1835: Lefevre questions nervous theory of asthma

Amedee Lefevre (1798-1869) was yet another physician who believed in the spasmotic and nervous theories of asthma.  Yet while he believed asthma was nervous, he was not prepared to deny there weren't organic lesions as yet discovered in asthmatic lungs. (1, page 505)(2, page 23-24)

Orville Brown, in his 1917 book," said Lefevre was an asthmatic who observed by studying his own asthma that he expectorated large amounts of sputum. (3, page 31)

Of this, J.B. Berkart, in his 1878 book, said: 

Lefevre (in 1835)... reverted to the opinion of Laennec. Himself an asthmatic, he had watched his own case and that of a friend, and arrived at the conclusion that the dyspnoea could be produced only by a bronchial spasm. In looking thus upon asthma as a nervous affection, he still was not prepared to deny the possible existence of organic lesions; adding, however, that if such were present, they were of so fleeting a nature as to elude detection. The essence of the disease he considered to be an increased irritability of the nerves of the lungs, in consequence of which the slightest irritation applied to the bronchial surface induced spasm of the bronchial tubes. (2, page 23-24)

However, Berkart suspected that the patient's he was studying were not asthmatics, and therefore his experiments (of which he performed with  Joseph Bergson) did not support his theory that asthmatic lungs might possibly have organic lesions.  He said: (2, page 24) 

The cases, however, which he himself reported, do not confirm his views. It is difficult to recognise a nervous affection, much less a bronchial spasm, in the dyspnoeal attacks, which terminated always with the expectoration of thick masses of mucus. The expectoration was of a grey colour, very viscid, in consistency like boiled maccaroni, filamentous in shape, and, when disentangled, appeared as if moulded to the bronchi. Sputa of that kind sufficiently distinguish the preceding dyspnoea as the symptom of a fibrinous (croupous) bronchitis, and there can be no doubt that Lefevre and his friend were subject to that disease. (2, page 24)

So while he thought he was on to something with his theories, he probably added little evidence to advance either the spasmotic nor the nervous theories of asthma. The reason was mainly due to the inability to differentiate bronchitis with asthma.

Of interest is he also observed spirals in asthmatic sputum.  This would be an observation that would inspire investigations by later physicians that would ultimately lead to a new theory about asthma.  (1, page 505)

He also wrote a book called De 'lasthme , of which you can read if you can read French.  

References:

1. Sakula, Alex, "Charcot-Leyden crystals and Curschmann spirals in asthmatic sputum," Thorax, 1986, 41, pages 503-507
2. Berkart, J.B., "On Asthma: It's Pathology and Treatment," 1878, London, J. & A. Churchill; The reference used by Berkart is as followed:  "Recherches sur l'Asthme, M&noire couronne' par la Society de MfSdecine de Toulouse."—JournalHebdomad., 1835.
3. Brown, Orville Harry, "Asthma, presenting an exposition of nonpassive expiration theory," 1917, St. Louis, C.V. Mosby Company.  The above mentioned theory of vessel turgescence comes from this reference also on page 25; he refers to the same source as Berkart

RT Cave Facebook Page
RT Cave on Twitter

1823: More native American asthma remedies

John D. Hunter lived among the Indians and learned about their medicine through the normal course of life. There were many other "whites" like Hunter who lived among the Indians, some who were kidnapped by them as Hunter was, and others for the simple purpose of studying them as George Catlin did.

Virgil J. Vogel researched and studied their records and recorded a list of Indian remedies in his book "American Indian Medicine.

Some of these remedies as they pertain to our asthma and respiratory therapy history are listed here: :

