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).

Thursday, July 10, 2014

1913: Adam Toxaemic Theory of Asthma

By the turn of the 20th century the medical profession had readily accepted both the nervous theory of asthma and that spasmotic theoery of asthma. The allergic theory of asthma was in its infancy, and the old toxaemic theory of asthma was no longer written about in new editions of asthma books.

Yet it was the old theory, the toxaemic theory of asthma, that Dr. James Adam proposed as the most valid explanation of asthma.  He understood that is was no longer accepted by the medical community, and he understood treatment based on this old theory was considered radical.  This, therefore, was the reason he referred to his asthma book as "Asthma and its Radical Treatment." (1, pages 1-3)

Dr. Adam said he continued to have much respect for Dr. Henry Hyde Salter who, during a series of articles published in the 1950s, articulated support for the nervous and spasmotic theories of asthma.  Yet Dr. Salter also articulated support for the toxaemic theoery of asthma.  Of Dr. Salter, Adams wrote:
Hyde Salter’s book, written before most of us were born, must not be overlooked by anyone interested in the subject; he had probably a wider experience of asthma, and a better grip of the value of the dietetic treatment, than many twentieth-century authorities." 
Dr. Salter, from our own studies, was an ardent supporter of the idea that there was a direct correlation between what one puts into his body and asthma.  He wrote that many of his patients, including himself, observed that upon eating too much, or eating the wrong foods, often lead to a paroxysm of asthma.  The prevention of asthma, therefore, was to eat healthy and eat light.  The remedy was emetics and enemas.

Salter beleived the certain foods, or too much food , lead to some form of poison in the blood that lead to the nervous system causing bronchospasm.  Dr. Adam simply refined this theory as follows: (1, page 3)
Toxaemic theoery of asthma:  Asthma is a disease of the nervous system, and "all neurosis are toxaemias."  A poison enters the body and this "hits the nerves of the respiratory tract."

Adam suggests that asthma is caused in this way:
This toxaemia arises partly in the bowel, partly in the tissues; it arises partly by absorption of nitrogenous poisons resulting from intestinal puttefaction under microbic action ; but mainly is due to an error in nitrogenous metabolism, the result of imperfect oxidation or enzyme action. In short, the poison arises from Proteid food or proteid tissue.

The error in proteid metabolism is closely connected with excess of carbohydrate in the diet.


The oxidation of the excess of the simpler carbohydrate molecule seems to interfere with proper oxidation of the more complex proteid molecule. In other words, the excess of energy food interferes with the metabolism of the tissues and tissue-foods; the imperfectly metabolised products so resulting set up asthma.
In other words, as Salter explained, the poison, or toxaemia, was the cause of some error in diet.  The result, according to Adams, was as followed
The toxaemia, whether arising in bowel or tissues or both, tends to show itself first as catarrh, later as spasm, in the respiratory tract. This toxaemia shows itself in conditions, catarrhal and spasmodic, other than, but closely related to, asthma.
He beleived there were certain prodomata (early signs) of asthma that are often overlooked, and while these signs may not be present in all cases of asthma, if one is observed it can be a sign of an impending attack, such as:
  • Polyuria (excissive urine production)
  • Oliguria (diminished urine production)
  • Anuria (no urine production)
  • Constipation (unable to have a bowel movement)
  • Formication (sensation you have insects crawling under your skin)
  • Pruritus (sensation that results in urge to scratch; itchy sensation)
  • Urticaria (hives)
  • Erythema (redness of skin)
  • Cyanosis (Blueness of skin, representative of ischaemia of tissues of hand, foot, lips, etc.)
  • Petechiae (red or purple spots on the skin caused by minor hemhorage; local bleeding due to broken capillary vessels)
  • Embarassed breathing (asthma)
The above will continue until something happens involving the elimination of something, which generally involves:
  • Vomiting (spitting up stomach contents)
  • Diahrrea (loose stools)
  • Polyuria (excessive urination)
  • Expectoration (sputum production)

Due to the toxaemic effect, the following are also associated with asthma (all are associated with increases of eosinophilia in sputum): (1, page 34-35)
  • Eczema: Most commonest and most likely to occur in children with bronchitis. It usually shows up before asthma and disappears.  Although will continue to "dog" the patient if the asthma is not "cleared up." Cause is same as asthma, and treatment therefore same too (see treatment for both asthma and eczema is generally to restrict carbohydrates)
  • Ichthyosis: Probably caused by metabolic disorder
  • Psoriasis: Adams notes it's "said to be associated with asthma, but I have never seen the combination." Restricting carbohydrates generally doesn't work, but restricting "nitrogenous intake does." The difference in treatment may prove the non-association of psoriasis with asthma.
  • Dermatitis Herpetiformis:  Also associated with asthma. 
One of the reasons that he published his book was because he believed that "far too much attention has been paid (by the general practitioner) to the most striking feature of asthma, the asthmatic spasm; too little to the contitions that precede and cause the spasm, and those by which Nature cures it." Of course the toxaemic theory of asthma provides the answer to why the spasm occurs, and thus its radical treatments would prevent and treat asthma.

Adams also noted that his theory came at a time when other theories were more readily accepted by the medical profession.  However, his idea are "put forward with the hope that it will be useful not only in the treatment of asthma, but also in those other diseased states whose kinship with asthma is too."


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

Tuesday, July 08, 2014

1876: Many names for hay-fever

Prior to John Bostock defining hay fever for the medical community in 1819, hay fever seemed not to exist.  However, from our own history we know it probably did exist and was misdiagnosed as a cold, flu or some other such ailment.  Still, the term hay fever evolved as a term long before 1819, to the point that even Bostock himself labeled "hay fever" as an inapropriate name.  Yet it stuck nonetheless.

In the 1876 edition of his book, Morill Wyman noted that "at the time of the publication of the first edition (in 1872) of this Essay, the "June " or " Rose Cold " was the only form of annual catarrh generally known. Since then, the number of sufferers from the autumnal disease has apparently greatly increased, until they seem greatly to outnumber the others. That this apparent increase is in no small degree due to the greater knowledge, may be admitted. Still, there is reason to think that the disease is on the increase, and it may be that the cause of this increase is to be found in the change of condition and habits of the people of the northern section of the United States, and more particularly of New England, which seems to be the home of the disease." (1 page 101)

As the occurance of the disease rose, various names were used depending on the the season involved and the suspected exciting cause.  Edmund Holmes listed several of those names in his 1876 essay, "Summer Catarrh," and they were as follows: (2, page 200)
  • Hay-Fever
  • Summer-Fever
  • Rag-Weed Fever
  • Snow-Fever
  • Hay- Asthma
  • Rye-Asthma
  • Pollen-Asthma
  • PollenPoisoning
  • Pollen-Catarrh
  • Bostorck's Catarrh
  • Catarrhus iEstivus
  • Summer Catarrh
  • Summer Catarrh from Idiosyncrasy
  • Typical Early Summer Catarrh
  • Autumnal Catarrh
  • Summer Bronchitis
  • Rose-Cold
  • Peach Cold
  • Harvest Cold
  • June Cold
  • July Cold.
Chances are, as we read through the various books and articles on hay fever we'll come across enough unique names to double this list.  It must be considered that this was the beginning of knowledge of a disease that we now simply refer to as allergies. 

References:
  1. Wyman, Morill, "Summer Catarrh," 1876 (first edition was published in 1872), New York, Hurd and Houghton
  2. Holmes, Edmund W., "Hay Fever," Philadelphia County Medical Society: Proceedeings," volume XVII, session of 1897, Augustus and