Asthma once believed to be a disease of the mind

Asthma is all in your head! Well, not really, yet that's was a common theory from the middle of the 19th century to about the middle of the 20th century when it was determined to be untrue. However, the asthma continues to have a role in asthma.

The idea that asthma is a nervous disease was spearheaded by Dr. Todd (first name unknown) in an article published in the Medical Gazette in December of 1850, as described by Dr. Henry Hyde Salter in his book "On Asthma." Dr. Salter accepted Dr. Todd's theory and gave it credibility when he first published his book in 1864.

Dr. Todd really wasn't the first to come of with the idea of nervous asthma, yet he was the first to take the idea seriously, and kind of got the ball rolling that, yes indeed, asthma was a psychosomatic disorder. Other doctors of his day followed suit, especially once Dr. Salter wrote about Dr. Todd in his book. Dr. Salter went on to become one of the preeminent asthma doctors of the second half of the 19th century, and he was even the physician to the future president, Teddy Roosevelt (in fact, this will be the subject of a future post).

In his article, Dr. Todd wrote that asthma is caused by a "poisoning" of the nervous system as it pertains to the respiratory system. He describes that the signs of asthma (particularly bronchospasm and the resulting dyspnea) are not what asthma is, but merely a symptom of asthma. Asthma, according to Dr. Todd, is the poisoning of the nervous system.

The idea here is that even if you are not having an exacerbation of asthma, you still have asthma. He describes that asthma is a permanent condition of the mind. It is always there, yet it only shows itself some of the time.

Todd describes the following conditions as similar in that most of the time the symptoms are not there, yet an event might "irritate" the nervous system and the resulting symptoms of the disease will become prominent:

• Gout (Sudden joint pain that eventually goes away)
• Epilepsy (Seizure that eventually goes away)
• Asthma (Shortness of breath that eventually goes away)

Salter rejected other theories of the past, yet he accepted and even gave credence to the theory that asthma was a nervous disorder. As you can see by this post, Salter's remedies had to do with his nervous theory of asthma.

Todd was the supposed physician who brought the nervous theory of asthma to the attention of other asthma physicians in the 1800s. The nervous theory of asthma was the predominant asthma theory from about this time until about the 1950s when it was disproven.

Yet even though it was disproven in the 1950, when a new idea in medicine is proposed, it generally takes a long time to change the minds of physicinas who went to medical school and learned the old ideas. In other words, it's hard to change the paradigm. Once doctors learn one way of thinking it's hard to change, and it's hard to comprehend that you could be wrong all these years.

Still, the very first idea that asthma was a nervous disease might have been proposed by Claudius Galen of Pergamum, was an ancient Greek physician who lived from about 120-200 AD.

He actually proposed an idea that the bronchial muscles (or fibres as he called them) were somehow connected to the brain. He was wrong, yet Galen's writings were studied as absolute truths for another thousand years.

However, it was not Galen who first proposed that asthma was a nervous disorder. That honor (or dishonor considering the truth about asthma was stalled for almost 400 years as a result of his research), was given to Johannes (Jan) Baptista van Helmont, the same guy who discovered carbon dioxide (click here for more on that). Stay tuned, because van Helmont has earned an upcoming post of his own.

The mind does still have a role in asthma, yet asthma is not all in the mind. Many studies have proven that stress, depression, anxiety and sudden bouts of excitement (laughter) can trigger an asthma attack.

Likewise, many studies have also linked asthma with anxiety and depression. In fact, this was a topic I recently wrote about in my latest post over at MyAsthmaCentral.com. You can link to it here.

Click here for more asthma history.

(Good article about asthma as a psychosomatic disorder)

Happy Easter!!!!

Happy Easter fellow asthmatics.  The two girls and dressed real cute in matching dresses.  The older boy is dressed nice but more interested in the baseball cards he got in his Easter basket (yes, 12 year olds are spoiled by Easter bunnies too).  And the 8 MO is is giggling and cooing and crawling all over the place looking for trouble.

Sure the squabbles and the occasional wine is normal, and it's on days like this we are reminded of the joys of being a parent.  It always seems there is always one Easter basket that gets hidden really well, even so well that the dad can't even find it.  This year it so happened to my 7 YO, and she was even getting frustrated and thought the Easter Bunny had forgotten her.

Yet when she finally did find it hidden behind the towels in the bathroom, this just made her smile that much bigger.  So here we are ready to set off on another Easter adventure, which will consist of nothing but a modest trip to church and a brief meal with the wife's siblings.  Nothing exciting, yet always special, especially to the little ones.

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.

A perfect description of the asthma attack

Consider the following description of an asthma attack:

"In marked attacks not only is the struggle for breath so severe as to make the patient sit or kneel in bed, but he may even get out of bed and stand gasping at an open window, or clutching at any support that will aid the respiratory muscles of respiration. many will not go to bed at all, but sit in a chair all night, dozing when they can."

If that doesn't describe one of my typical asthma attacks when I was a kid I don't know what does.

The only thing missing from that description is the audible wheeze, although the wheeze was added in a later description.

This was written by an asthma expert by the name of James Adam in his 1913 book, "Asthma and it's Radical Treatment." After interviewing so many asthmatics in his day, or perhaps due to his own asthma experiences, he had the asthma esperience nailed to a tee.

Henry Hyde Salter

Most asthma experts prior to the mid 20th century were mainly doctors making observations about their own patients.

One of the premier asthma experts of the 19th century was Henry Hyde Salter. In fact, many will even say that he was the asthma expert most respected in the second half of the 19th century.

Perhaps the most proof of this comes from the fact that young Theodore Roosevelt's doctors referred to Mr. Salter's 1864 book "On Asthma" for help managing the young, future Presidents asthma.

Yet as I've written about before, young Teddy mentioned at one point that many of the so called remedies were pure torture.

If you read his book, most of what you'll get from it is that he was very observant of his asthma patients. He studied the cases of asthma that he treated, and from his own observations he came to conclusions.

Salter was also an asthmatic himself, which may have added to his interest in the phenomenon. And based on his own experiences with asthma remedies offered by his doctors when he was affected by an episode of asthma, he developed an interest in the disease.

Thus, based on his own experiments to control and treat his disease, and experiments he performed on his own patients (mainly based on the readings of other asthma experts of the past, plus his own theories and observations), he came up with the ideas that formed the basis for his book, "On Asthma."

So I thought a good place to start in my quest to examine the history of asthma would be with the great Henry Hyde Salter. From there I will flip through the pages of time to examine people effected with this ailment, ancient theories, old remedies, and anything else of interest we can come up with.