Wednesday, November 02, 2011

1649-1734: Floyer redefines asthma, upholds supernatural

Sir John Floyer
The early 17th century centered around a struggle by Western men who were losing their enchantment with the old world and increasing curiosities about the truth obtained by scientific progress and thought. John Floyer was born into this world in 1649 and he rejected it.

In fact, it was because he rejected it that he became one of the most interesting and popular personalities of his generation. He put forth a defense against modern logic and a defense for Ancient ideas, yet at the same time he provided a stunningly accurate description of asthma based on his own experience and experimentation

Floyer lived at about the same time as Jean Baptiste van Helmont and Thomas Willis, yet it was Floyer's ideas regarding asthma that were more readily accepted by his generation. The reason was partly because Floyer had asthma and he used his own experiences to describe the disease.  Yet also because he disregarded science and accepted old superstitions that were popular, while the other two endorsed science.

It's true.  Floyer rejected the ideas of van Helmont and Wilson and other "quacks" because they "know little of Anatomy, and the Nature of Animal Humours."  Likewise, Floyer accepted the ideas set forth by Hippocrates and Galen that all diseases were caused by some external poison that caused an imbalance of the humors:  black bile, yellow bile, phlegm and blood. (1)

Floyer's Treaties of the Asthma (a)
Since this was the accepted dogma of the day -- the paradigm that mankind was stuck in at the time -- Floyer's ideas were much easier for other physicians to accept.  

Floyer was born in 1649 in the small town of Staffordshire, England, the same year as the execution of Charles I.  He suffered from asthma as a child and through much of his adulthood, and it was because of this he would later take up the study of this disease. (2)

He received his medical degree from Oxford in 1680.  Shortly thereafter he returned to Lichfield which was only a few short miles from his birthplace and became an important member of the British society, and he was even knighted by James II in 1686. (3)

He was an ardent supporter of cold water bathing, and in n 1701 he published "A History of Cold Bathing: Both Ancient and Modern." He would often recommend this book to his many patients including his asthmatic patients. (4)

In 1682 Andreas Cleyer's Specimen medicinae Sinicae introduced the West to the ancient Chinese method of counting a pulse to diagnose diseases.  Floyer liked this idea, and he expanded it and made taking a pulse a routine task when assessing a patient. (5)

To make the task easier he invented a "pulse watch" that had a second hand that ran for one minute.  Alex Sakula, "Sir John Floyer's A Treatise on Asthma (1698)," wrote that one of the reasons this "pulse watch" was so important for his study was because he believed that each disease was associated with a specific pulse. (6)

He wrote about his watch in "The Physician's Pulse Watch" volume 1, in 1707.  You can read about it in more detail here.  The pulse watch was advanced many times even during Floyer's own life, and it soon became a popular site to see your neighborhood physician with a pocket watch. The practice of taking vitals, a pulse and respiratory rate, became commonplace.

The art of watching the hands of a watch revolve is often attributed to Sir John Floyer.

When it came to asthma, Floyer was not a fan of  modern remedies for asthma that were prescribed by other physicians of his day, such as Van Helmont and Wilson.  In fact, he flat out rejected many of them, and instead preferred the more supernatural remedies such as those proposed by Hippocrates and Galen.

Yet while he preferred the supernatural, he's also the first asthma expert to make the case for asthma as a separate disease from other lung disorders. He makes this case in his 1698 book A Treatise of the Asthma.

In this book Floyer described respiration as "preparing the blood or air vessels by tumours or by injury to the muscles of respiration or to the 'spirits, moving those Muscles.'"  He describes asthma this way:
When the Muscles labour much for Inspiration and Expiration, through some Obstruction, or compression of the Bronchia, &c. we properly call this a Difficulty of Breath: But if this difficulty be by the Constriction of the Bronchia, 'tis properly the periodic Asthma: And if the Constriction be great, it is with Wheezing; but if less, the Wheezing is not so evident; the Pulse being stopt in the Asthma Fit, the Respiration is Rare."
Then he described two forms of asthma:

1.  Continued:  Dyspnea was the result of other diseases such as dropsy, empyema, tubercles in the lungs, thoracic tumors, abdominal tumors, and spinal conditions such as scoliosis.  He used continued the way we use chronic, meaning that the "asthma" is always there.  We now know this is not really asthma but other conditions, such as chronic bronchitis.