• Skunk Cabbage:  Mainly used for consumption more so than asthma, but it was used as an expectorant. In either case, the dried roots were used. Imagine a medicine man bringing you this stinky remedy and saying, "Well, eat up."   (2, page 207, 367)
• Red Cedar Berries (perus virginiana) and Wild Ginger (Asarum canadense):  A "steeped infusion" of these was used by the Rappahannocks. (4, page 207)
• Balsam Poplar:  It was turned into a salve that was inserted into the nares by the Pillager Ojibwas to relieve congestion caused by a cold (which would probably sometime be allergies).  It was used for colds, catarrh (a cold), and bronchitis. (2, page 276-7)
• Indian Balsam:  (Balsam fir (Abies balsamea):  Vogel says that Hunter said it was good for colds, coughs, asthma, consumption. (2, page 277-8)
• Corn oil:  Dr. D.C. Jarvis (1881-1966) wrote about folk medicine, and noted that corn oil was often recommended for hay fever, migraine, and asthma. (2, page 293)
• Cottonseed oil:  Used in South Carolina and by the Mayans to treat asthma. (2, page 295)
• Ginsing Root (Panax quinquefolius L):  It was often used as a panacea by the North American Indians, Europeans and the Chinese.  The French are known to have used it for asthma.  (2, page 307)
• Green Helebore:  Used by the Iroquois to relieve catarrh. It was also used as a narcotic to treat asthma and other lung diseases.  It was also used to reduce heart rate and blood pressure.  (2, page 316)
• Indian Hemp (Apocynum cannabinum L.): It's often used as a narcotic, and is the source of marijuana.  It made it's way to the United States and Europe to be included in asthma powders and cigarettes.  It was used by the Indians for asthma and whooping cough, although mainly because it "promoted perspiration." (2, page 319)
• Indian Turnip:  Hunter says it was mixed with spikenard and wild licorice to treat a cough. It was also used for asthma, chronic catarrh, fever, and a variety of other ailments. An "Indian Doctor" by the name of John Briante said "the dried and pulverized root" was good as an expectorant, for asthma.  Dr. David Clapp (1811-1853) said it was good for asthma and chronic cough.  (2, page 322)
• Jimson weed (Datura Strammonium):  The Rappohannock Indians of Virginia smoked leaves for shortness of breath.  It is similar to Belladonna, and was often used in folk medicine as a hallucinogenic and asthma remedy.  As it made it's way to America and Europe in the early 19th century, it was determined to have an alkaloid called Atropine in it that was a mild bronchodilator.  (2, page 328) Modern medicines such as Atropine, Atrovent, Spiriva are been derived from this plant, although many of the modern mediicnes are synthesized (made in a factory)
• Mullen (Verbascum thapsus L.):  The leaves were smoked to relieve asthma and sore throat by the Mohegans and Penobscots.  The Catawbas "boiled het root and sweetened it to make a syrup for croup in children." The Creeks "boiled the roots with those of button willow for a drink used internally for coughs. The leaves were also boiled and the patient bathed in teh infusion while it was hot.  The Forest Potawatomis smoked the dried leaves for asthma, but Smith is uncertain whether they learned teh practice from teh whites or vice versa.  A smoke smudge was made of the leaves and the fumes inhaled for catarrh adn to revive an unconscious patient.  The Menominees smoked the root for pulmonary disease.  Smith said he had often seen whites smoke the leaves for asthma and bronchitis, and tehat the flowers were believed to be diuretic (good for heart failure) and had been used for tuberculosis."  (2, page 341)
• Tobacco:  It was used (probably ingested) by the Maya for asthma, cough and headache, as well as a variety of other ailments.  Some considered it a panacea.  It was even used by some to treat bad breath.  Of interest to note is that while many people loved this panacea, Vogul writes that "The 'Counterblaste to Tobacco' of James I has been widely quoted for its quaint condemnation of smoking as a 'custome lothsome to the eye, hateful to the nose, harmefull to the braine, dangerous to the Lungs, and in the blacke stinking fume thereof, nearest resembling the horrible sigian smoke of the pit that is bottomlesse.'"  Vogul also notes that the "Menominees inhaled tobacco smoke to induce a narcotic state.  The blowing of tobacco smoke into the ear for earache was reported in this century among the Chickahominys, the Mohegans, and the Malecites... Louisiana Choctaws blew tobacco smoke on snakebites."  So tobacco was used as early inhaltions and fumigations of sorts.  (2, page 380-385)
• Wintergreen:  It was made into a tea and used as a remedy for asthma.  It was also used for "coughs and diseases of the breast," according to Dr. Clapp.  (2, page 394)
• Balsam of Copaiba:  It was used as an expectorent and diuretic
• Balsam of Tolu:  It was used as an expectorant.  Vogul also notes that "In 1822 Dr. Bigelow called it useful in chronic bronchitis, asthma, and catarrh." 

So there's a small sample of some of the remedies that were used by native Americans, many of which made their way to the American and European pharmacopoeia. 

References:

1. Vogel, Virgil J. "American Indian Medicine," 1970, London, Oklahoma University Press

RT Cave Facebook Page
RT Cave on Twitter

1901-1920: Hay fever becomes allergy

Paul Portier

The term hay fever was used for the first time in medical nomenclature in 1812 by Dr. John Bostock to describe seasonal allergy symptoms associated with the hay season. The term had been used by lay people much longer than that. So, even while many physicians doubted it was an appropriate term, it stuck in medical nomenclature like gum on a little boy's shoe.

However, a series of discoveries shortly after the turn of the 20th century would introduce the world to a series of new terms, such as anaphylaxis, atopy, and allergy.

In 1901, the Prince of Morocco summoned two scientists, Paul Portier and Charles Richet, to study a sea anemones called the Portuguese man-of-war. Their job was to learn how to protect swimmers from its sting, which caused painful blisters. (1, page 608)

Initially, the two believed the painful blisters were caused by toxins from the animal's tentacles once they were entered into the skin of humans.  Back then vaccination was becoming a household name, and so the two set out to create an antitoxin vaccine.  (1, page 608)

Richet started the experiment by extracting toxins from sea anemones, and gave them in small amounts to test dogs.  After the initial injection they figured the dogs would develop antibodies that would protect them from a second exposure of the toxin.  In this way they would develop a natural protection against it, or prophylaxis.

Charles Richot

However, when they extracted the toxin of sea anemones and inserted it into test animals (dogs in this case), the reaction they got was the opposite of what they expected.  The first two doses did no harm to the animals, but subsequent doses caused many of the dogs to go into a state of shock, and most did not recover.  Richet and Portier determined the animals died due to the effects of the toxins.

Instead of prophylaxis The animals developed aniphylaxis, a new term devised by the two men.

It's time for some definitions:

• Greek pro means toward or before
• Greek phylaxis means protection
• Greek ani means opposite or away
• Prophylaxis means to add protection
• Aniphylaxis means to cause harm

So, instead of protecting the animals from developing symptoms, they caused the symptoms.  The scientists learned that a "foreign protein" was transferred from the sea anemones to the dogs making them hypersensitive to that protein. (2, page 11)

Other scientists performed similar experiments and came to similar results.

Clemons von Pirquet

In 1906, an Austrian pediatrician named Clemons Von Pirquet observed many of his patients were hypersensitive to substances that didn't bother other people.  These normally innocuous (harmless) substances were pollen, dust mites and some foods.

The purpose of the immune system is to attack foreign particles that want to harm the human body.  Yet sometimes the immune system attacks allergens that are not meant to cause harm.  Von Pirquet and Schlick observed this, and they coined the term allergy to describe when the immune system causes harm.  (5, page 53)(3)

Once again a definition is in order:

• Greek allos means other
• Greek ergon means action or enery
• Allergy means the immune system causes the opposite effect as its intention (causes harms)
• Allergen means a substance or protein that may incite the allergic response hen a hypersensitivity is present
• Hypersensitivity means over-reaction; a hyper-reaction of the immune system; as in when exposed to allergens (Dated to 1870s)(Dictionary.com)

Von Pirquet actually believed that asthma was an allergic condition, and curing this disease was only a matter of finding the right foreign proteins to inject. History would prove him right in juxtaposing asthma and allergies, yet wrong on the front of this leading to a cure.

