1798: Bree's Symptoms of Asthma

The following are the symptoms of asthma as described by Robert Bree in his book "A Practical Inquiry into Disordered Respiration Distinguishing the Species of Convulsive Asthma, their Causes and Indication for a Cure."  It was written in 1810.

Note:  You must understand that Bree's undestanding of asthma was very puerile compared to our modern definition.  Much of his descriptions and theories on asthma are based on observation and personal experience with the disease as opposed to scientific facts.  However, some facts were available at this time and he used this information to support his opinions.  This was not uncommon for his day and age.

Anxiety:  Owing to the difficulty attending the efforts of nature to removing an irritating offense.

Itching of the skin of breast and neck:  This sometimes precedes the violence of the fit and declines as agony of the fit decreases. This may be an effect of sympathy with the lungs and first passages. Irritating matter in the stomach is the probable cause of this symptoms.  Another cause may be the difficulty to which venous blood is returned to the heart

Perception of heat:  You feel like you have a fever, but you don't.

Great desire of cool air:  Probably occassioned by a desire for oxygen, as you feel the means of obtaining it is increased by fresh air.

Closeness:  Areteaus wrote:  "The patient loves walking in the open air, with his mouth open, and is dissatisfied with the largest house, which seems to small to breathe in."

Dyspepsia:  (Upset stomach)  Always precedes periodic asthma.  This causes flatulence of the stomach and bowels and pain over the head and eyes and sleepiness.

The attack of the paraxysm in the night:  By concentrating, and by sacrificing sleep by staining up late and sitting in a recliner instead of the bed, this can often be avoided.

Diabetes:  By this I think he's referring to the need to pee a lot during an asthma attack. He says this is common, although it provides little relief to the asthmatic.  He gives a few reasons, none of which make any sense.  Such as in the case of hysteric asthma, he says the kidneys may be relaxed due to sudden passions of the mind.  He says the kidneys receive nerves from the intercostals, and there is likewise a strong association between the lungs, kidneys, and stomach.  May also be linked to edema, swelling of the ankles and legs.

The straightness of the breast:  He supposes that this makes it easier for the exchange of air when the air sacs are filled with secretions, which is often the case in asthma.  The rest of his several paragraphs describing this are simply meaningless poppycock.

Intermitting pulse:  John Floyer attriutes this to constriction of the arteries, by circumvolving nerves, may more probably proceed from this condition of the heart.  It may also be cauesd by dyspepsia because of the strong relationship between the stomach and the heart.

Spitting of black mucus:  He believes the coloring agent in the sputum to be carbon in the blood, which in the healthy person was exhaled

The pulse is generally feeble:

Urine is pale and copious:

Sleepiness:

Belly seldom regular:  Constiation may alternate with diarrhea, and may be attributed to dyspepsia (upset stomach). There is remarkable action of the abdominal muscles and all the muscles  used to discharge faeces.  And he flatters himself that evacuation of such will provide breathing relief.

The habit of the asthmatic is generally cold:  The temperature will be lower than normal.

The mind is impatient:  Not only does Bree write this as a symptom, he adds, "...and he suffers much from opposition to his method of management in his own case."  After several episodes of asthma he learns methods of comforting and satisfying himself, but help from others is often received with anxiety.  He becomes irritable during the fits, "and, with difficulty refrains his disposition to petulence."

Generosity:  Bree notes the following interesting fact:  "It may be observed generally as a fact, that the mind of an asthmatics is more susceptible of generous and grateful feelings than that of any other invalid, subject to a chronical disease equally obstinate."  Emphasis added by me.

Respirations more numerous during asthma attack:  They never exceed 30 without a considerable increase in pulse.  Bree recognized this is in general opposition to Floyer

References:

• Bree, Robert, "A Practical Inquiry into Disordered Respiration Distinguishing the Species of Convulsive Asthma, their Causes and Indication for a Cure," 1810, London, pages 117-140, Section IX

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1798: Bree's asthma remedies

Dr. Robert Bree was recognized as a predominant expert on asthma during the first half of the 19th century, as I wrote here.  In 1910 he wrote a book titled, "A Practical Inquiry into Disordered Respiration Distinguishing the Species of Convulsive Asthma, their Causes and Indication for a Cure."  The following are the remedies he recommends for asthma:

1.  Cathartics:  These are medicines or herbs that cause evacuation of the bowels, or purging.  Purging is the use of vomiting or laxitives to clear the stomach, according to dictionary.com.  For example, one patinet noted taking "10 grains of powder of jalap, and three grains of colomel when the fit commenced, which completely removed the fit, on many occasions by evacuating a load of bile."  Yet Bree wasn't a big fan of cathertics, and suggested that if this relieved the asthma the cause was something other thanas asthma.  However, he admits that cathertics to work for some asthmatics.

