1849: The dawn of modern medicine (the height of the scientific revolution)

Oliver Wendell Holmes was among the first to realize that
fevers can be spread by unclean hands. (4, page 457)

William Henry Osler was born in Canada on July 12, 1849.  This was an era where age old habits, methods and ideals used by physicians were being reconsidered.This was an era where physicians were just starting to adapt the use of the stethoscope, laryngoscope, thermometer and microscope into their daily practice.  It was from these devices that physicians were leaning that what went on inside the body effected what went on outside the body.  Through scientific method, many ancient ideas about medicine were being reviewed, and some were even cast away in favor of better wisdom.

Consider the following wisdom that was plastered throughout the medical community:

1843:  Oliver Wendell Holmes (1809-1894) announced to the medical community that women in child bed should not be attended by physicians who had studying the victims of perpetual fever.  He was concerned the causative agent might be spread to the mothers and their babies.  He recommended that physicians and medical caregivers wash their hands and change their clothing after leaving patients infected with perpetual fever. He received harsh criticism from his fellow physicians who were in harsh opposition to change. (4, page 457)

Ignaz Semmelweis proved washing hands and changing
dirty attire between patients reduces the spread of sickness.
Despite his evidence, he was mocked and ignored. (4, page 458)

1846:    Ignaz Philipp Semmelweis (1818-1865) became an assistant in an obstetric ward in Vienna where there was such a high death rate from child bed fever that women feared to go there.  Semmelweis observed the death rate was higher in the 1st ward where he and his fellow male physicians worked compared to the 2nd ward where female mid wives worked.  Upon investigation he learned the women were much cleaner in appearance than the physicians, who often walked proudly around with blood stained hands and aprons.  The physicians also were more likely to perform postmortem investigations just prior to checking the vagina.  The women, on the other hand, did not have blood stained clothes and washed their hands in calcium chloride solution between patients.  When he insisted his physicians likewise wash their hands and put on clean clothes prior to checking women in child bed, the death rate fell from 9.92% to 3.8%.  The following year it was down to 1.27%.  The proud physicians were unhappy, and eventually rejected Semmelweis.   After they went back to their old poor habits, the death rare once again duly rose.  (4, pages 457-8)

1859:  Charles Darwin  (1809-1882) published his "Origin of Species" in which he published his theory of evolution.  This may have been one of the key publications that helped to spark the scientific revolution. The medical profession was one of the main beneficiaries of this revolution.  However, many proud and stubborn medical professors and physicians refused to let go of old theories.  Continued investigations, and scientific evidence, would ultimately force change.  

Louis Pasteur forever changed medicine with his
Germ Theory of Medicine. 

1865:  Louis Pasteur (1822-1895) discovered that microbes were the cause of diseases, and he saved the silk worm industry by his discovery that "microbes were  went on" to extend his germ theory to develop causes and vaccinations for diseases such as anthrax, cholera, TB and smallpox." (3)

1870s:  Joseph Lister (1827-1912) discovered that antiseptic use reduced post surgical infections.  He was a British scientist and physician who observed that about 50 percent of amputation patients survived the surgery but died later of septic fevers, or what was known as "ward fevers."   With knowledge of the works of men like Pasteur and Semmelweiz, Lister surmised microbes in the air were infecting wounds, and so he used phenol as an antimicrobial to reduce the death rate by 15 percent. (4)  He recommended the antimicrobial carbolic acid to be placed on bandages to keep the wounds clean, and he invented a machine to pump carbolic acid into the air in the rooms where surgeries were being performed, and mortality rates from infections after surgeries plummeted. (5)

1879:  While working with Jordan Wheat Lambert (1851-1889), Lister invented an antiseptic to use during surgeries.  In honor of Lister's discovery, Lambert insisted the product be named "Listerine," introducing it to surgeons in 1879.  The product was so successful that it was ultimately marketed to dentists as an oral rinse in 1895, and to the public as a mouthwash in 1914.  The product is still available on the market to this day (although the taste has been improved).