Also in 1906, German physician Alfred Wolff-Eisner surmised that pollen is similar to the poisons of the Portuguese man-of-war in that it could trigger the immune response in some some people.  By inserting drops of pollen into the eyes of volunteers, he was able to produce the same response suffered "during the hay fever season: red, swollen, and itchy eyes." He published his findings in 1906.  (5, page 54)

Thanks to Wolffe-Eisner's discovery linking hay fever with the immune system, hay fever was no longer believed to be a nervous disease.  It as no a disease caused by a hypersensitive immune system. This was an essential transformation because it would effect the future course of treatment for the disease.  Instead of seeking to alleviate a nervous disorder, the goal of treatment as not to fix a broken immune system.  (5, page 54)

In 1910 Samuel Melzer observed the "similarity" between anaphylaxis and asthma "in which a person became sensitized to a definite substance, and an attack occurred every time the substance entered the circulation (of that patient).  Minute quantities of the substance, if inhaled, would bring on an asthma attack." (2)

We now know that about 75 percent of asthmatics have allergies.  Yet we also know that many people have allergies and not asthma.  We also know that both conditions have been linked to the immune system and can be developed at any age.  Yet in 1906 scientists were at the dawn of such allergy wisdom.

Pirquot believed it was the body's response, not the foreign particles, that resulted in the allergic reaction. He listed as things that might cause this "hypersensitivity" as bee stings, mosquito bites, hay fever caused by pollen, and substances in certain foods such as crabs.

Soon thereafter Arthur C. Coca, founder of the Journal of Immunology, and Robert Anderson Cook, were attempting to understand studies regarding allergic conditions, used the term Atopy which literally means "strange disease."  They thought atopy should be used to describe hereditary hypersensitivities such as asthma, hay fever and eczema, and hypersensitivities that could afflict anyone should be referred to as anaphylaxis.

By 1919 two allergists, Cooke and Albert Vander veer, published the results of a study of 500 patients with asthma, hay fever, and other allergic diseases that confirmed that age old theory that these conditions were inherited and perhaps linked to other conditions.

Initially all prophylactic and anaphylactic reactions were referred to as allergies, as this as the recommendation of Van Pirquot.  He believed the two reactions should have a common name.  (3)

Yet ultimately it was learned that there were three conditions associated with hypersensitivities that didn't fit into this classification:  asthma, hay fever and eczema.  In asthma the hypersensitive response lead to constricted air passages, in hay fever it lead to a runny and stuffy nose, and in eczema it lead to red and itchy skin.

These three conditions -- asthma, hay fever and eczema -- are now often referred to as the atopic triad because in many individuals they come as a package.  One major difference between the atopic triad and anaphylactic reactions is that anaphylaxis can be induced in almost anyone, while the others occur in only a small percent (about 10 percent) of individuals and are quite often hereditary.  (4, page 608)

In subsequent years allergy was used to denote an immunal hypersensitivity or hyperresponsiveness to a foreign substance and atopy was used to denote the inherited conditions of asthma, hay fever and eczema.  Although, quite often the terms allergy, atopy and anyphylaxis are used interchangeably.

References:

1. Klein, Jan and Vaclav Horejsi, "Immunology," 1997, page 608
2. Brenner, Barry E, "Emergency Asthma," (ed. Barry E. Brenner), 1998, New York
3. Ehrlich, Paul M., Elizabeth Shimer Bowers, "Living with Allergies," 2008
4. Klein, Jan, Vaclav Horejsi, "Immunology," 1997, page 608
5. Mittman, Gregg, "Breathing Space," 2007, New Haven, London, Yale University Press

1910: Melttzer links asthma with allergies

Samuel James Meltzer (1851-1920)

Samuel James Meltzer is another significant figure in the history of asthma. He collected and studied as much data regarding asthma as he could, and performed some studies on his own, all in an attempt to learn as much as he could about the disease.  His discoveries would have a significant impact on the evolution of the definitions of both asthma and allergies.

He was born in Curland, Russia in 1851, studied medicine in Germany, received his medical degree there in 1882. 

He visited the United States on various occasions when he was a ship surgeon during trans Atlantic trips. He stuck with this job even though he often became sick at sea because it was the only way he could afford to get to the United States.  (4, page 12)(5, page 25)

He found the democratic government of New York appealing, and decided to set up his practice there. This allowed him to make enough money to support his family, and to dedicate a portion of his time to research. (4, page 12) (5, page 25)

In 1904, he became head of the Rockefeller Institute's Department of Physiology and Pharmacology, and in 1907 he became a full time physiologist. This was of no surprise to those who knew him, because his favorite subject was physiology and research.  He became the first president of the American Association of Thoracic Surgery in 1918, and was instrumental in the advancement of the organization.

Dr. George B. Wallace explained that Meltzer:

"...was a man who loved and pursued knowledge for it's own sake.  This was an inherent characteristic... With the environment in which his medical education began, it isfemall wonder that Meltzer's interest turned to research work. What especially impressed him from the beginning was first, the necessity of careful observation and thoroughness in work, and, second, the importance of facts rather than theories. Those who have heard Meltzer present experimental work will, I think, recall numerous instances in which, when pressed for an explanation of his results, he has replied that although he had a theory, it was only the fact itself that he wished to bring out. (4, page 13)

By his research and ideas, he made significant contributions to a variety of areas of medicine.  For the sake of our history, he made significant contributions to the field of respiratory therapy.  For one thing, he invented a device for providing breaths to victims during artificial respiration. 

