1808: Reisseissen discovers smooth muscles along air passages

Samuel Thomas von Sommering (1755-1830)
was a German physician and anatomist who,
confirmed Reisseissen's discovery. (6, page 4)

Dr. Franz Daniel Reisseissen (1773-1828) was a German physician who studied the lungs, and proved that smooth muscles line the air passages. This was a significant discovery, and set the stage for later physicians to prove the spasmotic theory of asthma.

He performed experiments in 1808, and the results were published as essays in Berlin in 1822.  (1, pages 196-197)

W.H. Geddings, in the 1885 edition of A System of Practical Medicine, said Reisseissen discovered...

...smooth muscle fibres of the bronchial tubes. These fibres are found not only in the large and medium-sized bronchi, but even in those of the smallest calibre."(2, page 185, 193)

Emanuel Aufrecht (1844-1903)
attended school in Berlin
and was a student of Ludwig Traub
and Rudolf Virchow.
He graduated from medical school in 1866.
He became a physician at
 Magdeburg-Alstadt City Hospital in 1868,
and physician in chief of Internal Medicine
at Magdeburg in 1879.
He worked out the arrangement
of the bronchial muscle fibres. (7, page 163)
While chief of clinical medicine at Magdeburg,
he published a book with his colleagues in 1902
called "Diseases of the Bronchi, Lungs and Pleura."
(8, title page)

Gedding said the discovery was "The first step toward a truly scientific theory of the pathology of asthma."

Without his discovery, none of the discoveries that readily proved asthma was spasmotic would have been possible, including those of Charles J.B. William and Francois Longett.

Rene Laennec, in his 1819 book "Mediate Auscultation" said there were various theories as to the structure of the lungs prior to Reisseissen's discovery.  For instance, Laennec said: (3, page 154)

(Marcello) Malpighi conceived that the air cells (later to become known as alveoli) were formed by the inner membrane of the bronchi being divided, previously to their termination, into cells like those of a sponge. Helvetius fancied that he had ascertained by direct experiment, that the air cells were formed by a simple cellular tissue, disposed without any regular order, and derived from the cellular envelopes of the various vessels by which the lungs are traversed. (Albrecht von) Haller entertained almost the same opinion, which is, indeed, that of the greater number of anatomists. (3, page 154)

M. Varnier confirmed Reisseissen's experiments
that the bronchi may constrict when stimulated.
He believed "irritating fluids or fumes forced
into the lungs caused contraction therof."
There were also various other physicians
who confirmed Reisseissen's experiment,
including: Prochaska, Gotfried, Reinhold,
Treviranus, and Wedemeyer
(6, page 4)(7, page 27)

The speculation ended when, according to Laennec, Reisseissen...

...by means of a great many microscopical observations and mercurial injections, has ascertained that the bronchi, at their extremities, are subdivided into a multitude of small canals, terminated by cul-de-sac of globular form, grouped somewhat in the manner of terminal branchlets of cauliflower. (3, page 154)

John Forbes quoted Reisseissen as saying...

... that, although it appears difficult to follow the muscular fibres further, analogy leads us to admit their existence in the smaller branches, and perhaps even in the aircells. (4, page 186)

Dr. J.B. Berkart, in the 1878 edition of his book "On Asthma: It's Pathology and Treatment, said that while Reisseissen was aware of muscular fibres surrounding the large and small air passages, their function remained a mystery to him. (5, page 17)

The significance of these muscular fibres has still not been determined as of this writing, as I explained in my post "Asthma: The Appendix of the Lungs.

However, the significance of their impact on asthma lead to a massive search that would last for the duration of the 19th century. The hunt was on to learn more about them and what they did. This task was begun by Charles J.B. Williams and Francois Longett.  Yet the debate would continue on for the duration of the century.

References:

1. Addison, Thomas, J.M. Bourgery, and George Rainey, "On the air cells of the lungs," The Edinburgh Medical and Surgical Journal, volume 69, 1848, pages 192-214
2. 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.
3. Laennec, Rene Theophile Hyacinthe, "A treaties on the diseases of the chest, and on mediate auscultation," translated by John Forbes, 1838, New York, Philadelphia, Samuel S. and William Wood, Thomas Cowperthwaite and Company
4. Forbes, John, ed., "The Cyclopaedia of practical medicine," 1833, volume 1, page 186
5. Berkart, J.B., "On Asthma: It's pathology and treatment," 1878, London, J. & A. Churchill
6. Shmiegelow, Ernst, "Asthma, considered specially in relation to nasal disease," 1890, London, H.K. Lewis
7. Brown, Orville Harry, "Asthma, presenting an exposition of nonpassive expiration theory," 1917, St. Louis, C.V. Mosby Company
8. Hoffman, Friedrich Albin, Ottomar Rosenbach, Emanuel Aufrecht, writers, John H. Musser, editor, Alfred Stengel, translator, "Diseases of the Bronchi, Lungs and Pleura," 1902, Philadelphia, New York and London,asthma history, COPD history, inhalation therapy history, medical history W.B. Saunders and Company. 

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1800: Albrecht von Haller studies respiration

Albrecht von Haller (1708-1777)

Albrecht von Haller was not an asthmatic, although he was a sickly in his youth, and this would force him to focus on his studies.  He would become among the most brilliant minds of his era, and what he accomplished had a great impact on the evolution of many diseases, including asthma.

