Thursday, May 15, 2014

1729-1805: Buchan and Smellie's self help book

While William Cullin's studies and writings helped distinguished asthma from other forms of dyspnea, William Buchan  (1708-1805) and William Smellie (1740-1795) brought a basic knowledge of asthma into the homes of thousands of Europeans and Americans.

Their book brought scientific ideas about diseases known to physicians, and placed them in an easy to read format, replete with preventative measures and remedies. The book, "Domestic Medicine" was first published in 1769.

While Buchan is given credit for the book, the name of Smellie only appeared in the first edition as the printer.  Buchan was a physician, and Smellie was a printer, editor and encyclopedist.  While they probably wrote the book for "economic reasons," it was also written "for the humanitarian purpose of providing substitute for the deficiancies of medial care.  But, besides this, its author saw a useful, even necessary virtue in 'laying Mediine more open to mankind'."

At this the authors succeeded.  Buchan and Smellie's book was the most popular "self help book" prior to the 20th century. (1, page 217) Over 80,000 copies of this book were sold prior to the authors death in 1805, and the book was ultimately translated into every European language, and over the next 200 years would go through 19 editions.  (2)(5, page 20)

The book was also "published in Philadelphia in 1771," and "continued to appear from a variety of towns and at frequent intervals until its demise at Boston in 1913. Throughout its many variations the basic form of the book remained unchanged." (5, page 20)

While Buchan was credited as writing the book, little else is known of his life. Although we do know that one of his teachers was William Cullen.  Smellie, on the other hand, "compiled, edited and contributed to the first edition of the Encyclopedia Britannica published in 1771."  He also wrote "Philosophy of natural history," another book that had a successful run.  (5, page 21)

Buchan was a physician, and Smellie extensively studied medicine.  Most evidence suggests Buchan wrote the original copy of the book, and "Smellie compressed, corrected, and to some extent rewrote."  Although to what extent each of these authors contributed to the book no one really knows.  Some even go as far to say that Smellie wrote the book himself.  (5, page 21)

Like Cullen and other of his contemporaries of the day he wrote that asthma seldom presented with a cure.  He wrote against following the writings of "quacks" who believed in superstition, and that simple chants will cure any disease.  (3, page 72)

Buchan continued to describe asthma as a greater degree of dyspnea, as he describes it this way: (4, page 406)
The asthma is a disease of the lungs, which seldom admits of a cure.  Persons in the decline of life are most liable to it.  It is distinguished into the moist and dry, or the humoural and nervous.  The former is attended with expectoration of spitting; but in the latter the patient seldom spits, unless sometimes a little tough phlegm by the mere force of coughing."
Allow me to attempt to explain Buchan's view here.

1.  Moist (humoral):  Asthma (dyspnea) associated with increased fluid in the chest, either due to mucus or fluid.  This results in moist sounds from the airway, and excessive phlegm to cough up.  Today we would either describe this as follows, both of which cause dyspnea:
  • Chronic Bronchitis:  Increased sputum in the chest.  This is more likely to be seen in aging people
  • Pulmonary edema:  Fluid from the bloodstream that seeps into the lungs due to heart or kidney failure. This is more likely to be observed in patients near death.  
2.  Dry (nervous):  Asthma (asthma) associated with no further evidence of disease.  This would result in little excessive phlegm or secretions to cough up.  Other physicians started referring to this type also as convulsive or spasmotic asthma.  Today we know it is not caused by the nerves, instead by an abnormal immune response.  