2.  Emetics:  These are medicines that induce vomiting, according to Dictionary.com.  Tartarized Antimony and Antimonial Wine or small doses of Ipecacohan can incuce vomiting.  Amid other things, they promote exhalation from the lungs and are therefore "powerful expectorants."

3.  Diaphoretics:  These are medicines that promote sweating, according to dictionary.com  He recommended "gentle diaphoresis, but not sweating."

4.  Bleeding:  This is where you cut a vein and allow blood to flow in an attempt to balance the humors.  He believes this has "doubtful effects" on asthmatics.  However, he does recommend it for most species of asthma.

5.  Diuretics: These are medicines that make you pee.  "Natron taken every night, in doses of eight grains, has been found to be very beneficial" for certain types of asthma.

6.  Issues:  These are medicines to treat mental or emotional problems, according to dictionary.com.  "In very old asthmatics, issues are sometimes necessary.  In younger subjects, when the disease is not yet inveterate, they may occasionally be useful, by diverting acqueous humour from the lungs, and giving a better opportunity for the operation of tonic remedies...  When the disease is complicated by dropsy (an old term for edema, according to dictionary.com), I have seen great advantage to the breathing, from from their application in the thighs."

7.  Antispasmotics:  These are medicines that relax smooth muscles, such as the muscles that wrap around the air passages in the lungs or that line the respiratory tract.  One common medicine is opium and it is enhance by the use of ether.  Calcined zinc has proven beneficial for epilepsy, although is not useful for asthma.  "Velerian, cardamine, camphor, musk, castor, belladonna, tobacco infusion, extract of  henbane, fetid gums, cuprum ammoniacle in various doses, more or less joined with the other antispasmotics, or tonic medicines, and combined with opium in large and small portions" helps sometimes but most often prolongs the paraoxym.

8.  Expectorants:  These are medicines that induce sputum production.  Ammoniac is a very valueable expectorant, although it should be given with opium to prevent purging (unless you want purging).  Squills are sometimes useful.  Squills also work when given with vinegar, similar to what John Floyer prescribed.  This is often called vinegar of squills.  A side effect is nausea and purging.  Tincture of squills combined with extract of henbane and the nitric acid is a good combination of expectorant and sedative.  Oxymell is efficatious if combined with vinegar or squill.  Honey and sugar are good for cough, but not so much for asthma.  Decoction of seneca can be useful in older persons, but is too irritating for younger people.  If asthma takes on the character of peripneumonia, decoction of seneca should be given with amonia during the febrile state, and when the fever goes away squill and camphorated tincture of opium will promote expectoration, perspiration, and urine.  All expectorants may cause nausea and vomiting, and this may be good in that it may remove the irritaing matter.  However, they also help relieve phlegm from the chest.

9.  Inhaling vapours:  "Hippocrates introduced the inhalation of vapours from various herbs and gums.  He used herbs and nitre boiled with vinegar and oil, and directed the vapour of such boiling compositions to be drawn into the lungs through a proper pipe."  Fumes can also be used to dry secretions that are known to cause asthma.  Frankincense, myrth, and many other gums, and these are occasionally mixed with arsenic.
Modern physicians recommended inhaling vapour of aether "raised in the steam of warm water."  However, aether can make asthma worse.  Vapour of hemlock leaves can be useful for some forms of asthma, and especially for it's narcotic qualities.

10.  Smoking tobacco:  Bree actually recommends asthmatics stop smoking "with great advantage to their health."

11.  Oxygen:  May benefit asthma when the color of the skin turns blue.  May help cease labored respirations.  It works expecially well for convulsive asthma.