He was born in Bern, Switzerland, in 1708.  His biographer, Charles Bert Reed, said:

"Like many other men of genius, his infancy was sickly and feeble. He had rickets, which retarded his physical, even as it accentuated his mental, development. Driven in upon himself for entertainment, he studied, read, and drew designs at the precocious age of four." (6, page 17)

It was observed from a very young age that he was a genius. Reed said:

As with Mozart, Macaulay, Goethe, Leibnitz, and others, the most extraordinary things are told of Haller's ability and greed for knowledge. During his childhood he outstripped all his companions. By the end of his ninth year he was thoroughly familiar with the Greek Testament. He made a lexicon of the Greek and Hebrew words in the Old and New Testaments, with their different roots and meanings. He made a grammar of Chaldee. He assembled the lives of 2000 celebrated people, on the model of Bayle and Moreri, whom he had read. Unlike most boys he preferred long and exhaustive treatises with interminable sentences and no paragraphs. His unusual industry, his fiery zeal to educate himself, and his unlimited patience seemed to make nothing impossible. He, also, "took all knowledge for his province.'' (6, page 17-18)

He early began to exhibit the exceptional understanding, the unfailing memory, the tireless industry and the impulses thereto, that characterized his entire life. He entered upon his emotional period at the age of twelve. At this time, while sick with smallpox, he was inspired with love toward the young lady who read aloud to him, and to her he dedicated his first poem. It was written in French, and appropriately named "The Resolution to Love." (6, page 18)

After the death of his father, Haller moved nearer the city and entered the gymnasium. His thesis for admission was in Greek, although Latin was sufficient. He wrote much and after the manner of all aspirants to eminence he aped sedulously the form of some admired exemplar. Homer, Horace, Ovid, and Virgil were his familiars. Homer for romance and Virgil as the model for his verses. Being chained to his room often and long by reason of his feeble constitution, he took refuge in poetry, which he read and practiced in all the tongues he knew. He wrote poems of occasion, tragedies, translations of Ovid, Horace, and two books of Virgil, together with an epic of 4000 lines on the'' Origin of the Swiss Union of States." (6, page 18)

His father had wanted him to go into the ministry. However, when he was fourteen, and after his father died, he moved in with a friend of the family at Biel who happened to be a physician. This man had an impression on a young Haler, and inspired him to go into the medical profession. (6, page e18)

After a year at Biel, he went to Bern to start his medical education, then to Tubingen, and then to Holland where he studied at Leyden.  There he became a student of Herman Boerhaave, the leading medical professor of the era.  It was probably from Boerhaave that Haller would have learned as much about the respiratory tract and respiratory medicine as was available at that time. (6, page 18-19) (2, page 143)

Medical historian Thomas Bradford said he had such a zeal for anatomy that, while at Tubingen, he dissected dogs, and, at Leyden, he purchased half a body for dissection.  He also "engaged in grave robbing, and betrayed by the stench that arose, was obliged to flee." (2, page 143)

When he was 19 he showed senior Professor Coschwitz, who had dissected a new salivary duct.  Haller proved that it wasn't a salivary duct, it was a vein.  (1, page 322)(6, page 20)

In 1727, when he was only 19, he earned his medical degree.

So his gift of intelligence was evident at a very early age; he was a prodigy.  He would go on to become the greatest systematist (of medicine) since Galen, and one of the most imposing figures in all medical history," said Garrison.  He was "the master physiologist of his time." (1, pages 321-322)

He then traveled as part of his studies, and wrote poetry about nature along the way.  One of his poems, Die Alpen, was about his journey through the Swiss Alps in 1728, and it was finished in 1729, the same year he started his medical practice in Bern. The poem, along with several other poems he wrote, was published in his Gedichte in 1732. Die Alpen would end up being his most famous poem. (5)(6, page 21-23)

His book of poetry went through several editions, and, although some say it was quite popular, others contend that he wasn't the best poet.

In 1731 he gave lectures and demonstration at Basel, in place of his teacher. He then returned to Bern, "where his thorough knowledge, broad scholarship, and influential connections assured to him an immediate success," said Reed.  (6, page 27)

He added:

His practice increased, but he kept up his botanical enthusiasm. Ten miles a day he averaged over hill and valley in search of specimens, which he identified and wrote up in the evenings or during meals. Meanwhile his vast and various powers were fed with the most extensive, the most accurate, and the most elaborate study of botany, anatomy, and medicine. Not a moment was wasted. He reread the Greek and Latin writers wherever he happened to be—at the table, on promenade, and on horseback, and the major portion of his wedding day was spent upon an abstruse problem in Differential Calculus. (6, page 27)

He tried to get in as directing doctor at the University at Bern, and later as professor of history (he probably knew more history than anyone in Bern at the time), but he failed in attempts.    (6, pages 30-31)

At 26 he became professor of anatomy and director of the hospital at Bern. He became especially famous for his botanical and anatomical research, of which he earned the attention of King George II.  (2, page 143)(5)

King George II created Goettingin "in the hope it would surpass the universities of Halle, Leipzig, Wittenberg, and Helmstedt."  In 1736 King George II called Haller to the chair of professor of anatomy, surgery, chemistry and botany at this new university.  (2, page 143)(6, page 32-33)

His wife and his four children moved with him from Bern to his new home, and four weeks later his wife died.  The emotional stress of this even caused him to write another poem.

"Thy death, beloved, shall I sing? Ah, Mariane, what a theme! When sighs my words are mastering, And thought is but a troubled stream, That longing which for thee I feel, My constant needs intensify; The wounds within refuse to heal — Again I seem to see thee die. "My love too eager was, I know; But thou deservedst it and well; Thy form is mirrored in me so That all thy beauty I must tell. Each telling of this love for thee Some former joy recalls to mind; In part thou livest still in me, A tender pledge Love left behind."

