series of papers, presenting its most prominent and important practical points in the diagnosis, prognosis, and treatment of the disease," 1850, London, Printed by W. Clowes and Sons
2. Laennec, Rene, "Mediate Auscultation," translated by John Forbes, Notes by professor Andral, 4th edition, 1838, New York, Samuel S. and William Wood

RT Cave Facebook Page
RT Cave on Twitter

1768: Bosier de Sauvages classifies asthma

Francois Boissier de Sauvages (1706-1767)

One of the key figures in the early days of nosology was the French physician and nosologist Francois Boissier de Sauvages (1706-1767). He worked with the disease classification system created by Thomas Sydenham, and divided diseases into ten categories based on symptoms in his 1763 book, "Nosologie Methodique (diagnostic methods)."  (1)(2)

De Sauvages, like Sydenham, was from the vitalist school of medicine in Montpellier. It is Sauvages who is often given credit for making vitalism popular among the medical community in the 17th century.

Vitalism was an ancient system of medicine that was started by the ancient Greeks (if not earlier) and perhaps first described through the writings of Hippocrates and Aristotle.  It was a belief that a vital spirit, or a soul, was responsible for maintaining the balance of health and sickness.

They believed that the vital spirit within the body was determined by the opposing humours within the body: black bile, yellow bile, phlegm, and blood.  As noted earlier in this history, even the Chinese had a system regarding the balance of substances in the body, such as Qi.  So systems of vitalism, of sorts, existed from an earliest moments of civilization.

Vitalism was revitalized, so to speak, by George Ernest Stahl (1660-1734).  He believed a significant difference between living organisms and inorganic bodies was that living organisms possess a vital spirit.  This view was worded well by the authors of Encyclopedia Britannica:

From his observation that organic bodies decompose rapidly after life ceases, while inorganic bodies remain chemically stable, he concluded that the strong corruptibility of organic matter must result from its material nature (that is, chemical composition) and that there was an immaterial reason that kept a living body from its natural decomposition. Stahl identified this reason with the principle of life, which he sometimes called “natura” (nature) and sometimes “anima” (soul). This natural reason of anima was the source of the remarkable self-healing power of the organism, and when misled, such as by emotions, it produced illnesses. This double character of the vital principle made it the foundation of physiology and pathology, and it dictated that physicians should work to facilitate or restore its healing power based on attentive observation. (6)

Stahl, like most vitalists, understood that the body was a complex system, but he rejected the idea that it was purely mechanical, (6) or consisted of a system of "pulleys and levers" that worked together to maintain health. He did not believe that health could be explained by physical or mechanical means. (5)

Stahl believed it was this soul, or anima, or vital spirit, that made the difference between living organisms like human beings and inanimate objects. The vital spirit was the vital principle of life, health, and healing. (6)

Following the beliefs of Stahl and his vital principle were Sydenham and then Sauvages.

Dr. John Charles Thorowgood, in 1879, said during a lecture on asthma to the Medical Society at London, that by the mid 17th century physicians started to take notice of the periodicity of asthma, or the fact that asthmatics tend to go long periods between episodes. (3, page 5)

Thorowgood said that Sauvages, In his 1768 book Genera Morborum, defined  asthma as "Difficultas spirandi periodice recurrens, chronica (difficult breathing that recurs periodically and is chronic)."  (3, page 5)

In 1879, Francis Ramadge said Sauvages used the term suspirium (sigh) instead of the term asthma.    However, Ramadge said that Sauvages made the same error as the ancients "by giving to asthma a sense almost as extensive as that which belongs to dyspnoea. (4, page 5)

References:

1. "Francois Boissier de Sauvages," encyclopedia.com, http://www.britannica.com/EBchecked/topic/525610/Francois-Boissier-de-Sauvages, accessed 10/12/13
2. "Francois Boissier de Sauvages," neuroportraits.eu, http://neuroportraits.eu/portrait/fran%C3%A7ois-boissier-de-sauvages, accessed 10/12/13
3. Thorowgood, John Charles, "The Lettsomian Lectures delivered at the medical society at London, 1879, on on bronchial asthma: its causes, pathology and treatment," 1879, London, Bailliere, Tindall, & Cox
4. Ramadge, Francis Hopkins, "Asthma, its species and complications," 1835, London, Longman, Rees, Orme, Brown, Green, and Longman
5. "Vitalism," Dictionary.com, http://www.merriam-webster.com/dictionary/vitalism, accessed 10/12/13
6. "George Ernst Stahl," encyclopedia britannica.com, http://www.britannica.com/EBchecked/topic/562520/Georg-Ernst-Stahl, accessed 10/12/13

RT Cave Facebook Page
RT Cave on Twitter