My first trip to the ER in 16 years

For sixteen and a half years I've managed to stay out of the emergency room as an asthma patient.  That was the longest streak of my 43 years on this planet.  The previous long was 4 years, from 1993 to 1997.  Yet, as they always say, good streaks always come to an end.

So I was sitting around, or, rather, pacing back and forth, worrying about what I should do. I was also using my ventolin with increased frequency over the past week and a half.  I actually wrote a post about this once: "Having asthma symptoms? Here's five tips to help you decide what to do." Based on my own tips, I decided it was time to take the plunge and go to the emergency room.  

It was awkward being the patient, as in the triage room I sat on the wrong side of the desk, generating a laugh from the triage nurse.  Twice as a different person came to introduce herself, saying something like, "Hi, I'm Sarah from admitting," I almost said, "Hi, I'm Rick from Respiratory Therapy."  I also have this habit of thanking people. "Thanks for giving me that shot." 

It was my pleasure," the nurse said.  

I added, "What really makes me happy is you gave it in the side of my hip as opposed to my butt, so now I can still sit."

She laughed, "That's what I like about you, Rick." 

The worse part about the visit was that they sent me to a portion of our ER called Fast Track, where a nurse practitioner was pretending to be doctor.  I had tough time explaining to her that I did not have ordinary asthma.  Finally, as she was lecturing me about how I use my ventolin so much, my wife chimed in on my behalf.  She said:

"Rick has had severe persistent asthma his entire life.  He had trouble with it as a kid, and even spent six months at a research hospital once.  He takes all the best asthma medicines, and still needs to take his rescue medicine every four hours, and sometimes more, on a good day: that's as good as it will ever get for him.  If he came to the ER every time he used his inhaler every hour, he'd be in here every day."

That cheered me right up. That flustered the NP, who had trouble speaking after that, and yearned to get out of the room.  But before she could escape, she had to defend her position, although she sputtered in the process.

She came back a while later, and she said she was debating giving me an antibiotic.  I said, "I don't think I need any, as I have no symptoms other than asthma.  But I'll do whatever you want."  I actually wanted to say, "why don't you just do some lab tests, and an xray, to make sure I'm okay."  I think further testing would give me further peace of mind, perhaps relieving some of my anxiety (yes, 300 puffs of ventolin and steroids does increase anxiety).

In good jest, she offered me a sucker.  I said, "How about some xanax?"  She said she couldn't give xanax, but she could give Ativan.  Later, a nurse came in with 1 mg of ativan in a syringe.  

"At home he takes .5 mg of xanax, and 1 mg of ativan is like 2 mg of xanax.  How about giving him half of that so he can function at home," my brilliant wife said (yes, she is also a nurse). "It doesn't make sense that she would give that much ativan when one .5mg xanax works for him just fine."

My thought was: "Dough! Wifey, what are you doing."  But the .5mg ativan worked great, as I got my best night sleep last night in the past week.  I do not, however, feel much better this morning, so we'll have to see how this turns out.  If I end up going back to that place, I'm going to insist on seeing a doctor in the ER, someone who knows a little about asthma; or at least someone with a little common sense. 

I am an asthma conundrum

What is frustrating about my asthma is that I feel worse than I look.  Seriously!  I feel like I can't get a full, deep breath in, and I can feel that I have air trapping when I exhale, but I don't look short of breath at all.  The only way the people around me know I'm short of breath is because I tell them, and I think that deep down my wife probably wonders if I'm making it all up.  But she loves me and so she trusts that I'm telling the truth. 

That's the delimma I have with my asthma.  I was actually having a really good summer asthma wise, until about a week and a half ago when I was rummaging through boxes in my basement.  Since then I've felt this way.  I currently have no allergy symptoms and no signs of a cold.  It feels, to me, like pure asthma.   I've used up a ton of ventolin, via both the inhaler and nebulizer route.  I've gone through at least 2 full inhalers, and who knows how many Albuterol nebulizer treatments. 

