Thursday, May 10, 2012

1810: Robert Bree's 4 Species of Asthma

Robert Bree, our formost expert on asthma during the first half of the 19th century, described four species of asthma in his 1797 book, "A practical inquiry into disordered respiration: distinguishing the species of convulsive asthma, their causes and indications of cure."   

His "species" of asthma are based on his theory that asthma, and dyspnea, are caused by some irritating or peccant matter, and the asthma will continue until this peccant matter is removed.  The asthma attack, hence, is the effort of the body, or lungs, to expectorate this matter.  In this way, an asthma attack usually ends with the expectoration of sputum.

Now that we understand that, here are his species of convulsive asthma:

1.  The first species:  It's called Periodic or sometimes Convulsive Asthma (as described by John Cullen).  It's usually preceded by dyspepsia (irritated stomach).  It may show symptoms for years before it turns into a fit of asthma.  Dyspepsia is aggravated during the attack of asthma.  This usually effects the melancholic personality.  This is irritation of the serum within the lungs.  (1)

Symptoms include ("When an asthmatic feels these symptoms, he may be convinced that his enemy is at hand.":
  • Flatulence
  • Distended bowel
  • Pain over forehead and eyes, which may become worse in the evenings
  • Eructation of wind (burping)
  • The evenings are attended with sleepiness
  • Irritability that repels friends
  • Tingling and heat in the ears, neck and breast (itching of the lungs)
  • A motion to expel contents of the bowels
  • Uneasiness of abdominal muscles
  • After sleeping, he wakes with great difficulty of breathing
  • Feels need to have an erect posture
  • Inspiration performed with great effort of the muscles, but never performed deeply
  • Diaphragm seems to descend with great difficulty against a force
  • Speaking becomes distressing
  • Irritibility of mind continues
  • Wheezing sound on respiration
  • There is a propensity to make water (pee, urinate), which is copious (lots) and pale
  • After several hours cough birngs up phlegm
  • Relief follows
  • Tranquil state of feeling induces sleep with wheezes
  • Remission on second day
  • Expectoration of phlegm on 2nd or 3rd day ends the episode
2.  The second species:  Like the first it's caused by an irritating matter in the lungs.  It's accompanied by little or not expectoration of mucus.  For this reason it's commonly called Dry asthma. This is irritation from areal acrimony within the lungs.  (2)

Symptoms include:
  • Little sputum, or none
  • It comes on suddenly
  • Succeeds sudden changes such as alterations in the wind, or a change of situation.
  • The cause is of acrid or offensive quality, such as a strong smell, or subtle matter carried by the air. 
  • The irritant is inhaled and attaches to the bronchial pipes or tracheal membrane. 
  • The irritant usually atatcks by day more so than night
  • No wheezes
  • Action of intercostals and abdominal muscles are increased (as in other species of asthma)
  • Dry cough
  • Inflammation
  • Hoarseness
  • More prevalent in populous places or manufacturing places
  • May come on suddenly when you come upon a town, and go away when you get back to the pure air of the country
3.  The third species: This is when the irritating matter that causes convulsive asthma is found in some organ other than the lungs. These causative organs are generally found below the thoracic cavity, such as the stomach or other viscera.    However, it cannot be proven the irritating matter was not present in the lungs at the same time. The irritating matter of another organ might be removed by an unobserved power of absorption, and the irritating matter of the lungs may be removed through expiration.

Many physicians doubt another organ causes asthma, and therefore inappropriately give blame to the lungs.  Many people think the lungs are the cause because of the respiratory distress.  For example, some physicians have found a link between spasm of the bladder or rectum and spasms of diaphragm and abdominal muscles, which are muscles "subservient to respiration."  In this way, Bree believed abdominal problems can cause respiratory problems.  (3)

4.  The fourth species:  This is convulsive asthma that is dependent on the habit of the person, and caused by sensation, after the irritation has been removed from the thoracic or abdominal viscera. I believe the idea here is that the asthma is caused due to the treatment of some other disease. Paroxysms return by minute causes in effect, such as mental association with the idea of being short of breath.  This usually is seen in those with frequent episodes of species 1-3.  For this type opium or other antispasmotics seem to work quite well. (4)

Further reading:
  • To see other remedies for the above species see this link.
  • To learn more about Dr. Robert Bree's definition of asthma click here
  • To view the history of asthma click here
References:
  1. Bree, Robert, "A practical inquiry into disordered respiration: distinguishing the species of convulsive asthma, their causes and indications of cure," 4th ed., 1810, London, page 43- 56
  2. Bree, ibid, pages 182-193, 286-287
  3. Bree, ibid, page 194-212, 287-290
  4. Bree, ibid, pages 213-233, 290-292

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