Friday, February 14, 2014

1850s: Dr. Salter's Asthma Features

What makes one case of asthma similar to another?  This was a subject Henry Hyde Salter took up in writing his infamous book about asthma in 1869 called "On Asthma: It's Pathology and Treatment."  So what follows are the general features, or principles, of asthma.

1. Periodicity: "The paroxysms occur at regular and definite intervals or periods.  Such periods can be a day, a week, a month, or a year.
  • Random:  In some cases the periods vary a great deal, in some it is lost entirely.  It is impossible to predict when they will occur
  • Regular:   When the attack will occur can be "predicted with the greatest certainty and never fails to occur at the right time. They occur regularly under:
    • Certain cycles (as in at a certain time of year, such as summer, winter, and fall asthma)
    • Recurrence of certain conditions either external or inside the body (monthly period, eating full meal every Sunday, hay fever season)
2.  Tendency to habitude: "A disposition to maintain and constantly repeat any peculiarity it may have acquired." This means the same external conditions, and removal of the external condition remedies the asthma. This means that every time it occurs, the patient can predict what will happen to him and what remedy will fix him.   The benefit of this "is the asthmatic becomes 'up' in his own case; every symptom is an old acquaintance to him; her recognizes the slightest indications; and can predict every event of his disease exactly as it will happen; he knows when an attack is coming on long before others can see any sign of it; he knows when it will go off; he soon comes to learn, too, by this exact repeated experience, what he may do and what he may not; what will do him harm and what good; and thus often becomes his own best physician."  He learns whether the attack will come on during the night or day, the time, the length of time, and the remedy.  A physician can actually get some reliable hints from his patient as to what to do. The best remedy may be breaking the chain of repetition, such as relocation to London for example.

3. Change of Type: Slow gradual changes occur in the characteristic of the disease over time, "brought on by slight and almost imperceptible variations in these recurrent phenomena.  You may see a change in type, periodicity, and habitude.  The attacks may become more severe or less severe.  Their character may change, time of day they occur may change, length of time they last may change, the symptoms may change and remedies also may change.

4.  Capriciousness:  "It is always puzzling its victim and his friends by the exhibition of some unexpected vagary; giving him pleasant and unpleasant surprises, raising his hopes and then disappointing them, and altogether confounding his calculations." Each case of asthma is capricious, and every case of asthma is capricious in itself (no two cases of asthma are the same).  One case may get better in humidity, another worse.  One case may get worse with ipacec, another better. One is worse in winter, another summer, another all year.  "One flies from the place another seeks." In one nitre-pater is the cure, in another it does nothing. Strammonium works for some, and not for others. (There is no better example of the caprice of asthma than the exciting causes of asthma, as what may excite one person's asthma, may not excite another's asthma. 1, page 77)

5.  Time of life of first access: "There appears to be no time of life at which asthma may not make its appearance -- from the earliest infancy to old age." These cases have a tendency to be pure asthma.  However, most cases of asthma have a tendency to form in the early stages of life. Those with the lowest risk of developing asthma are between 40 and 60 years of age. The time asthma develops has a direct correlation with the causative agent, as the person may never have been exposed to hay until he is, say 39.  At which point the disease makes its appearance.
  • Early life: The cases that come on earlier in life are usually due to "bronchiolar disorders of childhood... that causes a sensitive bronchial mucous membrane, some pulmonary collapse, and emphysema." 
    • Infantile bronchitis
    • Measles
    • Whooping Cough
    • Etc.
  • Later life: Asthma that comes on later in life has a tendency to be caused due to some organic changes in the lungs or body, such as cardiac asthma, kidney asthma, or chronic bronchitis. Many cases of elderly asthma are actually chronic bronchitis (an old man coughs, wheezes and spits). 
6.  Influence of Sex:  While both sexes are prone to develop asthma, you are twice as likely to get it if you are a male.  One theory is that men have a "greater proclivity to asthma on the part of the male nervous system than the female." However, Salter does not believe this.  He has a tendency to believe another theory, that  men are more likely to be exposed to the hardships of life:
  • Inclemencies of the weather (cold and wet weather)
  • The wear and tear of hardships of life (stressful jobs, night working)
  • The stress of violent and sustained respiratory efforts (heavy labor, intemperance)
7.  Hereditariness: Salter notes that "I think there is no doubt that it is."  He states that " In all diseases a certain number of cases will be found in which, on the mere doctrine of chances, the parents, or other members of the family, have been similarly affected." Based on his studies, it is hereditary on the "proportion of two to three."  There are a variety of members of the family who may have had asthma in the past, such as:
  • Inherited from the father
    • Father a confirmed asthmatic
    • Father a confirmed asthmatic, brother suffers from hay asthma.
    • Grandfather a confirmed asthmatic.
    • Brother and paternal grandmother asthmatic.
    • Father, two paternal uncles, and paternal grandfather.
    • Paternal sister died of it.
    • Father died asthmatic at forty-seven.
  • Several indirect branches of the family asthmatic, but neither parent.
    • Mother slightly asthmatic, maternal grandmother severely.
    • Grandfather now suffers from asthma.
    • Grandfather and uncle both asthmatic.
    • Sister and paternal grandmother asthmatic, brother with hay asthma.
  • Inherited from the mother:
    • Mother asthmatic
    • Two brothers, and uncle, and a nephew.
    • Mother, grandfather, two sisters, nephew, and grandchild asthmatic.
    • Grandfather, great-grandfather, two great aunts, two of his
And such are the features of asthma s recorded by Dr. Salter.


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