He describes the following as causes of asthma: (4)
  • Hereditary 
  • Bad formation of the breast 
  • Fumes of metals or minerals
  • Violent exercise, especially running 
  • Haemorrhoids
  • Gout
  • Small pox
  • Measles
  • Sudden fear or suprise
  • Any cause the either impedes circulation of the blood through the lungs, or prevents their being duly expanded by the air
His asthma symptoms were typical of that time.  (4)
Quick laborious breathing, which is generally performed with a kind of wheezing noise. Sometimes the difficulty of breathing is so great, that the patient is obliged to keep in an erect posture, otherwise he is in danger of being suffocated. A fit or paroxysm of the asthma generally happens after a person has been exposed to cold easterly winds, or has been abroad in thick foggy weather, or has got wee, or continued long in a damp place under ground, or has taken some food which the stomach could not digest, as pastries, toasted cheese, or the like.
To treat and prevent a fit of asthma, the asthmatic must follow a specific regimen.  If this alone doesn't prevent or allay symptoms, there are certain medicines that can be trialed.  The regimen included: (4)
  • The food ought to be light, and of easy digestion
  • Boiled meats are to be preferred to roasted, and the flesh of young animals to that of old
  • All windy food, and whatever is apt to swell in the stomach, is to be avoided
  • Light puddings, white broths, and ripe fruits baked, boiled, or roasted, are proper
  • Strong liquors of all kinds, especially mak.liquor, are hurtful
  • The patient should eat a very light supper, or rather none at all, and should never suffer himself to be long costive. 
  • His clothing should be warm, especially in the winter-season.
  • Nothing is of so great importance in the asthma as pine and moderately warm air
  • Asthmatic people can seldom bear either the close heavy air of a large town, or the sharp, keen atmosphere of a bleak hilly country a medium therefore between these is to be chosen.
  • The air near a large tpwn is often better than at a distance, provided the patient be removed so far as not to be affected by the smoke. 
  • Some asthmatic patients indeed breathe easier in town than in the country; but this i$ seldom the case, especially in towns where much coal is burnt.
  • Asthmatic persons who are obliged to be in town all day, ought at least to sleep out of it. Even this will often prove of great service
  • Those who can afford it ought to travel into a warmer climate. Many asthmatic persons who cannot live in Britain, enjoy very good health in the south of France, Portugal, Spain, or Italy.
  • Exercise is likewise of very great importance in the asthma, as it promotes the digestion, preparation of the blood and etc. The blood of asthmatic persons is seldom duly prepared, owing to the proper action of the lungs being impeded. For this reason such people ought daily to take as much exercise, either on foot, horseback, or in a carriage, as they can bear.
Buchan recommends medicine when the asthmatic is "seized with a violent fit. This indeed requires the greatest expedition,:as the disease often proves suddenly fatal. He writes the following: (4)
In the paroxysm or fit, the pody is generally bound; a purging clyster, with. a solution of afafeetida, ought therefore to be administered, and if there be occasion, it may be repeated two or three times. The patient's feet and legs ought to be immersed in warm water, and afterwards rubbed with a warm hand, or dry cloth. Bleeding, unless extreme weakness or old age should forbid it, is highly proper. If there be a violent spasm about the bread or stomach, warm fomentations, or bladders filled with warm milk and water, may be applied to the part affected, and warm cataplasms to the soles of the feet. The patient must drink freely of diluting liquors, and may take a tea-spoonful of the tincture of castor and of saffron mixed together, in a cup of valerian tea, twice or thrice a-day. Sometimes a vomit has a very good effect, and snatches the patient, as it were, from the jaws of death. This however will be more safe after other evacuations have been premised. A very strong infusion of roasted coffee is said to give ease in an asthmatic paroxysm.
He then describes two types of asthma: moist and convulsive/ nervous.  Moist asthma was a common term for asthma that presents with chronic cough and excessive sputum production, and it may actually be what we refer to as chronic bronchitis.  For this type of asthma he writes: (4)
Such things as promote expectoration or spitting ought to be used; as the syrup of squills, gum ammoniac, and such like. A common spoonful of the syrup, or oxymel of squills, mixed with an equal quantity of cinnamon-water, may be taken three or four times through the day, and four or five pills, made of equal parts of afafœtida and gum-ammoniac, at bed-time*.
Convulsive or nervous asthma is a type of asthma whereby some exciting cause incites the nervous system to send signals to the lungs to cause the muscles wrapping around the air passages to spasm.  Buchan wouldn't have known about muscles, although he was well aware by his own observations and observations of others that the air passages of the lungs spasm during a fit.  Spasms generally left no lesions, and therefore were often regarded as a neurosis.  For this type of asthma he writes: (4)
For the convulsive or nervous asthma, antispasmodics and bracers are the most proper medicines. The patient may take a tea-spoonful of the paregoric elixir twice a-day. The Peruvian bark is sometimes found to be of use in this cafe. It may be taken in substance, or infused in wine. In short, every thing that braces the nerves, or takes off spasm, may be of use in a nervous asthma. It is often relieved by the use of asses milk; I have likewise known cows milk drank warm in the morning have a very good effect in this case.
He also writes:  (4)
In every species of asthma, setons and issues have a good effect; they may either be set in the back or fide, and should never be allowed to dry up. We shall here, once for all, observe, that not only in the asthma, but in most chronic diseases, issues are extremely proper. They are both a safe and efficacious remedy; and though they do not always cure the disease, yet they will often prolong the patient's life.
So this is what you would learn about asthma upon referencing his book.  As noted above, it was among the few medical self help book prior to the 20th century.  Most other books regarding diseases and medicine were written for physicians.  As noted by Buchan in his 11th edition: (4, page vi)
Although the Domestic Medicine was never intended to supersede the use of a physician, but to supply his place in situations where medical assistance could not easily be obtained, yet the Author is sorry to observe, that the jealousies and fears of the Faculty have prompted many of them to treat this Work in a manner altogether unbecoming the professors of a liberal science: notwithstanding their injurious treatment, he is determined to persist in his plan, being fully convinced of its utility;nor shall interest or prejudice ever deter him from exerting his best endeavours to render the Medical-. Art more extensively beneficial to Mankind. 
So he was well aware of the reception his "self help" book would have (did have) among the medical profession -- they resented esoteric medial wisdom getting out.  This, I must say, was nothing new, for Philip Stern wrote a book specifically for asthmatics in 1768 and it too was rejected by the medical community.  Yet unlike Stern's book, Buchan's was a major success.