The treatments help open me up and make me feel better, although in the end I still don't feel perfectly opened up.  Still, my regular routine of life has not bee effected.  Although, considering I've been pumping so much ventolin into my system, I've been extremely anxious lately, as might be expected.  This is probably exacerbated by the fact I've been getting up several times in the night to puff on my inhaler.  Or, worse, to take continuous breathing treatments in the morning hoping to catch my breath so I can get back to sleep.  But usually, after taking this action, I'm so wired I can't sleep.

So I'm working tonight, and I'm walking around doing my work, when I feel tight.  Well, I've been mildly short of breath all night and all day yesterday, but at the moment I was feeling worse.  So I went back to the department to give myself a breathing treatment, when I decided to run myself through the whole gammut of tests. 

I did a pre and post peak flow: 

• pre: 750 (maxed device out)
• Post:  750:  (maxed device out)

Then I did a pulmonary function test on myself:

• Pre Duoneb breathing treatment
• FVC: 4.42 or 85% predicted
• FEV1: 3.64 or 88% predicted
• FEV1/FVC: 82
• FEF25-75: 3.66 or 96% predicted
• FEF Max: 10.09 or 103% predicted
• Post Duoneb breathing treatment
• FVC: 4.42 or +3
• FEV1: 3.90 or +7
• FEV1/FVC: 86
• FEF 25-75: 4.64 or +27
• FEF Max: 11.20 or +7

Based on these results, you can see that all of these tests show greater than 80% or predicted, which would show that I have normal lung function.  Now from the graphic, you can see a slight obstructed patern, although nothing significant.  However, there is a nice improvement with the Duoneb, so the PFT does shoe a benefit with bronchodilator. 

Still, this is frustrating for me, because I feel like I have air trapping.  I feel like I don't feel normal, so I started myself on a prednisone pack today, yet I really don't fee significantly better after doing that.  What stinks is I was hoping doing this PFT would help me decide what the next course of action is for me to do if these steroids don't kick in soon.  I actually was thinking of going to the ER after work, and I was hoping these tests results would ease my mind a bit.  But not so. 

It could be all in my head, I suppose.  However, as I take a deep breath, and feel that something is in there.  And as I exhale, my exhalation is prolonged and wheezy.  Welp, tis the life of being a hardluck asthmatic.  Yet as you can see here, none of these tests match how I feel. That peak flow meter is about useless to me. 

Now, one more thing I want to add.  You might find this awkward, and I sometimes wonder if any other asthmatics have had the same thing happen.  Once all my kids are up, and things are situated around the house, I go into the basement and do my workout.  Yes, I even run on the treadmill (or wog, or whatever you call it. But at least I do it).

Even yesterday morning, after getting out of bed and telling my wife "I'm still having trouble breathing," I said, "And I'm going into the basement to run on the treadmill."  She said, "How can you run on the treadmill if you can't breath."   I said, "Life must go on." 

My point there was that for some reason my asthma doesn't seem to get worse when I'm running on the treadmill.  Why that is I have no clue.  But I'm going to take advantage of it, because I know from my experience if I let myself get out of shape, I get dyspneic from being overweight, and then everything gets nasty.  So if I can, I work out.  And I have.  But I do a light workout as opposed to a vigourous one when I'm like this.  It goes along with the asthma experts who insist that you should always exercise even when  you have hardluck asthma, or no matter how bad your asthma is. 

So I started a medtol pack after much delay, mainly because it's normal for me to dilly dally, to hymm and haw, and to come up with excuses not to do anything.  Asthma can be so awkward at times.   My asthma is awkward.  It's a conundrum.  It'a a major riddle.  I yearn to see if any of my asthma friends have ever experienced anything like this: where your asthma does not match your appearance, and all your tests are normal, even better than normal (such as your PFTs).  Thoughts?

400-1743: The first use of the term influenza

In the ancient world all diseases were attributed to the wrath of the "diety." If a Pandemic ravaged a village, town or nation, it was attributed to an angry god or spirit.  Both the ancient Greek poet Homer (800-701) and Hippocrates (460-370) described pandemics during their lifetimes.  It's probable some of these were attributed to the influenza virus. 

