1860: Dr. Salter's Asthma Features

What makes one case of asthma similar to another?  This was a subject Henry Hyde Salter took up in writing his infamous book about asthma in 1869 called "On Asthma: It's Pathology and Treatment."  So what follows are the general features, or principles, of asthma.

1. Periodicity: "The paroxysms occur at regular and definite intervals or periods.  Such periods can be a day, a week, a month, or a year.

• Random:  In some cases the periods vary a great deal, in some it is lost entirely.  It is impossible to predict when they will occur
• Regular:   When the attack will occur can be "predicted with the greatest certainty and never fails to occur at the right time. They occur regularly under:
• Certain cycles (as in at a certain time of year, such as summer, winter, and fall asthma)
• Recurrence of certain conditions either external or inside the body (monthly period, eating full meal every Sunday, hay fever season)

2.  Tendency to habitude: "A disposition to maintain and constantly repeat any peculiarity it may have acquired." This means the same external conditions, and removal of the external condition remedies the asthma. This means that every time it occurs, the patient can predict what will happen to him and what remedy will fix him.   The benefit of this "is the asthmatic becomes 'up' in his own case; every symptom is an old acquaintance to him; her recognizes the slightest indications; and can predict every event of his disease exactly as it will happen; he knows when an attack is coming on long before others can see any sign of it; he knows when it will go off; he soon comes to learn, too, by this exact repeated experience, what he may do and what he may not; what will do him harm and what good; and thus often becomes his own best physician."  He learns whether the attack will come on during the night or day, the time, the length of time, and the remedy.  A physician can actually get some reliable hints from his patient as to what to do. The best remedy may be breaking the chain of repetition, such as relocation to London for example.

3. Change of Type: Slow gradual changes occur in the characteristic of the disease over time, "brought on by slight and almost imperceptible variations in these recurrent phenomena.  You may see a change in type, periodicity, and habitude.  The attacks may become more severe or less severe.  Their character may change, time of day they occur may change, length of time they last may change, the symptoms may change and remedies also may change.

4.  Capriciousness:  "It is always puzzling its victim and his friends by the exhibition of some unexpected vagary; giving him pleasant and unpleasant surprises, raising his hopes and then disappointing them, and altogether confounding his calculations." Each case of asthma is capricious, and every case of asthma is capricious in itself (no two cases of asthma are the same).  One case may get better in humidity, another worse.  One case may get worse with ipacec, another better. One is worse in winter, another summer, another all year.  "One flies from the place another seeks." In one nitre-pater is the cure, in another it does nothing. Strammonium works for some, and not for others. (There is no better example of the caprice of asthma than the exciting causes of asthma, as what may excite one person's asthma, may not excite another's asthma. 1, page 77)

5.  Time of life of first access: "There appears to be no time of life at which asthma may not make its appearance -- from the earliest infancy to old age." These cases have a tendency to be pure asthma.  However, most cases of asthma have a tendency to form in the early stages of life. Those with the lowest risk of developing asthma are between 40 and 60 years of age. The time asthma develops has a direct correlation with the causative agent, as the person may never have been exposed to hay until he is, say 39.  At which point the disease makes its appearance.

• Early life: The cases that come on earlier in life are usually due to "bronchiolar disorders of childhood... that causes a sensitive bronchial mucous membrane, some pulmonary collapse, and emphysema." 
• Infantile bronchitis
• Measles
• Whooping Cough
• Etc.
• Later life: Asthma that comes on later in life has a tendency to be caused due to some organic changes in the lungs or body, such as cardiac asthma, kidney asthma, or chronic bronchitis. Many cases of elderly asthma are actually chronic bronchitis (an old man coughs, wheezes and spits). 

6.  Influence of Sex:  While both sexes are prone to develop asthma, you are twice as likely to get it if you are a male.  One theory is that men have a "greater proclivity to asthma on the part of the male nervous system than the female." However, Salter does not believe this.  He has a tendency to believe another theory, that  men are more likely to be exposed to the hardships of life:

• Inclemencies of the weather (cold and wet weather)
• The wear and tear of hardships of life (stressful jobs, night working)
• The stress of violent and sustained respiratory efforts (heavy labor, intemperance)

7.  Hereditariness: Salter notes that "I think there is no doubt that it is."  He states that " In all diseases a certain number of cases will be found in which, on the mere doctrine of chances, the parents, or other members of the family, have been similarly affected." Based on his studies, it is hereditary on the "proportion of two to three."  There are a variety of members of the family who may have had asthma in the past, such as:

• Inherited from the father
• Father a confirmed asthmatic
• Father a confirmed asthmatic, brother suffers from hay asthma.
• Grandfather a confirmed asthmatic.
• Brother and paternal grandmother asthmatic.
• Father, two paternal uncles, and paternal grandfather.
• Paternal sister died of it.
• Father died asthmatic at forty-seven.
• Several indirect branches of the family asthmatic, but neither parent.
• Mother slightly asthmatic, maternal grandmother severely.
• Grandfather now suffers from asthma.
• Grandfather and uncle both asthmatic.
• Sister and paternal grandmother asthmatic, brother with hay asthma.
• Inherited from the mother:
• Mother asthmatic
• Two brothers, and uncle, and a nephew.
• Mother, grandfather, two sisters, nephew, and grandchild asthmatic.
• Grandfather, great-grandfather, two great aunts, two of his

And such are the features of asthma s recorded by Dr. Salter.