He also made significant advancements in the study of asthma. The following are the conclusion he made about our disease:

1.  By performing studies in his lab he determined the symptoms of anaphylactic shock were similar to the symptoms of asthma.  Both conditions result in shortness of breath due to spasms of the air passages in the lungs. (1, page 173) (2, page 54)(3, page 115)

2.  He described how an asthmatic can become sensitized to certain substances, and then, when exposed to those certain substances, the asthmatic air passages become hyper-reactive.  This response is what results in an asthma attack.  (3, page 115)

3.  He discovered that Atropine relieved asthma symptoms, and he believed it worked because it relieved allergy symptoms.  (3, page 115)

4.  Based on all the accumulated data he obtained from both his research and studies, he postulated that asthma was not a nervous disorder and that it was, in actuality, an allergic disorder.  This would have a significant impact on other asthma experts of his era, because for many generations asthma was believed to be nervous in origin.  (1, page 173) (3, page 115)

He passed away on November 7, 1970, although through his contributions to medicine his legacy will live on. The best summary of his life was made by Howell:

By his good work and his high character he attained a position of honor and distinction in American medicine and endeared himself to his fellow workers in all parts of the country. His productivity was remarkable. The list of his published papers includes over two hundred and forty titles, distributed among some forty-eight scientific journals of this country, Germany and England. These papers contain contributions to the subjects of physiology, pharmacology, pathology and clinical medicine together with a number of lectures and general addresses. That he was an investigator of recognized standing in these several branches of medicine and was regarded as a valued contributor to so many scientific journals of the first rank is a striking demonstration of the breadth of his interests and knowledge. ... his work... entitles him certainly to be ranked among the foremost American physiologists." (5, pages 25-26) 

We can especially thank him for his contributions to asthma, as through his research scientists were better equipped with knowledge to more accurately define the disease.

References:  

1. Lipkowitz, Myron A., Tova Navarra, "Encyclopedia of Allergies," 2nd edition, 2001, New York, page 173
2. Mittman, Gregg, "Breathing Space: How allergies shape our lives and landscapes," 2007, New Haven and London, Yale University Press, page 54
3. Jackson, Mark, "Asthma: A Biograhy," 2009, New York, Oxford University Press, page 115
4. Wallace, George B., "A tribute to Dr. Meltzers life and service," during a memorial service fo Dr. Melter, published in the book "Memorial Number for Samuel Meltzer, M.D., Founder and First President of the Society for Experimental Biology and Medicine," 1921, New York, Press of the New Frontier Company, pages 11-16
5. Howell, William H, "Dr. Melter's influence on American Physiology."  This was a speech given in tribute to the life of Dr. Meltzer published in the book "Memorial Number for Samuel Melzer," 1921, New York Press of the New Frontier company, pages 25-36

1918, 1947: Frances M. Rackemann redefines asthma

Frances Rackemann

The year 1901 was the dawn of modern asthma wisdom and treatment. This was a year that saw the introduction of epinephrine and ephedrine. It was also the year that a young man named Francis Milton Rackemann graduated from Harvard College at the age of 14.  He would grow to become the greatest asthma and allergy expert of the 20th century.

In a memorial tribute to his friend, Dr. Walter S. Burrage explained that Dr. Rackeman was born in 1887, and then, after graduating from college, a series of coincidences lead to him becoming an allergist.

First, he followed his cousin to Harvard where he was completing his registration to medical school on the last day. After his cousin was done, the Registrar turned to Rackemann and said, "How about registering yourself? Just mail us a copy of your college diploma and turn up tomorrow at nine o'clock for the first class." Rackemann did both, and four years later he graduated cum laude.

Second, in 1914 and 1915 he worked with Warfield T. Longscope doing research on anaphylaxis. The two would write a series of papers about allergies. This experience catapulted Rackemann's career as an allergist, and he would go on to write over 175 papers on allergies. (7)

There were two popular views on asthma at this time. One was that asthma was a nervous condition, and treating it was as simple as soothing the mind of the patient. The second was that asthma was an allergic condition and that curing it was as simple as finding the right protein to inject into the patient.

Rackeman would write several papers refining the definition of asthma.  The most significant were: "A Clinical Study of One Hundred and Fifty Cases of Bronchial Asthma," written in 1918, "Intrinsic Asthma," written in 1947, and "Nervous Factors in Asthma," written in 1969.

Rackeman believed asthma was a symptom more so than a disease. He also believed not all asthma could be defined as allergic, and therefore, in his 1918 paper, he categorized most asthma cases as either extrinsic or intrinsic. He further expounded on this in his 1947 paper.

Extrinsic asthma was defined as asthma caused by substances inhaled or ingested from "without the body." In these cases, the asthmatic develops hypersensitivities to proteins on these foreign objects. Their bodies develop proteins (later identified as IgE antibodies) to these substances (now referred to as allergens), and subsequent exposures cause the allergy and asthma responses. (3).

He described extrinsic asthma as being more often associated with childhood-onset asthma and generally presents prior to the age of 12. It affects more boys than girls. Today, it's often referred to as allergic or atopic asthma and has a greater tendency to be hereditary.

The diagnosis of extrinsic asthma may be made by allergy skin testing. For the treatment of extrinsic asthma, he recommended allergy shots to make the patient less sensitive to the proteins in that substance. For example, for a pollen allergy, "treatment with an extract of the specific pollen will relieve the hay fever and the asthma often entirely."

Although, he did mention that desensitization or immunotherapy as it is often called, does not work for all patients. For example, he suggested that, for those asthmatics allergic to horses, injecting these patients with the proteins of horses does not always prevent the allergic response of those patients to horses.  (3)

Intrinsic asthma was defined as asthma caused by substances from "within the body." It would include asthma caused by sinus infections, chronic sinusitis, nasal polyps, teeth infections, gum infections, throat infections (croup), acute bronchitis, colds, kidney failure (kidney asthma), heart failure (cardiac asthma), gastrointestinal irritation, etc.  It usually affects adults more so than children and is more likely to be chronic than extrinsic asthma.

The remedy for intrinsic asthma was fixing the causative agent.  For example, if acute bronchitis is the cause, then the remedy would be to resolve the bronchitis.

