Friday, February 03, 2012

1800-1900: Experts aim to prove asthma theories


So here I continue my description through the 19th century in my guide's time machine.  Earlier I described how my guide explained about how experts tried to defend old theories, and then worked to debunk them.  Through the glass walls I see a blur and then the machine seems to come to a stop, and the man we see is...

"It's Jean Baptiste van Helmont," my guide says.  I take a picture with my iPhone hoping it will turn out.  "I apologize I didn't explain this before, but what we are seeing are mere images from the past, not real scenes.  Like vampires, they don't show up on film."

"Oh, I guess I kind of figured that."  Yet I continue to snap pictures, hoping beyond hope to have proof to offer on my blog as I'm writing about this later.  

In a harsh voice, my guide explains "that the nervous theory of asthma is first described in the 17th century by Jean Baptiste van Helmont and Thomas Willis, and in the 18th century by William Cullen.  Most asthma experts in the 19th century believe wholeheartedly that asthma is caused by a nervous response, and the evidence -- so they think -- is overwhelming."

He says, 'Ironically, when Cullen's convulsive theory of asthma is proven, this does nothing to disprove the nervous theory.  In fact, many experts go on to prove that beyond a reason of a doubt the convulsive theory of asthma further proves their nervous theory of asthma."

He continues:  "In 1808 Franz Reisseisen performs experiments that prove muscular fibrers wrap around the air tubes of the lungs, according to Jenny Bryan in her book 'Asthma.'"  (1)  He hands me the book.  "In our day we know these muscular fibres are smooth muscles we call bronchial muscles."  I set the book down on a glass table to my right.

We now see a man, with a bloody apron and knife, standing before a table with a corpse cut about the chest. We can see inside the body, and we can see that this man is looking at the heart and lungs.  "The body I have no idea who that is.  My guess would be a prisoner, although I have no evidence of that.  The doctor, that is a doctor, his name is Dr. Robert Bree.  He's the pre-eminent asthma expert from 1800 through 1850.

"So Mark Jackson explains -- yes, we're back to him again because his review of asthma through my century, the 19th century, is exemplary -- 'that Robert Bree attempts to prove his theories by dissecting the lungs of asthmatics who died of an attack, however this is a problem because asthmatics rarely die.  Bree therefore has to dissect the lungs of people who died of other diseases similar to asthma." (2)

While caressing his cigarette, he looks at me.  "Many people from your era find this hard to understand, but most asthma experts in my day wrote in their respective books that few asthmatics died from asthma.  Surely the condition was a nuisance, yet it killed few.  At least this was true of pure asthma.  If asthma killed, it was because it was accompanied with another disease, like bronchitis, emphysema or pneumonia."

He notes that prominent experts who note this are Henry Hyde Salter and William Henry Osler.  "While low risk of death bodes well for the asthmatic, it doesn't bode well for science."

He lights a match and watches as the flame flickers in a breeze from a vent on the side of his seat.  He says, "Either way, by 1808 Franz Reissesen discovers that the fibres wrap around the air passages of the lungs even to the 'minutest bronchi,' according to Pepper and Starr.  As these fibres contract, the air passages of the lungs become narrower. 

"Rene Leannec's 1816  invention of the stethoscope allows physicians to differentiate the unique sounds of asthma from other diseases.  Like Bree, laennec attempts to compare signs and symptoms of disease during life with what he saw on autopsy.  Laennec assesses patients and comes to conclusions.  He comes to believe in the convulsive theory of asthma, and he also believes catarrh to be the most frequent cause of asthma.

"And,"  He waves the flame out as it nearly singes his finger. "James Thomas Whitaker in his 1893 book, 'The theory and practice of medicine' quotes Leannec as saying: 'Few terms have been so abused in medicine or made to designate such different diseases (than asthma).'  By using his new stethoscope, he aimed to prove asthma is a disease of bronchospasm and nothing more.

"Laennec is the first to use such descriptions as rhales and rhonchi to describe lung sounds heard by auscultation, and the sounds heard during an asthma attack he describes as rhonchi."  He lets the cigarette fall to his lap.

"Rhonchi is later be divided into sibilant and sonorous, with sibilant rhonchi (now called a wheeze) being the sound of air traveling through narrowed airways, and sonorous rhonch (now called rhonchi) being the sound of air traveling through secretion filled airways."

References

  1.  Bryan, Jenny, "Asthma," 2008, page 8
  2. Jackson, Mark, "Asthma: The biography," 2009, London, pages 86-88 (If you're interested in a good asthma history book, this is it.)

Continue the journey by clicking here.

References:
  1. Pepper, William,  Louis Star, "A System of Practical Medicine," Volume 3, page 184
  2. Berkart, J.B., "On Asthma: It's pathology and treatment," 1878, London,  Chapter II, "History of Asthma," page 12
  3. Bree, Robert, "A Practical Inquiry into Disordered Respiration, distinguishing the Species of Convulsive Asthma, their Causes, and Indications of Cure, London, 1810.  I could not find the 1790 edition online, yet this one serves our purpose.
  4. Schmiegelow, Ernest, "Asthma, considered specially in relation to nasal disease," 1890, London, page 4 
  5. Jackson, Mark, "Asthma: The biography," 2009, London, pages 86-88 (If you're interested in a good asthma history book, this is it.)
  6.  Bryan, Jenny, "Asthma," 2008, page 8
  7. Floyer, John, ed., "The Cyclopaedia of practical medicine," 1833, volume 1, page 186
  8. Whitaker, James Thomas, "The theory and practice of medicine," 1893
  9. Brenner, Barry E, ed, "Emergency Asthma" 1998, page 7 (chapter one is a history of asthma written by Brenner)
  10. Berkart, J.B.,"On Asthma:  It's Pathology and Treatment, 18xx, volume I, page 23 (Berkart started his book with a good history of asthma up to his time.  I base much of this post on his thorough asthma history.)
  11. Pepper, op cit, page 194
  12. Berkart, op cit, page 27
  13. Daintith, John, "Biographical encyclopedia of scientists."


Click here for more asthma history.

References:
  1. Pepper, William,  Louis Star, "A System of Practical Medicine," Volume 3, page 184
  2. Berkart, J.B., "On Asthma: It's pathology and treatment," 1878, London,  Chapter II, "History of Asthma," page 12
  3. Bree, Robert, "A Practical Inquiry into Disordered Respiration, distinguishing the Species of Convulsive Asthma, their Causes, and Indications of Cure, London, 1810.  I could not find the 1790 edition online, yet this one serves our purpose.
  4. Schmiegelow, Ernest, "Asthma, considered specially in relation to nasal disease," 1890, London, page 4 
  5. Jackson, Mark, "Asthma: The biography," 2009, London, pages 86-88 (If you're interested in a good asthma history book, this is it.)
  6.  Bryan, Jenny, "Asthma," 2008, page 8
  7. Floyer, John, ed., "The Cyclopaedia of practical medicine," 1833, volume 1, page 186
  8. Whitaker, James Thomas, "The theory and practice of medicine," 1893
  9. Brenner, Barry E, ed, "Emergency Asthma" 1998, page 7 (chapter one is a history of asthma written by Brenner)
  10. Berkart, J.B.,"On Asthma:  It's Pathology and Treatment, 18xx, volume I, page 23 (Berkart started his book with a good history of asthma up to his time.  I base much of this post on his thorough asthma history.)
  11. Pepper, op cit, page 194
  12. Berkart, op cit, page 27
  13. Daintith, John, "Biographical encyclopedia of scientists."
Other readings:

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