Joesph Lister proved that antiseptic use during surgery
greatly reduced the post surgery morbidity and mortality.

A young William Osler must have been inspired by all this wisdom.  He became so rapt in it that he cast aside his father;s wish that he go into the ministry to study medicine.  However, while a young, impressionable Osler was keen about the new ideas regarding medicine, other physicians were pent on grasping onto the old theories holding on for dear life.  

For example, there were many medical professors who learned about Robert Bree's theory that asthma was caused by some peccant matter in the lungs, and an ideal sign this peccant matter was present was increased sputum.  Sputum, in essence, was the bodies attempt to rid of this peccant matter from the body.  These seasoned physicians worshiped this theory so long it was hard for them to let go.

This does not mean these were bad physicians.  They did the best they could with the wisdom that they had, although instead of doing better when the evidence was presented to them, they rejected it.  This is not in any way abnormal to humans.  It's normal to reject new ideas prior to accepting them.  Stated another way: the truth hurts before it makes you better.

By the various experts performing autopsies and dissections, these types of theories were cast aside for better ones, such as the spasmotic and nervous theories of asthma, as so duly noted by Henry Osler in his review of asthma in his 1892 book "The Principles and Practice of Medicine." (2, page 497)

In his review of heart failure he must have been among the first to describe it as a separate disease entity, as opposed to looping it under the asthma umbrella as so many physicians before him.  Through his writings on heart failure we can see how new ideas were still commingled with old theories.

Listerine bottle from the 1920s

Consider the following regarding heart failure from "The Principles and Practice of Medicine":

Osler explailned that as the flow of blood through the heart and lungs becomes blocked, perhaps from a stenosis (narrowing) of blood vessels or emphysema in the lungs, the heart becomes overworked.  This causes the heart to become hypertrophied (enlarged).  The heart becomes weak, and may cause blood flow to become "embarrassed" (slowed down, backed up, congested).  This in turn will cause acute (it's happening now) symptoms of heart failure (cardiac asthma).  (2, page 624)

Treatment for this would be:

1. Rest: Allows heart time to catch up and breath can be restored
2. Relief of embarrassed (impaired) circulation:  Dyspnea from blood pooling in the lungs may be severe, even fatal.  The vessels of the body become engorged with blood, thus dilating (enlarged). When this can be seen upon assessment, and when there is orthopnea and cyanosis, the following are the recommended treatment options:
1. Venesection (bleeding): The abstraction of 20-30 ounces of blood. He notes that "this is the This is the occasion in which timely venesection may save the patient's life. It is a condition in which I have had most satisfactory results from venesection. It is done much better early than late. I have on several occasions regretted its postponement., particularly in instances of acute dilatation and cyanosis in connection with emphysema.'' (2, page 624)
2. Depletion through the bowels:  This is particularly valuable when dropsy is present. Of the various purges the salines are to be preferred,and may be given by Matthew Hay's method. Half an hour to an hour before breakfast from half an ounce to an ounce and a half of Epsom salts may be given in a concentrated form. This usually produces  (2, pages 624-625)

So you can see that science had impacted his description of heart failure, although old theories regarding its treatment were still held on to.  It must have been well known to him that he couldn't cure disease, yet he did have the ability to alleviate pain and dyspnea with medicines like opiates, morphine and strammonium (or, in some cases, bleeding).  .

Through it all, and regardless of scientific advancements, even Osler must have known the limits of medicine. He must have known that the gentle touch of his hand, or the soft ring of his assuring voice, was all that was needed to alleviate suffering. Providing hope may have been the main job men like Osler, even during this era of improved medical wisdom. (3, pages 50-60)

Click here for more asthma history.

