Tuesday, July 29, 2014

3000 B.C.: The baru will predict your future

Divination is the interpretation of omens or signs to predict the future.  Most ancient societies, from Ancient Greece, Ancient Egypt, Ancient Mesopotamia, Ancient India, Ancient China and Ancient Rome all believed in omens.  And there were good and bad omens.  (1,2)

You are sick.  You have sinned.  You are impure.  You are in disharmony with the world.  You are a burden on society.  You are unclean.  So you go to see a healer; a priest. Since disease, your symptom, is caused by magic, you need a magic remedy.  The healer gives you an incantaion.  He also, if you can afford it, can use divination to learn how you got sick and how to heal you.

Through divination he can give you hope, which modern studies have proven, can help you get better.  Optimism heals.  Or he could predict that your ill health is futile and that you will die, and in that case fill you with gloom and pessimism.  He could predict success in wartime, and inspire soldiers.  Or he could predict a loss, and therefore cause resignation among soldiers.

The priest who did this were the baru, the diviner.  They are specially trained in the divination.  They may ask you questions:  Did a bird cross your path.  If it did, was it to the left or right.  If you saw birds flying to your left when you broke your foot the birds brought back luck.  This was no coincidence.  You are cursed.  The remedy is to chant this incantation or to put this amulet on a chain around your neck, or over your doorway or window.(2)

There were other means of getting omens, depending on how much you can afford.  Probably the most expensive, yet most revealing, would be to have a baru examine the liver of a sacrificed animal by Babylonian baru. 

By studying the liver, most often by sacrificed animals such as sheep, the baru could learn much about the future.  According to Henry Osler in his series of lectures at Yale University in 1913, "Of all the organs inspected in a sacrificial animal the liver, from its size, position and richness in blood, impressed the early observers as the most important of the body.  Probably on account of the richness in blood it came to be regarded as the seat of life --- indeed, the seat of the soul."

The liver to the Babylonians is similar to the heart to the modern world:  it's the soul  of life; the center of vitality  "Hepatoscopy," Osler states, "thus became, among the Babylonians, of extraordinary complexity, and the organ of the sheep was studies and figured as early as 3000 B.C.  In the divination rites, the lobes, the gall bladder, the appendages of the upper lobe and the markings were all inspected with unusual care."

Readings:  gallbladder... liver....

Cheaper methods would be to drop oil over water and watch what happens.  Or a flame was lit and the flickering was examined, conclusions drawn.

Knowledge that the baru had was esoteric.  Many religious texts ended in "May he who knows instruct him who knows.  And may he who knows not read this."  And "He who does not keep the secret will not remain in health -- His days will be shortened." (2, page 433)

Writings means for physicians were the same, and ended with similar sayings.

References:
  1. Osler, William, "Evolution of Modern Medicine: a series of lectures at Yale University to the Silliman Foundation in April 1913, 1921", New haven, Yale University Press, pages 18-19
  2. Sigerist, Henry E., A history of medicine," 1955, 2nd edition, volume 1, pages 453-5, 433

Thursday, July 24, 2014

1913: Two types of chronic asthmatics

James Adams explains that most cases of asthma are chronic before they are seen by a physician; that these cases are usually treated as bronchitis first (airway inflammation and increased sputum production).  Bronchitis "is really the form asthma commonly takes at first."  Only as time progresses, does asthma be come chronic. (1, page 31, 33)

He describes two types of chronic asthma: (1, page 30)
  1. Fat: Less common; overeating can lead to asthma; chronic bronchitis
  2. Lean: More common; usually as the disease becomes more chronic, a toxaemia in the blood will cause the asthmatic to become thin, with expanded shoulders and chest due to chronic laboring and emphysema.  
Adam writes that the most common sign of chronic asthma is "dusky, sallow skin with chloasms round the eyes, sure token of toxaemia. There is no mistaking this asthmatic chachexia (fatigue, weakness, as in wasting away) and the first sign of improvement resulting from correct treatment is the clearing of the skin; it looks as though it has been washed from the inside -- as it has been... it takes prolonged, repeated and severe paroxysms to develop the other (signs of chronic asthma). (1, page 31)

What causes the signs of chronic asthma, Adam notes, is the hyperaemia that is constantly ongoing and not treated (and it's usually not treated because most physicians don't respect the toxaemia theory of asthma.).  Toxaemia that is constant acts on the "skin and bronchial mucous membrane as well as on the tissues generally, producing the cachexia and bronchitis, the stress of the dyspnea, which is the main factor in producing the other thoracic changes, is intermittent.

