Thursday, May 17, 2012

1810: Bree's Symptoms of Asthma

The following are the symptoms of asthma as described by Robert Bree in his book "A Practical Inquiry into Disordered Respiration Distinguishing the Species of Convulsive Asthma, their Causes and Indication for a Cure."  It was written in 1810. 

Note:  You must understand that Bree's undestanding of asthma was very puerile compared to our modern definition.  Much of his descriptions and theories on asthma are based on observation and personal experience with the disease as opposed to scientific facts.  However, some facts were available at this time and he used this information to support his opinions.  This was not uncommon for his day and age. 

Anxiety:  Owing to the difficulty attending the efforts of nature to removing an irritating offense.

Itching of the skin of breast and neck:  This sometimes precedes the violence of the fit and declines as agony of the fit decreases. This may be an effect of sympathy with the lungs and first passages. Irritating matter in the stomach is the probable cause of this symptoms.  Another cause may be the difficulty to which venous blood is returned to the heart

Perception of heat:  You feel like you have a fever, but you don't. 

Great desire of cool air:  Probably occassioned by a desire for oxygen, as you feel the means of obtaining it is increased by fresh air.

Closeness:  Areteaus wrote:  "The patient loves walking in the open air, with his mouth open, and is dissatisfied with the largest house, which seems to small to breathe in."

Dyspepsia:  (Upset stomach)  Always precedes periodic asthma.  This causes flatulence of the stomach and bowels and pain over the head and eyes and sleepiness.

The attack of the paraxysm in the night:  By concentrating, and by sacrificing sleep by staining up late and sitting in a recliner instead of the bed, this can often be avoided. 

Diabetes:  By this I think he's referring to the need to pee a lot during an asthma attack. He says this is common, although it provides little relief to the asthmatic.  He gives a few reasons, none of which make any sense.  Such as in the case of hysteric asthma, he says the kidneys may be relaxed due to sudden passions of the mind.  He says the kidneys receive nerves from the intercostals, and there is likewise a strong association between the lungs, kidneys, and stomach.  May also be linked to edema, swelling of the ankles and legs.

The straightness of the breast:  He supposes that this makes it easier for the exchange of air when the air sacs are filled with secretions, which is often the case in asthma.  The rest of his several paragraphs describing this are simply meaningless poppycock.

Intermitting pulse:  John Floyer attriutes this to constriction of the arteries, by circumvolving nerves, may more probably proceed from this condition of the heart.  It may also be cauesd by dyspepsia because of the strong relationship between the stomach and the heart. 

Spitting of black mucus:  He believes the coloring agent in the sputum to be carbon in the blood, which in the healthy person was exhaled

The pulse is generally feeble

Urine is pale and copious


Belly seldom regular:  Constiation may alternate with diarrhea, and may be attributed to dyspepsia (upset stomach). There is remarkable action of the abdominal muscles and all the muscles  used to discharge faeces.  And he flatters himself that evacuation of such will provide breathing relief.

The habit of the asthmatic is generally cold:  The temperature will be lower than normal. 

The mind is impatient:  Not only does Bree write this as a symptom, he adds, "...and he suffers much from opposition to his method of management in his own case."  After several episodes of asthma he learns methods of comforting and satisfying himself, but help from others is often received with anxiety.  He becomes irritable during the fits, "and, with difficulty refrains his disposition to petulence." 

Generosity:  Bree notes the following interesting fact:  "It may be observed generally as a fact, that the mind of an asthmatics is more susceptible of generous and grateful feelings than that of any other invalid, subject to a chronical disease equally obstinate."  Emphasis added by me. 

Respirations more numerous during asthma attack:  They never exceed 30 without a considerable increase in pulse.  Bree recognized this is in general opposition to Floyer


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