References:

1. "Sir William Osler At Seventy -- A Retrospect," The Journal of the American medical Association," 1919, Saturday, July 12, pages 106-108
2. Osler, William, "The Principles and Practice of Medicine," 1892, New York, pages 497-501
3. Bliss, Micheal, "William Osler:  A Life in Medicine," 1999, New York
4. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1921, London and Philadelphia, 

Further readings:

1. Jackson, Mark, "Asthma: The Biography," 2009, New York, pages 211-12
2. Brenner, Barry E, ed., "Emergency Asthma," 1998, New York, pages 212-14

1892: Dr. Osler defines asthma x

William Osler is often referred to as the
Father of Modern Medicine.  He shared his
medical knowledge in 1896:  "The Principles
and Practice of Medicine

William Henry Osler is considered by many to the the Father of Modern Medicine. He shared his medical knowledge in his 1896 publication "The Principles and Practice of Medicine."  It is from this book we can still delve into his mind to see what he was thinking about various diseases, including our own: asthma.

It was his ideals about medicine that transformed the way medicine was taught.  He was well respected by physicians around the world, and his word was considered like words from the Bible.

In this way he was able to settle many debates about medicine, and push forward new ideas that were scientifically solid and old ideas that continued to have merit in the newly founded scientific world of medicine.

While he didn't have much new to add to asthma wisdom, he set the standards for future practice and research in this area.  He believed the following to be true about asthma and allergies:  (1):

1. It's of nervous origin
2. Various triggers set off an acute attack
3. Attacks involve swelling of bronchial mucus membrane
4. Attacks involve constriction of bronchial muscles
5. Attacks involve increased secretions 
6. Flow is obstructed by this swelling, constriction and increased secretions
7. Asthma and allergies are similar in origin and unique in their symptoms
8. Asthma and allergies are hereditary
9. Many asthmatics present with allergies (hay fever)
10. Children are more affected than adults
11. Men are affected more so than women (1)

As with Frances Rackemann, his ideas about asthma being a nervous condition sent many researchers and scientists down the wrong path, and may ultimately have delayed progress in the field of asthma. He wrote that "the affection sometimes runs in families, particularly those with irritable and unstable nervous systems."

Yet his understanding of the benefits of science in medicine would prove to benefit asthmatics.

Further reading:

• 1849-1919:  Father of modern medicine
• 1892:  Osler's asthma remedies (to be published 7/7/13)

References:

1. Osler, William, "The Principles and Practice of Medicine," 1892, New York, pages 497-501

1976: Asthma terror in the hotel room

In 1976, even though there were some on the market, I did not have access to rescue medicine.I do not know why this was. However, I might presume that it had something to do with the scare that occurred during the 1950s when the inhaler was first introduced to the market. There was a rise in asthma related deaths during the ensuing decade, and the inhaler was blamed. So, perhaps due to that, doctors feared prescribing rescue medicine for kids especially. I would verify this with Dr. Gunderson, my doctor from this era in my life, but he has since passed away.

What I was prescribed was a pink solution. It was in the bathroom medicine cabinet. Once a day, and usually only when I was having trouble breathing, mom gave me a dose with a teaspoon. She probably should have measured it out better, but this was the method her mom used with her for giving medicine, so it's what she did. At least, that's what I would imagine.

I don't know why, but my mom made me responsible for remembering my medicine when we went places. You could judge my mom and say this was stupid. But, as my wife always says: You do the best you can with the wisdom you have today, and as you learn better you do better. My mom, when I asked her about this, has no memory of it. I don't blame her. It makes sense that I'd remember it and not her, as there is one of me and she had many other kids to take care of, including herself and dad.

In my own defense, asthma was treated as an acute disease back then. This means that you didn't take medicine when you felt good; you didn't take medicine every day to prevent asthma symptoms. Mom only spoon fed this medicine to me when I complained of feeling short of breath. So, considering I might go months without needing it, this made it easy for me to forget to take it with me when we went on vacation as a family.

So, I did have a bottle of some pink syrup. When I was short of breath mom took me into the bathroom and gave me this medicine with a teaspoon. What was it? I have not idea. I wonder, however, if it was Alupent solution. Dr. Gunderson must have decided this was the best medicine, the safest medicine, for an asthmatic child. However, I would be more inclined to say it was theophylline solution. It may also have been a steroid. My memory is hazy here, and I have no way of clearing it up, unless someone reading this has some wisdom to share.