Other signs of chronic asthma would be your distended chest and shoulders, pigeon chest, etc. These are signs that the person has a toxaemia, and that the person has been working hard to suck in air. (You can see more signs of the toxaemic effect on asthma in this post (1913: Lesions in respiratory tract cause asthma on 7/22/17)

Bronchitis is generally caused by a metabolic disorder, and therefore, the treatment generally revolves around decreasing carbohydrates (sugary foods), such as "sweets cakes." (1, page 33, 35)(also see chapter on atypical asthma)

References:
  1. Adam, James, "Asthma and its radical treatment," 

Tuesday, July 22, 2014

1913: Adam: Abnormalities associated with asthma

Dr. James Adam believed the most common cause of asthma was a toxin or poison in the blood.  The other cause of asthma was lesions in the respiratory tract (published 7/10/14).  While most physicians focused their attention on spasms in the lungs, he believed they should be focused more on one of these two causes of airway spasms. 

He observed that many asthmatics, although not all, present with one or more of the following abnormalities along their respiratory tract or amid the chest and body:(1, page 12, 35-38)
  1. Polypi
  2. Septal deviations blocks air passage
  3. Turgid turbinals: blocks air passage
  4. Irritable turbinals (very sensitive to stimulus, causing coughing or sneezing)
  5. Congestion of mucus membrane (anywhere from nose, trachea or bronchi)
  6. Pigeon breast: from a lifetime of asthma the chest becomes deformed, where one sternum, or breastbone, is pushed outward
  7. Emphysema during asthma attacks, becomes chronic if asthma not cured 
  8. Barrel chest: rounded, bulging chest that shows little movementn with respiration.  It occus during a paroxysm, and becomes chronic if asthma not treated (sign of emphysema)
  9. Rounded, almost stooped shoulders (sign of emphysema)
  10. Unilateral nasal obstruction
  11. Sputum at the end of the attack
  12. Curschmann spirals in the sputum
  13. Eosinophile cells in sputum, with Charcot-Leyden crystals
  14. Heart Rate of 90-110
  15. Blood pressure within normal limits: paroxysm does not raise the blood pressure, but adrenalyn used to treat asthma may
  16. Blood pressure of 80-90 mmHg at end inspiration, and 120-130 at end expiration: decreased BP on inspiration may probably be due to impeded pulmonary circulation
  17. Flatulence during the paroxysm
  18. Asthmatics live long: In this, he agrees with other asthma physicians such as Salter and Berkart. (1, page 38) Adam notes this is true "so long as they don't become drug slaves)
While most other members of the medical community focused most of their attention on the spasmotic and nervous theories of asthma, Adam was focused on the Lesion Theory of Asthma and the Toxaemia theory of asthma, and for that reason his "radical treatment" would better help asthmatics as opposed to the more traditional treatment prescribed by other physicians.

References
  1. Adam, James, "Asthma and it's radical treatment," 1913, London, Gasgow: Alexander Stenhouse

Thursday, July 17, 2014

1866: Catologue of stethoscopes

Check out these stethoscopes from the a physician's catalog of S. May and Son from 1866:




Reference:
  1. S. Maw and Son, Manufacturer of respiratory equipment, "A catalogue of surgeon's instruments, air and water beds, pillows, and cushions, bandages, trusses, elastic stockings, inhalers, galvanic apparatus, and other appliances used by the medical profession," 1866, London, 11 Aldersgate St., Buttler and Tanner, The Selwood Printing Works, page 127-8

Wednesday, July 16, 2014

1786: Thomas Withers and his "Treaties on Asthma":

William Cullen was among the first physicians to form conclusions about asthma based on studies he performed, as opposed to speculating about it.  He believed a muscle was a continuation of a nerve, and therefore that asthma was a nervous disorder.  In 1786, Thomas Withers wrote a book called "A treaties on Asthma," in which he expounded on the ideas of Cullen.  (1, page 75)(2, page 17-18)

Thomas Withers (1750-1809) was a physician to the New York County Hospital.   Like Cullen, he believed asthma started in the mind and resulted in convulsions of the fibres that wrap around the lungs.  He believed in the nervous theory of asthma and in the convulsive theory of asthma.  (1, page 75)