12.  Hydrogen:  This has been proven to be beneficial to asthmatics, particularly spasmotic asthma.

13.  Stomachics:  "These remedies are absolutely necessary in asthma to correct dyspepsia (upset stomach), in whatever species of the disease it may appear.  Bitter tinctures are not to be used in the paroxysm, but bitter infusions and testaceous powders are generally beneficial.  Acetous acid is also grateful to the stomach when any bilious acrimony is present.  In this case "

14.  Diet:  Any food that is an exciting cause of asthma should be avoided.  Barley water and all weak liquors that are likely to ferment or relax the stomach should be avoided.  Infusion of coffee is good for any type of asthma except the second. "Pure cool water has frequently removed the bad effect of an imprudent meal.  If the asthmatic perceive his stomach to be disordered or uneasy, he may next expect more certain symptoms of a paroxysm.  In these circumstances I have experienced, very frequently, the advantage of repeated draughts of water, so that two or three pints have been taken in the whole, from the commencement of the uneasiness; and this has given perfect relief when coffee had failed."  It is wise not to eat more than the stomach can handle."  (page 204)

Note:  According to Bree, the above remedies vary in accordance to the species of asthma diagnosed by the doctor.  However, in order to simplify Bree's work I have left out which species of asthma the above remedies are for.  In either case, all of the above remedies were recommended for one or another species of asthma.  I did find Bree's writings to be quite complicated to understand, and I apologize if my interpretations of Bree's work isn't exactly as he understood.

References:

• Bree, Robert, "A Practical Inquiry into Disordered Respiration Distinguishing the Species of Convulsive Asthma, their Causes and Indication for a Cure," 1810, London, 4th ed., items 1-13 are obtained from pages 237-278, item 14 from page 292-294

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1793: Ryan likes cold baths for asthma

Michael Ryan was an18th century physician who strongly supported the idea of taking cold baths as the best treatment for asthma.  He was so in love with the idea that wrote an entire book on the subject 1793 called "Observations on the history and cure of asthma."

In the preface he explained:

Among the various chronic complaints to which the human frame is liable, very few can be considered of a more formidable nature than a confirmed asthma. The idea of its being an incurable disorder, its threatening instant suffocation at every attack, are circumstances altogether so alarming to a patient, as must necessarily weaken and depress a mind endowed with the utmost fortitude and resignation. Any remedy then that could be found capable of administering permanent relief, to a person in such an afflicting situation, must be looked upon as of the utmost importance to mankind... Unhappily, however, the efforts of physicians hitherto, in the asthma, have generally failed in that respect. (1, page v)

He said cold bathing was recommended as the cure of "chronic complaints, particularly in the nervous and spasmotic, experience has stamped a value on it superior to that of any medicine yet discovered.  In the asthma, however, this practice has been rarely recommened." (1, page 131)

He said that Caelius Aurelianus was the only ancient physician to recommend it. Of this, Ryan wrote:

Caelius Aurelianus says, that residing at the sea-coast, and bathing in the water, are highly useful to asthmatics; though he produces no instance of its success to support his assertion. (1, page 132)

Of this, Sir John Floyer said:

Celius Aurelianus commends... washing the Head is certainly useful against it. (2, page 121) 

The next authority to recommend it was Sir John Floyer. Ryan quotes him from his Treaties on Cold-Bathing as saying the following: (1, page 131)

I have discoursed with an asthmatic person, who has had an habitual asthma for many years, and she informed me that she went into St, Winifred's Well at Holywell, and that her asthmatic dry cough went off for some time, but at last returned again. (2, page 121)

Then he quoted him again as saying:

I have had several accounts of people being much relieved, and some perfectly cured by the use of cold immersion, in asthmas, and other difficulties of breathings especially if the infirmity is taken in the beginning, and not confirmed by time: yet an old gentleman, of sixty years lately told me that, having had a convulsive asthma for at least seven years, he was so cured by three times bathing, that he had not the least fit for three months after; and believes that, had he lived temperate, and continued bathing sometimes, it would not have returned."  (1, page 132-133) (2 page 314)

Floyer also wrote the following about cold water and asthma:

I am certain no Hot Regimen can be proper for tde Asthma, but the Cld is very useful, viz. to drink Water in the Morning, to have oft, and wash the Head every Morning, and a Cold Bath once in a Month or Fourteen Days." (2, page 174)

Ryan states that "in all the late publications on the asthma, cold-bathing is not even mentioned as a remedy, except in one work (Thomas Withers wrote about it in his 1876 book "A Treaties on the Asthma).  (1, page 144)

However, he concludes that all of the other physicians who recommended cold bathing offered little evidence of its usefulness. He said that even Floyer, while he recommended it in his writings, rarely recommended it for his patients. And, although he had asthma of greater than 30 years, he rarely used it on himself.

