Monday, February 11, 2013

1820-1850: Race to define asthma

In the year 1840 Dr. Charles J.B. Williams proved the bronchospasm theory of asthma, and Dr. William Budd rejected this proof by performing experiments of his own.  This theory was debated for the rest of the century.

Likewise, from this year on you had one physician after another came up with his own theory as to the cause of asthma, with each being convinced he is right, with each offering proof.  Historians can argue whether this slowed down or sped up search for better asthma wisdom.

Dr. Franz Daniel Reisseissen:  He was a German physician who studied the lungs, and concluded "there is another apparatus appointed for contracting the bronchi, which consists of transverse muscular fibres.  As far as the cartilaginous rows extend, these fibres are inserted...." (1, page 186)

Reissiessen proved muscle fibres wrap around the air passages of the lungs almost all the way to the alveoli.  His writings are published in Berlin in 1822. You can check out his 1835 book by clicking here*

Charles J.B. Williams later proved that certain irritants cause contraction of the muscular fibres that Reisseissen proved wrap around the air passages in the lungs.

Francis Hopkins Ramadge:  In 1835 he described food as an asthma trigger, recommends moving from the city to country,  and of asthma being mostly a nocturnal disease. He discourages use of opiates because they impede respirations that are already impeded. He mainly recommends strammonium because it "produces a grateful forgetfulness and a balmy oblivion like opiates." (2, page 7)  He regarded asthma as a neurosis of the respiratory organs.

Prize essays of Bergson and Lefevre:  This occurred in 1836.  They regarded, as did Ramadge, asthma as a neurosis of the respiratory organs (3).  He also observed his own asthma and that of a friend and concluded asthma could only be caused by bronchospasm, and that this bronchospasm was caused by the mind, according to J.B Berkart. (4)

Berkart explains that "in essence of the disease he (Lefevre) considered to be an increased irritability of the nerves of the lungs, in consequence of which the slightest irritation applies to the bronchial surface induced spasm of the bronchial tubes." (4)

Romberg:  He further established the view of asthma as a nervous disorder in 1841, and based his conception of the disease as a spasmus bronchialis, upon the discovery by Reiseissen (1808) of muscular tissue in the finer bronchial tubes, and the contraction of these tubes under galvanization of the lungs by Charles J.B. Williams (1840), and irritation of the vagus (nerve) by Dr. Francois Achille Longet (1842)." (3)

Dr. Francois Achille Longet:  According to William Pepper and Louis Star, "It was ascertained by (Charles J.B.) Williams that by irritating the lung he could cause contraction of these fibres, and Longet subsequently proved that the same effect could be produced by galvanizing the pneumogastric nerve."  (5)

Berkart explains that in 1842 Longet performed experiments to prove "irritation of the pneumogastric nerve always produced spasmodic contraction of the bronchi, whereas section of the nerve led to emphysema, which was described as distention of the air vesicles."  (4, page 27) Longet also believed bronchospasm and emphysema were both parts of asthma.

Rudolph A. von Killiker:  In the 18th century William Cullen believed the muscle was just a continuation of a nerve.  von Killiker was a histologist who proved this was not true.  von Killiker basically confirmed teh works of Williams and Reisseissen when he isolated smooth muscles in the lungs  (6, page 422)

This essentially proved Cullen wrong, that the muscle was not just a continuation of a nerve.  Yet since nerves still connected to muscles, van Killiker's discovery was unable to stop the fallacy of the nervous theory of asthma. (6, page 422)

Interesting notes:  Williams must have agreed with Rene Laennec and J.B. Berkart that asthma was an abused term.  James Thomas Whitaker noted that in 1768 there were 17 different types of asthma (as described by Savage) and in 1822 this was reduced to 11 (by Richter). This was confusing.  Williams wanted to simplify the definition of asthma.(3)

The thing to note about most of these experts is that even while they believed in the bronchospasm theory of asthma, they continued to believe in the nervouse theory of asthma, and their experiments proved the two co-existed  -- or so they thought.

During the 1850s, asthma was described by Dr Henry Hyde Salter as a disease of bronchospasm caused by an exciting cause that triggers the nervous system.

*Ramadge, Francis Hopkins, "Asthma, its species and comications, 1835, London

  1. Floyer, John, ed., "The Cyclopaedia of practical medicine," 1833, volume 1, page 186
  2. Brenner, Barry E, ed, "Emergency Asthma" 1998, page 7 (chapter one is a history of asthma written by Brenner)
  3. Whitaker, James Thomas, "The theory and practice of medicine," 1893
  4. Berkart, J.B.,"On Asthma:  It's Pathology and Treatment, 18xx, volume I, page 23 (Berkart started his book with a good history of asthma up to his time.  I base much of this post on his thorough asthma history.)
  5. Pepper, William,  Louis Star, "A System of Practical Medicine," Volume 3, page 184
  6. Daintith, John, editor, "Biographical encyclopedia of scientists." 2009, 3rd edition, Florida, CRC Press

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