The 1882 definition of asthma

The asthma definition changes over time, as you'll note by my occasional posts where I write about one of these older definitions. As was defined by Hippocrates in Ancient Greece, asthma was essentially anything that caused shortness of breath, not just asthma as we think of it today.

That in mind, in n his book "On Asthma" published in 1882, Henry Hyde Salter defined asthma in the following manner:

"SPASMOTIC ASTHMA -- paroxysmal dyspnea of a peculiar character, generally periodic with intervals of healthy respirations between attacks

This doesn't sound much different from today's definition, although simplified. Asthma today is also defined as generally reversible, and life may be normal in between episodes. Yet then Salter defines what he calls PURE ASTHMA:

• PURE ASTHMA: Asthma without the slightest signs of organ involvement. It is rare, and the only way for this to occur is for the attacks to be infrequent, and short enough to not cause permanent injury to the lungs and heart. Generally, pure asthma is mild asthma.

It appears to me that his definition of "mild asthma" would be what we would define as asthma by today's standards. The other forms of asthma may either be severe persistent asthma, chronic bronchitis (COPD), emphysema (COPD), heart failure, or some other disease of the lungs.

Salter also believed that while the exacerbation of asthma was bronchospasm, it's central component was a "poisoning" of the central nervous system.

As we know by today's scientific evidence, if an asthma attack goes on long enough it can produce permanent lung damage. It can cause lung scarring. It can develop into severe, persistent asthma that may even be classified as a type of COPD. Yet in the end, it is still asthma.

Yet Salter describes that most asthmatics have some form of heart trouble, which may imply an enlarged heart due to working so hard to push blood through the lungs. Today we know this can happen with end stage COPD, Cystic Fibrosis, Pulmonary Fibrosis, or any disease that permanently scars or blocks the air passages.

Asthma rarely effects the heart unless it is of the very severe and persistent variety (COPD). I'm talking very serious, and even quite rare. Although I'm sure it's happened from time to time.

Yet for the most part, heart trouble is not asthma as we define it today. Heart trouble is the result of the heart working too hard (cor pulmonale), or from the heart becoming a weaker pump overall, and thus being unable to meet the demands of the body. This results in fluid buildup in the lungs, and may result in dyspnea. This is not asthma, it is heart failure.

Salter new about bronchitis, yet it was often difficult to distinguish between it and asthma. So chronic bronchitis was often diagnosed as asthma, cystic fibrosis was probably often defined as asthma, heart failure was asthma, and emphysema was asthma.

Now we know that asthma and emphysema have some similarities. They both can cause air trapping and a barrel chest. Yet these signs in asthma are reversible, and these signs in emphysema are permanent.

Even so, Salters descriptions of someone suffering from asthma (or dyspnea) are very descriptive. The following are the signs of asthma:

• The sense of impending suffocation
• Expression of intense anxiety
• Unable to move
• Unable to speak
• Unable to make signs
• The chest distended and fixed
• The head thrown back between the shoulders
• The muscles of respiration rigid and tightened like cords
• Tugging and straining for every breath that is drawn
• Skin pallid
• Skin cold
• Skin sweating

The following are the general effects on the life of the asthmatic:

• He knows an episode may happen at any time,
• So he knows he's different than his peers
• He is conscious that he is not sound
• He knows parts of his future will have to be dedicated to suffering
• He cannot make plans without provisions
• He cannot participate in many events
• He cannot do many occupations
• He cannot do many of the things he enjoys
• His usefulness is crippled
• His marriage is marred
• He's afraid his breathing might get worse, and cause even worse suffering
• He is looked on as an asthmatic for life
• He knows remedies are irregular and sometimes gruesome
• He knows there is no single remedy

Thus was how Salter defined asthma.