However, he wrote that "the treatment of intrinsic asthma is far from satisfactory.  Local treatment of the nose, throat, and teeth has been long considered important.  The removal of nasal polypi, the drainage of sinuses and the extraction of teeth will all relieve the asthma.  This relief, however, rarely amounts to a cure and even if very marked is rarely permanent.  The fact that many patients have spontaneous intervals of freedom from asthma which last for months or years, makes the results of any treatment difficult of interpretation."

In his 1940 article, he discussed the idea of vaccines to prevent bronchial infections, yet, he wrote, "from these cases must be left for some future time." (9)

Rackemann explained that while asthma may be distinguished by extrinsic and intrinsic, the general symptoms of the disease are very similar. For instance, while pulmonary function testing may help diagnose asthma, it cannot distinguish between intrinsic or extrinsic. (3)

In 1927, he wrote the chapter on asthma and allergies for the first edition of Cecil's A Textbook of Medicine, a medical textbook still used to this day.  He explained the most up to date wisdom of these diseases at this time and listed several allergens such as dust, fumes, foods and animal dander.

He also mentioned that most asthma cases were associated with increased eosinophils in the blood and sputum, including Charcot/ Leyden Crystals. (4, page 21)

He also supported the 19th-century theory that asthma was a nervous condition. However, while he supported the nervous theory, he did not support the age-old idea that a nervous condition, such as anxiety or stress, explained all cases of asthma.

He described this in his 1969 paper. He explained that to diagnose all asthma as nervous would result in missing the real cause, which may be an allergy to a cat pillow or an infection caused by a cold. (8)

He explained that some cases of asthma are mainly nervous, and most of the time this involves intrinsic asthmatics.  He also explained how desensitization shots or skin testing may have no other effect that to "impress the patient and show that something is real and being done." (8)

Rackeman believed that the best treatment could be provided when the physician worked with the patient.  For 33 years he set up his general practice at his home, and often his family members had to shuffle through patients to get to their bedrooms.  He would also often visit his patients at their homes, and at times walk away "bandishing a guilty feather pillow." (7)

He was likewise friendly with his students.  He is believed to have provided the first exposure to allergy testing and desensitization to medical students.

In over 175 writings on allergies, he listed a variety of proteins that might cause asthma (6):

• Ragweed
• Horse hair
• The spit protein of wheat
• Egg white
• Goose feathers
• One meat, as beef
• One fish, as codfish
• Dust  (4, page 21)
• Fumes
• Animal dander
• Molds (5)

Other than removal from or fixing the causative agent, Rackemann recommended the following as treatments for asthma (note that the treatment for asthma improved throughout Rackemann's career) (4):

• 0.25 ml Adrenaline chloride repeated every half hour as needed (almost always works for all cases of asthma)
• Smoking strammonium leaves
• Cocaine nasal spray
• Morphine (rarely works)
• 20-25 mg of ephedrine three times a day as an alternative to adrenaline
• Potassium iodide
• Ipacec
• Moving to a dry climate
• No eating during an attack
• Aminophylline in cases where adrenaline doesn't work (after it was proven to be an effective bronchodilator in 1922, it became more prominent intravenously after studies proved it to be effective in 1937.  I have an upcoming post about theophylline)
• Diuretics for pulmonary edema (although we now know pulmonary edema is associated with cardiac asthma and not true asthma)

Burrage explained that Rackemann provided some of the first exposure to allergy skin testing that students had ever had. Other than Dr. Robert Cooke, Rackeman made more contributions to the understanding of allergy than any other physician. His name was well known within the medical communities in the United States as well as several other countries. (7)

He was a community organizer.  In 1923 he became founder of American Society for the Asthma and Allied Conditions and founder of the Allergy clinic at Massachusettes General Hospital, the first of its kind in the U.S.  He was the first president of the American Association of Allergy in 1934.  Ultimately these two organization merged to become The American Academy of Allergy.

Based on respect for Rackemann and his belief that asthma was an allergic condition and a nervous condition, most emphasis on asthma research was focused on these areas.  While he was on the right track and had noble intentions, this may have slowed the progress of asthma wisdom in other areas.

Yet, it was, Dr. Rackemann's interest asthma drove others to study it more intensely in the years between WWI and WWII. This resulted in a continued growth in asthma and allergy wisdom. Asthmatics should remember him as the most well known and respected asthma expert of the first half of the 20th century. He passed away in 1973 at the age of 85.

His dictum was "there is always something that can be done to help the asthmatic." (7) It was this way of thinking that lead to his many observations about allergy and asthma that lead to improved care for the asthmatic patient.

References:

1. McFadden, E. R. Jr. "A Century of Asthma," American Journal of Respiratory and Critical Medicine, Vol 170, pages 215-221.  
2. Adkinson, N. Franklin JR, "Is Asthma Always An Allergic Disease?", 1946, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2376710/pdf/tacca00085-0288.pdf
3. Rackermann, Frances M., "A Clinical Study of One Hundred and Fifty Cases of Bronchial Asthma," Archives of Internal Medicine (The American Medical Association), Oct., 1918, Vol. 22, No. 4, page 517-552
4. Brenner, Barry E., ed., "Emergency Asthma," 1999, New York
5. Rackerman, Francess M., "Molds as a cause of hay fever and asthma," 1937, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2242158/pdf/tacca00017-0255.pdf
6. Rackerman, Frances M., "Asthma, Hay Fever and Allied Conditions," The Medical Clinics of North America, Jan. 1920, Philadelphia and London, pages 1065-
7. Burrage, Walter S, "Francis Minot Rackermann, M.D.," Trans. Am. clin. Climatol. Assoc., 1974, 85;xliv
8. Rackemann, Frances M., "Nervous Factors in Asthma," 1969
9. Rackemann, Frances M, "Intrinsic Asthma," January, 1940, http://www.jacionline.org/article/S0021-8707(40)90829-2/pdf, accessed 

1823: Native American sweat houses, an early panacea

Native Americans of both South and North America believed that sweating was one of the simplest and most effective means of treating diseases. The various people who lived among or studied native Americans observed their use of herbal remedies to cause a sweat, or sweat houses.

