Monday, January 20, 2014

1851: Beau rejects spasmotic, nervous theories of asthma

In 1851 J. S. H. Beau (1806-1865) was a French physician who, along with his pupil, Dr. Louis de Crozant, devised theories that  rejected the spasmotic and nervous theory of asthma.  They insisted, instead, upon the bronchitic theory of asthma, or that asthma was caused by increased sputum in the lungs that was capable of blocking the air passages with mucus plugs.

While Beau's ideas regarding medicine were the antithesis of the trend of the time, it was typical of French physicians at the time.  His ideas tended to be on the same track as Dr. Robert Bree, who, near the turn of the 19th century, wrote a book supporting the bronchitic theory of asthma.  (2, page 24)(4, page 373)

Henry Hyde Salter, in his 1864 book "On Asthma" said Beau in his "A Distinction of Two Forms of Bronchitis," said Beau considered asthma a form of bronchitis that he called "bronchite a rales vibrants."  He said Beau believed the "wheezing and the dypspnoea alike obstruction depend on the obstruction of the air tubes by the inflammatory products of this bronchitis. (2, page 24)

Salter quoted Beau as saying the following:
This opinion, adopted by many conscientious physicians from respect for medical traditions, is no longer capable of being maintained, since auscultation and percussion have given us the means of seeing (so to speak) what occurs in the chest. It has, in fact, been ascertained, with the assistance of these two methods of inquiry, and in a manner the most positive, that there is no asthmatic dyspnoea without an obstruction of the bronchial tubes, which causes vibrating rales (the sound of secretions moving through air passages)and which, producing an obstacle to the exit of the inspired air, forces it to react on the vesicles and to dilate them. (3, page 24)(4, page 373)
A decade later, J.B. Berkart, in his 1878 book "On Asthma," said the following of Beau:
Beau and his pupil, Crozant regard asthma as a chronic bronchial catarrh, accompanied with very viscid secretion. Such sputa, they maintain, are capable of obstructing the bronchi, and of thus producing the dyspnoeal attacks, as well as the sonorous and sibilant rhonchi—their "rales vibrants."*  With the displacement of the mucous plug into a larger bronchus, or on its expulsion by means of a fit of coughing, the dyspnoea ceases, and with it also the rales disappear. This form of bronchitis is, in their opinion, due partly to an idiosyncrasy of the patient, partly to exciting causes, which greatly vary in different individuals.
The views of Beau, however, met with but little support. Apart from their inherent imperfections, the belief in the nervous origin of the disease was too deeply rooted to be readily abandoned upon the mere denial of its foundation. Beau omitted to offer any proofs that a bronchial spasm was impossible or improbable. He declared the experiments of Williams and Longet as not sufficiently convoncing, and therefore, endeavoured to substitute his theory for theirs. (1, page 30-31)
So while Beau may thought he had evidence to support the bronchitic theory of asthma, most of his medical colleagues, or at least those outside France, objected to his claims.

Further reading:
  1. The history of asthma sputum
*Sibilant rhonch is basically an old way of saying a wheeze. Rhales vibrants was basically an old way of describing the sound of loose secretions in the chest. 

References:
  1. Berkart, J.B., "On Asthma: It's Pathology and Treatment," 1878, London, J. & A. Churchill
  2. Salter, Henry Hyde, "On Asthma: It's Pathology and Treatment," London, 
  3. Salter, ibid, page 24; Salter said he obtained this quote from "an able review on this subject by D. W. T. Gairdner, who, in commenting on this very passages by M. Beau, so Happily exposes the untenability of the bronchitis-theory of asthma."
  4. "Reviews: Memoirs on a New Distinction of Two Forms of Bronchitis by J.H.S. Beau," British and Foreign Medico Chururgical Review or Quarterly Journal, Volume XI, January-April, 1853, New York, S.S.&W. Wood, pages 355-376

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