In a review on Wither's book, Tobias George Smollettt, in 1786, compared him with John Floyer, who is considered by many to be the father of the convulsive theory of asthma.  Smollet said:
'This is an old building, with a modern front and fashionable ornaments: in other words, it is the valuable work of Floyer, with explanations from the modern nervous papathology. Dr. Withers, in his former works, adhered so closely to his master's precepts, almost to his words, that we did not expect any thing new. (2, pages 17-18)
 Smollet continued:
We hoped, indeed, that experience might have opened sources of enquiry, which his unwearied diligence would have pursued; but the little which is his own, is not of the best kind. The account of the asthma, as may be expected, when we consider the sources, is clear, intelligible, and judicious: the cafes are sometimes unnecessarily minute, at others imperfect; they arc in general very trifling, and the effects of remedies unreasonably exaggerated.  (2, page 18)
Dr. Withers believed spasmotic asthma was "a nervous disorder accompanied with great irritability of the lungs." Through his various books he provided various pithy examples of cases of asthma he witnessed, along with the remedies used. (3, page 300)

He believed a good remedy for nervous, or spasmotic, asthma was opium, which "diminishes the irritability and spasmotic contraction of the air vessels; mitigates the cough; lessens the pain, anxiety and difficulty of breathing; shortens the duration and the facilitates the cure of the asthmatic fit." (3, page 300)

References: 
  1. Jackson, Mark," Asthma: The Biography," 1999, New York, London, Oxford University Press???????
  2. Smollet, Tobias Georgy, ed., "The Critical review, or, Annals of literature, Volume 62, 1786 , page 17-18, a professional review of withers book, "a treaties of the asthma, to which are added cases and observations, in which the asthma is complicated with other diseases." 
  3. Withers, Thomas, "Observations on the Abuse of Medicine," 1775, London, 339
  4. Griffiths, Ralph, Grifiths, G.E., ed.,  "The Monthly Review, or Literary Journal," London, 1787, pages 332-334, a professional review of Wither's "A Treaties on Asthma."
  5. Ramadge, Francis Hopkins, "Asthma, its species and complications, or researches into pathology or disordered respiration; with remarks on the remedial treatment applicable to each variety; being a practical and theoretical review of this malady, considered in its simple form, and in connection with disease of the heart, catarrh, indigestion, etc." 1835, London,  Longman, Rees, Orme, Brown, Green, and Longman

Tuesday, July 15, 2014

1909: Pituitrin tried for asthma and hay fever

Pituitrini was an extract of bovine pituitary gland.  Along with other uses,
it was trialed for asthma by various physicians, and with success, around
1909 and 1910. The medicine was provided by Park-Davis & Co. out
of Detroit, Michigan in one ounce glass stopper bottles and glaseptic
  ampoules (ready for immediate hypodermic injetion) as seen here. (2)
Another medicine that was trialed for asthmatics around the 1910s was a medicine called Pituitrin.  It was an extract of bovine pituitary gland containing oxytocin and vasopressin, and being a relatively new medicine it garnered much attention among the medical community. As with other new medicines, it was trialed for various purposes, including asthma. 

The medicine "has been somewhat extensively used for the past two or three years," by European physicians for its oxycotin effect on some pregnant women to help strengthen labor and reduce bleeding.  (1) It does this by constricting blood vessels.  It also is a bronchodilator, and for this reason it was trialed on asthmatics.

In 1919 the Therapeutic Notes reported the following:
The fact that Pituitrin has an Adrenalin-like action, and the fact that this action is more prolonged than that of the suprarenal active principle, has suggested its utility in the treatment of asthma and hay-fever. It has been tested clinically by leading practitioners, who pronounce it a valuable drug in these diseases. Some opinions are here given:
 "One of my asthmatic patients has experienced great relief from the use of Pituitrin.""I have used Pituitrin in two cases of hay-fever with satisfactory results. While ischemia is accomplished less slowly it seems to last much longer; one patient who experienced great irritation from the use of Adrenalin says that the Pituitrin is almost without any irritating effect.'' 
"I have one case of asthma which was relieved by the use of Pituitrin; it is also of a great deal of use in the treatment of hay-fever." 
"A case of hay-fever treated with Pituitrin in normal salt solution (1:3) showed decided relief. I found that its. action was slower, more prolonged and less irritating than Adrenalin, and no after-congestion resulted as in the case of the latter." 
"I used Pituitrin daily in one case of hay-fever, employing the undiluted solution so as to give the hardest possible test as to its irritation. There was no irritation and the relief was perfect.'
"When used in a 10-per-cent normal saline solution the results were very satisfactory."
 It's very common throughout human history to find a medicine experimented with in this fashion, and this continues to this day.  Also, in the 1970s a medicine called terbutaline was approved for asthma as a rescue medicine, and it was ultimately more commonly used to delay pregnancies.

