x1960-1990: The asthma institution

By the 1960s the two asthma institutions in Denver that were opened to take care of tuberculosis patients were now mainly taking care of asthma patients, according to NationalJewishHealth.org.  And "by this time TB patients comprised only half of the patient population and asthma patients a third." (5)

It was in this decade that National Jewish Hospital opened a facility specifically for the increasing population of asthmatics with high risk asthma that was non responding to conventional therapy.  It was in 1969 that a fee for service based on a patients ability to pay was begun.

By 1976 Asthma was recognized as the most prominent chronic disease among children, affecting 1.5 million children in the United States, and this included myself.  It produced a lot of suffering for those afflicted, and it also accounted for about one-forth of all school days lost. (4, page 164)

It is a debilitating disease not only for the child who is suffering, but for parents who don't understand the disease, and fear their child might die.  Yet perhaps even worse than that for the parent is the helpless feeling that there's nothing you can do, and what you do do doesn't help. Probably because most of what they did back to was based on fallacies of the past, such as putting asthmatics in a steam filled bathroom hoping that would relieve an attack.

Yet for the child the suffering is even worse yet, and here I can allude to my own experience.  Many nights I would stay up late, many times all night long, my wrists firmly pressed on the window sill, by face up against the cold screen with the intend on sucking in cool air and oxygen.  Many nights I suffered in this way from an asthma attack.

When I was little I sat up on the bed, all frogged up, gasping for air.  I did this probably because I didn't know there was anything not normal about it.  When I was older I'd push open the window in secrecy in the middle of the night because I didn't want to bother my busy parents.  Another reason I suffered in secrecy like this was because I didn't want my parents to worry about me.

Another reason may have been because of a poor self esteem exacerbated by parents who disciplined me because I underachieved, even when I was probably underachieving because of my asthma.  Another reason for my low self esteem was because kids picked on me at school because I acted different from the "normal" kids.  I had a runny nose and they didn't.  I wasn't able to play baseball on teh dusty baseball diamond.  So they picked on me.  The same way my brothers sometimes picked on me when I didn't play baseball with them.  I was basically fodder for the other kids. 

Now as I look back on all this I think I'm sometimes just saying this kind of stuff to justify why I was picked on as a kid, but based on my own medical records my counselors, my psychologist, and my medical physicians all believed this.  Asthma had taken a physical and psychological toll on me.  And to make matters worse my teachers and parents had no clue this was going on, and the end result was a shot self esteem and shot level of self confidence.

And then I had mood changes. And many children have mood changes, so my parents and physicians probably figured I was just one of those intractable children. I became stubborn sometimes at home, and I was emotionally distraught.  I remember being extremely depressed to the point my parents once grounded me from watching the news.  I remember pacing the living room for hours worrying about the death of a relative, or that I was going to get old and die.  Of course my parents and doctors had no clue I was depressed, or at least at the time they didn't associate it with the fact my asthma was poorly controlled. More recently my mom acknowledged to me she was aware of it, but I don't remember her ever doing anything to help me.

So, again, I can understand the theory that asthma was believed to be psychological.  Plus when a child is admitted to one of these hospitals the environment is controlled.  By the 1970s and 1980s air conditioning was added to both the children's ward and the gymnasiums where children exercised.  There was a focus on a good diet, and we were exercising all the time. Stuffed animals and items that collected dust were not allowed.  Clothing was washed regularly so it was allergen free, and furniture was made of leather or other solid material that was easy to wash and didn't harbor allergens. 

By the 1970s there were two prominent asthma hospitals in Denver, one was National Asthma Center and the other was National Jewish Hospital at Denver.  By 1978 National Asthma Center admitted financial trouble, these two great hospitals merged to create National Jewish Hospital/ National Asthma Center.  The main campus was on Colfax Avenue, or the National Jewish Hospital campus.  The merger resulted in the "largest treatment center for pediatric and adult asthma," according to NationalJewishHealth.org.(5)

Once admitted the children would under go an examination by a physician, and then spend the next several days undergoing a variety of tests.  I remember doing many pulmonary function tests, x-rays, electrocardiograms, sweat test (to rule out cystic fibrosis), and so many other tests I can't even recall all of them.  I just remember being exhausted by the end of it.

I met with a counselor on day one, and I think the main reason for my counselor was to help me deal with the day to day life at my new home, and also to help me learn to cope with life once I return home.  I saw my counselor once or twice a week, and once every two weeks I saw a psychologist.  I only saw a psychiatrist once that I remember, and he prescribed Xanax to help me relax. He actually prescribed an antidepressent before that, but I had an allergic reaction that gave me hives all over my body, so he must have decicded just to stick with xanax.  It seemed to work pretty well (I'll tell you the story about that later). 

So I was admitted to the hospital in 1985, this was long after the psychosomatic theory of asthma had been proven to not be true.  But I'm certain the doctors trained to work there, and the psychologist, were still privy to these old theories.  I'm certain, especially after reading my medical records, that they believed much of my asthma was in my head.  They noted the anxiety.  They noted trouble when my mom visited, and how my asthma was exacerbated during these times.
Travis quotes one physician as saying that "once asthma has been established, acute attacks may be triggered by emotions.  There is a psychological basis for some emotionally precipitated attacks, particularly when the emotional upset is accompanied by shouting, crying and rapid breathing... it becomes impossible after a time to separate problems which are precipitating asthmatic attacks from those that are secondary to the asthma.  The secondary gain can be a significant problem."  (4, page 169)

This appears to be my proof that asthma was no longer believed to be psychological by the time I was admitted in 1985, although psychological factors can still trigger asthma. Most of the asthmatics admitted by this time were on systemic corticosteroids, and the fear of side effects was paramount.  Although, through the efforts of physicians at the hospital, I believe most patients went home on preventative asthma medicines, with controlled asthma, and off systemic steroids.  At least that was the case with me and the children I was admitted with.

It also must be noted that, even back in the 1940s I'm sure, occupational therapy was a major therapy given to asthmatic children admitted to the hospital.  Children with intractible asthma, and I can attest to this, do not develop many of the skills other kids do to cope with life.  This is the same for kids with other intractible diseases too.  They don't develop skills that most people take for granted, such as balancing a check book or searching for an apartment.  These types of basic skills that are worked on at the hospital, if the need is there.

And, again, there was a major focus on education and exercise.  These two were almost ingrained together at the asthma hospital.  You need to understand your disease and every part of it, and you needed to exercise.  Many times exercise was education, and education was exercise.  You need to know your medicine, and you need to be compliant with your medicine. And you need to now why you are exercising, and how it will make you better.

