Tuesday, July 15, 2014

1758-1839: Robert Bree defends old asthma theories

Like most asthma experts before him and after, Robert Bree's interest in asthma grew out of his own sufferings from the disease. His asthma made it his fate to go into medicine, and once he was a doctor he studied asthma and wrote about it.

Bree was born at Solihull in Warwickshire, England,  and in 1791 he completed his education.  Two years later, in 1793, such a severe asthma attack struck him that he was forced to quit working.  In 1794, while spending time in the military, his asthma improved.  In 1796 he was well enough to return to his practice.

His interest in medicine, and particularly the lungs, prompted him to research and write a book which he published in 1797 called "A Practical Inquiry into Disordered Respiration, distinguishing the Species of Convulsive Asthma, their Causes, and Indications of Cure." 

One of the things that made Bree such an interesting asthma expert is that he rejected the popular theories put forth by William Cullen  -- the nervous theory of asthma and the bronchospasm theory of asthma --  and aimed to prove by his writings that that older theories still held true.

In the Introduction to the fourth edition of his book he wrote, "Ancient description corresponds with the present state of the disease, although modern observation very slightly acknoqledges the resemblence.  In our time, the principal feature in the most considerable Species of the Disease is a subordinate object of attention; and if it were proved to be a cause by every other mode of evidence, demonstration would still be demanded before a material excretion, obvious to the senses, would be preferred to the theory of an invisible action that had revetted the attention of the Schools."

What you just read there was a flat out rejection of both the bronchospasm and nervous theories of asthma. He wrote there is no proof of their existence in life nor in autopsy, and it cannot be seen.  Based on autopsy results, he came to the conclusion they did not exist. 

You have to understant here that William Cullen's writings were highly popular, so you can understand that Bree's writings came with much criticism form his colleagues.  Another Birmingham physician by the name of  George Lipscomb aimed to prove Cullen right and Bree wrong.  In 1800 he even wrote a book of his own called "Observations on the History and Cause of Asthma."

Meanwhile, in his 4th edition Bree responded to the criticism by writing that "theories, built upon hypothetical foundations, are one cause for the turn of quackery that infests this country."  He wrote that some people are too quick to accept new theories and reject that of which can be proven.

Likewise, he wrote,  that while you cannot see what others propose, you can see what he (Bree) proposed, and he proved this by performing autopsies and coming to logical conclusions.  His conclusions about asthma, and the remedies that go with his conclusions, was the basis for his books.
Bree did not believe entirely in the bronchospasm theory of asthma.

Ernst Schmiegelow in his book "Asthma, considered specially in relation to nasal disease," (1890 page 4), wrote that "Bree does not actually deny the possibility of bronchial spasms taking some part in the cause of asthma, but it is only secondary; the primary cause is an exudation in the bronchial tubes, by which the lungs (specially the muscles of respiration) are stimulated to contraction, in order to expel the mucus which they contain."

In other words, Bree believed that mucus was the cause of most diseases, including asthma.  He believed the contraction of the lungs was a defense mechanism to expel mucus from the lungs.

 As Jackson writes, Bree believed that "just as spasmotic contractions of the gut were caused by irritation and were aimed at removing any noxious material 'for the safety of the body', so convulsive contractions of the respiratory muscles in asthma essentially operated 'to relieve the internal functions from injury or interuption'."

Yet Schmiegelow explains that Bree's theory was disproved as soon as the stethoscope gained favor, as it's easily proven an attack of bronchitis does not precede asthma, that rales are heard later during the attack.   
In 1808 Franz Reisseisen performed experiments that proved muscular fibrers wrap around the air tubes of the lungs, according to Jenny Bryan in her book "Asthma" (2008, page 8).

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