Thursday, April 03, 2014

1850s: The stomach causes asthma

Due to the relationship between the stomach and lungs, "in no direction is asthma more accessible than through the stomach," or so surmised the infamous asthma expert Dr. Henry Hyde Salter.  And, therefore, one of the best ways of preventing asthma attacks is by eating small, healthy meals.  

The reason for this is "due to the close relationship between the stomach and lungs," writes Salter.  What you put into your stomach can and will trigger your asthma, and therefore, to prevent an attack, you must consider a proper eating regimen, and this is among the first things Dr. Salter would consider when taking you in as an asthma patient.  The remedy that worked was a remedy, and the preventative treatment was to eat less food on Sundays.  

For instance, Dr. Salter was requested at the home of a boy who presented with a case of asthma.  Upon questioning the boy and his family, Dr. Salter realized that the attacks occurred every Monday.  Then, upon further questioning, it was learned that Sundays was a day when the family participated in a great feast.  So it was wise of Dr. Salter to surmise the asthma was brought on through due to a full stomach.

So there are various ways asthma can be caused through the stomach. (1, page 135)

1.  Dyspepsia:  (Upset stomach; indigestion)  Asthmatics are generally dyspeptics. Rarely do you find an asthmatics with a perfectly strong, sound stomach.  "The stomach and lung symptoms are part of one morbid condition; the whole thing is deranged pneumogastric innervation, and the asthma of the pulmonary portion of it." (1, page 135)
  • Their stomachs are irritable, 
  • Their digestion capricious and irregular
  • Dietary restricted
2.  Errors in diet:  "To prevent asthma the most scrupulous care is necessary in all that relates to food," with any of the following bringing on an attack:
  • A debauch (self indulgence)
  • A late dinner
  • A heavy supper*
3.  After meals:  Asthma has a tendency to follow shortly after meals, and when an attack is on the asthmatic will feel obliged to starve as long as the attack is upon him.  Since the asthmatic will continue to have an appetite for food, this starvation only adds to the suffering.  (1, page 137)

4.  Gastric symptoms: 
  •  Flatulence
  •  Hiccough,
  •  Etc.  
By the observation that any of the above may cause asthma that Salter came up with his theory that "the taking of food (either by its mere presence in the stomach, or by the process or results of digestion) acts as an irritant to the morbidity irritable pulmonary nervous system. The affair is excito-motory; the food is the immediate or remote irritant, the nervous circuit involved is the pneumogastric, and perhaps in part the sympathetic; and, in obedience to the common law of reflex action, the potency of the stimulus is increased, or, in other words, the reflex nervous irritability is exalted, by the condition of sleep."

The remedy:  Basically, a diet should have consist of three qualities: it should be small in quantity, highly nourishing, and of easy digestion. 
  • Eat a healthy diet
  • Don't eat too late in the day, or too soon before sleep*
  • Do not eat food that is indigestible (should be plain and well cooked)
  • Foods should vary; do not give same foods over and over again
  • Foods should be nutritious (due to less food eaten in a day by asthmatis)
  • Avoid meat pies, beef steak, kidney pudding 
  • Avoid drinks containing carbolic acid (Bottled Scout, Scotch ale, etc.)
  • Avoid strong coffee with sugar (undigestible)
  • Avoid any unwholsome foods (as in all of the above)
  • Avoid eating too much (because it's indigestible, not because a full stomach presses up on diaphragm)
  • It is better to eat a large meal at breakfast, as opposed to a large meal at dinner time (this may be due to the fact the stomach has better digesting power in the morning.  As the day progresses, the digesting power becomes "exhausted by succeeding meals) (1, page 141)
  • Nights rest (restores digesting power of stomach)
The most important thing to remember regarding diet is this:  *let no food betaken after such time in the day as will allow digestion being completed and the stomach empty before going to bed

The following is Salter's recommended asthma diet:
For breakfast, a small basin, or breakfast-cup, of bread-and-milk, and besides this, an egg (two for a strong man with a good appetite), or a mutton-chop, or some cold chicken or game. As a drink, if any is required besides the bread-and-milk, I think tea is better.than coffee, cocoa better than tea, and milk-and-water better than either. For dinner (not before two or after four o'clock), let mutton be the staple meat, beef or lamb but rarely, pork or veal never. A little succulent vegetable and potato should be taken; and a little farinaceous pudding, or stewed fruit, or the fruit of a tart, should conclude the dinner. Only one helping of either meat or pudding. I believe, unless there is some special reason to the contrary, that water is the be3t accompaniment to an asthmatic's dinner. No cheese, no dessert. A great sufferer from hay asthma tells me that a little boiled fish and brandy-and-water have the least tendency to bring on his asthma of anything he can take; he can take this when a dinner of butchers' meat would be certain to be followed by difficult breathing. With regard to the brandy-and-water I will not speak positively of its advantages in hay asthma, but in ordinary asthma I do not like stimulus of any kind. With regard to the fish there can be no doubt that it is less of a diet, yields more readily and rapidly to digestion, than butchers' meat, and is, therefore, less provocative of any evil depending on prolonged and laborious digestive effort.' And here let me observe that butchers' meat is of all foods (with the exception of those particular articles of diet which are specially offensive to asthma, and to which I shall refer presently) that which is most apt to aggravate asthmatic dyspnoea, and it is because dinner is a meat meal that it is necessary to take it so early. From any occasional late meal that convenience, or circumstances, may force upon the asthmatic, butchers' meat should always be excluded.
Basically, based on this theory, Salter would question his patient as to his diet.  If you have an asthmatic, for instance, who eats butchers meat every day at 1 p.m. and who later has an asthma attack, then the solution may be eliminating the butchers meat.  If someone eats too late in the day, perhaps the solution is to eat earlier, eat less, or stay up later.

Now keep in mind here this is just a recommendation.  Salter was of the belief that what works for one asthmatic may not work for another, and that is why he was usually up to the idea of the patient experimenting to find what remedy -- or diet -- works best for him.

*A heavy supper causes a full and bloated stomach.  This will cause the stomach to press up against the diaphragm creating less room for the lungs to expand.  Some believe this causes asthma.  Salter believes this theory to be false, that a full stomach causes asthma because "the bulk of the food diminished digesting power by over-distending the stomach and so paralyzing its movements, and by being altogether in excess of the secreting powers of the gastric mucous membrane."  This in turn renders the food indigestible. If the mechanical theory were true the asthma would come on in direct proportion to the stomachs bulk, which is not true.  When eating healthy foods, such as arrow root, one can eat all he wants and this will not bring on a fit of asthma.  He may drink water all he wants, and this will not cause asthma. Another proof of Salter's theory is that asthma does not come on immediately after eating when the stomach is most full, but an hour or two later. Relief by an emetic is not mechanical, as it relieves asthma the moment nausea is felt, not upon vomiting. An emetic works even when the stomach is empty.(1, page 141)

References:
  • Salter, Henry Hyde, "On Asthma: It's Pathology and Treatment," 1882, New York, William Wood and Company, pages 168-9  (original publication of chapters in magazines during the 1850s. The articles were compiled and published as a book, the first edition of which was in 1860 in London)

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