Homer describes how Zeus used his thunderbolt to "punish impiety," and "for vengeance for an insult offered to his priest, the shafts of the Sun-god carried sickness into the Argive camp, destroying first the dogs and mules, and then thousands of warriors," writes Arthur Hopkirk, in his 1914 book "Influenza."  (1, page vii and viii)

In reality these warriors may have died of a pandemic caused by a virus or bacteria, such as influenza.  Although the ancients had no clue about the internal workings of the human body, nor about invisible invaders of the human body.  It was easier for them to believe in fake gods and attribute them when bad things like plagues happened.

"On mules and dogs th' infection first began;

And last, the vengeful arrows fix'd in man."

Those described as having sweats and chills (signs of a fever) were the most likely to succumb to the disease.  In man's desire to help his fellow man, the following were the remedies tried (1, page 15-16):

• Purging
• Venesection
• Bleeding by the ranal vein
• Emetics

And sometimes the remedy wreaked more havoc than the plague.  If ruthless venesection was performed, this in and of itself could have been the killer.  Yet the plague was blamed nonetheless.

The plague struck again and again.  In 412 B.C. the following was written regarding a plague in Rome (1, page 16):

“A plague, however, which broke out at that time and gave more alarm than it proved destructive, diverted the people’s attention from the forum and political disputes to look after their families and take care of their health. The city was all over oppressed with sickness, though no great mortality ensued.”

It struck again (or so historians think) in (1, page 20-26)...

• 827 A.D. in France and Germany
• 876 in Italy
• 889 in Germany
• 927 in France and Germany
• 996-97 in England
• 1173 in Germany and Italy (it was called "a dense fog" in Italy, first authentic outbreak)
• 1239
• 1311
• 1323 in Italy and France
• 1327-28
• 1357
• 1287 in France and Germany
• 1403 in Paris, France
• 1404
• 1410-11 in France
• 1413-14 in France
• 1427 in France caused a "Poisonous air."
• 1438
• 1482
• 1505
• 1510

The following quote comes from 1323 (3):  

In the year, 1323, and in the month of August, there was a pestilential wind, which caused nearly all the inhabitants of Florence to fall sick of cold and fever, and the same thing took place throughout almost of whole of Italy.

And the following from 1327 (3):

In the said year and month, there was throughout the whole of Italy an infection fever caused by cold; but few people died of it.

Regarding the 1387 outbreak, the following was written (4):

There came a general pestilence in the whole country, with cough and influenza, so that hardly one among ten remained healthy. 

Regarding the 1427 outbreak, an anonymous chronicler from St. Albans wrote (1, page 25-6):

In the beginning of October, a certain rheumy infirmity which is called 'mure' invaded the whole people, and so infected the aged along with the younger, that it conducted a great number to the grave. 

The remedy for the 1387 pandemic, which took few lives, was "decoctions of chamomile and coriander berries, sweetened with syrup and poppies; clymasta; diaphoretics; and low diet." (1, page 23)  This would have been a more pleasant remedy compared to what the ancient Greeks treated the symptoms.  

Many of the deaths that resulted occurred on the fifth or sixth day, and Hippocrates notes that death usually occurred on the seventh day.  Later, in the first century A.D., Galen agreed with Hippocrates that death usually occurred on the seventh day.  (1, page 17)

At some point in our history, sometime in the ancient world, the concept that little creatures in the air may be responsible for spreading some diseases was postulated, although who postulated this theory, and when, remains a mystery.

Hopkirk says the first to write of this concept may have been the Greek "polyhistorian" Varro (117-36 B.C.), who wrote the following:

It is to be observed that wherever there are marshy districts certain most minute animals will grow, which cannot be discerned by the eye; but, carried by the air, reach the body through the mouth and nostrils, causing serious disease." (1, page x)

Varro was referring to the malaria plague in "Corfu when Pompey was there with an army and fleet."  Although the same concept may be applied to other contagious diseases, such as influenza.  Varro recommended the following to prevent the spread of the disease malaria: (1, page x)

• Isolation
• Ventilation
• Destruction of insanitary dwellings
• Etc.