Ryan was probably biased about bathing as a remedy before he ever tried it.  Yet when he recommended the remedy to a 25-year-old lady, it worked.  When he returned home he described the case in his journal, and later transcribed the account in his book.  He wrote:

The first instance of the good effects of cold-bathing in asthma that happened to come within my knowledge, was that of a woman, about twenty-five years of age, who had borne several children. From her first pregnancy onwards, she was subject to spasmodic complaints of the stomach and bowels, both during the periods of gestation, and the intervals thereof; without the smallest tendency, however, to any disorder of the lungs. But on exposing herself to cold shortly after a lying-in, she began to feel an uneasiness in her breathing, attended with a short teasing cough, which, in a few days, terminated in a confirmed spasmodic asthma. In no case whatsoever were the pathognomonic symptoms of idiopathic asthma better marked than in the present: the fits returned most commonly late in the evenings, preceded by flatulence, continued through the night, and ended towards morning with a free and plentiful expectoration. In fact, all those symptoms were present that usually characterise the most violent and alarming state of this disease.
Blisters, asafeetida, camphor, and the rest of the usual remedies in those cases were tried ; but all to no purpose, for the fits still returned every night with very little abatement of their violence. At length recourse was had to cold-bathing, and the success that attended its use far exceeded any expectations that were formed of it. In less than a week from the first immersion, the patient found herself very sensibly relieved ; and by continuing the practice for the space of six weeks, she obtained a complete and lasting recovery.

If a single fact can authorise a particular mode of treatment in any disease, we are certainly warranted in recommending the cold bath in asthma from the precedent before us, especially as the utmost precaution was taken to guard against any deception about it. I was altogether so exact, that I even intermitted the bath for a few days, after some change for the better had taken place, in order to satisfy myself of its efficacy: but the patient began to relapse so suddenly into her former situation, that an immediate repetition of the bath was found absolutely necessary.

Hence we see that very little room is left for supposing that nature was in any degree entitled to the merit of this recovery; and this will be the more readily acceded to, if people consider how feeble and deficient her endeavours must be, when engaged in combat with such a formidable adversary as the asthma.

River water was the bath made use of on this occasion, from its vicinity to the patient's habitation, and as a preparatory step to bathing in the sea; but as the former answered every purpose that could be expected, the latter was neglected, and the cure went on equally well without its assistance, This, however, is the only instance in which I have seen a cure obtained without sea-bathing; its powerful stimulus being in most cases necessary for restoring to the lungs their lost elasticity and tone. (1, pages 147-151)

 Yet this wasn't the only instance where the remedy worked, because upon traveling to the home of Richard dunphy, he applied the same remedy with equal success.  He wrote:

Richard Dunphy, of whom some account is to be given in this place, was about the age of forty when first attacked with the asthma. During the winter season, in particular, he was subject to frequent fits of his disorder ; and, in the intervals of them, was affected with more or less of difficult breathing. He laboured under his disorder twelve months and more, when he first applied to me in April 1785. Several remedies were tried, such as antispasmodics, blisters, expectorants and others, with little or no alleviation of the symptoms: indeed the disorder seemed to gain ground, notwithstanding the repeated use of them for the space of seven weeks.

Finding very little probability of gaining any advantage by the medicines of the Materia Medica, I thought myself bound to recommend a trial of the cold bath, from the glaring proofs of its efficacy in the case just now related; nor had I any cause to repent of my rashness, as the patient soon experienced the happiness of getting rid of a disorder which must have inevitably terminated in his death. By his own account, it appears that he had not bathed above six days, when he found a very sensible change for the better; and by continuing the practice once a day for seven weeks only, the asthmatic fits were totally removed.

On this occasion sea-bathing was made use of, and nothing was done previous to the course, except the taking of a mild purgative: the precautions to be mentioned hereafter were not attended to in this, or in the case immediately following: both patients were constantly employed in bodily labour; and on this account they probably did not stand much in need of a preparation for sea-bathing, by having first bathed in water of a warmer temperature. (1, 151-153)

Dr. Ryan offered several other similar cases, all of which, according him, proved that cold bathing was a viable cure for asthma.