Virgil Vogel, in his 1970 book "American Indian Medicine," notes that the Aztecs used the sweat bath as a cure all for many ailments. There were various experts who noted the use of sweat baths among the natives of North America. He quotes Jean Bernard Bossu (1720-1792) who observed the Choctaws of Canada using "steam cabinets in which are boiled all sorts of medicinal and sweet-smelling herbs. The vapor filled with the essence and salts of these herbs enter the patient's body through his pores and his nose and restores his strength." (2, page 255)

John D. Hunter also describes sweating, and says it's a good asthma remedy. In fact, Hunter says that most of the medicines used to treat asthmaare meant to induce a profuse sweating, which is believed to cause healing. You may read of other remedies, and sweating is usually the desired result; rather, improved breathing through sweating. (1, page 410)

We must understand that sweating was not just used for asthma, it was sort of a panacea for many ailments. (2, page 256) It was a way of cleansing the body and the soul. Hunter describes this:

Nes-ni-ne-shu-ka-ah. — The salt water runs. Sweating. — Among all the various Indian nations with which I am acquainted, sweating constitutes one of their principal remedies, and amongst some of them * like bathing, it is practised for the pleasurable sensations which it produces. Various means are resorted to for the attainment of this object. Some effect it by drinking warm infusions; others assist these means by enwrapping themselves in blankets or skins, while a majority have separate apartments prepared for the purpose of procuring it by exposure to the steam of water. For this, a house sufficient in size to contain one, two, or more persons, is constructed of sticks or logs; commonly on the sloping side of a hill, and convenient to water. An excavation is next made in the earth-flooring, in which they place heated rocks. The bath thus prepared, the patient closes himself in, and pours water on the rocks till the apartment is filled with steam, and the intended effect produced. Herbs and roots of various kinds are placed on the rock, with a view that their virtues may unite and ascend with the vapour. During the process, the patient drinks freely of the infusion of dittany, mountain tea, or other herbs. He remains in as long as the heated rocks retain warmth sufficient to produce vapour. When he leaves it, he wraps himself in a buffalo robe or blanket, and immediately, if able, repairs to his house, and if not he is assisted and goes to bed. I have frequently known them to remain in until they became quite faint. When this bath is used as a luxury, they frequently, on leaving it, plunge into cold water; and I have never witnessed any dangerous or ill effects to arise from the practice. Some tribes resort to another expedient to induce sweating. They make a hole in the ground of a size and depth sufficient to contain the body of the person wishing to undergo the operation. They continue a fire in it till it becomes quite heated. The patient wrapped in his blanket or robe, stands over the excavation, water is poured in it, and the steam rises between his body and its envelop; while others again immerse themselves in the water.They also produce sweating by covering themselves in the hot sands of the barrens, and I believe with much advantage in some cases. (This may also be considered an early, or primitive, fumigation.) (1, page 423-44)

It was a soothing remedy and one that was easy to do. It was a remedy that was inculcated deep into folk medicine. I remember when I was a kid and having asthma trouble, my dad would sit with me in the bathroom with the hot water showering in the tub. My grandma would have me sit with my head
under a towel in the bathroom sink with the hot water on. Surely this provided a cool sensation, but it rarely if ever provided any breathing relief.

References:

1. Hunter, John D., "Memoirs of a captivity among the Indians of North America, from childhood to the age of fifteen: with anecdotes descriptive of their customs to which is added some accounts of the soil, climate and vegetable productions of the territory westward of teh Mississippi," 1823, London, Paternoster-Row
2. Vogel, Virgil J. "American Indian Medicine," 1970, London, Oklahoma University Press

RT Cave Facebook Page
RT Cave on Twitter

1823: Hunter shares native American asthma remedies

Figure 1 - John D. Hunter

John D. Hunter published a book in 1823 describing his experiences growing up among the Indians of North America, providing us a rare opportunity to see inside Indian Tribes. Of particular interest to our asthma history is Hunter's description of how the Indians perceive hasthma and what remedies they used to treat it.

Hunter recollected no idea where he was born, although he knew the Indians massacred his parents, and took him prisoner. He became the property of a warrior named Fongoh of a tribe of the Kickapoo Nation along the Kalkaska river in Michigan. The Kickapoo were among the hundreds of thousands of Algonquin Indian tribes, and they were nomads who "roam with unrestrained freedom" to hunt for game and to cultivate the soil for the purpose of planting crops used to make food and crafts. The main crop of the Indians Hunter lived with was sugar, at least while they lived along the Kalkaska River. (1, page 8)

Figure 2 -- Kickapoo Hut (wickiup) and tribal member

The Kickapoo set up huts called wickiups, which consisted of an "oval base and a rough frame covered with reed mats, grass, or brushwood."

You can see a picture in figure 2.

As they traveled from place to place these were easily set up. Inside many of these homes, and amid the contents carried on their backs as they traveled, were medicine bags made of beaver or otter skin that were "curiously ornamented."

These bags contained "small sacred articles," along with "medicinal barks, roots, and herbs." Since they were considered sacred, not even "unhallowed hands" would interfere with their contents. (1, page 342)

Hunter said that...

