Friday, February 03, 2012

1800-1900: Race to define asthma is on


The rest of the 19th century consists of one physician after another coming up with his theory as to the cause of asthma.  Each is convinced he is right, and each offers the best proof he can.  Historians can argue whether this slowed down search for better asthma wisdom, or actually sped it up.

Franz Daniel Reisseissen is a German physician who studies the lungs, and he concludes that "there is another apparatus appointed for contracting the bronchi, which consists of transverse muscular fibres.  As far as the cartilaginous rows extend, these fibres are inserted...." (7)

In other words, according to "The Cyclopaedia of practical medicine" (edited by John Floyer in 1833, volume 1, page 186), Reissiessen proves muscle fibres wrap around the air passages of the lungs almost all the way to the alveoli.  His writings are published in Berlin in 1822.

It isn't until "the paper by Francis Hopkins Ramadge (1835, you can view his book here*.) and the prize essays of Bergson and Lefevre (1836) that asthma is really regarded as a neurosis of the respiratory organs," according to Whitaker. (8)

Barry E Brenner, in "Emergency Asthma" (edited by Barry E. Brenner, 1998, page 7) wrote that Ramadge, described food as an asthma trigger, recommends moving from the city to country,  and of asthma being mostly a nocturnal disease. He discourages use of opiates because they impede respirations that are already impeded. He mainly recommends strammonium because it "produces a grateful forgetfulness and a balmy oblivion like opiates." (9)

J.B. Berkart in his 1878 book "On Asthma:  It's Pathology and Treatment" (volume I, page 23) described that Lefevre observed his own asthma and that of a friend and concluded asthma could only be caused by bronchospasm.  Yet he (Lefevre) believed this bronchospasm was caused by the mind.  (10)

Berkart wrote that "in essence of the disease he (Lefevre) considered to be an increased irritability of the nerves of the lungs, in consequence of which the slightest irritation applies to the bronchial surface induced spasm of the bronchial tubes." (10)

Whitaker wrote that the view of asthma as a nervous disease was further established by "Romberg (1841) who based his conception of the disease as a spasmus bronchialis, upon the discovery by Reiseissen (1808) of muscular tissue in the finer bronchial tubes, and the contraction of these tubes under galvanization of the lungs by Charles J.B. Williams (1840), and irritation of the vagus (nerve) by Dr. Francois Achille Longet (1842)."

According to William Pepper and Louis Star, "It was ascertained by Williams that by irritating the lung he could cause contraction of these fibres, and Longet subsequently proved that the same effect could be produced by galvanizing the pneumogastric nerve."  (11)

Berkart wrote that Williams performed experiments that proved without a doubt "that mechanical and electrical stimuli do produce contraction of the air-tubes. Thus the theory of a bronchial spasm obtained the support of experimental physiology. And even those who until then wavered in their opinions as to the possibility of such a spasm saw now no reason for doubting, but readily accepted that doctrine."

Williams must have agreed with Laennec and Berkart that asthma was an abused term.  Whitaker noted that in 1768 there were 17 different types of asthma (as described by Savage) and in 1822 this was reduced to 11 (by Richter). This was confusing.  Williams wanted to simplify the definition of asthma.

Williams became the first to break asthma into two types: spasmodic and paralytic. Berkart wrote that as of the writing of his (Berhart's) book, the two terms described by Williams were the ones accepted by most experts.  However, other doctors would continue to reclassify asthma to their own content and amusement.

Yet while his research led Williams in the correct direction, along came Dr. Francois Achille Longet who, in 1842, did experiments of his own only to prove that, as Berkart wrote (page 27) that "irritation of the pneumogastric nerve always produced spasmodic contraction of the bronchi, whereas section of the nerve led to emphysema, which was described as distention of the air vesicles (what we now call air trapping)."  (12)

Longet also believed bronchospasm and emphysema (air trapping) were both parts of asthma. If we could hop into our virtual time machine we could tell him he was right. We could tell him that spasming of the bronchiole muscles (which he referred to as fibres) caused air to become trapped in the alveoli. This we know is air trapping, or what what was grouped back then under the term emphysema.

If we could do that we could have put an end to the whirlwind of theories that I think delayed progress that may have resulted in beta adrenergic medicine to relax these smooth muscles long before they were finally discovered in 1900. We could have stopped the whirlwind of false steps and experiments that lead to poppycock theories such as the nervous theory of asthma.

So in 1840 Charles Williams -- who was ultimately the same person to come up with the term lub dub to describe the beating of the two chambers of the heart -- became the first to prove that certain irritants cause contraction of the muscular fibres that Reisseissen proved wrap around the air passages in the lungs.

In 1848 histologist Rudolph A. von Killiker confirmed the works of Williams and Reisseissen when he isolated smooth muscles of the lungs, according to John Daintith in his book "Biographical encyclopedia of scientists."  (13)

This essentially proved Cullen wrong, that the muscle was not just a continuation of a nerve.  Yet since nerves still connected to muscles, van Killiker's discovery was unable to stop the fallacy of the nervous theory of asthma.

The thing to note about most of these experts is that even while they believed in the bronchospasm theory of asthma, they continued to believe it the nervouse theory of asthma, and their experiments prooved the two co-existed  -- or so they thought.

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:
Note:  This post updated on 2/14/13 and republished under a different url 

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