1899 bronchitis triggers x

In 1899 Dr. Samuel Gee, in his article, "Bronchitis, Pulmonary Emphysema and Asthma, (The Lancet, March 18, 1889) defined bronchitis as a common disease that causes pulmonary catarrh and has the ability to strike anyone at any age.  It's inflammation that results in irritation of the mucous membranes and causes excessive secretions.

He mentioned as possible causes the following:

• Nitrous fumes
• Inhaled microbes
• Breathing dust
• Grass pollen
• Strong smells (odour of roses)
• Dust from molds
• Dust from fungi
• Influenza
• Typhoid fever
• Common cold
• Unexplained

Was this 19th glass factory poorly ventilated and cause asthma?

The idea that "dusty trades" caused breathing trouble was nothing new, Gee wrote.  He mentioned Ramazzini "two centuries ago developed several chapters of his book "De morbis artificum" to the diseases, chiefly pulmonary, which attend dusty trades."

Regarding dust he describes two types.  One is insoluble dust, such as those emitted from cotton mill smoke.  This type of smoke can cause cause bronchitis that is chronic and slow in developing.  It's a "mechanical irritant to the bronchial membranes." 

Yet he also observed that most people who work in trades where this type of dust is prevalent also smoke and drink alcohol.  So whether the bronchitis is a result of inhaling dust or these other habits is difficult to determine.

Insoluble dust would also include "dust from unclean and ill-ventilated rooms will be very likely to contain morbific microbes and the irritation of the air passages set up by inanimate dust will favour the operations of the many bacteria which are potent to cause bronchitis.  It obviously would be very improbable that these microbes should swarm in impure air and should not be found in the upper air passages of man.  And thus, as a matter of fact, our mouths, noses, and throats harbour many morbific microbes in a latent state; they are there awaiting a favourable opportunity for becoming active and virulent."

Inanimate dust would be your grass pollen which causes hay fever.  This condition results in inflammation (catahrr) of the nasal passages and this ultimately results in inflammation of the lungs (bronchitis). 

He mentions that strong smells, such that of roses, can cause bronchitis.  These flowers might also emit particles small enough to be inhaled.

Yet he also mentions one study where a doctor placed an artificial rose in the presence of a person, that this caused bronchitis.  From this "we have learned how large a part in the production of such a catarrh can be played by the power of imagination."

Dust from moulds and fungi are also considered inanimate dust.  Of interest is he also described two different types of sputum:  mucous and purulent.  He observed that some patients have both types in the spitting pot, and he surmised that "probably the different secretions come from different parts of the bronchial tract."

Today we might think of such patients as either suffering from chronic bronchitis caused by irritants and smoke, yet he may also be referring to asthma irritated by such substances.  Either way, Gee's observations were quite stunning given the knowledge of such diseases known at that time.

Reference:

Gee, Samual M.D., "Bronchitis, Pulmonary Emphysema, and Asthma," The Lancet, 1899, March 18, page 743-747

1839-1911: The infamous Dr. Gee

Samuel Gee (1839-1911)

"I'm punctual and expect the same from you," the philosophy professor said just after the bell rung.  "If you're not here when the bell rings you're not here at all in my eyes, and you'll fail my quizzes and tests."

By his 30 minute lecture on punctuality he scared us all, and earned our respect.  He also turned out to be an impeccable teacher who taught us a valuable lesson juxtaposing timeliness with success. 

While his name has since left my mind, the lesson he taught lives on.  I have this sense of urgency when it comes to being on time, although I wouldn't go as far to say I'm "punctual." 

I can't remember this teacher's name, yet I'm reminded of him as I delve into the life of Dr. Samuel Jones Gee who was well known for his punctuality. 

The Historic Hospital Admission Records Project described Dr. Gee this way: 

"His reputation as a teacher was second to none, and his punctuality the stuff of legend. He was leaving his house in a cab one day, when a patient detained him. As the conversation continued, the door of the vehicle swung open, hit a tree, and fell off its hinges. He insisted on carrying on to Bart’s minus the cab door, so that he would not be late." (1)

He was born in 1839 and developed a love for history, and because of this he became proficient in many languages, including Ancient Greek.  His ability to read and write in Greek would eventually benefit children around the world, as it allowed him to compare ancient accounts of diseases with what he observed during his own personal assessments and examinations on autopsy.

He attended college at University College School in London and studied medicine at the University College Hospital.  He impressed as a student enough to be hired as house surgeon at University College Hospital where he worked until 1865 when he earned his medical degree.

He was then hired at the Hospital for Sick Children, Great Osmond Street where he would eventually serve as pediatrician and pathologist.  He was passionate about learning about diseases and how to treat them, and he loved performing autopsies.

While his main job was working at the children's hospital, he also worked at St. Bartholemew's Hospital and managed to maintain a private practice.  A private practice back then involved the doctor traveling to the patient's home instead of the other way around as it is today.  So, while lucrative, it was a lot of work, and often quite risky.

He wrote 2 books and published 46 papers in St. Bartholemew's Hospital Report, with almost all of his writings on pediatric diseases -- which include asthma, bronchitis and consumption (tuberculosis).   HHARP mentions that one of the biggest complaints against him is he didn't write enough. (1)

What he is best known for is a lecture he gave in 1887 in which he gave the first modern day description of coeliac disease, a condition that affected many of the children he treated.  He described the condition this way:

“There is a kind of chronic indigestion which is met with in persons of all ages, yet is especially apt to affect children between one and five years old. Signs of the disease are yielded by the fæces; being loose, not formed, but not watery; more bulky than the food taken would seem to account for; pale in colour, as if devoid of bile; yeasty, frothy, an appearance probably due to fermentation; stinking, stench often very great, the food having undergone putrefaction rather than concoction".

He learned a lot about this disease by reading ancient accounts written by Aretaeus of Cappaocia who was a master clinician about 100 A.D.  Areteaus is known for providing some of the first descriptions for many diseases, such as pleurisy, diphtheria, tetanus, pneumonia, diabetes epilepsy and asthma.