There was an alupent inhaler on the market at this time. There was also an epinephrine inhaler called Primetime Mist that was available over the counter, but most doctors advised against prescribing this medicine, especially to kids. On the box of antihistamines was a warning not to let asthmatics use it, so this was not allowed either. So, other than this little pink solution, there weren't many options when I felt short of breath -- such as if I was exposed to my asthma triggers. Here I was a kid, and I had no rescue inhaler. I had not Primetime Mist, and I had no Alupent. I did not even know they existed at this time in my life. If my asthma got bad enough, mom was told to take me to the emergency room for 0.5cc of epinephrine. Mom even had a note from doctor Gunderson for when we went on vacations, such as we did in June of 1996 when we went across country to California.

If my asthma got bad enough, dad would run the hot shower and close the door. He and I would stand in the bathroom until we couldn't stand it any more. We would exit the bathroom. It definitely felt soothing to leave the hot and steamy bathroom into the cool hallway air, but it did not do anything for my breathing. I would be short of breath when I entered the bathroom, and I would be short of breath when I exited the bathroom. This was an old wives tale that steam helped asthmatics. It does help kids with croup, but I didn't have croup. In the old days, these two ailments were often confounded. Steam is good for croup. Steam is bad for asthma. It makes air thicker and harder to inhale. But, you do the best you can with the information you have today, and as you learn better you do better. Back then, doctors didn't know better.

So, I was not aware of any Alupent inhaler. When I started coughing, wheezing, or showing any signs of being short of breath, my mom, or my grandma, or my dad, would resort to the old wive's tale asthma remedies.  I remember my grandma Lila rubbing Vix VapoRub all over my chest. My other grandma (my dad's mom) would run the hot water in the sink of her old Victorian home on 5th avenue in Manistee (she had no shower), and would put a towel over my head. This had the same steamy effect as the method dad used. I think it made grandma feel good that she was doing something. When she removed the towel, I would tell her I felt better, even though I probably didn't.

Well, actually there was a moment of relief as you left the hot steamy air to inhale cool, refreshing air. But this was probably because humid air is heavy and hard to inhale, and the cool air gave me an immediate feeling of relief.  In essence, this therapy was no better than creating pain in one part of your body to make you no longer feel the pain somewhere else.

These were all days when I felt mildly short of breath. You know, you can live that way. It's similar to what you see with many COPD patients today who, as the disease slowly progresses, get gradually more short of breath over time.  It happens so slowly they don't even realize they are short of breath. Then they come to the emergency room, we give them a breathing treatment, and they are amazed at how much better they can breathe. Chances are they didn't even come to the emergency room for their breathing. They had a bad stomach or something, and the ER doctor recognized the classic signs of COPD.

No, I'm not implying I didn't know I was short of breath.  I'm not saying that.  What I am saying is I sort of developed a tolerance to it.  I had asthma attacks since I was two years old, so I had lived with it for so long, knew there was nothing I could do about it, so I developed a coping strategy of grinning and bearing it -- at least until it got severe. But it was not severe in 1976 -- not yet. 

I must have been a little older than six if mom made me responsible for my medicine. Maybe it was 1978 or 1979. Maybe I was ten. But it seems it must have been before 1980. Anyway, sometime around there we went south to a Quinn family reunion. This would be my dad's mothers side of the family. I can't remember where the reunion was, but it was at a campground. Years earlier we camped. This year mom and dad rented a hotel room. Mom hated camping. Camping was bad for my asthma. So we stayed in a hote.

I remember getting there and feeling short of breath. I told mom. She got mad at me when it was learned I forgot my medicine. Again, I don't fault my mom here. Don't write me emails telling me how bad my mom was for making me remember my own medicine. Mom denies this ever happened. However, I am convinced it did. In fact, I know it did.