In the meantime, Haller wrote many books, and some say he was so busy that he slept in a library, said Bradford. (2, page 143)

Bradford said he is often given credit as the physician to revive experimental physiology, or the study of the functions of living organism. This, according to Garrison, was a subject that was lacking since the great Galen studied medicine in the first century. (2, page 143)(1, page 322)

Garrison said Haller believed "the specific imminent property of all muscular tissue, and that sensibility is an exclusive property of nervous tissue or of tissues supplied with nerve. This classic research, based on 567 experiments, of which he himself performed 190, was made at Gottingen in 1757.  (1, page 323-324)

He believed that "the normal act of expiration hindered the flow of blood through the lungs," and "demonstrated that the lungs contracted when concentrated acid was applied to it."  (3, page 27)

He also performed experiments that would verify the spasmotic theoery of asthma, or at least that the muscular fibres that wrap around the air passages may spasm under certain circumstances. (4, page 4)

Haller was an avid athlete as a youth, and was burdened by sports injuries the rest of his life.  He was inflicted with a disease the Germans called Heimweh at the age of 45 in 1753, and retired to Bern for the remainder of his days, "leading a life of most varied activity as pubic health officer and savant, with a touch of 'Lord High Everything Else'." (1, page 323)

In the short time he spent as a physician, botanist, physioloist and anatomist, he earned the respect of his peers.  While most people simply forgot the man by the time the 20th century rolled around, his biographer Charles Bert Reed said that in his own time he was simply "surnamed the great." (6, page 14)

References: see "1870-1900: What asthma theory won the era?"

1. Garrison, Fielding Hudson, "An introduction to the history of medicine," 
2. Thorowgood, John C., "Asthma and Chronic Bronchitis: A New Edition of Notes on Asthma and Bronchial Asthma," 1894, London, Bailliere, Tyndall, & Cox
3. Brown, Orville Harry, "Asthma, presenting an exposition of nonpassive expiration theory," 1917, St. Louis, C.V. Mosby Company
4. Shmiegelow, Ernst, "Asthma, considered specially in relation to nasal disease," 1890, London, H.K. Lewis
5. "Albrecht von Haller," http://www.nndb.com/people/677/000096389/, accessed 1/10/14
6. Reed, Charles, Bert, "Albrecht von Haller: A Physician -- Not Without Honor," 1915, Chicago, Chicago Literary Club

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1800: Lipscomb tries to discredit Bree's asthma theories

While Dr. George Lipscomb may have had nothing against fellow physician, Dr. Robert Bree,  personally, he strongly opposed his ideas regarding asthma in his 1800 book  "Observations on the history and Cause of Asthma."

I have yet to be able to obtain a copy of Lipscomb's asthma book, nor a picture of it, nor a picture of the doctor himself.  I have, however, been able to learn a bit about him and his thoughts on asthma through the writings of other authors.

According to his obituary, he was born in Quainton (Queen's Estate) in England, on January 4, 1773, which, ironically, is the same birthday as my own, only 197 years earlier.  His grandfather was Thomas Lipscomb, who was a surgeon in Hampshire County, and died in 1791 at the age of 92. (5, pages 88-89)

The eldest son of Thomas was James, and he was a surgeon in the Royal Navy, and resided in Quainton from 1764 until his death in 1794.  James was the father of George.  So you can see that he was born into a family of surgeons, and so there was a high likelihood that this was going to be his trade.  (5, page 89)

George received his elementary instruction at Quainton School and transferred to Aylesbury in 1783, and then was educated at home for his "hereditary vocation." He then studied under James Earle in London in 1791, started his own business, and in 1792 became house surgeon of St. Bartholomew's Hospital (5, page 89)

In 1799 he wrote "An Essay on the Nature and Treatment of Putrid Fevers." He also wrote various other essays. In 1800 he published his book containing all his wisdom regarding asthma, which included a history of asthma and criticism of Dr. Bree. (5, page 89)

George Lipscomb would die in 1846.

Asthma historian Mark Jackson, in his book "Asthma: The Biography," said Dr. Lipscomb, while born London, practiced, like Bree, in Birmingham.  While he admitted to not knowing Bree and having nothing personally against him, his book was an ardent attack on Bree's ideas regarding asthma.

Jackson quotes Lipscomb as saying the intent of his book was to "elucidate the history of a very prevalent and distressing disease, which has been hitherto but ill explained, and very unsuccessfully treated (1, pages 86)

Jackson said Lipscomb argued against many of the ideas of Bree, "criticizing his vague terminology, denouncing his over-reliance on ancient authorities, disputing his speculations about the irritating qualities of serum or the morbid state of the pulmonary vessels, and dismissing his classification of asthma into four species." (1, page 87)

William Cullen, our asthma expert from the 18th century, said asthma was a disease of constriction of the lungs. Bree, however, believed this theory was disproved as soon as the lungs were inspected, as no signs of constriction were found in asthmatic airways, and copious amounts of sputum were found in these airways. This was proof, he said, that asthma was bronchitic and not spasmotic.