He was also the first to describe the symptoms of coeliac disease, although he referred to it as coeliac diathesis.  Gee chose to respect Areteaus and referred to the condition as the coeliac affection.  Today we refer to the condition as coeliac disease. (2)

The condition causes it's victims to become pale, weak and appear to be wasting away, symptoms similar to tuberculosis.  Aerateaus believed it only occurred in adults, yet Gee recognized it could affect anyone, yet was most common among children aged 1-5, which was one of the main reasons Gee became so enthralled by the disease.

Gee was the first to differentiate between coeliac disease and tuberculosis, and he brought coeliac disease to the mainstream in the medical world.  He was also the first to suggest the cause and cure might be in the diet. 

Coeliac disease is similar to asthma in that neither disease causes any changes in their respective organs.  Of Coeliac disease Gee wrote, "Naked-eye examination of dead bodies throws no light upon the nature of the coeliac affection: nothing unnatural can be seen in the stomach, intestines, or other digestive organs."

Aerateus had a theory as to what caused asthma, and he likewise had a theory for coeliac disease.  He believed a "natural or indwelling" heat was needed for proper digestion, or "pepsis" as he referred to it.  Pepsis was the natural breaking down of food which occurred in the heat.  (2)

Aeratus explained that Coeliac affection was caused by a "chilling of the natural heat needed for 'pepsis.'"

Gee didn't agree with this, although he didn't pretend to know a cause or remedy.  A cause and treatment of the disease alluded the medical world until the 1950s when the condition was linked to the consumption of gluten in the diet.  Like asthma, coeliac disease is now considered an autoimmune disorders. 

Dr. Gee passed away in 1911, yet many of his publications are still available thanks to Google Books.  In our history of asthma and bronchitis I must make mention of him from time to time as so much of what he wrote is available to us thanks to Google.

Click here for more asthma history.

References:

1. "Dr. Samuel Jones Gee, "Historic Hospital Admission Records Project,  http://hharp.org/library/gosh/doctors/samuel-jones-gee.html
2.  Dowd, Brian, John Walker Smith, "Samuel Gee, Areteaus, and the Coeliac Affection," 1974, British Medical Journal, April 6, page 45
3.  Gee, Samuel, "Bronchitis, Pulmonary Emphysema, and Asthma,", Lancet, March 25, 1899, page 817

5000-50 B.C.: Egyptian priests/ physicians treat your asthma

So you are an Egyptian father of an Egyptian boy and you are convinced he is cursed by the god Isis.  You don't know what your son did, but he is outside leaning against a tree in order to breathe, and he's making loud wheezing sounds with each prolonged expiration.  You cannot bear to watch him suffer anymore, and so you send for help.  

It's possible that in the early days of Egypt you would have your child sit in the streets, and people who walked by would offer their medical advice; their diagnosis and medical treatment.  Some historians speculate this never actually occurred in Egypt, and others speculate it was an early transitional stage prior to the priest studying health at the temples, and maybe even prior to the transition of some priest into physicians.  (1, page 2)

Various temples were built where you could worship the various gods of Egypt, and specialized temples were built where you could worship the gods who specialized in health and healing.  These temples were places where the sick could sleep in the night, and a diagnosis and remedy would occur in the night, and in the morning a priest would interpret these dreams and visions. (1, page 2) (3, page 16)(8, page 19)

Patients who were too sick to leave their homes may send for a physician.  The president of the temple would determine the specialist best for the individual case, and that physician would be sent to the patient's home.  In this way, physicians made house calls.  (2, page 4) (4, page 17)

When he did so, he offered the following: (11, page 14)(12, page 13-15)

• Magic
• Draughts (potions)
• Blisters
• Poultices
• Plasters
• Powders
• Clysters
• Bleeding
• Pills made of dough
• Gargles
• Salves
• Inhalations
• Fumigations
• Supositories
• Incantations
• Amulets
• Hope
• Emetics
• Purgatives
• Diuretics
• Diaphoretics
• Cautery
• Surgery

The various drugs used were from animals (worms, snakes, insects, elephant, camel, crocodile, hyena), plants (radishes, onion), minerals (sulfur, zinc) and even humans excrements (feces, semen, saliva).  These were formulated in a variety of recipes that were prepared by the priests/physicians.  (12, page 15)

They would also prescribe good hygiene and a proper diet. (12, page 15)  They encouraged regular baths and purgings, and perhaps this was where the old adage came from: "prevention is better than the cure." People early on in history must have learned that nary a drug cured anything, and sometimes the drugs used made the person worse, or even killed him.  So the emphasis was placed on good hygiene and healthy eating, with the goal of keeping you healthy, and preventing you from getting sick.

Proof of this can been found in the Bible, when God told Moses to tell the people to follow a the laws set forth to prevent the spread of disease.  Moses, who probably studied under the tutelage of Royal Egyptian priest/physicians, encouraged Israelites to avoid diseased people, and not to touch corpes, and to wash and have good behaviors in order to prevent sickness. 

Common diseases treated were osteoarthritis, tuberculosis, rickets, and syphilis. (12, page 15)  Modern evidence from mummies suggests they also treated atherosclerosis. Although their limited knowledge of anatomy prevented them from knowing about these diseases, they basically observed and treated the symptoms, which to them were caused by the gods, and, if not treated by the powerful magic of the priests/ physicians, would result in death.

The god Thoth communicated with an ancient priest, perhaps Imhotep, and Thoth provided Imhotep with all the wisdom of the gods.  The god invented all the arts and sciences, including a written language, medicine, and laws.  Thoth provided Imhotep with all this wisdom, and he carved them into pillars of stone, creating 42 books, the last six of which containing all the medical wisdom of the gods, and the laws regulating their practice.  (2, page 3)(3, page 14)

The ancient Greeks called Thoth Hermes Trismegistus, and therefore the books he wrote are often referred to as the Hermatic books.  A specialty of priests became the scribes, and they were among the wisest and most revered priests in all of Egypt.  Scribes transcribed the Hermatic books so they could be visible in all temples of the gods of health and healing, and so these temples became the places of learning among the priesthood.