You need to know what aerobic exercise is, and if your legs weren't being kicked high enough in the air, you will be told this.  And unless you have a good excuse, like  your asthma was really acting up, you did as you were told.  And for the most part you did it because you wanted to, because you were just happy you were able to exercise at all, because most of use weren't able to prior to being admitted.

You will leave National Jewish educated, and if your physicians don't think you have a good grasp on your education, you will probably not be cleared for discharge.You need to take complete responsibility for your medicine, so that even if your parents back home aren't involved in your care, you know exactly what to do at all times.  You need to know why you are taking your medicines and why it's so important to take them every day. And you need to exercise. 

You need to plan ahead on the first day of the week, and plan out what pills you will be taking and on what day and on what times during what day.  You need to plan before every trip out of your house to make sure you take your medicine before hand, and that you have all the medicine you will need on the trip, such as your rescue inhaler.  You cannot just take for granted someone else, even your parents, will remember your medicine when you leave the house.  It is solely your responsiblity. 

You will have to also know when to take your rescue medicine, and when to wait.  You will also have to know your asthma triggers and how to avoid them.  You will also have to know what your symptoms of asthma are and what to do about them.  You have to know it all, and you have to be completely responsible for your own health.  That is essential, and it is engrained in your head over and over and over and over and over again until you are discharged.

And also you had to exercise every day.  The school I attended, the Kunsburg School, had a pool, and we swam two days a week during school.  And when we weren't swimming we had gym class.  Every evening after dinner we went to the gym in the school to do some form of aerobic activity.  We stretched, and then we moved for 20 minutes.  That was mandatory.  We did kickball.  We did basketball.  We did baseball.  We did dodge ball.  And if you weren't moving, you were pestered by the PE instructor until you did just that.

When you were first admitted you had a complete physical, followed by a series of tests.  Your asthma was stabilited one way or another, and then you were cleared within  You were then required to exercise, and you were required to attend school.

And then, during the evenings, and on the weekends, you had fun just like normal kids do. You go on field trips. You go to the mall shopping and you go to movie theaters to watch the best movies.  And you go to amusement parks, camping, and all sorts of fun things.  Sometimes you go to video stores and rend movies to watch at home.  You have parties with the other kids.  You have dances.  You have icecream socials.  You have dance and singing competitions.  You played games with the nurses and other kids. 

In the winter there was a basketball team, and either you joined the team or you traveled with the team and you watched the team.  And in the spring there was a baseball team, and either you played or you watched.  And it was much more enjoyable to play than watch.  And you traveled to other institutions in the area, including those housing other sick kids, or otherwise sheltered kids.  The goal is to make the hospital as much like home as possible.  And, for the most part, they succeeded at this.  It was a really fun experience.  And all along you learned. Everything was a learning experience.

At one point during my stay I wrote in my journal:  "The only thing that makes this place seem like a hospital is the nurses wear stethoscopes over their shoulders."  For the most part that was true.  Although you were still thousands of miles away from your home, away from your parens, and you were chronically sick.  So most of the kids got homesick, and that was another issues the staff there had to deal with.  And, I'd assume, another reason for all the activities. 

In 1985, while I was a patient at NJH/NAC, the name was changed to National Jewish Center for Immunology & Respiratory Medicine.  In 1995 the inpatient floors at the hospital were closed and a new pediatric outpatient program was added, and in 1997 the name was chanced again to

References:

1. Minton, Gregg, "Breathing Space,"
2. Wamboldt, Fredrick S. "Asthma Theory and Practice: It's Not Too Simple," April 2, 2008,
3. Jackson, Mark, "Asthma: A Biography,"
4. Travis, George, "Chronic Illness in Children," 1976, California, Ford University Press
5. "Clinical History," NationalJewishHealth.org, http://www.nationaljewish.org/about/whynjh/history/clinical/clinical-history3/, accessed 11/7/12

570-1070: Arabs save medicine

As we study medicine it's essential to understand that one author, one physician, one scientists, cannot make accomplishments in medicine without the accumulated knowledge of all who came before him.  Lacking such wisdom, no progress in medicine can be made.  Stated another way, it would be impossible to hunt for cures without having prior knowledge of such cures.  

Lacking access to knowledge, every person must start from scratch, and by the time he passes away he'd  learn no more than the men before him.  Thanks to writings, and schools, one man can be taught all ancient wisdom in a few years.  Instead of spending a lifetime relearning old wisdom, he can now study something new.  He can think of, invent and discover new things.  

When the last rung of the Roman Empire collapsed in 476 A.D., the west cast aside all such accumulated wisdom in favor of the Bible.  This, perhaps with the help of the Black plague, helped send western civilization -- mainly Eastern Europe -- back to a primitive era where the only medicine was religion.  All other knowledge, including medical knowledge, was the antithesis of the road to heaven.

During the same time western civilization was turning a blind eye to wisdom, Islamic nations were becoming united by Islamism under the name of Muhammad.  By their new religion the Arabs, Muslims, ultimately gained control of Egypt, Syria, Persia, Northern Africa, Islands of Sicily, Rhodes, and Crete. They even gained control of Spain in 720.  (1, page 122)

Similar to Christians, Arabic civilization believed the Koran contained all necessary wisdom, with all other knowledge being "superfluous," proven by the destruction of Alexandrian libraries and schools during the Egyptian conquest. Yet it is believed that the people of this Arabic civilization, even though they had a newly created language, were so poorly educated they couldn't even read their own Koran. (1, page 122, 125)

This changed during the life of Mohamet, of whom, "according to Islam, was the last messenger of Allah."  He lived from 570-632, according to dictionary.com.  Mohamet wanted to inspire his people to read, and so he told his people he obtained his wisdom after inspiration from heaven.  It was this encouragement that inspired the education of the Arabic civilization.  (1, page 124-125)

Mohamet told the story of how Gabriel came down from Heaven and said to him: (1, page 124)

Read -- added the angel -- in the name of God, the Creator.
He formed man by uniting the two sexes.
Read in the name of the adorable God.
He taught man the use of the pen.
He filled the soul with the light of science. (1, page 124)

So by the time Spain was conquered by the Arabs, learning was encouraged by Arabic leaders.  Ancient writings preserved in Egypt and Spain were transcribed to Arabic and studied by anyone eager to learn. 