Regarding this, 18th century physician Michael Ryan quoted Floyer:
When te asthma continues for some months, it is a true pulmonic asthma, and depends on some disease in the breast, as dropsy, tubercle, absess, which compress the bronchia; and till that evident cause be removed, it is impossible to cure the asthma fits."  (8, page 8)
2.  Periodic:  This is bronchial constriction due to "windy spirits" occurring after fevers, catarrh (nasal inflammation, allergies, hay fever, colds), and hypochondriacal fits (nerves) or as what he referred to as "flatulent slimey cacochymia, which is bred in the Stomach."

Floyer described his own asthma as periodic, and it is this type of asthma that covers the majority of his Treaties on Asthma.  Floyer noted that continued asthma is known to take the life of the asthmatic, yet most people with periodic asthma lived a normal life span.  However, periodic asthma did take a life from time to time.

A little less than 100 years later, Dr. Henry Hyde Salter would further refine Floyer's asthma definition using empirical knowledge known to him, and he referred to pure asthma as periodic in nature, and continued asthma as asthma associated with some type of organic changes, such as chronic bronchitis or enlarged heart.

Floyer became the first to describe seasonal asthma.  Floyer wrote how he kept a "diary of his disease, out of what I can give a more true Account than if I had now recollected what has long since passed."

He observed that he never had any problem with his asthma while he was at Oxford, yet when he returned to Staffordshire he "usually visited with a severe Fit or two.  The air of a Town makes the Fits more severe when they happen; but I do not think the Asthmatic so much expos'd to the Accident of the Weather in a City, as in the Country."

He noted that his asthma was worse in the summer than winter, and worse during "the change of the moon."  Barometric pressure can also affect asthma, he proposed, and that is why he recommended changes in weather as a probable cause of asthma.

So he may have been the first to notice the benefits of certain types of air in causing asthma, an idea Salter would later embellish upon.  Such observations may have lead to the later recommendation for asthmatics to move to other areas in order to treat and cure it.

He may also have been the first to describe how tobacco fumes from smoking cigarettes may trigger an asthma attack, yet his reasoning for this is quite supernatural:
"During the Fit of the Asthma, the Smoak of Tobacco is so offensive that it very much straitens the Breath, if it be smoaked the first Day of theFit, and much endangers a Suffocation. There are many Asthmatics that cannot bear the smell of it; therefore its Foetor is injurious any time, its Heat thickens the Phlegm and rerefies their aerial Spirits, making them restless; all the good it can do is to discuss the Windiness after the Fit abates, and to help the coughing up of Phlegm."
Floyer may have been among the first to note that very few people die of an asthma attack, and that between such attacks the asthmatic can live a relatively normal life.  He wrote:
"I have met with some Asthmatics who have been so for Fifty years, as they informed me, and yet in tolerable Health without any considerable Decay of their Lungs, or Disability to perform their usual Employments; which I oft reflect on to encourage my patients, and myself, who yet can study, walk, ride, and follow my Employment, eat, drink, and sleep, as well as ever I could; neither am I yet sensible of any Decay in my Lungs."
Alex Sakula noted that while Floyer's acceptance of Galanic principles would later be proven false, "his treatise shows that he was familiar with the multifactorial basis of asthma -- heredity, occupation, atmospheric pollution, hypersensitivity, infection, exercise, and psychological influences."

Because his theories about medicine were more readily accepted by society in the 17th century, Floyers is often given credit as the first to define asthma as a disease of it's own, more specifically as a disease of bronchospasm, even while this wasn't true.  Regardless, he did play a significant part in defining asthma.

Floyers would die on February 1, 1734, yet his teachings would be studied by physicians for the next hundred years, and his practice of measuring a pulse and respiratory rate became a common medical practice that is still used to this day.

Further reading:
  1. Floyer's asthma symptoms, triggers and remedies by clicking here. 
  2. Floyer establishes spasmotic theory of asthma (will be published 4/17/14)
Click here for more asthma history.

References:
  1. pending
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  6. Sakula, Alex "John Floyer:  A Treaties on Asthma," Thorax, 1984, 39: 248-254
  7. Floyers, John, "A Treaties on Asthma," 1698, London, pages
  8. Ryan, Michael, "Observations on the history of asthma, in which the propriety of using the cold bath in that disorder is fully considered," 1793, London, printed by G.G. J. and J. Robinson of Paternoster-Row

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