Thoth ultimately taught the priesthood to make paper out of stalks of papyrus, and scribes were able to transcribe the Hermatic text onto large scrolls, and in this way every physicians could now have his own copy. When called upon to visit the sick, he must have taken his scroll with him, perhaps carrying it with him in his medical bag.

While temples to the gods were places of worship and healing, many were also were also the centerpieces of places that acted like our modern universities, complete with schools, libraries, laboratories, papyrus/paper factory and boarding houses.  These were places of instruction for not just priests and physicians, but astronomers, mathematicians, and a variety of other professions. Some of the original and most famous temples/ universities were situated at Memphis, Thebes and Heliopolis, Sais, and Chennu. (3, page 16)(8, page 19)(11, page 9)

The higher class of priests at these schools studied the first 36 books, and others the last six*.  Perhaps it was at such schools where Egyptian priests/ physicians developed such beliefs as life "should be indefinitely prolonged, unless someone or something caused death, such as a spirit, or the soul of a dead man, which cunningly entered a dead person," according to Sandwich. (1, page 2)(9, page 25)

Perhaps it was at these temples that a greater understanding of diseases was speculated upon, and the realization was made that many diseases were associated with dirtiness, and that some diseases were spread from person to person.  It's for this reason, perhaps, that people contaminated with certain diseases, such as the lepers, were cast from society and you were warned to stay away from them.

The priesthood, then, learned the importance of cleanliness in maintaining good health, and it's from here where circumcision became standard practice, along with regularly scheduled bathing, the wearing of clean clothing, and similar such rituals.  It is also from here that diet and drugs were incorporated into the medical regime "to counteract the disorders which the strange being had produced in the body," according to Fleming Sandwich in his 1905 book. (1, page 2)

Such cleanliness must have been rather successful at keeping the Egyptians healthy.  William Hudson Garrison, in his 1922 history of medicine, quotes Aristotle from his Politics, as saying: "They purge themselves every month, three days in succession, seeking to improve health by emetics and clysters; for they suppose that all diseases to which men are subject proceed from the food they use. And, indeed, in other respect, the Egyptians, next to the Libyans, are the most healthy people in the world, as they, on account of the seasons, because they are not liable to change." (5, page 51)

Likewise, Plinio Prioreschi,  in his 1991 history of medicine, explains that Egyptian medicine gained a "great reputation" as noted by the following passage from Homer's Odyssey: (10, page 257)

...for there (in Egypt) the earth, the giver of grain, bears the greatest store of drugs, many that are healing when mixed, and many that are baneful; there every man is a physician, wise above human kind... 

Alexander Wilder, in his 1901 history of medicine, says that "the skill and learning of physicians of Egypt made them famous in the neighboring countries."   In one example, "the Prince Bakhtan (Bashan) sent an embasy to Ramases XII for medical aid for his queen's sister."  Ultimately "the pastaphori and physicians bearing a receptacle of the divinity... the mission was successful; the princess speedily recovered, and the god received the glory." (11, page 15)
-------------------------
By the height of Egyptian civilization, society evolved into six orders:  (4, page 32)

• Kings and princes 
• Priests
• Soldiers
• Shepherds
• Laborers
• Artisans.  

Of these six orders, only the kings and princes were privy to their own physicians.  

Most of these orders were divided into various castes, with various of the priesthood being chosen to specialize in the various wounds and diseases and these became the caste of physicians. Members of this caste becoming "the most respected and the most powerful" members of the society. The caste "was a depot of the laws, science and religion."  (2, page 32)

 Of these physicians, the great Greek historian Herodotus (484-425 B.C.) once wrote: (5, page 50-51):

"The art of medicine is divided among them: each physician applies himself to one disease only, and not more. All places abound in physicians; some physicians are for the eyes, others for the head, others for the teeth, others for the intestines, and others for internal disorders."

Each physicians specialized in one disorder, such as:

• Disorders of the head
• Disorders of the eyes
• Disorders of the rectum/ anus
• Disorders of the teeth
• Disorders of women
• Experts in child bearing
• Experts in surgery (surgeons)
• Internal medicine (treat asthma-like symptoms, cancer, upset stomach, etc.)

Homer even notes the following regarding Egyptians:

...in the land where the fruitful soil bore abundance of herbs potent for good or evil, nearly everyone was, so to speak, a doctor or a descendant of Paeon and learned among the men. (8, page 18)

Paeon (Paean) was the physician to the gods.  By Homer's reference, historians surmise that as medical knowledge was specialized, many of the commoners became knowledgeable in medicine, each becoming a pseudo-physician.  As our modern day homes, many people had their own medicine chests, and had the ability to treat basic cuts and scrapes, and ailments like the common cold.

When wounds were severe, or as diagnosis and treatment reached beyond the commoners scope of knowledge, only then would the greater expertise of a priest or physician be sought.

The classes of priest/ physicians were divided this way:  (3, page 16-17)(2, page 3-4)(7, page 13-14)

1. Chief Priests:  Also referred to as Sages, Soothsayers, Image Bearers, Magi, sorcerers, wise men or magicians.  These were the wisest of the priests/ physicians, and they were privileged to all the knowledge of the gods, and hence were responsible for reading the first 36 books of the Hermetic books. They were physicians of the "higher sciences."  These priests/physicians were responsible for "conjurations, dissolving the charms of the gods by prayer, interpretations of the revelations received by the sick during incubation in the temples."  (3, page 16-17) They were more like the medicine men of the primitive world, "disolving the charms of the gods by prayer... magic and divination."  (2, page 4)  They were even mentioned by Moses "in the 7th and 8th chapters of Exodus, under the names of wise men, the sorcerers, and magicians, of Egypt, whom Pharaoh called in to rival the miracles performed by Moses." (7, page 13)
2. Pastaphori: The lower class of priests were responsible for studying the last six of the Hermetic books, and were responsible for visiting the sick and treating them.  They were your prototypical physicians, or ordinary physicians devoted specifically to medicine and the art of healing. Each of these physicians/ priests specialized in a certain ailment, such as internal medicine, dentistry, rectum, etc. They treated "anatomy, pathology, pharmacology, opthalmology, and gynecology." This profession probably morphed from the need of physicians to leave the temples, especially as medicine (particularly rational/civilized) evolved. 
3. Military physicians:  They essentially were Pastaphori who followed the military, and mainly were experts in treating battle wounds with salves, casts, splints, incantations, etc. Each of these also specialized.
4. Veterinary:  They specialized in health and healing of animals.  They specialized as well, as your cattle doctors, fowl doctors, etc. 