Among the people driven from Rome in the 5th century were the Nestorians.  They were the followers of Nestorius (386-450) who was chosen to be Patriarch (Archbishop) of Constantinople by Emperor Theodosius II (401-450). He was consecrated in 428 and almost immediately started to make an impression.  In 430 he was condemned for heresy by a majority of his fellow bishops.  The condemnation was ratified by Theodosius and confirmed by Pope Sixtus III (died 440).  He retired to private life, although in 435 he was banished to the Oasis of Upper Egypt.  (3)(6, page 51)

His followers were allowed refuge in Persia. They established a school at Edessa in Mesopotamia, which was, according to historian Thomas Bradford, the "Athens of Syria.  It became the home of many scholars.  Many Greek and Latin works were translated into Syriac... Here on the Euphrates learning once more found a home.  A college and several schools were established." (6, page 51)

Bradford said the "Nestorians were given free exercise of their religion, and they were entrusted with the education of the children of the great Mohammedan families.  He said:

The Nestorians were the depositories of the old Greek medical knowledge. They revered the old names, and collected with great assiduity all the works on medical topics of all the former schools. Pupils hastened to their schools from all directions, and they were able to study practical medicine in a public hospital, probably the first institution of the kind... And this was the commencement of the great school of the future at Bagdhad. (2, page 51)

Speaking of Baghdad, another person who helped advance medicine in Persia was Almanzor (938-1002).  Bradford said Almanzor was responsible for the establishment of Baghdad and the establishment of the first Baghdad college.  He said: (2, page 57)

All the scholars rejoiced, and dreamed of a new Alexandria. Bagdad, the home of the caliphs, the city of the Arabian Nights, city of magnificance, and capital of the Saracens, was situated on the west bank of the Tigris river. In the old days its population was about 2,000,000. It is said that the caliph Almanzor was attacked by a dangerous disease, and sent for a physician who had been of the Nestorian school. Being restored to health by this physician, the caliph learned the value of the healing art, and became a patron of knowledge. Almanzor now made his new and beautiful city the home of the arts and sciences. He invited all the philosophers to visit him, no matter of what religion. It was not long before the cultivators of mathematics, astronomy, medicine and general literature abounded at the court of Almanzor. A medical college was established; there were public hospitals and laboratories for the benefit of students. So great was the culture of the medical faculty that power was given to it to examine all persons who intended to devote themselves to the study of medicine. So great was the number of professors and students who flocked to that centre of learning that at one time it contained six thousand professors and students. Almanzor enriched his new city with a great number of works on medicine, astronomy and philosophy, which he caused to be translated from the Greek. He had the works of Aristotle, Galen and Ptolemy translated, and these labors were continued by his successors.  (2, page 57-58)

Learned scholars banished from Europe in the 6th century were allowed to take refuge in Persia.  They were allowed to continue their studies and even set up schools where they became teachers.  When Arabs conquered Persia in the 7th century, ancient writings were transcribed and taught to Arabic scholars, who absorbed the wisdom eagerly, paying special attention to the works of Aristotle and Galen. To facilitate teaching they even set up hospitals.  (1, page 123)

The importance of education was appreciated so much that a school of medicine was set up in Baghdad.  "So Great was the estimation in which their learning and skill were held, that, notwithstanding the intolerant spirit of Mohammedans, they were permitted the free excess of their religion, and were entrusted with the classical instruction of those of the Moslemin whose education was most cared for.  Aristotle, Pliney, Theophrastus, Dioscorides, Galen, and other element authors (were translated to Syriac, Hebrew and Arabic)." (1, page 124)

Before this time the medical profession was open to all who chose to participate in it.  The Arabs passed laws requiring a diploma from a medical school.  Greek and Roman physicians gathered their own herbs and medicinal supplies from grocers and created their own internal remedies.  The Arabs were the first to create a separate profession, the druggist, who was responsible for creating and preparing medicine. (1, page 124)

The pharmacy profession was established.  They created rules for preparing drugs, which was an advancement to the old system where each physician had his own cook book of medicinal recipes.  The first pharmacopoeia (book of drugs) was created.  (1, page 123)

The Arabs also conquered Spain, and it became the most prosperous county in the world.  "Agriculture, commerce, manufacturers, wealth and population are represented to have flourished to such a degree... that, in reading accounts left by historians, as suspicion of oriental exaggeration is often forced upon the  mind.  It is not, therefore, surprising that, in speaking of the Arabs, the Spaniards of that time are represented as saying: 'They have taken our land, but they have covered it with gold.'" (1, page 128)

While other countries in Europe were on the decline, Spain became the "literary and scientific sceptre.  Seventy libraries were opened in Cordova, The medical schools were so great people came from all over the world to be educated.  Even Christian princes in need of medical help traveled there and trusted their lives to the Arabic physicians.  (1, page 128)

With the treasures of the ancient world available to the conquerors of Persia, they were now thrust to the "head of the scientific world."  (1, page 124)  Such was the way for the next 500 years, until this prosperous Arab world came to a halt.  They were driven from Spain by Ferdinand and Isabella, and they then sunk back into the world of ignorance. (1, page 128)

So we can honestly say that we owe true thanks to the Arabs of the middle ages for saving medical wisdom.  They borrowed medical knowledge from the ancient world, improved upon it, and returned it to the western world of which it came.

Since the fall of Arabian medicine sometimes during the end of the 13th century, "Arabia has been in mental darkness and superstition,"  said historian Thomas Bradford in 1898.  While eastern civilization moved into a dark ages of medicine, western civilization moved out of theirs. (2, page 77)

References:

1. Fourgeaud, V.J, "Historical Sketches: Medicine among the Arabs: XXI, Intnroduction," Pacific medical and surgical journal, vol. 7, ed. V.J. Fourgeaud and J.F. Morse, 1864, San Francisco, Thompson and Company, pages 122-130
2. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey
3. "The Heresiarch," Catholic Encyclopedia, http://www.newadvent.org/cathen/10755a.htm, accessed 10/29/13

1950s: Asthma at national Jewish Hospital

Figure 1 -- National Jewish Hospital today.  You can see the Goodman bulding
on the right.  It was there, on the 7th floor, where I was a patient in 1985.
The boy's ward looked out in this direction.  On the 7th floor was where kids
12-18 lived, and on the 8th floor was home to younger kids.  I stayed
on 7 Goodman for 3 months, andthen I was a patient of 2-May for 3 months
(another building not seen here).  The treatment greatly helped me.

So by the 1880s about 1 in 4 residents of Denver were patients with lung diseases, and many of them were literally dying in the streets.  It was for this reason the Jewish community came together and donated money to open the doors of National Jewish Hospital for the Treatment of Consumptives.  

It was not the only such sanatorium in the area, nor was it the only one in the United States.  In fact, many had opened both in the U.S. and in Europe, and all had about equal success.  What made National Jewish stand out over time was it's effort in 1914 to open the first building outside of a university with the specific goal of researching a cure for a disease.  