...every encroachment made upon their territory, whether with or without their consent, is, sooner or later, regarded as infringement of their natural rights, and has frequently given rise to long, cruel, and exterminating wars, not only between different tribes, but between the Indians and the whites. They regard the latter with much the most scrupulous jealousy; because experience has taught them that every settlement on their part, within their boundaries, is a precursor to their farther recess, which, they most sensibly feel, will only terminate with their final expulsion, extermination, or incorporation with those they esteem their natural and most bitter enemies. (1, page 8)

This, he believes, is how he came to live among the Indians. He watched them go to war with white families, and massacre the warriors, and take the children prisoners. While jealousy is a main cause for war, he said that in most cases the the Indians were "provoked" by "frauds and thefts practised upon them, which provoke to retaliation and aggression; consequently, the innocent and guilty indiscriminately suffer. Such conduct, mutually practised by them and the whites, along the whole extent of the conceived, though arbitrary boundary, is the cause of the inveterate hostility that exists between them, and leads to all the scenes of Indian cruelty that are practised on the frontier settlers." (1, page 9)

So it was in this way that he and others like him were "forced to assume the Indian character and habits," and after a while they became "happy and contended as though they had assembled directly from the Indians, and were in possession of their patrimony." (1, page 13, 14)

Many of the other white children raised by the Indians adapted to the simple primitive life so well that they chose to live out the remainder of their lives among the Indians, Hunter said.

He added that he was not one of these.   (1, page 13, 14)

When he was 19 or 20 he says he was allowed to go free, and he most duly accepted his freedom. He returned to become a citizen of the United States, and it was during this part of his life that he wrote of his experiences among the Indians.  (1, page 13, 14)

The first Indians he lived with marched north to Mackinac where there was better hunting, and they joined with other Indians, and at some point these Indians, and all the Indians he lived with, were massacred, and once again all the women and children were taken prisoners. Somehow along the way he ended up with a tribe associated with the Osages, who were much less settlers as the Kickapoo were, and more likely to wander in search of game. Occasionally they came into skirmishes, as did the Kickapoo, and in the course massacres occurred, and the heads of enemy warriors were walked back to camp, along with prisoner women and children. He didn't know the name of the tribe, although he knew they were among the Pawnee. (1, page 18)

His tribe ended up among the Kansas tribe, were ambushed, and members of his tribe either fled, were killed, or taken prisoner. Hunter was among those taken prisoner, and with his new tribe set off on a long march to the Kansas River. He was "adapted into the family of Kee-nees-tah by his squaw (wife), who had lost a son in one of their recent engagements with the Pawnees. I was exceedingly fortunate from this election; and not only the chiefs and squaws, but the whole tribe, treated me with regard and tenderness. This conduct in respect to myself was not singular, for all the women and children were treated in the same manner; while the warriors who were so unfortunate as not to fall in battle were nearly all tortured to death: a few of them, however, were respected for their distinguished bravery, and permitted to live amongst them. (1, page 19)

In comparing the Kickapoo with the Kansas, he said:

Injustice to my own feelings, I cannot avoid making some remarks in this place, on the difference of character that exists between the Kickapoo and Kansas Indians. The former are treacherous, deceitful, cunning, not tenacious of a good character, exceedingly remiss in their social habits and intercourse, and are held in humble estimation by the neighbouring tribes: while the character of the latter, according to the estimation I formed of their conduct to me, is directly the reverse.  In this difference of their general character, it is, however, possible for me to be mistaken; but gratitude is a virtue inculcated by all the Indian tribes with which I have been acquainted; and so great was the change of conduct towards me, after my transposition from the former to the latter, that I am persuaded my readers will excuse me, even should I have committed an error. (1, page 19-20)

They had horses, and they ate venison, buffalo meat, corn, nuts, etc. He learned how to ride horses, learned how to hunt, and learned to protect his hunting grounds from encroachments. He learned their virtues, values, and customs by listening to the "inspiring narratives" of the sages. The sages, according to Hunter, would say things like:

"Never steal, except it be from an enemy, whom it is just that we should injure in every possible way. When you become men, be brave and cunning in war, and defend your hunting grounds against all encroachments. Never suffer your squaws or little ones to want. Protect the squaws and strangers from insult. On no account betray your friend. Resent insults — revenge yourselves on your enemies. Drink not the poisonous strong-water of the white people; it is sent by the Bad Spirit to destroy the Indians. Fear not death; none but cowards fear to die. Obey and venerate the old people, particularly your parents. Fear and propitiate the Bad Spirit, that he may do you no harm; — love and adore the Good Spirit, who made us all, who supplies our hunting grounds, and keeps us alive."

It is in this way that Hunter learned the ways of the Indians, and became a credible author on the subject. He said that the Indians were were a very healthy people, and that the warriors were morel likely to die in a fray as compared to natural causes. There were essentially few diseases among the Indians, and most tribes were familiar with the diseases that were most common to their tribe, and by trial and error they learned of the best remedies for treating these maladies. Since asthma was a disease that plagued those who lived to old age, there would be remedies for asthma in many medicine bags. (1, page 342)

He wrote the following about asthma:

Asthma. — When we consider the hardships the Indians undergo, it is not surprising that they should be subject to asthma. This is not an unfrequent disease among them. Their remedies are blisterings, fomentations, and anodynes. There is, perhaps, no complaint, in which Indian remedies are more successfully employed. They use the sweat-oven, as before described, with great success. Sometimes relief is obtained by the application of small bags of wet ashes upon the breast; and sometimes by inhaling the streams arising from water poured upon hot stones, and herbs of various kinds. But by far the most valuable remedy ever used among them for the cure of this distressing complaint, is a small plant, .wesh-ke-nah. This plant somewhat resembles the common flax, though it is more branched, and not linty like the latter. An infusion of it, roots and tops together, in doses of half a pint, at intervals of twenty minutes, till relief is obtained, is the usual mode of administering it . In a short time its beneficial operation is perceivable by a gentle moisture on the skin, more easy respiration, ability to lie in a recumbent posture, &c. Shortly after a more copious sweating comes on, attended with an expectoration of phlegm or mucus, and entire relief from pain. The patient now falls into a comfortable sleep, from which he awakes free from his disease. Thus have I seen these untutored followers of Esculapius subdue some of the worst cases of asthma. (1, page 443-4)

This description of asthma is not the same as our modern definition. As would be normal for the time, his description was mainly of the symptom of shortness of breath or dyspnea, which could be from any generic cause.