Jackson said Lipscomb believed that Bree could no more prove Cullen's theories were wrong than Cullen could prove them right, mainly because, upon death, the lungs automatically relax (1, pages 86-87)

In this way, because the lungs automatically relax, even if asthmatic air passages were constricted, they would no longer be constricted upon death.  So Lipscomb argued that, while Bree's argument is flawed, Cullens

While Lipscomb argued against Brees theories, he postulated some flawed theories of his own.  Jackson said:

Lipscomb replaced the theories of Cullen and Bee with speculations of his own. Accepting the primary role of mucus obstructing the air passages, Lipscomb argued that any bronchial effusion must have originated in the arteries of the lungs. However, in asthmatics, the accumulation of serum in the bronchi was not the result of weakened capillaries, as Bree had assumed, but the product of some irritating, acidic, 'acrid matter' in the blood, which induced the rapid pulse and dyspepsia characteristic of early asthma as well as the paradigmatic shortness of breath. Although Lipscomb admitted that the mechanism by which acids produced irritation remained to be elucidated, he nevertheless insisted that the formation of acid in the blood constituted 'the real cause of asthma': 'If, then, a definition of Asthma be required, I have no objection to call it, an excessive contraction of the respiratory muscles, excited by the irritation of acid serum effused from the pulmonary vessels into the vesiculae and bronchia.' 1, pages 87-88) (2, page 86) 

In the year 1800 a review of Dr. Lipscomb's book appeared in the Monthly Review or Literary Journal:  (17, page 310)

This publication, notwithstanding its promise, contains merely an attack on Dr. Bree's Enquiry. Some of the observations may be just, but they are so minute as to assume a captious appearance; and the strictures on Dr. Bree's language are certainly conveyed with an unnecessary degree of severity. After our large account of the Doctor's work in the Review for May last, it is needless to repeat our opinion concerning the style and arrangement of it: but we, should not have expressed ourselves in the manner of Mr. Lipscomb. In p. 89, Mr. L. sneers at Dr. Bree's account of acid perspiration; but, if he will consult Dr. Wilson's book on febrile diseases on the subject of sediment in the urine, he will find ample proof of the fact. It is not indeed peculiar to asthma, nor to any morbid state of the body.  We are sorry to learn, from Mr. Lipscomb's preface, that he has enemies, who have succeeded in lessening his professional engagements. Lest we should be deemed desirous of adding to his uneasiness, we shall decline any farther examination of his criticisms. (17, page 310)

Another similar criticism occurred in the British Critic:

In his Preface, this author complains heavily of a combination of' persons or circumstances, which has occasioned him much uneasiness, and obliged him, as he seems to say, to quit his profession; hence leisure has been afforded him to examine Dr. Bree's book on Asthma, which he criticizes with a considerable degree of acuteness, and, we will add, of asperity too; although he positively disclaims bearing any ill will to the author, or even knowing him, he says, either as a gentleman or as a physician. The points however on which he disagrees with Dr. Bree, are principally speculative, and relate rather to the supposed cause, than to the mode of treating Asthma; and as it will never be demonstrably proved, whether the asthmatic paroxysm is occasioned by the'mere weight or bulk of the serum effused into the cellular termination of the bronchial vessels, as Dr. Bree seems to think; or by the acrid, or rather acid, quality of the aforesaid serum, as Mr. L. believes, the public will not think itself much interested in the dispute; we shall therefore dismiss this article, earnestly hoping, for the fake of Dr.Bree, as well as the author, that the cause of his present chagrin may cease, although we much doubt whether the production before us will at all contribute to that desirable end. (4, page 559-560) 

So you can see that Dr. Bree's arguments were rather strongly accepted by the medical community, and this was mainly because it was easier for the medical community to hang on to antiquated theories than science.  In fact, Dr. Bree was so well respected, little Lipscomb had to say would hold much sway.

However, this would change in 1819 when the stethoscope was invented, allowing physicians to hear constricted airways by a procedure called mediate auscultation.
References:

1. Jackson, Mark, "Asthma: A Biography," 
2. Griffiths, Ralph, editor, "The Monthly Review or Literary Journal, Enlarged: from May to August, inclusive, M,DCCC," 1800, Volume XXXII, London, Printed by A. Strahan for R. Griffiths, and sold by T. Becket, "Article 25: Observations on the history and cause of asthma; and a brief review of 'A practical enquiry on disordered respiration:' in a letter to Robert Bree, M.D., the author of that work. By George Lipscomb, surgeon, at Birmingham."
3. Lipscomb, George, "Observations on the History and Cause of Asthma," 1800, Birmingham
4. "The British Critic, for July, August, September, October, November, and December, MDCCC," Volume XVII, 1800, London, Printed by J. Rickaby, "Art. 26:  "Observation on the History and Cause of Asthma, and a Review of a Practical Enquiry on disordered Respiration, in a Letter to Robert Bree, M.D., the Author of that Work, By George Lipscomb, Surgeon at Birmingham
5. Urban Sylvanus, "The Gentleman's Magazine," January to June inclusive, volume XXVII, 1847, London, John Bowyer Nichol's and Son, "Obituary: George Lipscomb"

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1820-1930: Pneumonia, the new "captain of the men and death

Thomas Addison (1793-1860

For most of human existence tuberculosis was known as the deadliest disease.  It was such a deadly disease by the 17th century, that John Bunyan (1628-1688), the famous author of "Pilgrim's Progress" referred to it as "the captain of men and death."  It wouldn't be until the early 20th century that tuberculosis would take a back seat to pneumonia.

While pneumonia has been present since the beginning of mankind, and the medical profession has been aware of it since the 5th century, little new information was learned about it.  It really wasn't until the end of the 19th century that physicians started to get a grasp on this disease.

Dr. Thomas Addison, a physician to Guy's Hospital in London,  was the first to write about pneumonia not being a disease that affected just the "interstices" of the lungs but the "air vessicles" themselves. (8, page 193)

Carl von  Rokitansky, a German physician, was the first to describe lobar pneumonia. (10, page 1308)

He said:

The red inflammatory product becomes gray and compact and indurated.  The air cells contract over the granulations, coalesce with them round their circumference, and become obliterated, their tissue being changed into a fibro-cellular structure, in which, from the similarity of their organization, the granulations are most probably also merged. (10, page 1308)

Various physicians described a pneumococcus associated with patients with lobar pneumonia.  (8,page 197)

Carl von Rokitansky (1804-1878)

In 1880 Sternberg found it in the saliva, and in 1881 Louis Pasteur discovered the same. (8, page 197)

In 1882 Ernst victor von Leyden and Gunther drew fluid from hepatized lungs of living pneumonia patients and discovered pneumococci in this fluid. (8, page 197)

Yet in all of these cases, the significance of the discovery went unnoticed.  (8, page 197)

It wasn't until 1875 that Edwin Klebs associated pneumonia with the bacteria, describing an "oval coccus" that he obtained from cases of lobar pneumonia. (8, page 197)(?)