Influenza is known to cause much grief for those afflicted with it, although it causes only a few deaths.  Usually those who die from it are over the age of 65 or have some chronic underlying medical condition that is complicated by influenza.

Prior to the 16th century influenza was referred to by various names, depending on the geographic region of the person describing it.  Sometimes it was simply referred to as a pest, pestilence, or plague.  Historians determine if the "plague" was influenza by descriptions of the symptoms, a high morbidity, yet low mortality rate.  If many deaths resulted, chances are that particular plague was not influenza. (1, page 4-5)

The term influenza may actually have come from a misinterpretation of the Italian word influence.  The idea here is that around 1357 people believed the position of the stars "influenced" outbreaks of the disease.  Although how this term superseded all the other terms and made it's way into medical nomenclature remains a mystery.  (1, page 6)(2, page 31)

The following are just a few other names used to describe various pandemics or endemics most historians figure were influenza (1, pages 8-9):

1. Burzelen:  1307 in Germany (meaning to stumble?)
2. Le tac or le horion:  1411 in France
3. Tonawasches Fieber:  1414 in Germany (Because occurred in Danube district)
4. Coqueluche: 1414 in France (Caused oppressive pain in the head)(Victims wore cap on head)
5. Ladendo:  1427 in France
6. Schafkrankheit or Schafhusten:  1580 in Germany (Sheep's disease, cough)
7. Galanteriekrankheit or Modefieber: 1709 in Germany (Galant malady, fashionable fever)
8. Le Grippe:  1743 in France (from "agripper," meaning to sieze quickly and cause sore throat
9. Petite poste or petite courrier:  1762 in France
10. Zamporina:  Brazil in 1780
11. La Coquette:  France 1780-81
12. Russische Krankheit (lightning catarrh):  1782 in Germany (due to its sudden onset)
13. Corcunda (hunchback disease):  Brazil in 1816.  Violent cough made you hunch your back
14. Polka Fever:  1846-7 in Brazil

In Great Britain during the 14th and 15th centuries, common names were faucht and slaodan.  Creatan was a word derived from creat (chest), and was another common name.  In 1562 it was called "the newe acquayntance.  In 1580 "the gentle correction."  It was also referred to as "the jolly rant," "the new delight," "the Dunkirk rant," and "the knock-me-down fever." (1, page 9)

An outbreak in Britain in 1485 was described as "English Sweat." It was so back that "King Henry VII had to postpone his coronation," according to Evelyn Kelly and Claire Wilson in their 2011 book "Investigating Influenza and Bird Flu."  "The disease was treated with tobacco juice, lime juice, and bloodletting." (2, page 32)

Finally, in 1743, the term influenza was used to describe influenza.  No one knows why, but this is the term that stuck, and has since made it's way to medical nomenclature.  The only exception was in Germany, where the Grippe was the term commonly used as of 1743.  

While the names varied through early history, the "grip" the disease held on it's victims were similar:

• Catarrh:  Inflammation of the respiratory tract (nasal congestion)
• Fever:  Usually over 100 degrees
• Chills:  Associated with the fever
• Headache:
• Body or muscle aches: Especially of the back, arms and legs
• Dry cough: Helps spread the disease from one victim to the next
• Fatigue and weakness:  General feeling of tiredness
• Suspended Business: Many stopped working to take care of their families

It's generally the commonality of symptoms described, the high rate of morbidity, and low mortality, that has allowed historians to feel confidence these epidemics and pandemics were probably influenza.  