It also became the first such institution to open a ward specifically to treat children with a disease in the 1920s.  So by the 1930s National Jewish had the capacity to take care of hundreds of tuberculosis patients of all ages, plus it was a leader in the attempt to find a better treatment and a possible cure.  

And partially through the efforts of this hospital, the number of people getting tuberculosis saw a steady decline beginning at the turn of the 20th century, and then a steep drop off after the discovery of an effective treatment in the 1940s and 1950s.  So while the goal of the hospital was to treat consumptives, consumptive patients were slowly disappearing.

When the hospital was opened in 1899 the president of the institution said, "that its doors may never close again until the terrible scourge is driven from the earth."  It probably appeared that was exactly what was going to happen.  The disease was never driven from the earth, although it's one that is readily controlled, for the most part, in modernized nations of the world, particularly in the United States and Europe.  

Yet there were other respiratory disease that continued to plague the west, and we must not forget that these patients were also welcome at National Jewish.  So as tuberculosis declined as a leading cause of death, and is now at the bottom of the yearly list, other disease saw a steady rise and deserved the attention of the world's leading lung experts, particularly those at National Jewish Hospital.  

Due the the rise of people smoking cigarettes following WWI the incidence of chronic bronchitis and emphysema was on the rise.  Likewise, with the modernization of the west, asthma was also on the rise.  These folks, mainly adults with COPD and children with asthma, needed a place where they could find help.  And that place was National Jewish.

During the 1940s various centers for asthma were opened in the United States, yet National Jewish was already an option for them.  Yet the 1940s saw a rise in the number of asthma patients at the hospital.  Many asthmatics were taken away from the stress of their home lives, with their parents and doctors that had little knowledge of the disease, and admitting them to these asthma and research centers.  (2, page 29)

During the 1960s various discoveries, such as the IgE antibody and cortisone, allowed for better methods of treating asthmatics.  Although cortisone worked to trmeat asthma, there were some pretty significant side effects to taking it long term.  So this brought about the corticosteroid inhaler, although the fear of side effects prevented physicians from using it as a daily preventative medicine.    This fear persisted until the 1980s when studies proved the benefits far outweighed the side effects.

When I was a child in the 1970s with asthma my physicians treated me only when I was symptomatic with rescue medicine like Alupent solution via a nebulizer or epinephrine or susphrine, both when I was admitted to the emergency room.  I have discharge papers telling me to use my inhaled corticosteroid inhaler (Vanceril) only until I felt better, and then to only use it when I was having trouble.

But this was the normal accepted means of treating asthmatics back then, so it wasn't that my doctors were not good doctors.  Yet the physicians at hospitals like National Jewish were participating in the research, and were privy to the latest techniques in treating the disease.  And it's for this reason kids like me with "high risk" asthma were being admitted for long-term treatment, control, and education to hospitals like National Asthma Center/ National Jewish Hospital.

So as the medical needs of society changed through the years, so to did the name of the hospital.  

• 1899 — National Jewish Hospital for Consumptives
• 1925 — National Jewish Hospital at Denver
• 1965 — National Jewish Hospital and Research Center
• 1978 — National Jewish Hospital / National Asthma Center
• 1985 — National Jewish Center for Immunology and Respiratory Medicine
• 1997 — National Jewish Medical and Research Center
• 2008 — National Jewish Health

I was a patient of the hospital in 1985, and was there when the name was changed.  That was also the year the address was changed from Kolfax Avenue to Jackson Street. I think the main reason for the name change at that time was to show that the hospital wasn't just for asthma and COPD patients.  

In 1990 it was proven that inhaled corticosteroids were safe for asthmatics, or at least the benefits outweighed the side effects.  It was also proven that all asthmatics have a certain degree of inflammation always in their lungs.  This proved that asthma was a chronic disease that should be treated on a daily basis to prevent symptoms, as opposed to treating only acute symptoms.  

By 1997 the children's wards that I lived in were closed mainly because asthma had run its course. Surely there still exists the disease, although back in 1985 regional doctors weren't privy to the latest asthma treatment and the physicians at National Jewish were.  

Today, however, partially thanks to the various asthma guidelines, and even while asthma rates continue to rise, asthma is much easier to control.  Part of the reason is better medicine, but another reason is the efforts of National Jewish Health physicians making an effort to better educate regional physicians.  

Today, under the name National Jewish Health, the hospital's doors are still open.  I would imagine COPD patients are still treated on the 2nd or 3rd floors of the Goodman Building as they were back in 1985.  Yet asthmatics are no longer living there. 

Floors like 7-Goodman, where I stayed for three months, and 2-May, where I stayed for 3 months, and 8 Goodman, where younger kids stayed, are now closed.  Replacing this type of long term treatment are very effective outpatient programs.  
Why did the hospital wards end?  Well, I would imagine homesickness and dealing with teenage boys was a major problem.  Yet I think another main reason was that physicians at National Jewish Health, along with other asthma experts, made a major initiative to educate regional doctors to focus on asthma control and prevention, as opposed to simply treating acute symptoms.  

Another major reason for the change was the initiative to create asthma guidelines in the late 1990s.  These guidelines are created by the worlds most prolific asthma physicians and experts.  The goal is to provide a guide for asthmatics all over the world, and the physicians treating them.  

So the need to use a hospital like National Jewish Health has greatly diminished for both the tuberculosis and asthmatic patient.  However, both those diseases are still present, asthma more so than tuberculosis. 

And, when needed, the hospital is still around, and still looking for better ways of treating, and, perhaps more important, curing these disease.  Plus, when needed, hospitals like National Jewish provide a way to help hardluck asthmatics gain better control of their disease, so that they can live life more like a normal person.  (3)

References:

1. Dobozin, Bruce S, Stuart H. Young, "Allergies: The complete Guide to Diagnosis, Treatment, and Daily Management," 2011
2. Bjorklund, Ruth, "Asthma," 2005, China, Marshall Cavendish Corporation0
3. In 2008 I interviewed the Public Relations Representative for National Jewish Health and she provided me with an interview where I obtained up to date information about the NJH children's asthma program.  

642 A.D.: Stephanus, the last Bryzantine physician

Stephanus (550-630 A.D.) is generally referred to as the last known Byzantine physician to be educated at the school of Alexandria.  He was professor of philosophy and medicine when the school was captured by Arabs in 642 A.D.  (1, page 213)

Perhaps it's because he was born in Athens that some refer to him as Stephanus of Athens.  Perhaps it was because he was educated at Alexandria, and later became a physician at the school, that some refer to him as Stephanus of Alexandria. Perhaps it was because he flourished in Byzantine during the reign of Justinian I (527-565) that he is sometimes referred to as Stephanus of Byzantine.