A few years later Karl Friedlander and Hans Christian Gram started working together in the morgue of a hospital in Berlin and added to Klebs work by identifying the specific types of bacteria associated with pneumonia.

In 1882 Friedlander isolated streptococcus Pneunomiae in the sputum of a patient inflicted with pneumonia, and in 1884 Gram isolated Klebsiella Pneumoniae in the sputum of a patient  inflicted with pneumonia.

The procedure that Gram described when writing of his discovery was later called the gram stain.  It's a technique where a small sample of the sputum is stained, and this causes the cell walls of the bacteria to turn a certain color so the bacteria can be clearly identified. 

This technique is still used in labs to this day.  Yet while Gram simply used the technique to identify bacteria in sputum samples, it's used today to distinguish between different types of bacteria.

In 1888 Nikolia Fedorovich Gamaleia was working in Pasteur's lab when he inoculated sheep and dog with pneumococcus and this caused lobar pneumonia in these animals.

This experiment proved that pneumococcus was the cause of lobar pneumonia.  Gamaleia is also credited in 1888 as discovering bacteriolysins that destroy bacteria.  (11)

He also worked with pasteur to improve the process of inoculation.

By 1891, interstitial changes may occur in acute lobar pneumonia and this may result in fibroid pneumonia (fibrosis of the lungs), and this will be chronic.  (10, page 1309)

In 1896 French student Ernest Duchesne discovered penicillin, yet the significance of his discovery went unknown, and the discovery was left hanging.

William Henry Osler, in the early editions of his book, "The Principles and Practice of Medicine," mentioned using oxygen for emphysema and asthma, and by 1898, or the third edition, he finally recommended oxygen for pneumonia.

However, while he mentions oxygen as an option, he rarely prescribed it for his patients.

He wrote:

It is doubtful whether the inhalation of oxygen in pneumonia is really beneficial. Personally, when called in consultation in a case, if I see the oxygen cylinder at the bedside I feel the prognosis to be extremely grave. It does sometimes seem to give transitory relief and to diminish the cyanosis. It is harmless, its exhibition is very simple, and the process need not be all that disturbing to the patient. The gas may be allowed to flow gently from the nozzle directly under the nostrils of the patient, or it may be administered every alternate 15 minutes through a mask. (12)

In 1901, in his popular medical textbook "The Principles and Practice of Medicine," Dr. Osler referred to pneumonia as the new captain of men and death. He wrote:

The most widespread and fatal of all infectious diseases, pneumonia, is now the "Captain of the Men and Death," to use the phrase applied by John Bunyon to consumption." 

 By 1918 pneumonia became the leading cause of death, overtaking tuberculosis. In describing the new leading cause of death, Osler burrowed from Bunyan, describing pneumonia as "captain of men and death. (4)

References:

References:

1. "Leading Cause of Death, 1900-1998," http://www.cdc.gov/nchs/data/dvs/lead1900_98.pdf
2. Sturges, Octavius, "The Natural History and Relations of Pneumonia," London, 1876
3. "History of Pneumonia," The British Medical Journal,  Jan. 19, 1952, pages 156-158
4. Schmitt, Steven K., "Oral Therapy for Pneumonia:  Who, When, and With What?" editorial, Journal of Clinical Outcomes Management,  March, 1999, vol 6, No 3, pages 48-50
5. Bellis, Mary, "The History of Penicillin," http://inventors.about.com/od/pstartinventions/a/Penicillin.htm
6. Marrie, Thomas J, "Community Acquired Pneumonia," 2001, New York, chapter one by Jock Murray, "The Captain of Men and Death: The History of Pneumonia."
7. Auld, A.G., "The Pathological Histology of Bronchial Affections," The Lancet, Aug. 6, 1892, page 312
8. Allbutt, Clifford, ed, A System of Medicine, 1909, Toronto, chapter on "Lobar Pneumonia,"  by P.H. Pye-Smith, pages 191-205
9. Addison, Thomas, "A Collection of the published works of Thomas Addison," 1868, 
10. Auld, A.G., "Fibroid Pneumonia," The Lancet,  June 13, 1891, page 1308-1310
11. "Nikolai Fedorovich Gamaleia, The Free Dictionary by Farlex, http://encyclopedia2.thefreedictionary.com/Nikolai+Fedorovich+Gamaleia
12. Osler, William, "The Principles and Practice of Medicine," 1898, 3rd ed., New York
13. *Photo compliments of sciencephotolibrary.com
14. "Plutarch," britannica.com, http://www.britannica.com/EBchecked/topic/465201/Plutarch, accessed 7/20/14
15. Laennec, Rene, "Mediate Auscultation," translated by John Forbes, Notes by professor Andral, 4th edition, 1838, New York, Samuel S. and William Wood, pages 84-87 for bronchitis treatment, and 175-177 for emphysema treatment
16. Andras, author of the notes in the book, "Mediate Auscultation, by Rene Laennec," ibid
17. Reynolds, Arthur, R., "Pneumonia: The New Captain of the Men and Death," February 28, 1903, Journal of the American Medical Association," XL(9):583-586, http://jamanetwork.com/journals/jama/article-abstract/854678, accessed 1/2/16

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1800-1920: Oxygen cylinders and chambers

Fig 1-- Left to Right: Oxygen tank, rubber bag (400 cc), thermometer
in glass tube, water-manometer and small cannula (1908)(1, page 288)

While the benefits of oxygen therapy were known, it took a long time for its use to be accepted by the medical community. The main reason was that there were no efficient and inexpensive means of making it and delivering it to patients. Plus experiments provided sketchy results at best.  