Perhaps to allay the minds of the skeptics, Dr. Ryan lists a few contraindications for cold bathing in the treatment of asthma, all of which were capable of being exciting causes of asthma.  (1, pages 200-220)

• Ulcers of the lungs: 
• Tubercles (consumption)
• Inflammation of the lungs
• Catarrh recent (colds)
• Catarrh, long lasting, with phlegm (humoral asthma)
• Dropsy of the chest (water in the chest)
• Malconformation of the chest (abnormal formation that may lead to plethora)
• Plethora (Accumulation of blood in the vessels of the lungs that may rupture with cold bathing) (1, pages 200-220)

While these were all reasons to hold off on cold bathing, they were not always absolute reasons for abstaining from the treatment.  Ryan believed that in many instances they could be treated and resolved, and then the patient could jump in a cold bath, thus receiving the benefits thereof.

Other conditions that should be treated prior to cold bathing were:

• Humoral asthma: The accumulation of phlegm should be expectorated with emetics, blisters, or other expectorants, prior to cold bathing. 
• Plethora: Should be treated with bleeding and blistering.  
• Plethora caused by malformation of the chest: Treated with bleeding, blistering, emptying stomach and bowels, or blisters to the chest. (1, page 207, 210, 214)
• Dropsy of the chest:  The "characteristic symptoms of water in th chest are on many occasions very obscure," although, "as the reigning symptoms will clearly point out the danger that must attend cold-bathing in such a situation." (2, page 215)
• Difficult breathing:  Bathing should ideally be "entertained" when the patient is breathing easy between paroxysms.  However, should the patient have "uninterrupted difficult breathing," the bath may be "dangerous" and "the more cautious we should be in making use of it."  However, so long as the difficult breathing is caused by the "spasmotic affection" and not by plethora or tubercles, it can be tried. An antispasmotic may be tried to make the breathing easier prior to bathing.  (2, page 216-218)

Ryan also noted that he, along with Floyer, observed that the elderly respond well to cold water bathing whether they are breathing normal or are breathing with difficulty.  He said it's difficult to know at what age one is considered elder, although he said: (2, page 219-220)

If we can rely upon the authority of Sir John Floyer, an asthmatic of sixty not only escaped with impunity, but obtained great benefit from cold-bathing. However, it is much to be dreaded that, at such an advanced period of life as this, the remedy would prove a greater evil than the disease, not merely from the debility that attends old age, but more especially from this circumstance, that the asthma of old people seldom appears in a simple form, but is generally complicated with obstruct tions of the internal parts, or such an affection of the lungs as must render cold-bathing highly pernicious.

So, when cold water bathing is to be attempted as a preventative or as a remedy for asthma, the following remedies should be applied prior to submersion into the water.

• Empty the stomach and bowel in order to give the lungs as much room as possible to expand. 
• A small bleeding may be beneficial to those of full habit.
• Blistering plaster should be applied if any stricture is felt on the chest 

The water should not be fresh water, but impregnated with salt.  This is done because fresh water seldom agrees with the asthmatic lungs.  

Regardless, Ryan said cold water bathing should be found useful both as a treatment and preventative measure for most types of asthma.  

References:

1. Ryan, Michael, "Observations on the history of asthma, in which the propriety of using the cold bath in that disorder is fully considered," 1793, London, printed by G.G. J. and J. Robinson of Paternoster-Row
2. Floyer, John, "History of cold bathing: both ancient and modern," 5th edition, 1722, London, Printed for William and John Innys at West-End of St. Paul's Church-yard 

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1792: The first attempts at neonatal resuscitation

Fig. 1 -- Represents the box-wood tube.  One end was inserted
into the infants airway.  The caregiver would lace his mouth
over the other end (bottom of the figure in the photo) and provide
breaths to the child.  Bellows may also be connected to the tube.
(14, page 77-78, 196)

Perhaps among the first attempts at artificial respiration were performed on a stillborn child. The mother and father waited patiently for nine months, a perfectly formed child was born, but it wasn't breathing.  Frantic attempts were made to excite breathing.

More often than not such attempts failed, but every so often there was success, which brought great joy and excitement, just enough to motivate the next generation to make such efforts given the same frightful situation.