Despite the various names, little is known of him.  Rather, perhaps that so little is known about him has resulted in such a wide variety of names for him.

Oxfordreference.com says he was a contemporary of Justinian and that he was a Christian. He was neither a a geographer nor a historian, but a grammarian.  He was not completely uncritical, although his main task was as a compiler of the ancient writers whose works had been lost.  (8)

At some point during the reign of Heraclius (575-641) he migrated to Constantinople. (7, page 52)

He is known to have expounded on the works of Hippocrates, Aristotle and Galen, and is important to our history mainly because he expounded on the Hippocratic view regarding asthma. (2, page 82)

Garrison says that Stephanus was a "pupil of Sylvius at Paris, and a prominent publisher of medical books during the Renaissance, was persecuted and imprisoned for heresy and died in prison. (5, page 156).

I'd delve further into the life of Stephanus, although apparently he left no clues as to his life, and nothing was written by anyone who followed him.  All that we know of him is that he was the last of the Byzantine physicians and that he published books, one of which is relevant to our history: "Commentary on Hippocrates' Aphorisms."  

Jackson quotes Stephanus form this book as saying the following about asthma:

We know already what asthma is: quick and frequent breathing.  And how do we explain the asthma?  There is an inward pressure on the vertebrae at the occiput (the back portion of the skull), it presses on the esophagus, which presses on the larynx and thus narrows the air passage, so that there is quick and frequent breathing called asthma by Hippocrates.  (3, pages 26-27)(6)

Furthermore, Galen explained that the faculties of nature were those naturally occurring events in the body that result in life.  For example, the soul and nature make life, the veins and liver make blood, the blood makes nutrition, nutrition is assimilated into the organ to make growth, and adequate growth assures continued life as long as possible, or good health.

He likewise explains that diseases are caused when changes in the body, perhaps caused by a weakening of the natural faculties, results in an increase or decrease in any one of the four humors: blood, yellow bile, black bile or phlegm.  An increase in phlegm in the lungs, for example, is what he thought caused asthma.

Staphanus expounded on this, as he's quoted here by Jackson:

Middle age is characterized by an irregular temperament, and by this irregularity of temperament the natural faculties are weakened, in consequence of which various and manifold diseases  are produced in this group; in the same way autumn with its irregular temperament produces various and manifold bad humors, which naturally cause various and manifold bad humors, which naturally cause various and manifold diseases owing to the weakening of the faculties, since irregularity of any kind weakens the faculties and upsets the constitution... middle age is analogous to autumn, the prime of life to summer; and because of this analogy, just as autumn is the cause of many diseases, so there are many various diseases which middle age tends to produce. (3, page 27)(6) 

These people are prone to asthma. We have heard more than once what asthma is: heavy and very fast breathing.  The asthma is easily explained by the irregularity of the temperament. Phlegm is produced by weakening of the faculties and failure to digest the food; this phlegm flows to the pharynx, the larynx, and the trachea, thus the air is prevented from passing, and this causes asthma.  (3, page 27)(6) 

It's a shame we know so little about a man who worked so hard to save the works of Hippocrates, Aristotle and Galen.  Regardless, his works provide an essential ingredient to our history of asthma.    

References:

1. Frampton, Michael, "Embodiments of Will: Anatomical and Physiological Theories of Voluntary Animal Motion from Greek Antiquity to the Latin Middle Ages, 400 B.C.- A.D. 1300," 2008, page 213
2. Smith, William Sir, "A Dictionary of Greek and Roman Biography and Mythology," page 964-5
3. Jackson, Mark, "Asthma: A biography," 2009, New York, Oxford University Press
4. Prioreschi, Plinio, "A History of Medicine," 2004, Omaha, Horatius Press
5. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1913, Philadelphia and London, W.B. Saunders Company
6. Jackson, op cit, page 27, reference used by Jackson:  Stephanus of Athens: Commentary on Hippocrates' Aphorisms Sections III-IV, translated by Leendert G. Weserink (Berlin, 1992), page 151
7. Galen, De Diebus Decretoriis, from Greek into Arabic, translated by Glen M. Cooper, 2011, Great Britain, MPG Books
8. Stephanus of Bryzantium, Oxfordreference.com, http://www.oxfordreference.com/view/10.1093/oi/authority.20110803100531207, accessed 11/22/13

x1901-1920: Hay fever becomes allergy

Paul Portier

The term hay fever was used for the first time in medical nomenclature in 1812 by Dr. John Bostock to describe seasonal allergy symptoms associated with the hay season. The term had been used by lay people much longer than that. So, even while many physicians doubted it was an appropriate term, it stuck in medical nomenclature like gum on a little boy's shoe.
However, a series of discoveries shortly after the turn of the 20th century would introduce the world to a series of new terms, such as anaphylaxis, atopy, and allergy.

In 1901, the Prince of Morocco summoned two scientists, Paul Portier and Charles Richet, to study a sea anemones called the Portuguese man-of-war. Their job was to learn how to protect swimmers from its sting, which caused painful blisters. (1, page 608)

Charles Richot

Initially, the two believed the painful blisters were caused by toxins from the animal's tentacles once they were entered into the skin of humans.  Back then vaccination was becoming a household name, and so the two set out to create an antitoxin vaccine.  (1, page 608)

Richet started the experiment by extracting toxins from sea anemones, and gave them in small amounts to test dogs.  After the initial injection they figured the dogs would develop antibodies that would protect them from a second exposure of the toxin.  In this way they would develop a natural protection against it, or prophylaxis.

However, when they extracted the toxin of sea anemones and inserted it into test animals (dogs in this case), the reaction they got was the opposite of what they expected.  The first two doses did no harm to the animals, but subsequent doses caused many of the dogs to go into a state of shock, and most did not recover.  Richet and Portier determined the animals died due to the effects of the toxins.

Instead of prophylaxis The animals developed aniphylaxis, a new term devised by the two men.

It's time for some definitions:

• Greek pro means toward or before
• Greek phylaxis means protection
• Greek ani means opposite or away
• Prophylaxis means to add protection
• Aniphylaxis means to cause harm

So, instead of protecting the animals from developing symptoms, they caused the symptoms.  The scientists learned that a "foreign protein" was transferred from the sea anemones to the dogs making them hypersensitive to that protein. (2, page 11)

Other scientists performed similar experiments and came to similar results.

Clemons von Pirquet

In 1906, an Austrian pediatrician named Clemons Von Pirquet observed many of his patients were hypersensitive to substances that didn't bother other people.  These normally innocuous (harmless) substances were pollen, dust mites and some foods.