So for the most part, oxygen wasn't used therapeutically during the 19th century until a cholera outbreak in Europe in 1832. In 1857 S.B. Birch described a "renaissance of oxygen." His writings did create a "renaissance" of sorts. Yet, once again, results were sketchy.  (1, page 282)

Ernst Victor von Leyden (1832-1910)

During the 1860s Ernst Victor von Leyden performed experiments, and soon thereafter gave up the task. He postulated the following theories why oxygen failed to be accepted by the medical commuity:

1. It was thought to have curative powers, and it doesn't
2. It's difficult and expensive to make, and difficult to transport and deliver to patient
3. When prepared by physicians it often contains poisonous gases
4. The apparatus to deliver it is clumsy
5. Hypercritical attitude of physicians
6. Negative results by experiments

The most effective means of employing oxygen during the 19th century was mainly by putting the patient in an oxygen chamber or room, pumping in pure oxygen, and having the patient breathe normal. This concept was used in the variety of oxygen parlors that opened up. Patients with various ailments, and probably some people just wishing to stay healthy, came to breathe the medicated air.

Henry Fleuss (1851-1933)

Henry Fleuss was working to create a method so that scuba divers didn't have to rely on a person working a pump to provide air for him to breathe. He was aware that the first person to discover oxygen in 1773 kept bees alive in a jar by drawing out the carbon dioxide. Later studies showed animals could survive in a sealed chamber if oxygen was supplied.(2, page 83)

So Fleuss intended to use this knowledge to invent an apparatus that allowed divers to supply themselves with air. He, in turn, invented the compressed air or oxygen cylinder in 1879.  (2, page 83)

The device allowed for a "breathing bag mounted on the chest and scuba canister mounted on the back. His device was called a "rebreather" because air was repeatedly rebreathed. Oxygen was added from the tank, and carbon dioxide removed. He used his device to rescue coal miners who were trapped in a mine.   (2, page 83)

So the oxygen cylinder was now available for use in therapeutics as well, if the medical community was willing to use it.  Various manufacturers were now producing oxygen and storing it in steel cylinders.  

Fleuss Apparatus

Tissier describes the tank in Figure 3 as containing "40 gallons of oxygen under 1800 pounds of pressure are contained in a cylinder 3 inches in diameter, less than 13 inches in height, and weighing but 11 pounds. The gas will have a purity of 95 or 96 per cent., being diluted by the small quantity of air in the container. Mounted on the cylinder are a rubber bag of one gallon capacity, and a wash-bottle—so arranged that the gas passes first to the bag and then through the wash-bottle to the patient." (3, page 304)

Tissier explained that a manometer may be attached, although generally the pressure can be estimated by watching the bubbles through the wash bottle. He said that a "gentle, steady stream that does not cause appreciable splashing, and in which the individual bubbles can be distinguished, is best." I imagine regulators at this time weren't very accurate anyway, and someone would be required to make regular checks on the cylinder anyway to make sure there was still oxygen in it. (3, page 304)

Figure 3 -- Oxygen tank, rubber bag, wash bottle,
rubber tubing, mouthpiece (3, page 304)

Oxygen flows from the oxygen tank, some is stored in the rubber bag, which acts as a reservoir, through the wash bottle, through the rubber tubing, and to the patient by means of a nose piece, mouth piece, or face mask. Tissier recommended a hard rubber mouthpiece to prevent the patient from biting through it. For the nostril, glass or rubber could be used. (3, page 304)

He also said: "if nothing better, a funnel of paper cone may be held over the nose and mouth, but not touching the face -- so that expiration may take place beneath it." (3, page 304

The oxygen is set at the desired flow, which there was no way of measuring with accuracy, so it was basically by the gut feeling of the operator. Then the flow is "allowed to flow for a definite time, or, in urgent cases, almost continuously, unless distressing to the patient." (3, page 304)

The funnel is really not preferable because, as Tissier said, it will probably waste a considerable amount of oxygen. However, particularly with pneumonia, it "may save a life."  

Oxygen Chamber for the treatment of pneumonia (6, page 480)
To view more pictures of the chamber click here.

Oxygen can also be given with a desired amount of pressure, if pressure is desired to assist with the patient's breathing and/or to help diminish dyspnea. If this is the case, the oxygen system may be hooked up to one of the various gasometers. Oxygen may also be blended into the air of pneumatic chambers if so desired. (3, page 305) (I will describe gasometers and pneumatic chambers in later posts)

By the 1890s pure oxygen could be piped into rooms or chambers, although this method wasn't often used. Still, in 1922 Alvin Barach (remember this name) wrote that piping oxygen into a room, or a room within a room (also known as an oxygen chamber) provided for the best means of giving oxygen to patients simply because it was the least cumbersome. However, the oxygen provided wasn't always enough to be therapeutic, and the the chambers were inconvenient and expensive. Plus they weren't portible.