Some methods used to excite a newborn's first breath included: (1, page 77) (2, page 13)

1. Talking to the baby
2. Rubbing the baby's chest 
3. Shaking the baby
4. Tickling the baby
5. Blowing in the baby's face
6. Warming the baby with warm blankets
7. Applying moderate friciton to the body by rubbing 
8. Slapping the baby on the back or heels
9. Patting the baby on the back
10. Squeezing the rib cage
11. Hugging the baby
12. Performing mouth to mouth respirations, what was called inflating the lungs
13. Inserting a tube into the airway and breathing for the child that way 
14. Suctioning the baby's airway (not available until 1937)
15. Performing gentle chest compressions or abdominal thrusts
16. Tickling the nose with a feather
17. Tickling the arm pits, temples, stomach
18. Dunking the child up to the neck in warm water
19. Other gentle stimilation

Over time, and by trial and error, better methods were developed. By the end of the 19th century a basic form of neonatal resuscitation was taught to medical students, nurses, midwives, and members of societies such as the Humane Society. In fact, the report references and quotes Curry. 

A good example can be found in James Curry's 1815 book "Observatoins on Apparent death:"

WHEN a still-born Child appears in every respect perfect, and especially when, from the circumstances of the labour, there is reason to believe that the Child has not been long dead, measures may be taken for recovery, with very great hopes of success. With this view, the Lungs should be diligently inflated, and the heat of the body kept up, by the application of Warm Flannels, or by putting the Feet and Legs, or the whole Body up to the chin, into Warm Water. Moderate frictions with the Naked Hand, and gentle agitations, may also be used; and Stimulating Remedies applied to the Nose, Temples, and Pit of the Stomach. (1, page 77-78)

If these efforts did not work, then the physician or midwife would move on to the next stage of the resuscitation attempt, which would involve inserting tubes into the airway and breathing for the baby.  An example of this is noted by Curry:

If the Wooden Tube (Fig. 1.) be not at hand, the female Catheter (an instrument which every Practitioner in Midwifery is presumed to carry constantly about with him) will answer tolerably well for inflating the Lungs in this case: in defect of it, a joint of reed, the barrel of a qiull, or a piece of still paper or a card rolled up, may be; —one end being introduced into the Mouth, and the Assistant blowing into the other with his breath,* until the Lungs are expanded; then gently pressing the Chest;—and repeating this, so as to imitate Natural Respiration.

The recommendation by the Humane Society was similar, although the 1823 report of the Society suggested that bellows should be used to breathe for stillborn infants instead of the mouth.

Curry notes that in "some cases which have come within my knowledge prove, that Still-born Children may be recovered even after an hour or more has elapsed." His explanation for this is as follows: 

There are several reasons for believing, that the Vital Principle is not so soon destroyed here, provided the warmth of the body be kept up, as when Respiration has been established for a length of time, and then interrupted: for the new-born Infant which has either not respired at all, or had its breathing suspended very soon after birth, seems in a state of susceptibility somewhat resembling that which annually takes place in certain Animals, as the bat, frog, dormouse, &c, from the influence of the Winter's cold; the one requiring only the restoration of that warmth by the return of Spring, the other the application of Air to the Blood stagnating in its Lungs, to restore the Circulation, and with it the balance of functions necessary to Life. 

His theory is actually quite interesting considering anatomical pathology was only in its infancy during this era.  Over the ensuing years better wisdom improved the steps of neonatal resuscitation.  However, it wouldn't be until the 1980s that the technology was available to save the lives of infants not so perfectly formed.

References:

1. Curry, James, "Observations on Apparent Death from drowning, hanging, suffocation by noxious vapours, fainting-fits, intoxication, lightning, exposure to cold, & etc., and an account of the means to be employed for recovery. To which are added the treatment proper in cases of poison, with caution and suggestions respecting various circumstances of sudden danger," 2nd edition, 1815, London (the 1st edition was published in 1792)
2. "The Forty Ninth Annual Report of the Royal Humane Society, For the Recovery of  Persons Apparently Drowned or Dead," 1823, London, 

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1790: Defending old asthma theories

Dr. Robert Bree (1790-1859), an English physician who had asthma, wrote a book about asthma in 1797 called "A Practical Inquiry into Disordered Respiration, distinguishing the Species of Convulsive Asthma, their Causes, and Indications of Cure." It would go on to become the most read asthma book of the first half of the 19th century.

Dr. Bree was an ardent proponent of the bronchitic theory of asthma, a theory that states asthma is caused by an increase of phlegm in the lungs. The theory is similar to those postulated by ancient physicians, such as Hippocrates and Galen.  In this way, he is one of the last known physicians to defend old asthma theories.

