Wednesday, February 01, 2012

1800-1900: Debunking ancient asthma theories

Today I continue to describe my quest (that we started here) through the 19th century learning as much as I can about asthma.  My guide is a gruffy gentleman with a scruffy beard, offers me a cup of Joe, which is something more up my alley than the cigarette and shot of whisky he offered me earlier.

I lean back in my cozy little chair and put my feet on the ledge by the glass, something my guide has already done.  The time machine already took me back to 400 B.C and where I watched  Hippocrates and his fellow physicians study respiratory disorders and work on defining asthma as a medical term.

We're presently in the year 1816 on a hot and humid day in France.  My guide describes the man I'm watching as Rene Laennec.  The physician is leaning forwardwith his ear pressed on one end of rolled up bundle of papers, with the other end of the tube on the chest of a large, dusky, perspiring lady who's hunched up on the doctor's bed panting for air.

"The object he's using is clearly the first stethoscope," my guide says, "yet on this day he humbly refers to it  as le cylindre.  It will be a few years before Laennec is pressured by his peers into calling his object the stethoscope.  Regardless, this would turn out to be a revolutionary device responsible for the evolution of a term called asthma throughout the rest of the 19th century.  Laennec perhaps had no clue his invention would set off a hunt to redefine asthma, or at least provide the tool for such a task."

My guide continues, as Laennec continues to listen to the ladies lungs using his object.  He sets the end opposite his ear at various points on the ladies chest, both front and back.  The lady sits patiently while she continues to breath heavily.  "Over the ensuing years, which will go by fast in the comfy confines of our time machine, we will see a growing number of physicians using this tool to help them better diagnose and treat their patients.  And it's mainly this tool that sparks a hunt by asthma physicians to redefine asthma so it represents the disease as you know it."  He points at me.  "Yet how this evolution occurs is the purpose of our journey through time."   
Laennec's stethoscope

He says, "Through our travels thus far we've learned the Ancient Greeks used the term asthma to describe any condition that causes dyspnea, or shortness of breath.  So dyspnea could be caused by cardiac asthma (what you call heart failure), or humoral asthma (what you call chronic bronchitis), or kidney asthma (what you call kidney failure).

"William Pepper and Louis Star, in their 1885 book "'A System of Practical Medicine' explain that prior to the 19th century all dyspnea and all that wheezes were designated as asthma."

He continues, "John Floyer was the first to separate asthma from dyspnea, yet it was Rene Laennec who was the first to think of asthma as a term abused by the medical community.  He came up with the idea that many cases of asthma are actually heart disease, chronic bronchitis or kidney disease, not asthma.  So he spent a lot of time studying the signs and symptoms of his patients and comparing them with what he found on autopsy.

He reaches for a cigar, places it between his lips, and pretends to puff on it.  He hands you a book with that title, and opens it for you to page 184, where the following is highlighted using a 20th century marker:
 "These guys wrote about the term as covering such an 'extensive range of territory, it was found necessary to subdivide the disease into a number of varieties, each author classifying them according to his conception of the cause, seat, and nature of the trouble. Some of these -- e.g.a. dispepticum (upset stomach), still find their place in medical literature, but the vast majority of them, having ceased to be of any practical significance, have been discarded, and are now only interesting as examples of the crude and fanciful notions which prevailed in an age during which science rather retrograde than advanced." (1)
He took back that book and handed me one I often refer to at Google Books back home: an 1878  book by J.B. Berkart titled "On Asthma: It's pathology and treatment."   I set the book on my lap, and he says, "Open it to page twelve."

Here, on page 12, the following is highlighted:
"ALL early historical traces of the affection at present called asthma are lost. Although the disease is said to be mentioned in the Bible, and described by Hippocrates, Areteaus, Galen, and Celsus, there is not the least evidence that those remarks apply to the asthma of to-day. For in the former systems of medicine, all cases presenting the same conspicuous symptoms were, regardless of their anatomical differences, considered as of a kindred nature, and grouped into classes according to imaginary types. (2)
Laennec is now standing before the lady after his long assessment of the ladies chest  It appears that he even has a short smirk of joy on his face, knowing, perhaps, he is on to something with his invention here.  "I know these highlighted phrases are almost trivial, although I find it interesting because these physicians, in this era, were privy to the idea that they were taking part in the rapid evolution of the disease they were studying -- asthma.

My guide continues, "In essence, Laennec's discovery sparks a leap through time.  Where 7,000 years of asthma suffering results in little progress in the way of asthma wisdom and treatment, the next 81 years -- part of which we are now observing -- provides for asthmatics more than all those 7,000 years combined. I think that Pepper and Star and Berkart were well aware that this was happening.

"And we learn that between 1816 and 1900 many different theories about what causes asthma are created, and every one of these theories has followers.  Each expert writes his own definition of asthma based on his beliefs about the disease, and his own remedies based on these beliefs."

He explains that this is all done in the process of fine tuning the definition of asthma.  Yet in the end, the two theories that win the day are:
  1. Bronchospasm theory of asthma (a.k.a. spasmotic or convulsive)
  2. Nervous theory of asthma (a.k.a. it's all in your head)
By the end of the 19th century the ground is set for an even bigger leap through time as far as asthmatics are concerned.  By 1899 adrenaline is isolated, and this sets off a wave of wisdom that greatly improves the lives of asthmatics. Yet for the time being (no pun intended), we find ourselves drifting from cozy doctor's offices in large Victorian homes to laboratories of some of the worlds greatest asthma experts. 

  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

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