1855: Duchenne proves diaphragmatic theory of asthma

Fig. 1: Guilluame Benjamin Amand Duchenne
(1806-1875) was the first physician to treat
nervous and muscular diseases with electric shock
 therapy. He was, therefore, the founder of
electrotherapy. (1, page 690)

In 1840 and 1855 respectively, William Budd and Alton Wintrich disproved the convulsive and nervous theories of asthma.  Guillaume Benjamin Amand Duchenne was a French neurologist who, unaware of the works of Budd and Wintrich, proved Budd right in 1855 --or so he thought.

Amand was born on September 17, 1806, to a family of seafarers at Boulogne, so it only mades sense his father wanted him to become a sailor Amand,  on the other hand, had a passion for science that he believed sailing would not satiate.   (1, page 690)(2)

So instead of sailing, he attended school at Paris, and among the physicians he trained under was Rene Laennec, the man who invented the stethoscope. Armand graduated in 1831 with a medical degree, practiced in Boulogne for a few years, and then in 1842 he moved to Paris where he dedicated his life to neurology (the study of nerves) and electrophysiology (the study of electrical properties of cells and tissues). (1, page 690)(2)

Medical historian Fielding Hudson Garrison described Duchenne as follows: 

Fig. 2: Michael Faraday (1791-1867) came from
poor parents and received little formal education.
In 1831 he invented the technology needed to
that would allow him to turn it to good use.  He
invented electromagnetic induction, and created
the basic ideas behind the electric generator and
transformer.  He coined words like electrode,
cathode, and ion. Named after him is faradisation,
or a method of applying electric currents to cells
of the body for medical reasons. This, along
with galvanization, were early means of
applying electricity to various parts of the body
for study. (4)(5)

His method of prosecuting his studies was peculiar. A strange, sauntering, mariner-like figure, he haunted all the larger Parisian hospitals from day to day delving into case-histories, holding offhand arguments with the internes and physiciansin-chief, who frequently laughed at him for his pains, and following interesting cases from hospital to hospital, even at his own expense. All this was done in an unconventional and eccentric way, which at first laid him open to suspicion and exposed him to snubs, but the sincerity of the man, his transparent honesty, and his unselfish devotion to science for itself, soon broke down opposition, and, in the end, when his reputation was made, he was greeted everywhere with the warmest welcome. Being timid and inarticulate in relation to public speaking, he was aided by his friend, the fair-minded and generous Trousseau, who, out of fondness for Duchenne, often voiced his ideas with effect in medical societies. (1, pages 690-691)

Through his intricate study of the nervous and muscular systems of the body, he became the first to describe many nervous and muscular diseases that plagued mankind (such as a disease that later became known as Duchenne's Muscular Dystrophy), and he became the first to use electric shocks as a treatment of these diseases.  (1, pages 691-692)(2)

As an expert on nerves and muscles it only made sense that he would study asthma, which, at that time, was considered a nervous disorder.  J.B. Berkard, in his 1878 book, "Asthma: It's Pathology and Treatment," said:

Fig: 3: Duchenne was the first to use electric shock therapy
to treat patients with nervous and muscular disorders,
such as paralysis and hypochondria. He used
faradisation or galvanization to shock or stimulate
specific muscular or nervous cells. While often effective,
it was also very painful for the patient (4)(5)
(Photo from 8, cover page. Caption underneath
reads: "Duchenne, faradising the frontal muscle."

Duchenne demonstrated that faradisation (see figure 2) of the phrenic nerve caused tetanus of the diaphragm. In the animals experimented upon, that operation was followed by distension of the lower half of the thorax, projection of the epigastrium, and extreme dyspnoea, the frequency of respiration being at the same time considerably diminished. Death, however, invariably followed when the electrical irritation of the nerve was continued for more than a few minutes. Unacquainted with the opinions of Budd and Wintrich, Duchenne was at first inclined to attach no importance to his discovery, because he thought a tetanus of the diaphragm was not as yet known to occur in man. Vallette, however, subsequently met with and reported a case of acute articular rheumatism, in which a fatal attack of dyspnoea had lasted for several days uninterruptedly, and from the symptoms of which he distinctly recognised a tetanus of the diaphragm. Duchenne thereupon concluded that a tonic spasm of this muscle was the main cause of the asthmatic paroxysm. (2, page 35)

By these experiments, he therefore unknowingly verified the evidence of Budd and Wintrich in disproving the nervous and convulsive theories of asthma, and proving the diaphragmatic theory of asthma.

Near the end of his life he developed arteriosclerosis of the brain, and he passed away on September 15, 1875. He was 69 years old. (1, page 669)(6)

Note: So the diaphragmatic theory of asthma has been supported by Budd, Wintrich, and Duchenne.  The next, and final, supporter will be Bamberger.