He believed that the treatment of asthma was relative to the cause. He said asthma was caused by inhaling a peccant matter, and was cured when the peccant matter was expectorated.  This explained why asthma always ended after a fit of coughing that produced a wad of phlegm.

In this way, he believed modern theories regarding diseases like asthma were often the subject of quackery.  By autopsies and experiments he performed, he attempted to prove men like William Cullen, who postulated that science was a wiser approach to medicine than ancient theories. He was also one of the first physicians to describe asthma as spasmotic and nervous. (3)

Proving Cullen wrong about asthma was the essence of Bree's 1797 book.  He said Cullen is wrong because no science proves the nervous or spasmotic theory of asthma, especially considering those two conditions cannot be seen on autopsy.

On the other hand, phlegm can be seen on autopsy. So, if anything, science supports the bronchitic theory of asthma and the theories of the ancients, more so than the ideas of Cullen.

However, Bree did not completely reject the spaspotic theory of asthma, he simply considered it as secondary to some other cause.  In reviewing the opinions of Dr. Bree in 1890, Ernest Schmiegelow said:

Bree does not actually deny the possibility of bronchial spasms taking some part in the cause of asthma, but it is only secondary; the primary cause is an exudation in the bronchial tubes, by which the lungs (specially the muscles of respiration) are stimulated to contraction, in order to expel the mucus which they contain. (4, pages 8-9)

In other words, Bree believed mucus was the cause of most diseases, including asthma.  He believed the contraction of the lungs was a defense mechanism to expel mucus from the lungs.

About 30 years after Bree published his book the stethoscope was invented, and as soon as it was used to listen to asthmatic lungs Dr. Bree's theory was disproved, said Schmiegelow.  He said that once the stethoscope gained favor, it was easy to prove that an attack of bronchitis does not precede an attack of asthma, and that rhales (a lung sound Laennec used to describe the sound of secretions in the lungs) are heard later during the attack.

While Bree waswell respected in his day, his ideas about asthma, and even most of his remedies, slowly gave way to science.  In this way, Despite Bree's noble efforts, his bronchitic theory of asthma eventually took a back seat to Cullen's nervous and spasmotic theories.

Regardless, all three theories would be debated over the course of the 19th century.

Continue the journey by clicking here.

References:

1. Pepper, William,  Louis Star, "A System of Practical Medicine," Volume 3, page 184
2. Berkart, J.B., "On Asthma: It's pathology and treatment," 1878, London,  Chapter II, "History of Asthma," page 12
3. Bree, Robert, "A Practical Inquiry into Disordered Respiration, distinguishing the Species of Convulsive Asthma, their Causes, and Indications of Cure, London, 1810.  I could not find the 1790 edition online, yet this one serves our purpose.
4. Schmiegelow, Ernest, "Asthma, considered specially in relation to nasal disease," 1890, London, page 4 
5. Jackson, Mark, "Asthma: The biography," 2009, London, pages 86-88 (If you're interested in a good asthma history book, this is it.)

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1800-1900: The scientific revolution and the age of progress

Charles Darwin's "Origin of Species" may have helped
to spark the scientific revolution 

Perhaps among the most important centuries in the evolution of medicine wisdom was the 19th century. The great historian Fielding Hudson Garrison explained that this was the century that put an end to old dogmatic theories, thus opening the door for medicine and science to move forward. (1, page 424)

Respiratory diseases, particularly those looped under the umbrella term asthma, benefited greatly as pathology (the study of disease) and internal medicine (diagnosis and treatment of disease) were advanced during the course of the 18th century.  This brought us a greater understanding of the physiology of respiration,  setting the stage for what would transpire in the 19th century.

For instance, Mark Jackson, in his book "Asthma: A Biography, explained the following:

Eager to reject older irrational, mystical models of health and sickness, prominent Enlightenment physicians, such as Thomas Sydenham 1624-1689), George Stahl (1660-1734), Friedrish Hoffmann (1660-1742), and Herman Boerhaave (1668-1738), not only increasingly emphasized the importance of careful observation of the patterns and presentations of disease, but also strove to develop 'a simple and logical synthesis of medical knowledge designed to replace increasingly obsolete humoral conceptions inherited from antiquity' and to alleviate and conquer ill health.  (2, page 70)

Investigations of the human body, and new ideas such as "careful observation of patters and presentations of disease" brought about a better understanding not just regarding diseases, but the treatments to remedy them.  However, old theories persisted, thus acting as fetters to the furthering of wisdom.