Sir Joseph Barcroft (1872-1947)

An efficient oxygen chamber that was somewhat portable was introduced to the world during WWII by Sir Joseph Barcroft. He created an air tight chamber that is "leak tight in order to provide an atmosphere rich in oxygen and which is artificially ventilated in order to provide a comfortable environment. The oxygen content of oxygen is between 40-60 percent (21 percent is available in room air), which is considered the therapeutic range. It is ventilated in order to remove excess carbon dioixde, moisture and heat." (7)

Oxygen could also be provided to the patient by means of crude oxygen tents. These tents were comprised of a canopy that covered the patient's bed, and oxygen was piped into the canopy from a cylinder at the patient's bedside. Yet these early oxygen tents were poorly engineered.

Dr. Andrew H. Smith of New York provided one of the greater contributions to therapeutic oxygen when he wrote "The Inhalation of Oxygen in Acute Affections of the lungs," in 1898. He recommended oxygen for lung diseases that caused dyspnea. In the 1860s he showed the effectiveness of using oxygen to treat animals, and in 1870 he proved the inhalation of pure oxygen was harmless (although we later learned oxygen is a drug with side effects). (5)

Smith explained how methods of creating oxygen and filling rooms with oxygen were actually available in the 1860s, and experiments on animals proved that filling rooms with enriched oxygen can prolong the lives of people who would otherwise have died. Smith also wrote about the use of compressed oxygen, (5) which was discovered in 1895 by Karl Paul Gottfied von Linde of Germany and William Hampson of England.

Generally speaking, if patients required oxygen they would have to seek out an institution or physician with access to it. Oxygen wasn't available in hospitals until the 1920s.  

References:

1. Brainbridge, William Seaman, "Oxygen in Medicine and Surgery -- a contribution with report of cases," New York State Journal of Medicine, 1908, Vol. 8, June, No. 6, pages 281-295
2. Stephens, Jack, "Living Mirrors: A Coral Reef Adventure," 2003
3. 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.
4. Arthur, T.S., et al, editors,  "Oxygen, The Great Health Restorer," Arthurs Home Magazine, 1882, Philadelphia, page 770
5. Smith, Andrew H. "The Inhalation of Oxygen in Acute Affections of the lungs," Trans Am Climatol Assoc, 1898, volume 14, page149-153
6. "Studies from the Rockefeller Institute for Medical Research,",volume XLII, New York, 1922,  Rockefeller Institute for Medical Research
7. Barach, Alvin L., "A New Type of Oxygen Chamber," April 26, 1926,  http://www.jci.org/articles/view/100060/files/pdf, reviewed 10/28/12

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1800-1900: Oxygen used to treat asthma

The first known person to recommend supplemental oxygen therapeutically was Thomas Beddoes, who inhaled oxygen every day.  He performed various studies using the gas, applying it to various patients, including those inflicted with tuberculosis and asthma.  He showed oxygen could be useful as a marketable drug to treat diseases.

Yet, like most new discoveries in medicine, oxygen therapy for diseases did not catch on right away, wrote Brainbridge in a 1908 article in the New York State Journal of Medicine.  While it was used from time to time, he said:

"Here, as elsewhere, however, the efforts were desultory and ephemeral, and the quarter-century following the discovery of oxygen found its position as a therapeutic agent still anomalous." (1, page 282)

Brainbridge explained that it wasn't until 1818 that "the true value of oxygen came to be recognized."  It's increase in use was due to the appearance of the monograph, or detailed paper or study on one subject, according to dictionary.com.  (1, page 282)

Yet it wasn't used as a medical gas until 1832 due to an episode of cholera in Europe.  Then it's use faded and it wasn't until another quarter century that it received attention again. (1, page 282)

He said there was a renaissance of oxygen usage in 1857 due to the works and writings of S.B. Birch of London.  Between 1860 and 1870 Ernst Victor von Leyden (the same guy who discovered crystals in sputum) experimented with oxygen.  Yet he didn't get significant results and abandoned his research. (1, page 282)

Soon thereafter many prominent physicians began to recommend it, including Rene Laennec, the famed physician who invented the stethoscope.

According to an 1882 article in Arthur Home Magazine, Dr. Armand Trousseau (1801-1867), of Paris, in his work on Therapeutics, gives the names of nine physicians who recommend the use of oxygen to treat asthma. (3)

The writers quote Trousseau:

"The attack of Asthma is an affection very suitable for the use of oxygen. What more rational than to offer a purer and more vivifying air to the unhappy patient who inspires so little oxygen and becomes asphyxiated? At the very best Beddoes used it with the greatest success; then Marching; Poulie of Montpelier, in 1782; Stoll in 1774; Chaptel, and at last Thornton, partner of Beddoes, who gave it to a great many patients, and declared that the asthmatics were extremely relieved in the immense majority of cases."

Trousseau likewise adds,

"The experience we have had of oxygen in Asthma is very encouraging, and there are few remedies which give hope of such a speedy relief, except the bath of compressed air."

Emphasis was added by the original author.

By 2012 we know that oxygen is not necessary in mild or moderate cases of asthma, yet as the acute exacerbation turns into status asthmaticus, and mucus plugs start to block off parts of the lungs, the intake of oxygen may become inhibited and supplemental oxygen helpful.

While oxygen won't cure the asthma episode, it will treat the symptom of hypoxia until other remedies resolve the exacerbation.  The same is true for oxygen use for other disorders, such as and chronic bronchitis, pneumonia and heart failure.

Although, in all due fairness, Trousseau, as with other physicians of his era, might easily have confused these diseases with asthma, which was still a rubric term for dyspnea caused by anything except for diagnosed tuberculosis or pneumonia.