The purpose of the immune system is to attack foreign particles that want to harm the human body.  Yet sometimes the immune system attacks allergens that are not meant to cause harm.  Von Pirquet and Schlick observed this, and they coined the term allergy to describe when the immune system causes harm.  (5, page 53)(3)

Once again a definition is in order:

• Greek allos means other
• Greek ergon means action or enery
• Allergy means the immune system causes the opposite effect as its intention (causes harms)
• Allergen means a substance or protein that may incite the allergic response hen a hypersensitivity is present
• Hypersensitivity means over-reaction; a hyper-reaction of the immune system; as in when exposed to allergens (Dated to 1870s)(Dictionary.com)

Von Pirquet actually believed that asthma was an allergic condition, and curing this disease was only a matter of finding the right foreign proteins to inject. History would prove him right in juxtaposing asthma and allergies, yet wrong on the front of this leading to a cure.

Also in 1906, German physician Alfred Wolff-Eisner surmised that pollen is similar to the poisons of the Portuguese man-of-war in that it could trigger the immune response in some some people.  By inserting drops of pollen into the eyes of volunteers, he was able to produce the same response suffered "during the hay fever season: red, swollen, and itchy eyes." He published his findings in 1906.  (5, page 54)

Thanks to Wolffe-Eisner's discovery linking hay fever with the immune system, hay fever was no longer believed to be a nervous disease.  It as no a disease caused by a hypersensitive immune system. This was an essential transformation because it would effect the future course of treatment for the disease.  Instead of seeking to alleviate a nervous disorder, the goal of treatment as not to fix a broken immune system.  (5, page 54)

In 1910 Samuel Melzer observed the "similarity" between anaphylaxis and asthma "in which a person became sensitized to a definite substance, and an attack occurred every time the substance entered the circulation (of that patient).  Minute quantities of the substance, if inhaled, would bring on an asthma attack." (2)

We now know that about 75 percent of asthmatics have allergies.  Yet we also know that many people have allergies and not asthma.  We also know that both conditions have been linked to the immune system and can be developed at any age.  Yet in 1906 scientists were at the dawn of such allergy wisdom.

Pirquot believed it was the body's response, not the foreign particles, that resulted in the allergic reaction. He listed as things that might cause this "hypersensitivity" as bee stings, mosquito bites, hay fever caused by pollen, and substances in certain foods such as crabs.

Soon thereafter Arthur C. Coca, founder of the Journal of Immunology, and Robert Anderson Cook, were attempting to understand studies regarding allergic conditions, used the term Atopy which literally means "strange disease."  They thought atopy should be used to describe hereditary hypersensitivities such as asthma, hay fever and eczema, and hypersensitivities that could afflict anyone should be referred to as anaphylaxis.

By 1919 two allergists, Cooke and Albert Vander veer, published the results of a study of 500 patients with asthma, hay fever, and other allergic diseases that confirmed that age old theory that these conditions were inherited and perhaps linked to other conditions.

Initially all prophylactic and anaphylactic reactions were referred to as allergies, as this as the recommendation of Van Pirquot.  He believed the two reactions should have a common name.  (3)

Yet ultimately it was learned that there were three conditions associated with hypersensitivities that didn't fit into this classification:  asthma, hay fever and eczema.  In asthma the hypersensitive response lead to constricted air passages, in hay fever it lead to a runny and stuffy nose, and in eczema it lead to red and itchy skin.

These three conditions -- asthma, hay fever and eczema -- are now often referred to as the atopic triad because in many individuals they come as a package.  One major difference between the atopic triad and anaphylactic reactions is that anaphylaxis can be induced in almost anyone, while the others occur in only a small percent (about 10 percent) of individuals and are quite often hereditary.  (4, page 608)

In subsequent years allergy was used to denote an immunal hypersensitivity or hyperresponsiveness to a foreign substance and atopy was used to denote the inherited conditions of asthma, hay fever and eczema.  Although, quite often the terms allergy, atopy and anyphylaxis are used interchangeably.

References:

1. Klein, Jan and Vaclav Horejsi, "Immunology," 1997, page 608
2. Brenner, Barry E, "Emergency Asthma," (ed. Barry E. Brenner), 1998, New York
3. Ehrlich, Paul M., Elizabeth Shimer Bowers, "Living with Allergies," 2008
4. Klein, Jan, Vaclav Horejsi, "Immunology," 1997, page 608
5. Mittman, Gregg, "Breathing Space," 2007, New Haven, London, Yale University Press

1820-1870: An ailment called Hay Fever

By the 19th century there were enough people suffering from seasonal sniffling and sneezing that certain physicians started taking a closer look at these symptoms, often referred to as hay-fever or rose-fever, especially if the physician himself was a sufferer.

This is exactly what happened on March 16,  1819 when Dr. John Bostock described his own "condition of catarrhal inflammation of the eyes and chest that appeared regularly each year during the early summer season," according to Gregg Mittman in his book "Breathing Space." (1, page 12) (also see 8, page 3)

Catarrh (catarrhal) is a 19th century term that refers to inflammation of the respiratory passages, particularly the nose, that results in a runny nose.

Bostock described his condition to the Medico-Chirgical Society, along with twenty-eight cases where patients suffered from a similar condition.  By 1828 he came up with a name for this ailment: "'Catarrhus Aestivus,' or 'Summer Catarrh.'" (1, page 12)(5, page 11)(8, page 3)

Yet despite Bostock's definition, hay-fever "still was not recognized as a distinct disease by the profession," writes William Clarence Hollopeter in his 1898 book "Hay-fever and it's successful treatment." And Bostock rejected to the term hay fever because he believed "hay-fever" not caused by hay but(10, page 19):

• Moist heat
• Dust
• Sunshine
• Fatigue 

Regardless, Hollopeter notes that he finds it "remarkable that the profession in England were unfamiliar with hay-fever when their king, George IV, was a sufferer from it." (10, page 19)

Dr. George Beard, in his 1876 book "Hay-Fever; or Summer Catarrh: It's Nature and Treatment," said that in 1828 Dr. MacCulloch wrote an essay called "An Essay on the Remittent and Intermittent Diseases," where MacCulloch described hay fever as being caused by "hot houses and green houses," and that it was "caused by hay-fields."  (5, page 11)(also see 8, page 4)  Although Hollopeter notes MacCulloch advocated nothing new of the disease. (10, page 19)

Bostock tended to agree that heat had something to do with hay fever, but he doubted that hay had anything to do with it.  Beard said that Bostock "cited a number of facts from his own experience which went to show that, in his case at least, heat and direct rays of the sun had more to do with the disease than any other traceable exciting cause. He states that one season he walked out frequently among acres of hay-grass, and suffered less than usual, except when it was very hot. Dr. Bostock, however, admits that in some persons the disease was apparently brought on by hay; but he was sufficiently skeptical on the subject to suggest that possibly they might be exposed to hay and heat at the same time, and confound the effects." (5, page 12)