Note: You can view Duchen's book here. 

References:

1. Garrison, Fielding Hudson, "An introduction to the history of medicine," 3rd edition, 1821, Philadelphia and London, W.B. Saunders Company
2. Berkart, J.B., "On Asthma: It's pathology and treatment," 1878, London, J. & A. Churchill
3. Brown, Orville Harry, "Asthma, presenting an exposition of nonpassive expiration theory," 1917, St. Louis, C.V. Mosby Company, page 34
4. "Michael Faraday," http://www.bbc.co.uk/history/historic_figures/faraday_michael.shtml, accessed 3/5/14
5. "1830s Electromagnetism and Faradisation," http://www.theiet.org/resources/library/archives/exhibition/medical/electromagnetism%20.cfm, accessed 3/5/14
6. "Guillaume Benjamin Amand Duchenne," britannica.com, http://www.britannica.com/EBchecked/topic/172882/Guillaume-Benjamin-Amand-Duchenne, accessed 3/5/14
7. Duchenne, Guillaume Benjamin Amand Duchenne, "Selections from the clinical works of Dr. Duchenne," translated, edited, and condensed by G.V. Poore, 1883, London, New Sydenham Society 
8. Poore, G.V., "A short sketch of the life and work of Duchenne," in the book "Selections from te clinical works of Dr. Cuchenne," edited by G.V. Poore, 1883, London, New Sydenham Society, pages IX-XX

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1854: Dr. Wintrich almost disproves spasmotic theory of astma

After Charles J. B. Williams and Francois Longet performed experiments that seemed to prove the spasmotic theory of asthma, the theory "met with little opposition" until, in 1854, M. Alton Wintrich performed experiments of his own aiming to prove it wrong, said W.H. Geddings, in an 1885 article.  (1, page 194) 

Geddings wrote: 

The theory that asthma is due to spasm of the bronchial muscles met with but little opposition until 1854, when Wintrich, after a series of experiments, arrived at conclusions directly opposed to those of Williams and Longet in regard to the contractility of the muscular fibres of the bronchi, and refused to accept the spasm theory on the ground that it afforded no rational explanation of the phenomena of asthma. He believed that the various symptoms of that disease were due to tonic spasm (tetanus) either of the diaphragm alone or of the diaphragm and the other muscles of respiration. These experiments of Wintrich were so carefully conducted, and his standing as a specialist in respiratory diseases so high, that his theory found many supporters, and might perhaps have been generally accepted had it not been for the distinguished French physiologist, Paul Bert, who in 1870, with improved methods of scientific research, succeeded in demonstrating that Williams and Longet were after all correct in their statements as to the contractility of the bronchial muscles. (1, page 194)

While Wintrich tried hard to reproduce spasm of the bronchial tubes by irritation of the vagus, he never succeeded.  He therefore concluded that his studies disproved the spasmotic theory of asthma, and therefore the nervous theory of asthma. (3, page 34)(4, page 4)

Wintrich, however, does not deny completely that bronchial muscles are a part of the asthma response, simply not the the extent that other physicians claim. When broncospasm occurred, it was secondary to tonic spasm of the diaphragm, that bronchospasm was due to "disturbance of innervation," said Dr. J.B. Berkart in his 1878 book.

In other words, when bronchospasm occurred, it occurred as a result of irritation of one part of the body (such as the diaphragm) effecting the nerves that lead to another organ (such as the lungs or glottis). So, he concluded, the underlying cause of asthma was not bronchospasm, but diaphragmatic spasm.  (3, page 34)(4, page 4-5)

Ernest Shmiegelow, in his 1890 book, summed up the theory of Wintrich best:

Wintrich...thinks that asthma can be explained by a tonic spasm of the diaphragm alone or combined with the respiratory muscles... Only a tonic contraction of the diaphragm can explain the deep immovable position it occupies in many cases of nervous asthma. (4, page 5)

The ideas of Wintrich were later confirmed in 1870 by the experiments of Heinrich von Bamberger (1822-1888).  

Berkart explained: 

In a case of fatal dyspnoea he had occasion to observe the tetanus of the diaphragm, and to convince himself by post mortem examination of the absence also of structural lesions. Although the symptoms of that case by no means resembled those usually assigned to asthma, he, nevertheless, regarded them as characteristic of the disease. " (3, page 36) 

Guillaume-Benjamin-Amand Duchenne was a French neurologist who seemed to support the diaphragmatic theory by his own experiments.  Of this, Berkart said:

Duchenne demonstrated that faradisation of the phrenic nerve caused tetanus of the diaphragm. In the animals experimented upon, that operation was followed by distension of the lower half of the thorax, projection of the epigastrium, and extreme dyspnoea, the frequency of respiration being at the same time considerably diminished. Death, however, invariably followed when the electrical irritation of the nerve was continued for more than a few minutes. Unacquainted with the opinions of Budd and Wintrich, Duchenne was at first inclined to attach no importance to his discovery, because he thought a tetanus of the diaphragm was not as yet known to occur in man.. Duchenne thereby concluded that a tonic spasm of this muscle was the main cause of the asthmatic paroxysm. (3, page 35)

Wintrich wasn't the first asthma expert to consider the idea that the diaphragm might be responsible for asthma, as Dr. Thomas Willis considered this idea back in the 17th century. (4, page 4)

Another physician to consider the idea (which we refer to as the diaphragmatic theory of asthma) was William Budd.  He performed experiments in the 1840s that he believed disproved the spasmotic theory, and instead proved the diaphragmatic theory.

So the diaphragmatic theory of asthma stayed alive for a few more years, although it would ultimately be disproved once and for all by the experiments of M. Alton Biermer in 1870.

Note:  Other physicians who supported the diaphragmatic theory of asthma were Dr. Neuman (4, page 4) and Dr. Vallette.  (3, page 35)

References:

1. 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.
2. Brown, Orville Harry, "Asthma, presenting an exposition of nonpassive expiration theory," 1917, St. Louis, C.V. Mosby Company
3. Berkart, J.B., "On Asthma: It's pathology and treatment," 1878, London, J. & A. Churchill
4. Shmiegelow, Ernst, "Asthma, considered specially in relation to nasal disease," 1890, London, H.K. Lewis
5. Thorowgood, John Charles, "Notes on Asthma," 1878, 3rd edition, London, J and A Churchill

You can view the 1865 book of M. Alton Wintrich, "Ueber asthma nervosum" by clicking here.

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1840: Dr. Williams proves spasmotic theory of asthma

Charles J. B. Williams (1805-1889)

Healthcare workers may recognize the name Dr. Charles James Blasius Williams because he was the first person to use the terms "lub-dub" to describe the sounds emitted by the two chambers of the beating heart.  This is what history best remembers him for.

While this fact is definitely important to our history, what we are mostly interested in is the fact that Dr. Williams was the first person to effectively prove the spasmotic theory of asthma by discovering that the muscular fibers that wrap around the air passages may spasm under certain conditions.

According to his own memoirs, Williams was the youngest of nine siblings. His mother was the eldest daughter of a respected surgeon, whose name was also Williams. She died shortly before her son Charles started college at Edinburgh University in 1820.

Despite Williams proof that the certain stimuli may cause the air
passages of the lungs to spasm, some physicians continued to
argue this in no way proved this had anything to do with asthma.
Other physicians, however, believed this proved nervous asthma
caused spasms of the air passages.  The above picture shows
how far science expounded upon the experiments of Williams
in the years between the publication of his work in 1840 and
the publication of Dr. Henry Hyde Salter's 1860 book,
Asthma: It's Pathology and Treatment." The caption under
the picture read: "Diagram showing the four ways in which the bronchial tubes may be narrowed.
1. Bronchial catarrh. 2. Recent bronchitis. 3. Old bronchitis 4. Asthma.  (6, page 39)

His father was Rev. David Williams, who came from an eminent family of many teachers and scholars. Along with being a Reverend, his father was also a successful tutor, having "prepared several gentle men for the university, who have since attained distinction as scholars." He educated his son at home until he was accepted at Edinburgh University in 1820, where he began his pursuit to become a physician. (1, page 1, 6, 9)

Williams credited his father with exposing him to subjects he wouldn't have been exposed to had he attended the public schools, subjects which would help him in his later endeavors, such as "Geography, History, Biography, Natural History, and above all, Natural Science." (1, pages 2-3)

Williams would have learned about Franz Reisseissen, who discovered in 1808 that muscular fibers wrap around the air passages of the lungs.  He would have learned about Rene Laennec, who believed Reisseissen's evidence was proof enough of both the spasmotic and nervous theories of asthma.

J.B. Berkart, in his 1878 book "On Asthma: It's Pathology and Treatment," said: (2, page 17)

Laennec assumed that they, being muscles, were endowed with contractility, and therefore liable to spasm. Such a spasm, he thought, might probably have been the cause of that fatal dyspnoea; but whether this supposition were correct or not, the case itself seemed to indicate the existence of a nervous asthma. Yet, notwithstanding the negative results of physical diagnosis and post mortem examination, he had doubts on the subject. Hesitatingly he admitted spasmodic asthma, with this limitation, however, that it generally consisted of nervous and organic affections combined.(2 page 17-18)

He would have been well aware of the evidence in support of the nervous theory of asthma, that asthma is a neurosis of the respiratory organs, that came from the papers of Francis Ramadge in 1835, the essays of Joseph Bergson and Amedee Lefevre in in 1836, and the verification of this evidence by the experiments of Moritz Romberg in 1841.   (4, page 506)

Williams must have been aware of these studies, and believed this evidence was too overwhelming not to support the nervous theory of asthma.

