Tuesday, May 29, 2012

1899 bronchitis triggers x

In 1899 Dr. Samuel Gee, in his article, "Bronchitis, Pulmonary Emphysema and Asthma, (The Lancet, March 18, 1889) defined bronchitis as a common disease that causes pulmonary catarrh and has the ability to strike anyone at any age.  It's inflammation that results in irritation of the mucous membranes and causes excessive secretions.

He mentioned as possible causes the following:
  • Nitrous fumes
  • Inhaled microbes
  • Breathing dust
  • Grass pollen
  • Strong smells (odour of roses)
  • Dust from molds
  • Dust from fungi
  • Influenza
  • Typhoid fever
  • Common cold
  • Unexplained
Was this 19th glass factory poorly ventilated and cause asthma?
The idea that "dusty trades" caused breathing trouble was nothing new, Gee wrote.  He mentioned Ramazzini "two centuries ago developed several chapters of his book "De morbis artificum" to the diseases, chiefly pulmonary, which attend dusty trades."

Regarding dust he describes two types.  One is insoluble dust, such as those emitted from cotton mill smoke.  This type of smoke can cause cause bronchitis that is chronic and slow in developing.  It's a "mechanical irritant to the bronchial membranes." 

Yet he also observed that most people who work in trades where this type of dust is prevalent also smoke and drink alcohol.  So whether the bronchitis is a result of inhaling dust or these other habits is difficult to determine.

Insoluble dust would also include "dust from unclean and ill-ventilated rooms will be very likely to contain morbific microbes and the irritation of the air passages set up by inanimate dust will favour the operations of the many bacteria which are potent to cause bronchitis.  It obviously would be very improbable that these microbes should swarm in impure air and should not be found in the upper air passages of man.  And thus, as a matter of fact, our mouths, noses, and throats harbour many morbific microbes in a latent state; they are there awaiting a favourable opportunity for becoming active and virulent."

Inanimate dust would be your grass pollen which causes hay fever.  This condition results in inflammation (catahrr) of the nasal passages and this ultimately results in inflammation of the lungs (bronchitis). 

He mentions that strong smells, such that of roses, can cause bronchitis.  These flowers might also emit particles small enough to be inhaled.

Yet he also mentions one study where a doctor placed an artificial rose in the presence of a person, that this caused bronchitis.  From this "we have learned how large a part in the production of such a catarrh can be played by the power of imagination."

Dust from moulds and fungi are also considered inanimate dust.  Of interest is he also described two different types of sputum:  mucous and purulent.  He observed that some patients have both types in the spitting pot, and he surmised that "probably the different secretions come from different parts of the bronchial tract."

Today we might think of such patients as either suffering from chronic bronchitis caused by irritants and smoke, yet he may also be referring to asthma irritated by such substances.  Either way, Gee's observations were quite stunning given the knowledge of such diseases known at that time.

Reference:

Gee, Samual M.D., "Bronchitis, Pulmonary Emphysema, and Asthma," The Lancet, 1899, March 18, page 743-747

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