1840 asthma definition: Spasmotic and Paralytic

Adding to what I wrote in my last post, Charles .J.B. Williams, the same man who proved dypsnea due to asthma was a result of bronchospasm, described two forms of asthma:

1. Spasmotic: Isolated attacks of dyspnea that accompany emphysema (air trapping)
2. Paralytic: Dyspnea associated with chronic pituitous catarrh.

If you're like me, you're saying, "What?"

After futher study, I've determined that Spasmotic asthma, according to Williams, was air trapping due to bronchospasm that goes away either on its own or with one or a variety of asthma remedies. It's a barrel chest that goes away.

Paralytic asthma is basically emphysema as we define it today, or the natural course of air trapping that occurs as the lungs break down with age. It's a barrel chest that never goes away.

So what is chronic pituitous catarrh? Well, it really has nothing to do with asthma. I think the best definition comes from Thomas Davies, "Lectures on the Diseases of the Chest, in the course of which the practice of Percussion and Auscultation is fully explained," The London Medical Gazette (Saturday, Nov. 22, 1934):

"The aerian (nasal) mucus membrane is moderately swollen, and frequently somewhat softened, it is rarely extensively redenned, but generally spotted irregularly. You will also find, that in almost all severe cases, the air cells of the lungs are more or less infiltrated with serum."

Basically, it results in very thick sputum in the chest, kind of like what occurs with chronic bronchitis (COPD) and bronchiectasis (CF). This thickened mucus, and emphysema together, can occur with age, yet now we know it's a disease process often associated with smoking. We now refer to it as COPD.

According to the "Textbook of Human Physiology," from 1889 (Philadelphia, pg. 663): Paralytic asthma might actually be "temporary paralysis of the pulmonary nerves, which excite the respiratory center (excito-respiratory). This is essentially a definition that comes from those who believe in the nervous theory of asthma, that asthma (bronchospasm, air trapping, dyspnea) are caused due to something stimulating an abnormal nervous response.

So perhaps they believed paralysis of the pulmonary nerves resulted in emphysema (i.e. air trapping).

Dr. J. Bergson in 1839 believed only in the spasmotic form of asthma and he wrote about it in "Spasmotic Asthma in Adults" in 1850. He believed asthma consisted of constrictions of the bronchi and air vessicles and this was secondary to someting irritating the vagus nerve. Thus, he believed in bronchospasm caused by a nervous response (emotion).

Bergson denied the theory of paralytic asthma. Actually, John Reid did experiments that disproved paralytic asthma and proved that it's only spasmotic. Bergson just applied Reid's theories to the understanding of asthma.

I think this is what Williams was referring to by his definitions. Yet it's significant to note here that none of these definitions are used today. If you Google Chronic Pituitous Catarrh, all the definitions come from old medical journals.