In 1829 Dr. W. Gordon wrote a paper where he "took the view that hay-fever was caused by the aroma of the flowers of grass, and especially of the Anthoxanthum odoratum. This writer had observed that the disease usually comes on as soon as this plant flowers, and disappeared about the time that this plant disappeared; and he stated that after the death of this plant patients could go through meadows without suffering. He believed that grass, and not hay, was the cause, and that the disease should be called grass-asthma.
 (6)

In 1831 Dr. Elliotson of England described hay-fever, and two years later and agreed with Dr. Bostock that the disease was not caused by hay, but opposed Dr. Bostock's claim the disease was caused by heat.  He believed grass was the main cause, according to Hollopeter. In 1841 Dr. Ramadge believed it was caused from "effluvia from flowers," Hollopeter adds.  (10, page 19)

Other physicians described patients with this ailment.  Many physicians reported this as being associated with wheezing and asthma.  Some physicians noted that asthma was worse during the dog days of summer.  (1, page 12) (5, page 11)

In 1837, any patient seeing Dr. J.J. Cazenave of Bordeaux, and who complained of hay-fever symptoms, were encouraged to wear goggles to protect their eyes from irritating matter.  As far as Morell Mackenzie is concerned, this was probably the first time a physician recommended protection to prevent hay fever. (11, page 15)

Mackenzie explains that Cazenave also "attempted to prepare the nasal mucous membrane for the enemy's attack by hardening it with nitrate of silver.  Cazenave attributed the complaint to the effect of light, and does not seem to have known that it had been described before." (11, page 15, 16)

In 1850 Dr. Gream "observed the symptoms of asthma were releaved after a fall of rain, and he argues that the laying of dust was the explanation; and, further, he maintained that the malady was peculiar to the summer, because at this season there was more dusts of various kinds in the air," writes Beard.  Gream believed indoor dust was just as much as an exciting factor as outdoor dust, and may have been the first to postulate this theory, notes Beard.(7)

The first to notice the difference between summer and fall hay fever was Dr. Swell from New York in 1852.  (11, page 15)

In 1859 Dr. Henry Hyde Salter, the formost asthma expert of the 19th century, refers to hay asthma as periodic asthma, in that it comes and goes with the hay season, which usually lasts 4-6 weeks.  Like other experts, he believed the exciting factor was "bright, hot, dusty sunshine."  He also blamed laughter, eating too much and hay. (5, page 14)

Also in 1859 Laforque of Tououse defined two cases of hay fever, and he described the condition as neurotic, a conclusion many of his contemporaries would also come to.  He described it as "neurotic in its origin and as being directly excited by heat."   In 1860 Dechambere was convinced "'an occult atmospheric influence' was the cause of the disease." (11, page 15)

So there were various physicians with varying oppinons on what caused hay fever.  It was heat.  It was hay. It was flowers.  It was grass. It was dust.  Some studies were perfomed, but mostly these physicians used their own experiences and observations with their own asthma, or that of their patients.  Still, the wisdom shared was mostly based on the best data available at the time. 

By the 1860s, Mittman writes, Hay Fever or Hay Asthma became a common terms used by the medical community,  (1, page 12) although some continued to use hay asthma.  In 1862, Mackenzie writes, Dr. Phoebus of Giessen, who formed opinions on hay fever from witnessing only one case, sent out flyers to various patients and obtained organized statistics about hay fever and came up with "a complete theory about the disease. I write further about phoebus here.  (11, page 17)

Another thing to note about Dr. Phoebus is that he was probably the first person to write about the link between air pollution and hay-asthma.  He referred to the substance in the air that is naturally occurring (and also a pollutant) as ozone.  Although Charles Blackley breathed the substance in his office for six hours with no effect on his hay fever. He was also among the first to note that dust might cause hay fever. (11, page 35)(8, page 79-90, 91))(I will write about this experiment in another post: See What causes Hay Fever)

Dr. Smith Abbots, Pirrie, and Moore also pulished pamphlets describing various theories about hay fever, "all, more or less, showing a disposition to limit the cause of its development to emanations from plants," Mackenzie writes.  (11, page 17)

Beard explains there's no way to know where the term "Hay Fever" originated from, although "probably it first became known among the people, who observed that the symptoms were brought on or made worse during the hay-making season." (5, page 12)

Other names used to describe related symptoms were: June cold, July cold, and rose cold.  (5, page ii)  Generally the symptoms were the same, and the diagnosis was based on the season.  Yet the most common term associated with them all, regardless of the season, was Hay Fever.

Much like asthma, hay fever left no scars inside the body, other than inflammation (catarrh) that went away in time.  So the condition, like asthma, was soon theorized to be a nervous affection. (5, page iii)

References:

1. Mittman, Gregg, "Breathing Space," 2007, New Haven and London, Yale University Press
2. Taylor, C.F., editor, "The Medical World," volume 16, 1898, Philadelphia, 
3. Fry, John, "The Natural History of Hay Fever," J. Coll. Gen. Practi1, 1963, 6, page 260
4. Ehrlich, Paul M., Elizabeth Shimer Bowers, "Living with Allergies," 2008
5. Beard, George, "Hay-Fever; or Summer Catarrh: It's Nature And Treatment," 1876, New York, Harper & Brothers
6. Beard, ibid, pages 12 and 13, referenced by Beard from Dr. Mr. W. Gordon's paper "Observations on the Nature, Cause, and Treatment of Hay-Asthma," London Medical Gazette, 1829, vol. iv, page p. 266
7. Beard, ibid, pages 13 and 14, referenced from "On the use of Nux Vomica as a Remedy in Hay Fever, Lancet, 1850, vol. 1, page 692
8. Blackely, Charles Harrison, "Hay-fever: its causes, treatment, and effective prevention," 1873, 1880 2nd edition, London, Bailliere
9. Smith, William Abbotts, "On Hay-Fever, Hay-Asthma, or Summer Catarrh," 1867, London, Henry Renshaw
10. Hollopeter, William Clarence, "Hay-fever and it's successful treatment," 1898, Philadelphia, Blakiston's Sons & Co.
11. Mackenzie, Morel, "Hay fever and paroxysmal sneezing," 5th ed., 1889, London, J&A Churchill

1930-1950: The rise of the asthmatic institution x

Figure 1 -- NJH patients receiving sunlight exposure treatment

Thanks to better care, improved diets and good hygiene, the number of tuberculosis patients declined significantly during the 1930s. National Jewish Hospital at Denver and National Home for Jewish Children in Denver continued to stay open mainly because the doors to these hospitals were open to people with other diseases besides just tuberculosis, particularly asthmatics having trouble managing their asthma at home.   (1, page 115)

In the 1940s the number of tuberculosis patients was generally higher than those with other diseases, like asthma.  However, the number of asthma patients at the institution was on the rise.  And, for the most part, the goal for people with chronic lung diseases was to seek the cool, dry climate of Colorado for improved breathing.  So both asthmatics and TB patients received open air treatment (see figure 1).