According to William Hamilton in his 1831 history of medicine, only certain priests were privileged to become physicians, and "the office of these priests was hereditary and their privileges were exclusive; as the son trod with unvarying servility in the footsteps of his father."  (7, page 13)

Physicians were free from the bondage of taxes, were paid by the collective, and profits belonged to the temple. The only obligation of the patient was to provide gifts, which sometimes included models of the organ fixed or operated on (such as an arm or leg), and these were kept at the temples as mementos, perhaps, of the healing powers of the gods. Likewise, "during war, or in the case of anyone falling ill upon a journey, the doctors were bound to render help gratis," (4, page 17) (9, page 25)(11, page 10)

Hamilton says that "Improvement to medical knowledge was effectually arrested by the penal discouragement of every attempt to deviate from the canons of practice laid down in the volumes ascribed to Thouth (Thoth); and the interests of the priests led to the perpetuation of the popular delusion respecting the cause of disease, (7, pages 13 and 14)

According to the Diodorus, diseases were diagnosed by the position of the patient in bed, (6, page 25), and treatment was standard, or based on your symptoms, as noted by Bradford: (1, page 6)

The Egyptians paid strict attention to dietetic rules; they thought that the majority of diseases were caused by indigestion, and excess in eating. They practiced abstinence and used emetics. They had a considerable knowledge of Materia Medica (the pharmacopoeia) and used many drugs in the cure of the sick. They were somewhat skilled in operative surgery. They practiced castration, lithotomy and amputations

So Egypt had a plethora of physicians who specialized in the various wounds and ailments that plagued Egyptian society.  Such specialization was both bad and good.  It was bad when you were sent a specialist who didn't specialize in what plagued you, such as if a physician who specialized in disorders of the rectum was sent to treat your son's dyspnea.

It was good when your specialist had knowledge of internal disorders, and had access to remedies that contained opium or belladonna that had magical abilities to sedate him so he can better deal with his agony.

While preparing the ingredients, he may he might site the following incantation: (3, page 23)

"May Isis heal me, as she healed Horns of all the ills inflicted upon him when Set slew his father, Osiris. 0 Isis, thou great enchantress, free me, deliver me from all evil, bad and horrible things, from the god and goddess of evil, from the cod and goddess of sickness, and from the unclean demon who presses upon me, as thou didst loose and free thy son Horus" 

As you can see, the medical profession among "the ancient Egyptians hold the honor of being the first people to cultivate medicine as a science," and that this "medicine was closely associated with the mythology of Egypt."  (2, page 1)

Surely we might look at Egyptian medicine, as well as medicine of any ancient society, and think to ourselves:  this is quackery.  Yet these ancient societies probably benefited more from the magic of incantations and  prayers, or by the gentle touch of a palm on the shoulder, than from any other form of medicine.  As noted by Henry Sigerist in his 1951 book, "A History of Medicine: Primitive and Archaic Medicine: (13, page 280-1)

The oral rite was all important.  The correct choice of words to frighten a spirit, to enlist the help of the gods, the intonation probably also in which a spell was recited or sung, this all must have had a profound effect upon the patient.  We know the power of suggestion and know how highly responsive religious individuals are to such rites.  I should not be astonished if the sorcerer with his spells had had as better results in many cases than the physician with his drugs.  Magician and priest were able to put the sick in a frame of mind in which the healing power of the organism could do its work under the best conditions.  They gave him peace and confidence and helped him to readjust to the world from which disease had torn him.(13, page 280)

Sigerist also writes the following:

The manual rites performed in the course of an incantation appear in infinite variety from teh simplest to the most elaborate and complicated.  the rite may have consisted of nothing but putting one's hand on the patient, the classical gesture of protection so familiar to us from the Bible.  After having exorcised a demon the magician said: 'My hands are on this child, and the hands of Isis are on him, as she puts her hands on her son Horus.'  Or the magician held his seal over the child and such as seal was obviously a powerful fetish: 'My hand is on thee and my seal is thy protection'  (13, page 281)

There may have come a day when "drugs were prepared and given without incantation and this was the moment when magic and medicine separated, when physicians and magician-priest became different individuals." (13, page 280  Yet the priest of the ancient world, whether using magic words or herbal remedies, would have known of the power of suggestion, and perhaps, just perhaps, never ceased to use the power of magical words, amulets, talismans and gesticulations.

So your son continues to struggle with his breathing, and you decide you need to seek help for him.  You summon a priest, and within a few hours a priest/physician is humming incantations while your son is inhaling fumes from herbs tossed on the fire. Perhaps by the doctor's appearance alone your boy is able to relax, allowing nature to heal him over time.

*Along with physicians, judges, mathematicians, astronomers, etc., were also educated at such schools. (8, page 19)

Further reading:

• 5000-50 B.C.: Asthma in Ancient Egypt: the Bible
• 5000-50 B.C.: Egyptian gods of healing
• 5000-50 B.C.: Asthma in Ancient Egypt, the Eber Papyri
• 2700 B.C.: Imhotep invents medcine
• 2700 B.C.: The Hermetic Books 
• 2700 B.C.: The birth of rational medicine
• 800 B.C.-800 A.D.: Asclepius will heal your asthma

 References:

