Friday, February 03, 2012

1800-1900: okay, so what really causes asthma

Remember Budd?  He's our asthma expert from 1840 who flat out rejected the bronchospasm theory of asthma.  In 1855 Guillaume Benjamin Amand Duchenne proved Budd right, or so he thought.  As Berkart wrote, Duchenn proved "faradisation of the phrenic nerve caused tetanus of the diaphragm.  (You can view Duchen's book here**)

So who cares what causes the symptoms, Berkart wrote of Constatt, who believed it doesn't matter the cause of dyspnea because antispasmotics (like belladona found in asthma cigarettes) work equally well for both asthma and emphysema.

Pretty much Constatt was correct, yet with greater wisdom comes greater treatments as we would learn in 1900.

Another neat theory that came along in 1855 was by a Dr. Ludwig Traube who denied nervous asthma but believed asthma was rare and the dyspnea that resulted was caused by "fluxionary hyperaemia of the bronchial mucous membrane."  What he is referring to here is "swelling of the bronchial mucus membrane," wrote Berkart.  This is what we now refer to as inflammation.

Traube also believed asthma was caused by sputum in the air passages of the lungs, according to Jackson.

Ah, if we could only jump into our time machine we could tell Traube he was on the right track.  It would take another 130 years for asthma experts to realize Traube was on the right track, that asthma is a disease of chronic inflammation.

Likewise, Traube wrote that this inflammation cannot be diagnosed during a person's lifetime, and can only be diagnosed by the symptoms it presents with, such as dyspnea and wheezing.

Then in 1859 Bervenisti, as Berkart continued, brought attention once again to the differentiation of the different causes of lung diseases that he believed were probably unrelated to asthma.  He (Bervenisti) believed that a doctor could not possibly diagnose bronchospasm by listening to lung sounds alone.  That sonorouis and sibilant rhonchi are also present with a pulmonary embolism, which also causes dyspnea.

Once again, if we could jump into our time machine we could tell him he was right, that lung sounds can help with a differential diagnosis.  For example, heart failure would result in coarse crackles throughout the lungs or half way up, pneumonia often results in crackles in one lobe of the lungs, a wheeze indicative of air traveling through narrowed air passages (asthma), and rhonchi indicative of air traveling through sputum (bronchitis).

In a way I'd like Mr. Bervenisti to come talk to the doctors that exist today who still believe all dyspnea is bronchospasm.  I'd like Mr. Bervenisti to set them straight.

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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