References:

• Salter, Henry Hyde, "On Asthma: It's Pathology and Treatment," 1882, New York, William Wood and Company, pages 47-60

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1811: Frank insists asthma is periodic

Johan (John) Peter Frank (1745-1821)

During the last half of the 18th century, a time when nosological systems were being framed, most physicians confused asthma with other causes of dyspnea and angina (chest pain).  One physician who did not do this was Dr. Johan (John) Peter Frank, said Joseph Bergson in 1851.  

According to britannica.com, Frank was born in Germany in 1745, and died in Vienna in 1821.  He studied at Heidelberg and Strasbourg. He became physician at Rastadt in 1769, professor at Göttingen (the school made famous by Haller) in 1784, and professor at Privia in 1785.  He held a couple other jobs before opening a practice at Vienna in 1811. (5)

Being that the second half of the 18th century was dedicated to nosology, or classifying diseases, Frank joined in on this quest, becoming known for is systematising of everything known about public health at that time.  He was among the first physicians to endorse the international regulation of health problems, according to britannica.com.   He likewise "endorsed the notion of 'medical police,' whereby one of the duties of the state was to protect the health of its citizens."(5)

He is often referred to as the founder, or father, of public health.  Along with being a physician, he also spent time as a teacher of physiology, pathology, forensic medicine, and public health. (6, pages 81-82)

His most significant book was System einer vollstandigen medicinischen Polizey published in 1784, and it was his systematisation of public health wisdom, and it made him quite famous.  In fact, is was due to this work that he was offered his jobs at both Rastadt and Göttingen. (6, pages 81-82)

As part of his writings he took some time to note what he thought about asthma. He wrote, via a review by G.H. Hill, the following in Latin: 

"Asthma non habetur solum pro respiratione anxia cum sibilo et stertore, sed exposcit, ut simul periodice recurrat, libera prebeat intervalla et nullius alterius evidentis morbi sit symptoms." (1, pages 374-375)

By running that quote through Google Translate, we get the following:

"Asthma is not the only breathing with a hiss and stertore anxious, but insisted that they periodically return provides free intervals and no other obvious disease is a symptom."

He basically said that asthma is not just a disease of wheezing and noisy breathing, but is a disease that occurs periodically.  When it does occur there are no obvious symptoms of disease, meaning there are no apparent scars or organic lesions on the body or lungs.

Dr. G. Lingen, in 1839, quotes him as saying:

"In asthmate, ut nominant, puerili, glandulas bronchioles, praeter sanitatis modum, turgidas, maxime verothymum insigniter tumefactum invenerunt anatomici: ita quidem ut totam fere anterioris pectoris regionem ille occupaverit, &c." (2, page 208)

Running this through Google Translate we get:

"In the asthma, to name, childish, glands of bronchioles, in addition to health manner of it, turgid, but especially the thyme and remarkably swollen with pride and they found a anatomists, even so, indeed, as he had taken possession of almost the whole of the anterior region of the breast, & c." 

He basdically said asthma results in swelling and congestion of the air passages of the lungs.

He also referred to asthma as "asthma thymicum," or spasm of the glottis.  It was periodic, and occurred frequently in children.  He, therefore, was probably referring to croup, or dyspnea caused by swelling of the vocal cords. He is essentially describing croup in children. (2, page 208) (3, page 202)

Frank wrote a book called De curandis hominum morbis epitome: praelectionibus academicis dicata, or "The curing of diseases, summarize, academic lectures devoted to the clinical," in 1811.

References:

1. Gill, M. H., "Review and Bibliographic Notices: "On the spasmotic asthma of adults," by Joseph 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
2. Lingen, G., "A Case of Asthma Thymicum Koppi, or Laryngismus Stridulus Anglorum, Crowing or Croup Like Inspiration," in the book "Miscallanies of Homeopathy," edited by an association of homeopathic physicians, 1839, Philadelphia, L. J. Kinderlen, pages 207-210
3. Stokes, William, "A Treaties on the Diagnosis and Treatment of the Chest," 1837, Philadelphia, A. Waldie
4. Rush, Benjamin, "Letters of Benjamin Rush," in this book Rush describes who Mr. Frank was and what he thought about asthma
5. Johan Peter Frank, britannica.com, http://www.britannica.com/EBchecked/topic/217186/Johann-Peter-Frank, accessed 1/19/14
6. Sigerist, Henry E., translator and author of the introduction, "The People's Misery: Mother of Diseases, An Address Delivered in 1790 by Johann Peter Frank, http://www.deltaomega.org/documents/mother.pdf, accessed on 1/18/14

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