1. Sandwich, Fleming Mant, "The medical diseases of Egypt, part I," 1905, London
2. Bradford, Thomas Lindsley, "Quiz questions on the history of medicine: form the lectures of Thomas Lindsley Bradford, M.D," 1898, Philadelphia
3. Baas, Johann Herman, author, Henry Ebenezer Sanderson, translator, "Outlines of the history of medicine and the medical profession," 1889, New York
4. Renouard, Pierce Victor, "History of Medicine: From it's origin to the 19th century," 1856, Cincinnati, Moore, Wistach, Keys and Co., page 26, chapter 1, "Medicine of the Antique Nation."
5. Garrison, Fielding Hudon, "An introduction to the history of medicine," 1922, Philadelphia and London, W.B. Saunders Company
6. Dunglison, Robley, author, Richard James Dunglison, editor,  "History of Medicine from the earliest ages to the commencement of the nineteenth century," 1872, Philadelphia, Lindsay and Blakiston
7. Hamilton, William, "The history of medicine, surgery, and anatomy, from the creation of the world to the commencement of the nineteenth century," 1831, volume I, London, Henry Colburn and Richard Bentley
8. Puschmann, Theodor, translated by Evan H. Hare, "A history of medical education from teh most remote to the most recdent times," 1891, London, H.K. Lewis
9. Puschman, Theodor, translated by Evan H. Hare, "A history of medical education from the most remote to the most recent times," 1891, London, H.K. Lewis
10. Prioreschi, Plinio, "A History of Medicine," Volume 1: Primitive and Ancient Medicine," 1991, Edwin Mellen Press, Chapter IV: Egyhptian Medicine, page 257.  Reference noted by author is as follows:  Homer, "Ocyssey, IV, 229-232, Translation by A.T. Murray.
11. Wilder, Aleander, "History of Medicine," 1901, Maine, New England eclectic Publishing
12. Osler, William, "Evolution of Modern Medicine: a series of lectures at Yale University to the Silliman Foundation in April 1913, 1921", New haven, Yale University Press
13. Sigerist, Henry E, "A History of Medicine: Primitive and Archaic Medicine," volume I, 1951, New York, Oxford University Press

1851: Dr. Salter, the famous asthma doctor

Figure 1 -- Dr. Henry Hyde Salter.

As a kid he suffered mightily from asthma, and when he grew up he made his disease the focus of his life.  He wrote a book that became the most famous asthma book of his era. His name was Dr. Henry Hyde Salter, the famous asthma doctor.

He was born on November 2, 1823. Within only a few weeks of his birth he suffered a bout of whooping cough that ultimately lead him to a lifetime of suffering from asthma. (1)

His dad was a prominent surgeon.  His grandpa, uncle and several members of his family were also physicians.  So it wasn't surprising that, after graduating from the University of London, he entered King's college to study medicine. (1)

He earned his medical degree in 1851 and soon opened a medical practice.  It probably didn't take him long to realize he had a special sort of empathy towards his asthmatic patients, particularly asthmatic children.

From a photograph of an asthmatic, whose disease

dated from whooping-cough at three months old.

(One might wonder if this is a photo of a young

Dr. Salter.) (6, page 115)

In 1851 he became assistant physician at King's College Charing Cross Hospital, and in 1852 he became assistant physician to Robert Bentley Todd (1816-92) in New York.  He sat in on Todd's lectures and took copious notes "almost verbatim," which were published in the Medical Gazette and ultimately this "added much to Dr. Todd's reputation. (1)

Likewise, in 1851, he became assistant-editor of the "Encyclopedia of Anatomy and Physiology."  He wrote articles on the tongue and pancreas, and he read and edited the entire collection.  (1)

In 1854 he returned to King's College where he lectured in physiology, physiological anatomy and medicine for the next 12 years.  His efforts as a writer, lecturer and physician earned him a spot as the youngest member of the Royal College of Chest Physicians in 1856 at the age of 33.  He gave a lecture to this group on dyspnea in 1866. (1)

Yet it was asthma that was his "special interest" in many of his research and study projects. (2) He gave many lectures, most about diseases of the thorax -- and asthma.  (5)

Dr. Salter's special interest in asthma gave him a unique inside take on what it was like to have asthma. This, coupled with his exemplary skill at writing, made him the ideal person to write on the subject.

In his book he provided some of the best and most vivid descriptions of asthma up to that time, as shown here:

"But not only is asthma not an uncommon disease, but it is one of the direst suffering; the horrors of the asthmatic paraxysm far exceed any acute bodily pain; the sense of impending suffocation, the agonizing struggle for the breath of life, are so terrible, that they cannot even be whitnessed without sharing in the sufferers distress." (6, page 17)

His description of the suffering was likewise vivid.  He wrote:

 "With a face expressive of the intensist anxiety, unable to move, speak, the head thrown back between elevated shoulders, the muscles of respiration rigid and tightened like cords, and tugging and straining for every breath that is drawn, the surface pallid or livid, cold and sweating -- such are the signs by which this dreadful suffering manifests itself." (6, page 18) 

As well as was his overall description of the asthma paroxysm.  He wrote:

But the dyspnoea of asthma tells a plainer tale than this; it tells us not only what it is not, but what it is. It gives the most positive evidence of narrowing of the air-passages. The asthmatic's breathing is what our forefathers called "strait," what we call " tight;" he feels as if a weight were on his sternum, as if his chest were compressed, as if a cord bound him, as if it would be the greatest relief to him if some one would cut his breast open and allow it to expand; he rushes to the window to get air, he cannot tolerate people or curtains about him, his clothes are loosened, and all the muscles of respiration tug and strain their utmost to fill his chest. But he can neither get air in nor out, he can neither inspire nor expire—his respiration is almost at a dead lock; he cannot blow his nose, ean hardly cough or sneeze, cannot smoke a pipe, and if his fire is failing, cannot blow it up; he has hardly air enough to produce the laryngeal vibrations of speech. (6, pages 37-38)

He even went as far to describe what life was like for an asthmatic between attacks.  He wrote:

"And even in the intervals of health, the asthmatics sufferings do not cease; he seems well, he goes about like his fellows and among them, but he knows he is altogether different; he bears about his disease within him wherever he goes; he knows he is struck... he is conscious that he is not sound... he only knows that a certain percentage of his future life must be dedicated to suffering; he cannot make engagements except with a proviso; and from many of the occupations of life he is cut off; the recreations, the enjoyments, the indulgences of others he dare not take; his usefulness is crippled, his life is marred; and if he knows anything of the nature of is complaint, he knows that his suffering may terminatein a closing scene worse only than the present." (4, page 17, 18)

Any person who ever suffered from an attack of asthma, or ever witnessed one, could easily relate to what Salter described.  It was such exemplary asthma prose that proved to his readers that he knew what he was writing about.  It was such that made him to be the famous asthma doctor.