In fact, Buchan's book was so successful it was often plagiarized, as noted by Buchan himself in his 11th edition:  (4, page vi)
But this illiberal treatment of the Faculty is not the only thing of which the Author has cause to complain. By some of them his Book has been served up mangled and mutilated, and its title, type, size, &c. so closely imitated, that purchasers are misled, and frequently buy these spurious productions instead of the real one. That a needy Author, incapable himself of producing an original work, should prey upon another, and that a mercenary Bookseller should vend such productions, knowing them to be stolen, are things not at all to be wondered at: but that all this can be done with impunity, shews that the laws of this country respecting literary property, are still in a very imperfect state, and stand much in need of amendment.
I bet there were many asthmatics who were very appreciative to Buchan for risking his own reputation to produce this book.

Further reading:
  • 1768:  Philip Stern writes book for asthmatics (8/6/13)
References:
  1. Nulan, Sherwin B, "The mysteries within: a surgeon explores myth, medicine and the human body," a good starting place is 216 where Nulan describes van Helmont's archeus and 
  2. Maryland, Hilary, "Medicine and Society in Wakefield and Huddersville: 1780-1870," 1987, Cambridge University Press, page 447 (this information is available too many references to name, and therefore is generally considered to be public knowledge.  I reference Maryland here mainly due to the quality of her reference).
  3. Jackson, Mark, "Asthma: The Biography," 2009, New York, Oxford University Press
  4. Buchan, William, "Domestic Medicine, or a treaties on the prevention and cure of diseases," 11th Ed., London, 1790, pages 406-410
  5. Lawrence, C.J, "William Buchan: Medicine Laid Open," Medical History, 1975, volume 19, pages 20-35. 
  6. Buchan, William, "Domestic Medicine: or, a Treaties on the Prevention and Cure of Disease by Regimen and Simple Medicines," 5th edition, 1776, London, pages 406-410
  7. Buchan, William, "Domestic Medicine, or the Family Physician: Being an attempt to render the medical art more generally useful, by shewing people what is in their own power both with respect to the prevention and cure of disease chiefly calculated to recommend a proper attention to regimen and simple medicine," 1774, 2nd edition, Philadelphia, Printed by Joseph Krukshank

No comments:

Post a Comment