Yet other physicians did not believe this was enough evidence to support any theory, especially Dr. William Budd, who performed experiments in 1840 that he believed disproved the spasmotic theory AND the nervous theory of asthma.

Yet our doctor Williams would have something to say about Dr. Budd's experiments.  Dr. Williams would prove them wrong, and he did it that same year: in 1840.

Dr. Berkart explained:

As the bronchial contractility was denied as often as asserted, Dr. C. J. B. Williams again took the question in order to settle the matter in dispute. He, indeed, succeeded in showing, by experiments conducted with all necessary precautions, that mechanical, as well as chemical and electrical stimuli do produce contraction of the air-tubes. Thus the theory of a bronchial spasm obtained the support of experimental physiology. And even those who until then wavered in their opinions as to the possibility of such a spasm saw now no reason for doubting, but readily accepted that doctrine.  (2, page 26)

Still, while Reisseissen discovered that muscular fibers wrap around the air passages, and while Williams proved that they may spasm under certain circumstances, this did not prove that they spasmed during an asthma attack. (3, pages 193-194)

Berkart said:

Yet one link was wanted to complete the chain of evidence in favour of a bronchial spasm. As yet nothing was known of the innervation of the bronchi. Irritation of the vagus had produced no effect upon their calibres, and Dr. Williams was therefore led to conclude that "the muscular fibres seem not to be excitable through the nerves of the lungs."(2, page 26)

This evidence would also come in 1840 by the experiments of Dr. Francois Achille Longet.  

Williams was among the physicians of his era to support that idea that the definition of asthma was too vague, including too many ailments that cause symptoms similar to asthma yet have nothing to do with the lungs.  He therefore wanted to simplify the definition. 

Berkart said:

Dr. Williams himself, assuming a plus and minus state of contractility, described two forms of asthma—the one spasmodic, the other paralytic. The former was supposed to be represented by the isolated attacks of dyspnoea which generally accompany emphysema; the latter by those which appear in connection with chronic pituitous catarrh. (2, page 26)

Wolff Freudenthal, in his 1917 article in A Weekly Review of Medicine titled "Bronchial Asthma, said:

In 1841, Doctor (J. B.) Williams, in Tweedie’s Dissertations of Diseases of the Organs of Respiration, describes two forms of asthma—a spasmodic and an atonic or paralytic form. He found “that defect of these properties (excessive contractibility of the bronchial tubes) would disorder the process of breathing, and is led to believe that there may perhaps be a nervous asthmaor dyspnea “from weakness or paralysis of the circular fibres, or of the. nerves which regulate their contractions.” (5, page 2)

Williams was correct that asthma needed to be redefined, yet his most impressive contribution to the history of asthma was his experiment proving that the muscular fibers that wrap around the lungs may contract when irritated by certain stimuli.

Surely his experiment didn't prove the spasmotic thoery of asthma, yet it made this theory look highly probable.  His experiment met with little opposition for the next 14 years (Wintrich, 1854), and would be noted by nearly every physician writing on the subject of asthma for the rest of the century.   

References:

1. Williams, Charles J. B., "Memoirs of Life and Work," 1884, London, Smith, Elder, & Co. 
2. Berkart, J.B., "On Asthma: It's Pathology and Treatment," 1878, London, J. & A. Churchill
3. 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.
4. Whitaker, James Thomas, "The theory and practice of medicine," 1893, New York, William Wood and Company
5. Freudenthal, Wolff, "Bronchial Asthma," New York Medical Journal: A Weekly Review of Medicine, edited by Edward Swift Dunster, James Bradbridge Hunter, Frank Pierce Foster, Charles Euchariste de Medicis Sajous, Gregory Stragnell, Henry J. Klaunberg, Félix Martí-Ibáñez, volume CV, January-June, 1917 (Saturday, January 6, 1917), New York, A.R. Elliot Publishing, Co., pages 1-5
6. Salter, Henry Hyde, "Asthma: It's Pathology and Treatment," 1864, Philadelphia, Blanchard and Lea

Further reading:

1. 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.
2. Biermer, Anton., "On Bronchial Asthma," in the book, " Clinical Lectures on Subjects Connected with Medicine Connected with Medicine, Surgery, and Obstetrics," by various German authors, 1866, London, New Sydenham Society,  pages 171-194
3. Williams, Charles James Blasius, Alexander Tweedie, William Wood Gerhard, "Tweedies dissertations of diseases of the organs of respiration," 1841, London, Lea and Blanchard

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