Thursday, February 14, 2013

1698: Floyer's asthma symptoms, triggers, treatment

John Floyer's A Treaties on Asthma provides a neat description of asthma, which probably comes from his own experiences with the the disease.   (4, page 374) He describes himself as having periodic asthma, which is probably more in line with our modern definition of the disease.

About a century after the first edition of his book was published a fellow asthmatic and asthma physician by the name of Robert Bree would quote Floyer's description of an asthma attack as such:
"I have found, that by late sitting up I have put by the fit for a night or two; and I have found it commonly necessary to rise out of bed, especially in the summer time, and to sleep in a chair the first night of the fit.  Two nights before the fit asthmatics want sleep frequently." (2)
Perhaps it's from his own experience that Floyer decided asthma into four parts, which are basically broken down as: (1)

Floyer's A Treaties on Asthma (1698)
1.  Symptoms:  A history of the fits or the asthmatic attack. It's generally based on his scientific description of bronchospasm: (1)
  • The attack usually begins at one or two of the Clock in the Night
  • The breath if very slow (early sign)
  • Fullness of stomach (early sign)
  • A slight headache (early sign)
  • Sleepiness (early sign)
  • Feeling rigid
  • Feeling stiff
  • Feeling inflated (head seems to be filled with Fumes or Serous Humour)
  • Began to suck in breath
  • Straitness of breath, seems to be for want of an easie Inspiration
  • Urge to sit in an erect Posture, that the weight of the viscera may pull down the diaphragm
  • Enlarging of the breast during inspiration
  • Muscles of inspiration strive and labour more vehemtly
  • Muscles of expiration cannot easily perform the Contraction of the Thorax, being hindered by the Stiffness or Inflation of the Membranes in the Thorax
  • Expriation is easier than inspiration
  • Expriation is very slow, and leisurely (and wheezing)
  • The patient can not cough, sneeze, spit or speak freely
  • The diaphragm cannot contract itself to move downward
  • Bronchi and trachea has its membranes and nervous fibres contracted which results in wheezing (mainly expiratory)
  • Muscular Fibres of the Bronchia and Vesiculae of the Lungs are contracted adn that produces the Wheezing noise, which is most observable on expiration
  • Convulsive cough before fit (inconsiderable)
  • Phlegm is spit up (inconsiderable) 
2. The nature of asthma as he saw it: Basically based on Galanic principles: (1)
  • A flatulent slimy Caccochymia which is bred in the stomach, and creates inflation there, and gives an effervescence in the blood and an inflation in the membranes in the lungs
  • At 2 a.m. the Chyle is more plentiful in the blood.. and the viscid Chyle and Lymph will not easily circulate through the lungs of the asthmatics
  • The Asthma is a High, Slow, Rare and Laborious Respiration, which depends immediately on the inflation of the Membranes of the Lungs by Windy Spirits, rarefied or propelled through the Glands of the Brain, either by external Accidents or periodic Febrile Effervescence (bubbling) of the Blood. 
3.  Triggers: (Accidental causes) or lifestyle causes or factors that precipitate an asthma attack: (1)
  • Great heats or cold
  • violent motions of the body or mind
  • Excess in eating and drinking
  • Venereal Pleasures
  • Heat of the bed
  • Changes of the weather to rain
  • Snow
  • Change in weather from frost to thaw
  • Alteration of clothes
  • Changes of the air at spring and fall (change in barometric pressure)
  • Moist air (dry air is good for the asthmatic)
  • Heat and smoke of from fires
  • Fumes
  • Perfumes
  • dust
  • Strong liquors and food
  • Exercise
  • Anger (makes humours more viscid)
  • Fear
  • Shouting
  • Excessive study (upset the spirits)
  • Any strong smells (candles put out, Smoak of tobacco, winie fermenting, soap making, burnign metals, etc.)
  • Sadness makes humours more viscid 
4.  Treatment: (The cure of the fit) and preventative measures.  These are probably things he tried out on himself: (1)
  • Light diet (fasting on day of attack with a light diet thereafter)
  • Gentle Exercise
  • Bleeding (performed in small quantities, but only in extreme cases)
  • Blisters (Applied to limbs and shoulders)
  • Narcotics/ opiates (if induced by sleep 'when nerves are filled with windy spirits'/ induce sleep)
  • Abstinance of anger or shouting
  • Emetics (to induce vomiting/  if excessive may bring on asthma/ monthly vomiting recommended)
  • Feather in throat (another option to promote expectoration of viscid sputum
  • Oxymel of squills (to induce expectoration)
  • Clysters (laxitives) or Purges (violent purging should be avoided, but regular purges are recommended)
  • Late sitting up (staying up late)
  • Avoid extreme climate changes
  • Febrifuges and Sudorifics to help fevers that accompany the asthma
  • Diuretics such as millipedes and woodlice
  • Cold water bathing (4, page 110)
  • Apple water (4, page 110)
Click here for more asthma history.

References:
  1. Floyers, John, "A Treaties on Asthma," 1698, London
  2. Bree, Robert, "A Practical Inquiry into Disordered Respiration Distinguishing the Species of Convulsive Asthma, their Causes and Indication for a Cure," 1810, London, pages 123-124
  3. Floyer, John, "History of cold water bathing," 1722, 5th edition, London, Printod form William and John, Innys, at West-end of St. Paul's Church-yard
  4. Gill, M. H., "Review and Bibliographic Notices: "On the spasmotic asthma of adults," by Bergson, published Gill's book, "The Dublin Quarterly Journal of Medical Science," volume X, August and November, 1850, Dublin, Hodges and Smith, pages 373-388

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