According to an 1861 editorial in The Cincinnati Lancet & Observer, most authors originally believed oxygen actually treated the disease of asthma.  As noted:

In the disease, says Professor J. Rowell, the lungs are so constructed that they cannot furnish to the blood its wonted amount of oxygen and eliminate from it carbonic acid.  The treatment (of oxygen), therefore, has either to relax the spasm of the bronchial tubes and thereby increase the breathing capacity of the lungs, or further an atmosphere for the respiration of the patient richer in oxygen, proportionate to the diminished capacity for breathing."  (2, page 564)

Yet oxygen alone should not be used.  The authors recommend if oxygen is needed, it should be supplemented by inhaling strammonium or chloroform, or by rubbing chloroform on the chest, or by burning selpetre paper (thought to make the air "richer" in oxygen).

The authors further add:

"The Chlorate of potassa... gives the same and greater relief, because from it more oxygen is eliminated.  Better still is oxygen carefully prepared and set free in the sick room, or inhaled from an ordinary gas-bag, diluted with one, two, or three measures of atmospheric air.  (2, page 564)

So this was the beginning of the use of oxygen to treat asthma and other disorders of the lungs.

References:

1. Brainbridge, William Seaman, "Oxygen in Medicine and Surgery -- a contribution with report of cases," New York State Journal of Medicine, 1908, Vol. 8, June, No. 6, pages 281-295
2. Stevens, Edward B. Stevens, John A. Murphy and Gustav C.E. Weber, editors, The Cincinnati Lancet & Observer, editorial, 1861, volume 4, Cleveland, page 564

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1950: The decline of asthma cigarettes and powder

Figure 10 --
The Medihaler was introduced in 1957.
It was easy and fast acting. 

The end for asthma cigarettes was a slow process. Trying to convince elderly asthmatics who had benefited by inhaling medicated smoke for years that there were better options was not easy.

Even as better products were introduced to the market, asthmatics didn't want to give up something that worked for them. It's no different than today's asthmatics fussing over the end of popular medicines like Chromolyn, epinephrine and theophylline.

Asthma cigarettes continued to be popular even after the discovery of epinephrine in 1900 and as the solutions of epinephrine and atropine became options for home use with the invention of the mass-producible electric nebulizer in the 1930s, asthmatics still lit up the powders.

Sales of asthma cigarettes and powders stayed consistent because they provided breathing relief, were less expensive than those other options, and were available without a prescription.  Plus the nebulizers available were bulky and fragile, as well as expensive. Plus, I would imagine, the hallucinogenic effect provided by smoking drugs was also nice, and perhaps even addicting.

Yet while asthma cigarettes were the preferred choice due to convenience and cost, that all changed in 1957 with the invention of the inhaler, and the release of the Medihaler-Iso and the Medihaler Epi.  These inhalers provided instant relief, were relatively inexpensive, and easily carried in pockets and purses.

As sales for asthma inhalers sales went north, sales of asthma cigarette went south.  Yet despite the decline in sales, there were still people who did not want to give up the cigarettes.  This was compounded by the fact that the cigarettes were available over the counter, while the inhaler was only available by prescription.

Yet it was all over for lovers of asthma cigarettes in 1980.  Slowly rising among the desires of mankind was the desire for recreational drugs.  There had already been efforts to clean up the streets of drugs such as marijuana and cocaine, and since those drugs were difficult to come by, kids would often result to purchasing asthma cigarettes.  Yet they did not purchase them because they had asthma, but because they wanted to get high. (9)

So studies were conducted to confirm whether or not asthma cigarettes really worked, and whether they should be taken off the shelves for good.

It must be noted here that there were many other options for asthma, most of them far better than inhaling smoke.  There were medicines such as alupent and albuterol as fast acting relief medicines, and theophylline and beclomethasone as asthma preventative medicines.

Plus there was atropine, sold in large brown bottles to keep the sun from spoiling the product.  It was stored in the refrigerator to prevent the contents from breaking down.  It was drawn up by syringe, about 0.5cc, and mixed with 0.3cc of normal saline in a nebulizer, and inhaled.

There was also another new product recently added to pharmacy shelves, and this was the synthetic version of atropine called ipatropium bromide (Atrovent).  It was available either as an inhaler or solution, and was much easier and much safer to inhale than any asthma cigarette.

Since atropine provided the same relief as asthma cigarettes, minus the hallucinogenic effect, there really was no further need for over-the-counter asthma cigarettes.

H.L. Elliot and J.L. Reid described in a 1980 article published in the British Journal of Clinical Pharmacy a study that concluded asthma cigarettes made of "herbal preparations containing Atropine-like alkaloids" were just as effective as using ipatropium bromide (Atrovent).

Dr. R. Schiffman's Asthma powder (3)

The researchers concluded that "an overdose of asthma cigarettes is manifestly capable of producing pharmacological effects (hallucinations, delerium, tachycardia)."

They also concluded that the dose of inhaled medication from cigarettes getting to the lungs was "variable and unpredictable."

Likewise, they noted that "In view of increasing evidence of abuse, there appears to be good reason to restrict availability of these preparations. Although a herbal cigarette might possibly be recommended for the asthmatic who insists on continuing to smoke," a majority of asthmatics would get just as much benefit with fewer side effects by using their Atrovent inhaler. (10) By 1985 asthma cigarettes were removed from the shelves of all U.S. Stores.  Yet while being generally extinct in western nations, they are still available in some third world nations.

References:

1. Jackson, Mark, "Asthma: The Biography," 
2. H.L. Elliot and J.L. Reid, "The Clinical Pharmacology of a Herbal Asthma Cigarette"British Journal of Clinical Pharmacy (1980, 10, 480-490) 
3. Picture used with permission from Inhalatorium.com
4. Jackson, Mark, "'Divine Stramonium': The Rise and Fall of Smoking for Asthma,"  Med Hist., 2010 April; 54(2): 171–194.

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