He also explains the asthma remedies stored in the medicine bag.

• Wesii-ke-nah.—  It relieves hard breathing. The flax weed—grows in the fissures of rocks, particularly on cliffs, on the margin of the rivers, to the height of ten or twelve inches; the root sends off many branches, which in July produce numerous small pale blue flowers. The Indians gather the plant, while in blossom, and prescribe it for asthmas and coughs with the happiest effect . The roots, leaves, and stalks, are made into a decoction, and given freely to the patient, as warm as he can conveniently take it; and no medicine displays its salutary effects more promptly. I speak thus confidently, because I have witnessed its operations. The Indians sometimes while travelling, or when just returned from long and fatiguing journeys, are seized with the asthma, but are certain to obtain prompt and decided relief from this remedy. I believe it almost uniformly excites a perspiration, on the appearance of which the patient becomes easy. (1, page 410)
• Was-saw-ba-he-ja. — The fat of the bear. Bears' oil.— This is used as a medicine, both internally and externally, in combination with many drugs...  For colds they seethe the roots of wild liquorice in it, which they drink hot as they can well bear it. They also take it for asthma and pleurisy. They esteem it among the most valuable articles of food, especially in their journies. It is highly nutritive, agrees well with the stomach, and produces no thirst . From the smallness of the quantity necessary to satisfy the appetite, it produces no shortness of breath. The Indians, while travelling, take about four ounces in twenty-four hours, which they continue for days together, with very little other nourishment. (1, page 404)
• Ne-pe-sha.—Bad luck to touch it. Milk-weed.— ...The Indians use the roots in decoction for the cure of dysentery, dropsy, and asthma. It is also used as an emetic, and held in tolerably high estimation as a medicine in the above cases. (1, page 414)
• Sin-des-nes-ni.—It grows by the water. Green-twig.—(Willow) This is a shrub very common on the banks of rivers and water courses. It seldom attains to a height exceeding six or eight feet, and is considered valuable in colds, and asthma; they give a warm infusion at night, with a design to excite perspiration. (1, page 411)
• TU-TUS-Se-GA-O-GA-SHE. To expel Wind. Spikenard. — This spikenard is one of the most luxuriant of the forest plants: it grows in the beds of hollows in hilly districts in great abundance, and if it possesses half the virtues ascribed to it by the Shawanee Indians, it merits a high rank in the Materia Medica. They give it with a view to expel wind from the stomach, to stop coughs, and to relieve pain in the breast and asthma. (1, page 422)
• Sweating:  The various herbs above usually cause improved breathing by causing the patient to sweat. (1, page 410)  Another means is to take in a draught of herbs and spices.  Another means was to places herbal solutions on heated bricks, rocks, or pots, and place a blanket or furs over the patient's head.  Another means was the sweat house, where water was placed on heated rocks and the fumes inhaled.  This was done while drinking tea. (1, page 423-4)

There are other ailments that plagued the Indians besides asthma, and these included pleurisy, fevers, and upset stomachs and pains. Consumption also plagued them, although rarely. (1, page 342, 347)

Usually the plagues were short term, and were the result of exposure to the elements and fatigue from long excursions and working hard and bravery. Although at times diseases became chronic, or the patient became "dangerously sick." (1, page 342, 347)

Some of these patients become sick enough to be housed in a hut for sick people, with cots that were raised from the ground. The medicine men would treat these patients daily, and nurses, usually women, would care for their daily needs. These may have been considered as hospitals. As they traveled from place to place, the sick were continuously cared for (1, page 342, 347)

Since pure asthma must have been extremely rare among the Indians, most asthma must have actually been bronchitis from inhaling smoke, or heart failure from old age, and these probably would have been the asthmatics referred to by Hunter. This must have often been what ensued when a warrior lived to old age. Of these, Hunter wrote the following: 

When all natural means fail, the physicians do not abandon their patients; on the contrary, they cling to them till their last gasp, but substitute, instead of their prescriptions, fastings and prayers to the Great Spirit. "So long as there is life," say they, "there is room for hope; and to despair of effecting good, and to neglect means that appear remote and almost foreign to the disease, bespeak a careless and unskilful practice." When their hopes fail, they seldom inform their patients of their danger, but are very cautious that their last moments may be calm and undisturbed. In general, they look upon sickness and affliction as chastisements for their offences against the Great Spirit, and commonly bear them with great resignation and fortitude. When they become peevish and fretful, as sometimes happens, their doctors then say, that the abatement of their disease permits their minds to be idle or unoccupied, and the danger is past. (1, page 350-351)

He described the Indians as having "no anxiety about the future, and they, but leave the world with an apparent satisfaction, under a belief, provided their conduct has been in consonance with the precepts which they have been taught, that their title to the future happiness is unquestionable." (1, page 352-3) 

This must be similar to modern Christians, whose belief in God and the afterlife allows them to end life with grace in dignity.

For the most part, however, as a remedy was needed, either the patient or the nurse, who was mostly the mom or consort or some other woman in the tribe, gave the remedy to the sick person.  

If the remedy no longer worked, which most likely would happen if the person was severely sick (as if close to death), the medicine man (or physician) would be consulted.  I will describe the healing powers of the North American Indian Medicine Man in my next post.  

Note:  Similar remedies were used for colds, pneumonia, consumption, and pleurisy.  (You can find some more asthma remedies by reading "Herbal and Magical Medicine: Traditional Healing Today," edited by James K. Kirkland et al, page 157)

References:  

1. Hunter, John D., "Memoirs of a captivity among the Indians of North America, from childhood to the age of fifteen: with anecdotes descriptive of their customs to which is added some accounts of the soil, climate and vegetable productions of the territory westward of teh Mississippi," 1823, London, Paternoster-Row

RT Cave Facebook Page
RT Cave on Twitter