Thursday, February 02, 2012

1750-1850: Defending old asthma theories


We now leave the comforts of our time machine and find ourselves in a smoke filled office.  Behind a large wooden desk sits a stout, mustached man with black hair falling down over his right eyebrow.  Stuffed in the corner of his mouth is a large cigar.

Our guide says, "This is the famous Dr. Bree.  He wrote a book about asthma in 1797 called "A Practical Inquiry into Disordered Respiration, distinguishing the Species of Convulsive Asthma, their Causes, and Indications of Cure." It would go on to become the most read asthma book of the first half of the 19th century.

"Dr. Bree," our guide continues, as the man we are observing flips the page of a book he appears to be perusing, "was an ardent proponent of the bronchitic theory of asthma, a theory that states asthma is caused by an increase in phlegm in the lungs. In this way, he is one of the last known physicians to defend the ancient theories of Hippocrates."

Our guide tells us that Dr. Bree was the most famous as

The first figure we meet in our journey to the 18th century is famed asthma physician Robert Bree.  He was one of the last asthma experts to defend old asthma theories.  He was an ardent proponent of the bronchitic theory of asthma, although he adjusts it somewhat to support opinions he forms by his own observations.

I'm in the comfortable confines of my time machine, loaf back in my leather chair, and a man with a scruffy beard and tux offers me a cigar.  I decline the offer.  He says, his voice gruff, "I have every brand on the market, including asthma cigarettes.  Just let me know if you're interested.  How about a drink."

He motions at a cabinet containing a variety of spirits. 

"How about a beer," I say, and he clips the top off a brown bottle and pours the contents in a mug.  I take a drink, "Phew!!!" The contents spew from spew from mouth, I drop the mug, and the contents spilling on the rubber matted floor.  "Sorry!" I said.  

"No problem at all," he responds.  "Get that response all the time from you time travelers."

Then why didn't you offer me something more civil? I think, and then dismiss it altogether as I see, through the glass walls of the time capsule, a man I've seen several times on my time journey, and i recognize him right away as Hippocrates, the father of medicine.  

"The treatment of asthma is relative to the cause," my guide says.  "Before Hippocrates, for example, asthma-like diseases were often believed to be caused due to a spirit, and the remedy consisted of chants and hymns to expectorate the evil spirit.  Occasionally a family member  knows of a herbal remedy for you to try, perhaps something mixed in tea, or smoked in a crude pipe."

After clearing throat, he says: "Hippocrates believes asthma is caused by an imbalance of the four humors -- yellow bile, black bile, phlegm and blood -- and diseases are caused by an imbalance of these humors.  This was pretty much the belief of both western and eastern societies, or at least to some extent.  So one remedy is bleeding to expectorate excess blood, and another concoction is believed to warm the patient, and both to balance the humours."

He continues:  "Galen, you met him the other day, Aurelius Celsus, you met him too, and other ancient asthma experts differed slightly in their descriptions and remedies.  Yet for the most part they believed in the humoral theory of asthma.  Yet William Cullen, the asthma expert you met in the 18th century, swayed from these teachings based on science, and he came up with the more modern nervous and spasmotic theories of asthma."

He lights a cigarette.

"Oh, please don't," I say, scoffing at the smoke he creates. "I have asthma."

"Don't worry," he says, smiling, "I have all sorts of asthma powders." He motions at the cabinet of cigarettes and cigars. "It's all good for asthma."

"Not in the modern... er, future world," I say.

"Huh?" he chimes, then seems to ignore my thought and continues:

"Robert Bree, however, was an English physician who believed such modern theories were the subject of quackery.  He set out to prove Cullen wrong and ancient asthma experts closer to the truth in his 1797 book 'A Practical Inquiry into Disordered Respiration, distinguishing the Species of Convulsive Asthma, their Causes, and Indications of Cure.'"  (3)

He hands me an old, worn out book.  It smells like an old worn out book too.  "If you want to meet Dr. Bree you can push this button here," he says. "First of all, he wrote that no science proves the nervous or spasmotic theory of asthma, especially considering those two conditions cannot even be observed in autopsy.  He said you can see phlegm on autopsy, so science supports his theories and those of Galen and Celsus more so than Cullen's.

"Now," he continues, "Bree did not completely reject the spaspotic theory of asthma, he simply considered it as secondary to some other cause.  Ernest Schmiegelow explained this in his book 'Asthma, considered specially in relation to nasal disease."  My guide hands me another book and refers me to page four.

As I'm flipping through the pages I check the date as 1890, and then proceed to page four.  He directs me to the following:
"Bree does not actually deny the possibility of bronchial spasms taking some part in the cause of asthma, but it is only secondary; the primary cause is an exudation in the bronchial tubes, by which the lungs (specially the muscles of respiration) are stimulated to contraction, in order to expel the mucus which they contain." (4)
My guide explains:  "In other words, Bree believed that mucus was the cause of most diseases, including asthma.  He believed the contraction of the lungs was a defense mechanism to expel mucus from the lungs. Bree's ideas about asthma are important to our 19th century history because he is considered by many the preeminent asthma expert of the first half of that century."

He grabs the book off my lap, and hands me another.  It was a book I own, and that sits on my nightstand.  Only this copy, I see as a peruse it, doesn't have all my markings in it. The book is "Asthma: A Biography," by Mark Jackson.

He says,  "George Lipscomb is a fellow asthma expert from England who set out to prove Bree wrong.  As Mark Jackson describes in his 2006 book, 'Asthma: The Biography,' the book that now sits on your lap, Lipscomb's goal was not to discredit Bree, his goal was to 'elucidate the history of a very prevalent and distressing disease, which has been hitherto but ill explained, and very unsuccessfully treated.''

He hands me another old book.  "Lipscomb published his own theories in this 1800 in this book: "Observations on the history and Cause of Asthma."  Lipscomb argued that Bree could no more prove Cullen's theories were wrong than Cullen could prove them right because upon death the lungs automatically relax." (5)

"Interesting," I say, "Very interesting.

"So the debate was on.  While experts are hard pressed to find evidence to prove either theory, Schmiegelow explains that Bree's theory is disproved as soon as the stethoscope gains favor, as it's easily proven an attack of bronchitis does not precede asthma, and that rhales, a lung sound Rene Laennec used to describe secretions in the lungs, are heard later during the attack.

"Likewise," he concludes, "while Bree is well respected in his day, his ideas about asthma, and even most of his remedies, slowly give way to to the spasmotic theory of asthma and the nervous theory of asthma.  These and other theories are debated throughout the century."

Continue the journey by clicking here.

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.)

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