So, instead of going to a pharmacy and getting me some medicine (or maybe this was not an option then), or instead of taking me to the hospital, mom gave me a cough drop and left us five boys in the hotel while they went out on a date.  Yes, that's a true story.  My older brother Bobby was in charge. No. Wait! I actually think my cousin Molly babysat us. I think that was it. 

I remember my brothers goofed around, and I never left my bed.  Little Tony was a baby and he was sleeping.  And Dan fell asleep right away.  David and Bobby were closer to my age (Bobby a year older and David a year younger) and they had fun.  They kept farting and running around the room. They might even have teased me, as they had no idea why I was being such a baby. In the meantime, I was stressed, sweaty, and panicky.  

Finally my brothers all fell asleep, but I remained awake.  I tried to sleep, but I could not turn the wheels off in my head.  I could not help hoping my mom and dad would walk through the hotel room door.  It seemed like hours, days, even weeks.  In actuality, it was probably only a few hours.  In actuality, it was probably no later than nine-o-clock: late for a kid but not late for adults out having fun with their friends and relatives.

I must have fallen asleep at some point, because all of a sudden I realized my inside cheek is all wrinkly from where the cough drop rested.  I was still positioned high on my pillow, and air I inhaled was hard coming.  I could get half a breath, but it was still very uncomfortable.  I remember I started to cry after my brothers all were sleeping. I was up late when my brothers were breathing hard, and farting in their sleep.  

Anyway, this was a terrible night in a hotel room. I think that by the time mom and dad came home I never said anything. By this time I didn't want to ruin their night. I had made it this far, I can make it the rest of the night. I do not remember what happened after that.More than likely, I just dealt with it

The next day we went swimming in the hotel pool. We did this all day. However, while my brothers had fun swimming, I stayed on the shallow end with my chest above the water. If my chest went under the water, my breathing became too heavy under the pressure of the water. I think at some point I decided to just get out of the water, as the chlorine must have bothered my asthma too. A fun day for everyone else, a not so fun day for the asthmatic who forgot his medicine. 

1942: Curare used as anaesthetic/ paralytic

Curare (succicholine) was a famous native American poison.  The Indians would rub it onto arrow tips, and when they pierced through the skin, the poisons would be injected into the animal's circulation.  The effects would paralyze the animals long enough for the Indians to finish the kill.  (1, page  page 4, 177-178)

The poison was first used during artificial respiration in 1811 by Sir Benjamin Brodie in England. Other 19th century physicians used it as an anaesthetic, although they struggled to find the best dose to use.  Some physicians even experimented by using it for various diseases, and some of these experiments resulted in better treatment.  (2, page 227)(1, page 177-178)

The medicine was not routinely used as an anaesthetic until 1942 when Canadian anaesthesiologist Harold Griffith used "in human anaesthesis."  (2, page 227)  This was a major breakthrough because it allowed surgeons the opportunity to sedate and ventilate patients during operations. 

It was later adapted as the ideal paralytic to use during an intubation because the effects wear off in a matter of minutes.  

1. Vogel, Virgil J., "American Indian Medicine," 1970, London, Oklahoma University Press
2. Szmuk, et al, "A brief history of tracheostomy and tracheal intubation, from the Bronze Age to the Space Age," Intensive Care Medicine, 2008, 34, pages 222-228, reference to page 227

502-575? A.D.: Aetius uses a painful asthma remedy

Teddy Roosevelt once said he'd rather get rid of all his asthma medicines because most seem to make him feel worse.  Perhaps there is no better example of this than a remedy proposed by an ancient physician named Aetius.

He was born a Christian in Amida in Mesopotamia, was educated at the school of Alexandria, and practiced in Constantinople near the end of the 5th century or beginning of the 6th.   He was another of those famous physician who recopied the works of all the ancient physicians who came before him, mainly Hippocrates and Galen.  His works voluminous works were published in Tetrabibles. (1, page 65 and 2, page 3)

He believed in many of the ideas of both the Humoralists and Methodists, and he added in some ideas based on his own observations. He described smallpox, fevers, and he attributed "'ringing in the ears' to the oscillations of the pneuma, or vaporous spirits, in the interior of the organ of hearing." (1, page 66)

Of interest of us is to note he "made frequent use of both the actual and potential cautery -- such indeed a few surgeons would advise, and still fewer patients be willing to endure it in our day."  (1, page 66)

So what about his remedies?  Like many of his predecessors he based many of his remedies on "incredulity and superstitious practices."  Some of which include amulets, charms and incantations.