After years spent suffering, and years spent studying his patients, and performing interviews and autopsies, he put his best asthma knowledge together during the 1950s in a series of articles that were published in medical journals throughout the decade.  Each article was ultimately turned into a chapter in his 1864 book "On Asthma:  It's Pathology and Treatment."

During the last four years of his life his asthma took a turn for the worse.  During the night he'd spend time leaning against the bed post with his shouders hunched while smoking datura leaves. During the day he ate lightly, and continued to work as a physician and to give lectures.

In 1871 he became thinner and weaker and was diagnosed with typphoid fever.  Yet ultimately it was discovered he developed a lung abcess and passed away on August 30, 1871, at the young age of 48.

Dr. Salter's book is referenced in nearly every article, every chapter, and every book on asthma for the rest of the decade.  Even the great Dr. William Henry Osler referenced Dr. Salter when he wrote his textbook for medical students.

Further reading:

• 1864:  Dr. Salter offers proof asthma is nervous
• 1864: Dr. Salter proves nervous theory of asthma (1/5/16)
• 1864: Dr. Salter disproves ancient asthma theories (12/30/14)
• 1864: Dr. Salter's Asthma Features (2/14/14)
• 1864: Dr. Salter's Varieties of Asthma (2/20/14)
• 1864  Dr. Salter's asthma triggers (2/27/14)
• 1864: Dr. Salter's asthma signs and symptoms (3/6/14)
• 1864: Dr. Salter's Consequences of asthma (3/13/14)
• 1864: Dr. Salter's Asthma Remedies (3/27/14)
• 1864: Dr. Salter's prognosis for asthmatics (4/10/14)

Click here for more asthma history.

References:

1. "The Late Henry Hyde Salter," Medical Times and Gazette, Sept. 13, 1871. 
2. McCulough, David, "Mornings on Horseback," 1981, New York
3. Sakula, Alex, "Henry Hyde Salter (1823-71) a biographical sketch," Thorax, 1985; 40; pages 887-888.
4. Salter, Henry Hyde, "On Asthma:  Its Pathology and Treatment," 1861, London, Philadelphia
5. Kidd, G.H. Dr., "On the pathology of Asthma," Dublin Quarterly Journal of Med. Science," 1861, May,
6. Salter, Henry Hyde, "Asthma: It's Pathology and Treatment," 1864, Philadelphia, Blanchard and Lea

1850: Asthma as a disease of the mind -- rewrote

So asthma is all in your head.  Any exposure to strong smells, dust, and anxious situations causes you to miss time with the guys.  It forces you to spend more time with your mother.  You are thus dubbed to have a nervous disorder.

While the idea was mentioned by ancient asthma experts, it was once again brought to the attention of the medical community in 1850 by a famous British doctor by the name of Dr. Robert Bentley Todd.  He wrote an article for the Medical Gazette in December of 1850, as described by Dr. Henry Hyde Salter in his book, "On Asthma." (1)

Salter explains how Todd really wasn't the first to come of with the idea of nervous asthma, yet he was the first to take the idea seriously, and kind of got the ball rolling that, yes indeed, asthma was a psychosomatic disorder.

In his article, Dr. Todd wrote that asthma is caused by a "poisoning" of the nervous system as it pertains to the respiratory system. The offending "poison," or "peccant matter, was referred to by Todd as  the materies morbi. The result is a "spurious and morbid sense of want of breath," writes Salter about Todd's theory.  "This breathlessness is the first step in the morbid phenomena. That it may have no real objective cause in the lungs themselves; that bronchospasm is a accompaniment not a cause, of the dyspnea of asthma; and that you may have asthma without any bronchial contraction whatever." (1)

Todd describes that the signs of asthma (particularly bronchospasm and the resulting dyspnea) are not what asthma is, but merely a symptom of asthma. Asthma is the poisoning of the nervous system.

The idea here is that even if you are not having an exacerbation of asthma, you still have asthma. Todd describes that asthma is a permanent condition of the mind. It is always there, yet it only shows itself some of the time.

In this way asthma is not unlike other conditions that "irritate" the nervous system to cause prominent symptoms, such as:

• Gout (Sudden joint pain that eventually goes away)
• Epilepsy (Seizure that eventually goes away)
• Asthma (Shortness of breath that eventually goes away)

Dr. Salter disagreed with Dr. Todd in Todd's assumption that asthma could occur without bronchospasm.  Salter believed simply the fact you can hear wheezes is a sign that bronchospasm occurs, because when you narrow pipes it makes a similar noice. (Salter, page 19)

Yet Salter agreed with Dr. Todd in his assertion that asthma is nervous.  Salter later went on to prove, or attempt to prove, why he suspected as much.

The following is Salter's evidence that asthma was nervous in origin:

• Fatigue and mental emotion bring about an attack
• Remedies that appeal to the nervous system allay an attack, such as stramonium, antimony and chloriform.  
• The periodicity of asthma.  It goes away and comes back without warning by recurrence of hay fever, indigestion after dinner, expectoration after a good nights sleep, etc.  
• Symptoms of asthma, such as clear urine (nervous urine), nervous headache, drowsiness, and  an attack after laughter or animation.  These are similar to hysteria and epilepsy.
• No organic change in the lungs during or following an attack.  Post mortem exam of asthmatics shows no organic changes, or damage, to the lungs.  They are essentially normal.
• Asthma is muscular in that it is caused by muscular fibre that spasm and squeeze the air passages of the lungs.  Muscular disorders like this are always nervous as the nerves are connected with the mind (2)

Salter's writings on asthma originally appeared in magzines, and was so well received he was encouraged to publish his works in a book.  He did such a good job by his writings that his ideas about the causes of asthma were well respected by the medical community.  