Such theoretic fetters holding back great minds did not exist in the 19th century, wrote Fielding Hudson Garrison in his book "An Introduction to the history of medicine,"  mainly due to such works as: (1, page 424, 426)

• Friedrich Schelling's "Natural Philosophy" in 1797, "which aimed at establishing a subjective and objective identity of all things." (1, page 425)
• Hermann von Hemholtz,'s "Conservation of Energy" in 1847, which established the idea that no energy was lost in muscle movement, and that there was no vital force that causes muscle movement (wikepedia)
• Charles Darwin's "Origin of Species" in 1859, which established the idea that living creatures, including humans, evolve over time as changes in their environments occur. 

These works were met with much reservation and controversy by a dogmatic society, although they had a significant impact on both science and medicine, helping to open up the doors for scientific progress. As the ideas put forth by these works were accepted, great minds were no longer limited by theories made by famous men of the past, thus opening up a whole new world for them. (1, page 424)

Hermann Hemholtz shot down the age old theory that
'there was a vital force responsible for muscle movement.
His scientifically proven idea helped spark a revolution.

As noted by Garrison:

"It took a long time to demonstrate that the advancement of internal medicine as a science can never be accomplished by hugging some pet theory out of a regard for it's author's personality, but only through the performance of a vast amount of chemical, physical, and biological research by thousands of willing workers." (1, page 426)

Yet even though medical theories were no longer existent, "the modern scientific movement did not attain its full stride until well after the middle of the century. The medicine of the early half was, with a few noble exceptions, only part and parcel of the stationary theorizing of the preceding age," wrote Garrison.  (1, page 425)

A good example of this we can find in our own asthma history.  Dr. Robert Bree, who was the preeminent asthma expert in the first half of the 19th century, continued to believe in old humoral theories.  On the other hand, Dr. Henry Hyde Salter, who was the preeminent asthma expert in the second half of the 19th century, devised modern conclusions regarding asthma based on scientific investigations. 

Friedrish Schelling encouraged the subjective and the objective
review of patients. His ideas helped spark the scientific revolution.

We have to under stand, however, that the fact Bree did not use science and Salter did does not mean that Salter's conclusions were flawless, because they weren't.  The fact that pure asthma left behind no scarring in the lungs caused him to deduce, as experts before him had, that asthma must be nervous in origin.  Surely he was wrong, but he also didn't know about the immune system. 

The term asthma went through an amazing transformation during the course of the 19th century, with many physicians hunting for answers, and each coming to his own conclusion.  Some were right, thus leading investigators in the right direction.  Some were wrong, thus leading investigators in the wrong direction.  Regardless, all such investigations benefited our disease, thus setting the stage for what would transpire in the 20th century. 

References:

1. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1913, 1st edition, Philadelphia and London, W.B. Saunders and Company
2. Jackson, Mark, "Asthma: A biography," 2009, New York, Oxford University Press; reference quoted by Jackson: Guenter B. Risse, "Medicine in the age of Enlightenment," in Andrew Wear, editor, Medicine in Society: Historical Essays, (Cambridge, 1992), pages 149-95

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1790: The first feeding tube

The feeding tube may not be directly related to respiratory therapy, although when you consider the big picture, it kind of does.  For instance, to put someone on a ventilator for several weeks would be a moot point if physicians were unable to provide nutrients to the patient.

The feeding tube was invented in 1790, and was another invention by Dr. John Hunter, the same physician who mastered the use of bellows to provide mechanical breaths to asphyxiated infants.  The feeding tube was significant because it helped advance surgery from a "mere technical mode of treatment to a branch of scientific medicine, firmly grounded in physiology and pathology." (1, page 352-355)

His artificial feeding through was a flexible tube inserted into the mouth to the stomach, and it allowed physicians to feed, and thus provide adequate nutrition, patients who were otherwise unable to eat, such as those recovering from complicated operations. (1, page 352-355)

This invention was significant because many physicians prior to him (and even some after) performed surgeries with little regard for anatomy, and therefore little understanding of diseased or injured body tissues and organs.

References:

1. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1922, Philadelphia, W.B. Saunders Company

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