Probably due to the success of adrenaline, pituitrin never caught on as an asthma medicine.  Yet it provided another option for physicians and asthmatis when such an option was necessary.

References:

  1. "Pituitin in difficult parturition," Medial Review, June, 1912, Volume 61, Issue 6, Picture is from an advertisement that follows the article paid for by Park-Davis & Co.
  2. "Pituitrin in Hay fever and asthma," Therapeutic Notes, Volumes 17 and 18, Park-Davis & Co., 1909 and 1910, page 70.
Further reading

  1. rticle on polen and hay fever



1758-1839: Robert Bree defends old asthma theories

Like most asthma experts before him and after, Robert Bree's interest in asthma grew out of his own sufferings from the disease. His asthma made it his fate to go into medicine, and once he was a doctor he studied asthma and wrote about it.

Bree was born at Solihull in Warwickshire, England,  and in 1791 he completed his education.  Two years later, in 1793, such a severe asthma attack struck him that he was forced to quit working.  In 1794, while spending time in the military, his asthma improved.  In 1796 he was well enough to return to his practice.

His interest in medicine, and particularly the lungs, prompted him to research and write a book which he published in 1797 called "A Practical Inquiry into Disordered Respiration, distinguishing the Species of Convulsive Asthma, their Causes, and Indications of Cure." 

One of the things that made Bree such an interesting asthma expert is that he rejected the popular theories put forth by William Cullen  -- the nervous theory of asthma and the bronchospasm theory of asthma --  and aimed to prove by his writings that that older theories still held true.

In the Introduction to the fourth edition of his book he wrote, "Ancient description corresponds with the present state of the disease, although modern observation very slightly acknoqledges the resemblence.  In our time, the principal feature in the most considerable Species of the Disease is a subordinate object of attention; and if it were proved to be a cause by every other mode of evidence, demonstration would still be demanded before a material excretion, obvious to the senses, would be preferred to the theory of an invisible action that had revetted the attention of the Schools."

What you just read there was a flat out rejection of both the bronchospasm and nervous theories of asthma. He wrote there is no proof of their existence in life nor in autopsy, and it cannot be seen.  Based on autopsy results, he came to the conclusion they did not exist. 

You have to understant here that William Cullen's writings were highly popular, so you can understand that Bree's writings came with much criticism form his colleagues.  Another Birmingham physician by the name of  George Lipscomb aimed to prove Cullen right and Bree wrong.  In 1800 he even wrote a book of his own called "Observations on the History and Cause of Asthma."

Meanwhile, in his 4th edition Bree responded to the criticism by writing that "theories, built upon hypothetical foundations, are one cause for the turn of quackery that infests this country."  He wrote that some people are too quick to accept new theories and reject that of which can be proven.

Likewise, he wrote,  that while you cannot see what others propose, you can see what he (Bree) proposed, and he proved this by performing autopsies and coming to logical conclusions.  His conclusions about asthma, and the remedies that go with his conclusions, was the basis for his books.
Bree did not believe entirely in the bronchospasm theory of asthma.

Ernst Schmiegelow in his book "Asthma, considered specially in relation to nasal disease," (1890 page 4), wrote that "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."

In other words, Bree believed that 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.























 As Jackson writes, Bree believed that "just as spasmotic contractions of the gut were caused by irritation and were aimed at removing any noxious material 'for the safety of the body', so convulsive contractions of the respiratory muscles in asthma essentially operated 'to relieve the internal functions from injury or interuption'."

Yet Schmiegelow explains that Bree's theory was disproved as soon as the stethoscope gained favor, as it's easily proven an attack of bronchitis does not precede asthma, that rales are heard later during the attack.   
In 1808 Franz Reisseisen performed experiments that proved muscular fibrers wrap around the air tubes of the lungs, according to Jenny Bryan in her book "Asthma" (2008, page 8).