But what is his remedy for asthma?  Yes, and that's what I'm getting to.  Note above that I mentioned he made bold use of the cautery.  Yes, that means, as is noted at the Freedictionary.com : "An agent or instrument used to destroy abnormal tissue by burning, searing, or scarring."

He believed cautery was a good remedy when the disease was "incurable or among the most difficult to treat."  And it's for this reason, perhaps, he believed it was a viable remedy for asthma, pthisis (tuberculosis) and empyema (inflammation of pulmonary sac).  As noted by V.J. Fourgeaud:

"In Chronic asthma, in phthisis pulmonalis and in empyema, he applied two cauteries on the upper part of the chest near the articulation of the clavicle with the sternum, taking care not to injure the trachea; two smaller ones beneath the under jaw, near the carotid arteries, one at each side, being careful to prevent them from penetrating more than skin-deep; two more below the breasts, between the third and fourth ribs; two on the back, near the fifth and sixth ribs; one a little above the xiphoid cartilage; two between the eighth and ninth ribs, and three along the course of the spine, one in the centre and one on each side.  A circular form for the eschars, is recommended by him, as tending to protract their healing, and he makes his prognosis of the recovery or death of the patient depend on the quantity of humors furnished by the suppuration which ensued." (2, page 67)

Um, no thanks!  What do you think?

References:

1. Fourgeaud, V.J, "Historical Sketches:  XL  Medicine from the time of Galen to the Arabic Period," Medical and Surgical Journal, edited by V.J. Fouregaud and J.F. Morse, Volume VII, 1964, San Francisco, pages 60-72
2. Wilkes, John, editor, "Encyclopaedia Londinensis, or, Universal dictionary of arts, sciences, and literature, volume 1,  1810, London

1500-1900: Hospital staff will probably not cure your asthma

If you had asthma prior to the 20th century chances are you would not want to go to a hospital.  These institutions were usually reserved for people who were desperate, miserable, and severely ill, such as those inflicted with the plague.

Surely there were hospitals built during the course of the 15th, 16th, 17th and 18th centuries with the intent on helping the sick, disabled, and wounded.  Many of these institutions were established around military bases, although many others were established in or around cities.

Along with the many hospitals that were built in Europe, there were also some built in America.  For instance, in 1524 Cortez set up a hospital in Mexico.  Later hospitals were set up in Quebec, Canada, in 1639 and 1693, Montreal, Canada, in 1644, and on Manhattan Island in 1663.  (1, page 308)

While hospitals were created with noble intentions, the results were often not so noble.  For instance, surgeons at these hospitals performed surgeries, and more often than not the surgeon knew little more about anatomy and diseases than the person being operated on.  Few lived to tell about how they survived an operation. The most common cause of death would be blood born pathogens, although this bit of knowledge would not be discovered until the mid 19th century (during the scientific revolution, or at the dawn of modern medicine).

Many of the hospitals had only a few patients, except during times of plagues and epidemics, which were frequently scattered throughout most of these centuries.  As the size of cities grew, as populations rose, and especially when and where sewage and garbage exposed, so too rose ideal environments for vermin, bugs, and the diseases they carried. Chances are that every person either knew someone who suffered from or died of disease, or they survived one themselves.

