Thursday, May 22, 2014

Evolution of asthma as a nervous disease

So far in our asthma history we have come across many references to asthma as a nervous disorder.  By the many writings about asthma during the 19th century and first half of the 20th century it almost seems as though the idea that asthma was nervous was just assumed.  Surely we don't think of asthma as a nervous disorder, but for most of history this was the case.  Why?

Back in the primitive and ancient worlds men and women were expected to do certain jobs.  Generally, the men hunted, gathered food, and build structures needed to support their families and the societies of which they served.  Women were generally responsible for taking care of the children, making clothing, preparing food, etc.  These jobs were essential to life.  It was simply expected they would be done.

So now let's assume a ten-year-old boy has asthma.  No doctor in either the primitive world nor the ancient world would have the knowledge of this disease we have today, so it would basically be diagnosed as dyspnea and wheezing.  Now say this asthma only came about when this boy was in the woods.  When his dad took him on a hunting trip for the first time, he had an asthma attack.  

Surely his mom and dad would be concerned for him, yet what could they do?  Surely there were medicine men in the primitive world, or a physician or priest in the ancient world, but even they wouldn't have much to offer other than an incantation or prayer.  They would probably think the boy was cursed, and he would be mocked and perhaps even feared by his peers.  He would become a week, useless burden to his family and society.  

As superstitious and religious medicine started to take a back seat to philosophy during the Ancient Greek and Roman eras, asthma was defined as a disease.  Yet, still, if you had it, you were a burden to your family and society.  Yet the Greeks might spare you your dignity by allowing you to think or write or do something productive.  Seneca might be among our first examples of an asthmatic lived this way.  He was accepted by society, even given a job as a Roman Senator, and due to the unique view he developed about the world around him through his asthmatic body, he wrote a lot about the world around him, including his asthma.

During this time asthma was defined as as nervous.  Hippocrates believed asthma was similar to epilepsy, which was clearly a nervous disease.  He figured asthma was much the same, only taking place in the lungs.  Many later physicians would refer to asthma as "epilepsy of the lungs" even into the 19th century.  

Playing on the Hippocratic theme that diseases are caused by an imbalance of the four humors, Hippocrates believed asthma was caused when there was too much phlegm in the brain. which caused epilepsy and seizures, including seizures in the lungs.  

Galen cut open human lungs and traced vessels from the lungs to the brain, and by this he may have believed he verified the Hippocratic connection between asthma, epilepsy and the mind.  He believed that since epilepsy was caused by increased phlegm in the brain, asthma was caused by increased phlegm in the lungs, although he didn't rule out the idea of "epilepsy of the lungs."

Avecinna (980-1037) also played on this theme.  He believed asthma was a chronic disease in which patients often suffered 'acute paroxysms with similarity of epilepsy and spasm.'  The flow of thick humours from the head to the lungs produced a situation in which 'the patient finds no escape from rapid panting, like the labored panting of one who is being choked or rushed'.  

Maimonides (1138-1204 A.D.) may have been the first to specifically refer to asthma as a nervous disorder when he to asthmatics as "mentally agitated." Noting that the disease causes the physical well-being to suffer and eventually he becomes physically ill.

 Jean Baptiste van Helmont (1579-1644) was the first to define asthma as a nervous disorder for the medical community, although it was Thomas Willis (1621-1675) who often gets credit as being the first to write this. I wrote about these two in this post.  

William Cullen (1710-1790) believed most diseases were fostered by some kind of disorder of the nervous system, and that the muscles was "a continuation of a nerve."  This theory affected his description of asthma, it's causes and remedies.  It also affected debates that occurred during the 19th century regarding the seven  theories of asthma, which included the nervous theory of asthma, at that time. You can read about these theories here

Through much of the 19th century the seven theories were debated by physicians, and you an read about the chronology of these debates here. The two theories that won the era were the spasmotic theory of asthma and the nervous theory of asthma, with most physicians just assuming that the later cause the former.  

During the course of the 1850s Dr. Henry Hyde Salter confirmed, proved and enshrined the idea that asthma was nervous into the minds of the medial community.  And we know that once an idea is so ingrained, one it grows roots, it's nearly impossible to pluck those roots even given adequate evidence.  And such was the case with the nervous theory of asthma.  It was debated throughout much of the 18th and 19th centuries, and may still be by some physicians.  You can read about Salter's nervous theory here. You can also read more here

By the 1870s the nervous theory of asthma won the debates of the era, along with the bronchospasm theory of asthma.  It was now believed that some exciting cause, as described by Salter, irritated the mind, and this caused a signal to be sent to the lungs, which causes spasms of the muscles that wrap around the air passages.  This results in the symptoms of asthma.  You read more about this here

In 1899 asthma was described as a Nerve Storm, and you can read about this theory by clicking here.  

Still, during the 18th century, most physicians, most writers on the subject, appear, by their writings, to have just assumed everyone knew asthma was nervous.  It was just a given.  We can see this by many examples.  

Examples in pepper and star (see 18th century)

By the 1940s asthma was believed to be caused due to emotions stemmed by stress caused by parents, and a common remedy was parentetomy: taking the kids from their homes and placing them in asthma hospitals such as National Jewish in Denver, Colorado.  You can read about this here. (1980s:  Parentectomy, coming 6/6/13)

Even after the nervous theory of asthma was finally disproved in the 1950s it wasn't 

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