His evidence that asthma was nervous continued to hold sway in the medical community until it was scientifically disproved in the 1950s.  Yet it was 30 years after it was disproved -- like in teh 1980s -- that asthma experts finally gave up the idea that asthma was nervous

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Further reading:

• Click here for more asthma history.
• Good article about asthma as a psychosomatic disorder

References:

• Salter, Henry Hyde, "On Asthma: It's Pathology and Treatment," 1882, London, pages 8-
• Salter, ibid, pages 13-16

1600s: Asthma could get you absolved from crimes

How would you like it if someone said to you:  "You're asthma is all in your head?"  If you're like me you wouldn't take it too well.  On the other hand, if having asthma could get you off the hook for a crime you committed, perhaps you'd think differently.

Asthma experts in the ancient world realized early on that life was different for those inflicted with asthma or allergies.  Consider the following:

• A boy rides a horse and has an asthma attack
• A boy wrestling in dry dirt has an asthma attack
• A boy is learning to dig trenches and has an asthma attack
• A boy learning to ride a chariot has an asthma attack

Obviously the boy will not be fit for battle.  This boy will be forced to stay at home with his mother instead of hanging out with the men.  He will be deemed as feminine by his peers, an outcast, mentally deranged, weak, and useless.  

Boys like this became the subject of some of the world's greatest minds.  Hippocrates, Galen,  Ballonius*, Felix Platerus**, and Avicenna*** all mentioned a relationship between asthma and the nerves of the brain.  (2)

It was clearly evident that asthma was a mental disorder.  And this surely didn't help the poor asthmatic boy who just wanted to fit in; who just wanted to be one of the guys.  

Asthma was clearly a nervous disorder:

Around 400 B.C. Hippocrates, or at least one of the Hippocratic writers, wrote a convincing text that linked asthma with an increase in the humor phlegm.  This caused a disorder of the mind that resulted in asthma, or gasping breaths.  

In the Greco-Roman era asthma was linked with the nerves of the mind.  In his 1933 report in the Proceedings of the Royal Society of Medicine, "The History of Bronchial Asthma and Allergy," Stoikland described how Galen mentioned in his experiments on monkeys that "cutting of the medulla spinalis, the respiration and the voice are affected.  Ballonius, speaking about a patient with renal calculus and dyspnoea, says that there is a 'nervulus' (small nerve) from the sixth pair which penetrates the diaphragm and goes to the kidneys and this may also cause dyspnoea." (2)

You must consider here that during this time asthma was not defined as we know it today.  Back then asthma was any disease other than pneumonia and tuberculosis that caused dyspnea. Asthma was a complicated disease that was poorly understood.  Those who studied it were prone to speculate as to it's cause, effect and treatment.  

Maimonides (1138-1204) may have been the first to define psychosomatic medicine (the mind causes diseases) when he wrote how a patient who is "mentally agitated" caused his physical well-being to suffer and eventually he becomes physically ill. 

Maimonaides also explained that "gaiety and joy gladden the heart, and stimulate the blood and mental activity.  Excessive indulgence in the pursuit of pleasure, however, is injurious to one's health.  The avoidance of illness induced by such excesses is by conducting oneself according to ethical and moral principles."

Felix platerus (1536-1614) was among the first to advocate the treatment of mental patients. He believed that "an obstruction in the small pulmonary arteries is the cause of asthma.  But he mentions also that the bigger nerves from the dorsal medulla, when disturbed by defluxions, occassion dyspnoea, e.g., in asthmatics.  He observed the attack when nothing abnormal in the lungs could be found."

Jean Baptiste van Helmont (1577-1644) and Thomas Willis (1621-1675) are believed by many asthma historians to be the first to write about asthma specifically as a nervous disorder. While others obviously noted the link, Willis is most often given credit for starting physicians thinking along the notion that asthma was nervous -- he launched the idea in the minds of asthma experts seriously attempting to define this disease.

Willis described asthma in this way (2): 

"Whatsoever makes the blood to boil or raises it to an effervescence, as violent motion of the body, or mind, the drinking of wine, venery, excess of external cold or heat..., any great change of the air or of the year, slightest errors, a thousand other occasions, doth cause asthmatical assault to such as are predisposed.... This kind of dyspnoea, merely convulsive, is excited by reason of the pneumnonoc nerves... It is not to be doubted that the fits of asthma wholly depend on convulsive matter being fallen into the nerves, serving to the stretching forth of the lungs.... Soon the asthmatic attack is finished, no signs of abnormal disposition of the lungs can be found.  Severe attacks of asthma may occur without any notable fault of the lungs."

Van Helmont described many examples that prove psychotic factors can lead to asthma.  He wrote about women who had attacks of the asthma as a result of exposure to flowers.  He describe one situation where a man was pressured to speak and he refused.  The man was so stressed that he had an asthmatic attack and died.  This was all attributable to psychotic or nervous asthma.(2)

John Floyer (1649-1734) likewise followed the ideas of van Helmont and Willis.  William Cullen (1710-90) believed asthma was a disease of airway constriction of the muscular fibres that wrap around the lungs and also that it was triggered by psychological factors.  Irritation of the mind by certain odors, smoke, and dust trigger the asthmatic response. 
So there was plenty of evidence to link asthma with the mind.  Yet it truly wasn't until the 17th century A.D. (the 1600s) that asthmatics caught a break. They still may have been mocked by society, but at least something went their way.

A big break for asthmatics:

Paulo Zacchia (1584-1659) was a Roman physician and a personal physician to the Pope Innocent X and Alexander VII  (3).  He published "Quaestiones Medicolegales" in 1621.  It was published as 11 volumes between 1621 and 1661 and "was considered an important landmark in the history of forensic medicine." (1)  It was mainly a book with legal information about wounds and "jurisprudence about insanity."  (3) 

The book displayed an up to date medical advice to be used in legal cases that considered the latest wisdom of science, which included knowledge that there was a difference between adult and fetal lungs, and acknowledged wisdom about the circulation of the blood.  This was a first of its kind legal journal that provided legal advice at a time when science was in its infancy

Paul Ammann's (1634-91) was a man of "acute mind and extensive learning, but a restless and irritable disposition led him to engage too much in controversy."  For instance, in a time where the writings of Hippocrates and Galen were worshiped by the medical community he "boldly" attacked the systems of medicine they created. (4)

Amman's book "Medicina Critica" was published in 1670 and was a compilation of medico-legal cases decided by the medical facility of Leipzig.  (1) These men were provided with the evidence that asthma was a nervous condition (some of which you read above) and perhaps had to defend asthmatic criminals in a court of Roman law.