Figure 2 --Children playing on swings at the National Home
 for Jewish Children, 1936 (6)

Likewise, patients who got better were provided the "added bonus of rehabilitation, social and education programs.  The education programs were intended to equip patients, who often came from lives of poverty, to function more effectively, in the world outside of the hospital."

Now, before I get into the rise of asthma patients at these hospitals, you have to understand the common thinking about asthma in this era.  First of all, asthma was a much rarer disease at this time, so it didn't get even close to the type of limelight that a deadly disease like tuberculosis got.

During most of the 19th century the two most prominent theories about asthma were that it was a neurotic disorder that resulted in airway constriction and shortness of breath.  This theory continued to be prevalent until it was disproved in the 1940s, and even then it held sway. So for the most part, if you had asthma, it was because you were a nervous person. This wasn't the only theory, but it was among the more prominent.

Another theory that became prominent around the turn of the 20th century was that asthma was also caused by allergies.  So while asthma was a nervous disorder, it was believed many cases were associated with allergies.  Many asthmatics got allergy testing to show they had allergies, and it was determined that some unknown substance in allergens -- like dust mites -- was causing asthma.  What it was no one knew, but some asthma experts believed this might lead to a cure for asthma.

In the meantime, many parents of severe asthmatics failed to understand the need to remove their children from asthma triggers, and so their asthma never got better.  They also failed to remove their children from their neurotic triggers, so, again, their asthma never got better.  Since asthma was much more rare back then than it is today, there was no push to better educate asthmatics, parents of asthmatic children, nor their doctors.

Regardless, the main theory regarding asthma in the 1940s was that it was a nervous disorder, or, as some called it, a psychosomatic disorder. It was all in your head.  Physicians heard stories by concerned mothers that when their asthmatic child went with the guys to do guy things the wheezing started.  So the logical conclusion made by these doctors was that these children were suffering from separation anxiety.  They were having asthma because they longed for their mothers.  For this reason they needed psychological help to be cured of their asthma.

As an asthmatic myself I can kind of understand this theory.  I remember not being able to do normal things with my brothers and dad, and when I did them I was a major burden on them more so than anything else. I remember my dad driving over an hour from hunting camp just to take me back home to mom because I couldn't breathe.  So ultimately I learned it was better for me just to stay home with my mom, where I became close to her.  So now it looks to others as though I'm overly attached to my mother, and when I go hang out with the guys I have separation anxiety, and this results in asthma.

Of course I really wasn't having separation anxiety, nor were any of these other kids back in the 1940s.  The truth is when they hung out with their dads and brothers they, like me thirty or forty years later, were doing things that made them get close up with their allergens.  Dad would take us deep into the woods to cut down trees, and he'd have us kids haul and stack the wood.  He'd come home and burn the wood, creating chimney smoke.  He'd take us to hunting camp, where allergens were galore.  And then when I was back at home my asthma would miraculously get better.

There were also many experts who believed the birth of a new brother could also result in worsening asthma, and this is exactly what happened to me on January 26, 1971 when my brother David was born.  So I suppose these experts might assume my asthma was a suppressed cry for my mother, who was providing all her attention to my little brother.  My physicians may not have thought this when I was suffering from asthma, yet this was the kind of thinking that persisted in the  1940s and 1950s and 1960s, and I'm sure  -- I'm positive -residue from these theories radiated into the 1970s and 1980s. I'm certain some of it affected me when I was a patient at NJH/NAC in 1985.

At first there weren't many asthmatics at these hospitals, mainly because, as noted, asthma was pretty rare in the 1940s. However, it was around this time Dr. M. Murray Peshkin, medical director for the National home for Jewish Children, observed a trend among asthmatic children at the hospital, and he postulated a theory based on his observation that would cause a spike in asthmatic children admitted to asthma hospitals around the nation.

What he observed was there were about 10 percent of asthmatic children who never got better at home, even when he personally visited their homes to make sure they were perfectly clean and antiseptic with no trace of any known allergen.  (2) He observed that as soon as being admitted to his hospital many of these children became immediately better. He observed that 99 percent of the chidlren treated this way had 'substantial or complete relief' of symptoms, according to his own reports. (3, page 145)

He concluded the reason for this was that once admitted to the hospital those children were away from both the stress of home life and away from the allergens at their homes.  So he proposed the idea of the "Parentectomy."  This basically means that children with severe asthma non-responsive to home treatment are removed from their homes, removed from their parents, and admitted to one of the many asthma hospitals around the nation.

So plucking the asthmatic and placing them in hospitals like National Jewish for one or two years was a growing trend throughout the 1940s and 50s, according to George Travis in his 1976 book, "Chronic Illness in Children."  He described that these hospitals worked on the "assumption that severe, intractable asthma stems from the family environment, and thereby removes the child from the parents from one to two years." (4, page 170)

Travis notes that there were some "interesting studies," and I might add, very credible studies, at very credible institution like National Jewish performed that proved the psychosomatic theory of asthma.  (4, page 170)  So it was only fitting that this theory, that began almost two thousand years earlier on some accounts, continued to reign prominent in the medical community. 

So this began the rise of the asthma institution.  It also resulted in some name changes:  In 1953 National Home for Jewish Children was changed to Jewish National Home for Asthmatic Children at Denver.  In 1957 the name was changed again to Children's Asthma Research Institute & Hospital (CARIH), and in 1973 to National Asthma Center.

References:

1. Minton, Gregg, "Breathing Space,"
2. Wamboldt, Fredrick S. "Asthma Theory and Practice: It's Not Too Simple," April 2, 2008,
3. Jackson, Mark, "Asthma: A Biography,"
4. Travis, George, "Chronic Illness in Children," 1976, California, Stanford University Press
5. "Clinical History: The Early Years," NationalJewishHealth.org, http://www.nationaljewish.org/about/whynjh/history/clinical/, accessed 11/7/12
6. Photo from Penrose Library, http://lib-anubis.cair.du.edu/About/collections/SpecialCollections/NAC/index.cfm, accessed 11/8/12