I'm certain there were good stories told of successful operations, and recoveries as the result of care at such an institution, although many gloomy pictures are painted.  For instance, one of the greatest medical historians of all time, Fielding Hudson Garrison, provides us with the following account:

Many new hospitals were built (in Europe) in the eighteenth century, but, in respect of cleanliness and administration, these institutions sank to the lowest level known in the history of medicine... (for example) In 1788, Jacobus-Rene Tenon published a series of memoirs on the hospitals of Paris, containing his famous description of the old Hotel Dieu, which was at that time a veritable hotbed of disease. There were some 1220 beds, the most of which contained from four to six patients, and about 486 beds for single patients. The larger halls contained over 800 patients crowded on pallets, or often lying about miserably on heaps of straw, which was in vile condition. Acute contagious diseases were often in close relation to mild cases, vermin and filth abounded, and the ventilation was often so abominable that the attendants and inspectors would not enter in the morning without a sponge dipped in vinegar held to their faces. Septic fevers and other contagia were the rule; the average mortality was about 20 per cent., and recovery from surgical operations was, in the nature of things, a rarity. (1, pages 416-417) (2, page 768-770)

Garrison quotes fellow historian John Herman Baas as saying:

"Even physicians declined hospital service as equivalent to a sentence to death." (1, page 416)

So how about the full quote by Baas.  In his 1889 book, "Outlines of the history of medicine and the medical profession," Baas likewise describes the situation inside most hospitals as deplorable.  He wrote:

Most of the hospitals were still in a lamentable, indeed, a dreadful condition, rather nests of disease than institutions for the cure of the sick: for hospital hygiene, with which even Theophrastus von Hohenheim (Paracelsus) was acquainted, was utterly lost sight of or neglected... Such was the condition of affairs almost everywhere, and it was not until the introduction of clinical instruction that the situation was somewhat improved...  How horrible the sanitary conditions of the hospitals were at the close of the 18th and the beginning of the present century, may be judged from the fact that in some places, e. g. Frankfort-on-the-Main, even physicians declined hospital service as equivalent to sentence of death. (6, page 768-770)

Anatomical knowledge did start to improve during the course of the 18th century, so over time the ability to perform surgeries must have likewise improved.  However, there continued to be a high death rate anytime a patient was cut open mainly due to the high rate of infections.  There must have been a rise in successful surgeries, only to have the patient die later of infection.

Along with the exceptional men who inspired improvements anatomical wisdom, pathology, internal medicine, etc., there were also exceptional men (and women) who inspired humanitarian movements that resulted in improved hospital safety.  Among the first such humanitarians was Florence Nightingale (1820-1910).  She worked hard during the course of her life to improve unsanitary conditions at British hospitals, thereby reducing death rates by as much as two-thirds (2)

Surgeries continued to be performed rarely, and only in emergent situations, until the middle of the 19th century when the scientific revolution was in full swing. It wasn't until men like Oliver Wendell Holmes,  Ignaz Philipp Semmelweis, Louis Pasteur, and Joseph Lister discovered that diseases were spread to patients by infected and unclean environments, and the means of preventing their spread was by creating a germ free environment.  

So it was efforts by folks like these that, slowly, resulted in improved conditions at hospitals.  Walls were painted white, and surgeons and nurses wore white linens so that dirt could easily be spotted.  Physicians and nurses were likewise encouraged, if not ordered, to wash between patient visits, and after surgeries.

Yes, the profession of medicine was slow to adapt to change, although in time it did what was humane; it did what was right; it did what was scientifically proven to benefit of the general public.  The result was a significant reduction in the spread of disease at hospitals, and a corresponding reduction in mortality.

Although while physicians were available at such institutions, and the remedies were probably on hand (what few and insignificant ones there were), these were not ideal places for asthmatics.  Until the turn of the 20th century, and the invention of medicines like cortisol and epinephrine, asthmatics found better results by toughing it out, or calling for their family physician.

So none of the above had an immediate impact on asthma per se.  However, with the advent of the germ theory of disease, this created a pathway to allow for a significant reduction, and in many cases eradication, of many diseases that plagued the civilized world.  With those diseases controlled, scientists now had an opportunity to focus on that were widespread, although not so deadly -- such as asthma and allergies.