Zacchia and Amman both believed that "as fear can provoke asthma, the asthmatics were absolved from criminal inquiry,"  according to E. Stolkind in his article "  In this way, it was common for asthmatics to be kept out of stressful, and dirty prisons as this might provoke an attack that might provoke a lawsuit. 

As we continue on in our quest to learn about the history of asthma you will find many references of asthma as a nervous disorder.  We'll pick this theme back up as we travel to the 19th century and meet Dr. Todd an Dr. Salter.

Click here for more asthma history.

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*Ballonius is a Parisian physician who lived 1538-1616 and is credited for coming up with the term rheumatism to explain vague pains in the external parts (5). To learn more about Hippocrates and Galen click on the links above. ** Felix Platerus was one of the first ot advocate the treatment of mental patients. (2, page 30)  *** Avicenna was a Muslim physician and philosopher who lived 980 A.D. 1034.  He wrote 150 treaties on philosophy and about 40 on medicine.  His most famous book was The Book of Healing which was a standard medical text for hundreds of years.

References:

1. Clark, Michael, Catherine Crawford, "Legal Medicine in History," 1994, page 105
2. Stolkind, E., "The History of Bronchial Asthma and Allergy",  (Proceedings of the Royal Society of Medicine, 1933, Vol. 26, part 2, page 1120; 36
3. Fielding, Hudson Garrison, "An introduction to the history of medicine," 1922, London, page 272
4. "Amman Paul," Encyclopedia Britannica of a dictonary or arts, science, and miscellaneous literature," 1842, 7th ed., vol. 2, part 2, page 657
5. The Massachusettes Medical Society, New Englang Surgical Society, Boston Medical and Surgical Journal, "Rheumatisms and Pseudo Rheumatisms," Vol. CXIII, 185, July-Dec., page 38

1810: Bree's Symptoms of Asthma

The following are the symptoms of asthma as described by Robert Bree in his book "A Practical Inquiry into Disordered Respiration Distinguishing the Species of Convulsive Asthma, their Causes and Indication for a Cure."  It was written in 1810. 

Note:  You must understand that Bree's undestanding of asthma was very puerile compared to our modern definition.  Much of his descriptions and theories on asthma are based on observation and personal experience with the disease as opposed to scientific facts.  However, some facts were available at this time and he used this information to support his opinions.  This was not uncommon for his day and age. 

Anxiety:  Owing to the difficulty attending the efforts of nature to removing an irritating offense.

Itching of the skin of breast and neck:  This sometimes precedes the violence of the fit and declines as agony of the fit decreases. This may be an effect of sympathy with the lungs and first passages. Irritating matter in the stomach is the probable cause of this symptoms.  Another cause may be the difficulty to which venous blood is returned to the heart

Perception of heat:  You feel like you have a fever, but you don't. 

Great desire of cool air:  Probably occassioned by a desire for oxygen, as you feel the means of obtaining it is increased by fresh air.

Closeness:  Areteaus wrote:  "The patient loves walking in the open air, with his mouth open, and is dissatisfied with the largest house, which seems to small to breathe in."

Dyspepsia:  (Upset stomach)  Always precedes periodic asthma.  This causes flatulence of the stomach and bowels and pain over the head and eyes and sleepiness.

The attack of the paraxysm in the night:  By concentrating, and by sacrificing sleep by staining up late and sitting in a recliner instead of the bed, this can often be avoided. 

Diabetes:  By this I think he's referring to the need to pee a lot during an asthma attack. He says this is common, although it provides little relief to the asthmatic.  He gives a few reasons, none of which make any sense.  Such as in the case of hysteric asthma, he says the kidneys may be relaxed due to sudden passions of the mind.  He says the kidneys receive nerves from the intercostals, and there is likewise a strong association between the lungs, kidneys, and stomach.  May also be linked to edema, swelling of the ankles and legs.

The straightness of the breast:  He supposes that this makes it easier for the exchange of air when the air sacs are filled with secretions, which is often the case in asthma.  The rest of his several paragraphs describing this are simply meaningless poppycock.

Intermitting pulse:  John Floyer attriutes this to constriction of the arteries, by circumvolving nerves, may more probably proceed from this condition of the heart.  It may also be cauesd by dyspepsia because of the strong relationship between the stomach and the heart. 

Spitting of black mucus:  He believes the coloring agent in the sputum to be carbon in the blood, which in the healthy person was exhaled

The pulse is generally feeble: 

Urine is pale and copious: 

Sleepiness: 

Belly seldom regular:  Constiation may alternate with diarrhea, and may be attributed to dyspepsia (upset stomach). There is remarkable action of the abdominal muscles and all the muscles  used to discharge faeces.  And he flatters himself that evacuation of such will provide breathing relief.

The habit of the asthmatic is generally cold:  The temperature will be lower than normal. 

The mind is impatient:  Not only does Bree write this as a symptom, he adds, "...and he suffers much from opposition to his method of management in his own case."  After several episodes of asthma he learns methods of comforting and satisfying himself, but help from others is often received with anxiety.  He becomes irritable during the fits, "and, with difficulty refrains his disposition to petulence." 

Generosity:  Bree notes the following interesting fact:  "It may be observed generally as a fact, that the mind of an asthmatics is more susceptible of generous and grateful feelings than that of any other invalid, subject to a chronical disease equally obstinate."  Emphasis added by me. 

Respirations more numerous during asthma attack:  They never exceed 30 without a considerable increase in pulse.  Bree recognized this is in general opposition to Floyer

References:

• Bree, Robert, "A Practical Inquiry into Disordered Respiration Distinguishing the Species of Convulsive Asthma, their Causes and Indication for a Cure," 1810, London, pages 117-140, Section IX