References:

1. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1921, London and Philadelphia, 
2. "Florence Nightingale Biography," Biography.com, http://www.biography.com/people/florence-nightingale-9423539, accessed 6/26/13
3. "Louis Pasteur Biography," Biography.com, http://www.biography.com/people/louis-pasteur-9434402, accessed 6/26/2013
4. "Joseph Lister Biography, "Biography.com, http://www.biography.com/people/joseph-lister-37032, accessed 6/26/2013
5. "Joseph Lister," historylearningsite.co.uk, http://www.historylearningsite.co.uk/joseph_lister.htm, accessed 6/26/13
6. Baas, John Herman, "Outlines in the history of medicine and the medical profession," translated by H.F. Handerson, 1889, New York, J.H. Vail and Co.

Does obesity cause asthma

The following is a post originally published by me at Asthmacentral.com/asthma on September 26, 2011.

So much evidence links fat with asthma that some folks like to call it Fasthma.  In fact, I was recently emailed this question:   "What are your thoughts on "Fasthma" a.k.a. "Fat Asthma" or obesity related asthma?"

I recently wrote a post  Can Eating High-Fat Foods Trigger Asthma?  I wrote about a 2010 study that determined lung function was worse after eating a high-fat meal.  One theory suggests that your asthmatic immune system might recognize saturated fat as an enemy and promptly acts to rid it from your system.

This response results in an increase in markers of inflammation such as leukotrienes and hystamine, and these increase inflammation in your respiratory tract. This causes muscles lining your air passages to constrict, and thus an asthma attack is the result.

If your exposed to something that's triggering the inflammatory response often enough, this inflammation may become permanant, and thus asthma is the result.  

Experts at the Harvard School of Public Health came up with two more theories why obesity may lead to asthma: 

1. Shallow breathing
2. Hormones released from fat tissue

Breaths are shallower than normal due to fat tissue making less room for the lungs to expand. Full stomachs also puts added pressure on the diaghragm, which further restricts the ability of the lungs to expand.

This shallow breathing increases the probability inflammation will exist in the air passages of the lungs, and this causes the airways to narrow.

Inflammation in of air passages is also believed to be caused by hormones, such as leptin, released from fat tissue. Leptin is present in all asthmatics, but it is elevated in the obese.

Likewise, people that are obese are less likely to have a hormone called adiponectin, which is an anti-inflammatory hormone.

On the flipside, inactivity due to asthma may cause obesity.  It's was also interesting to learn that researchers at Kings College in London discovered that Th2 cells responsible for causing inflammation in the lungs in asthma also a protein called PMCH which is known to increase appetite. 

In another post, Alright Asthmatics! Here's Your Incentive to Get in Shape This Year, I explained several studies that concluded that excissive adipose tissue -- fat tissue -- can cause asthma.  Or in other words, these studies show that obesity causes asthma. 

Consider the following:

• A study completed by the Center for Disease Control showed that obese adults were 66 percent more likely than normal weight adults to have asthma.
• Experts at the University of South California did a study that showed obese children were 1.5 times more likely to be diagnosed with new onset asthma.
• Results from the National Health and Nutrition Examination Survey 2005-2006 showed that "Obese children were about 26 percent more likely to have allergies than children of normal weight".
• Researchers from Kaiser Permanente, Massachusetts General Hospital and Harvard Medical School, people with asthma are five times more likely to be hospitalized for asthma, have a lower quality of life, and have worse asthma control as compared to those with asthma at a normal weight.
• According to a study released in 2007 by researchers at Emory Crawford Long Hospital, obese asthmatics are more likely to have persistent or severe asthma.
• This 2005 study by experts at the Harvard School of Public Health notes that 75 percent of emergency room visits are among asthmatics that are obese.
• Researchers also found obesity to make asthma medicines work less well, and in some cases require higher doses than normally recommended.

Surely a sedentary life from a lifetime of hardluck asthma can cause obesity.  Yet the evidence appears to be overwhelming that obesity can cause asthma too.  With the rising obesity rates of late, this may be something to be concerned about.

Regardless, this is all the more reason to eat a healthy diet and exercise -- especially if you have asthma.