References:

1. Hopkirk, Arthur F., "Influenza: It's History, Nature, Cause and Treatment," 1914, New York, Charles Scribner and Sons
2. Kelly, Evelyn B., PhD and Claire Wilson, "Investigating influenza and Bird Flu: Real facts and real lives," 2011, Enslow Publishers, U.S., Chapter 2, "The History of Influenza," pages 29-47
3. Hopkirk, op cit,Gluge, "in the course of his argument, quotes the following passages from Buoninsegni’s Istoria Fiorentina, Florence, 1580." The passages are recorded on page 21 of Hopkirk's book.  
4. Hopkirk, op cit, from Jakob von Konigshoven Stassburg Chronicles, of 1387, as recorded by Hopkirk on page 22 of his book

1750-1850: Tuberculosis wreaks havoc

The industrial revolution swept across the modern from 1750-1850. New inventions improved agriculture, manufacturing, mining, transportation and technology, and this had a stunning effect on culture and economies.  The world was forever changed for the better, or so people suspected.

Yet while culture and economies improved, a vicious killer spread across this modern world.  No one knew what it was. No one knew where it came from.  No one knew what to do about it.  The killer was generally referred to as consumption, and if you got it you were probably doomed. 

Yet since people were ignorant about what it was, and what caused it, and how it was contacted, they didn't know that by getting together in poorly ventilated areas of mills and factories that they were breathing the contaminated air that was exhaled by people who had the disease.  They didn't know that the bacteria was transported through the air and was inhaled.  

They didn't know the disease was spread by sharing hanker chiefs, and by touching contaminated people.  They didn't know that the disease was prevalent before the industrial revolution, but the disease was more of a random disease that occurred here and there by chance.  Yet with the beginning of the revolution, people gathered in small, poorly ventilated areas.  People moved to cities, right into the grasp of the killer.  They did this because they wanted to create a better life for themselves and their children, and they did this not knowing they were living with a beast.  

There were a variety of names for it.  It was called scrofula (swollen lymph nodes), Pott's disease (TB of the bone, spine), the Great White plague (17th century Europe), consumption or phthisis (TB of the lung),  lupis vulgaris (TB of the skin), Mesenteric disease (TB from non-pasteurized milk), white swelling (TB of bone), and King's Evil (TB of of lymph glands). Or sometimes it's simplty referred to as "captain of the ship of death." (9)  We refer to it as tuberculosis.  

A plague swept through Europe in the 16th century, and during this time what Hippocrates referred to as phthsis was referred to as the Great White Plague.  Yet it was usually described by scientists and physicians as either phthsis or consumption and sometimes even scrofula.

During the next 200 years thousands would be killed.  Little was known about it other than it's symptoms.  Usually, a patient was diagnosed by a physician only after the patient noticed he was coughing up blood.  By this time the disease was near its later stages, and prognosis was grim.

  Franciscus dele Bo Sylvius published a book in 1679 called the Opera Medica in which he made the association between nodules in the lungs with phthisis.  Perhaps as a result, in the 17th and 18th centuries there were many references to the disease being contagious, and many warnings about those infected with it.  (3)  Yet for the most part physicians thought it was hereditary, as Hippocrates thought.

Giovanni Baptista Morgagni, an Italian anatomist who lived 1682-1771, wrote quite a bit about medicine in his later years.  He warned that the condition might be an infection and he warned against doing autopsies on anyone infected with it. (1, page 2)

TB was called white plague from 18th-19th centuries

Right around the turn of the 17th century a health edict in the Republic of Lucca in Italy warned: "Henceforth, human health should no longer be endangered by objects remaining after the death of a consumptive. The names of the deceased should be reported to the authorities, and measures taken for disinfection.”(2)

English Physician Benjamin Martin published a book in 1720 called "A New Theory of Consumption."  He wrote that the disease was caused by "wonderfully minute little creatures."  He believed these "creatures" enter the body and cause the symptoms.

Likewise, Martin believed that those in close proximity to the patient, particularly those talking to the person, should be careful.  He wrote:

"It may be therefore very likely that by an habitual lying in the same bed with a consumptive patient, constantly eating and drinking with him, or by very frequently conversing so nearly as to draw in part of the breath he emits from the lungs, a consumption may be caught by a sound person...I imagine that slightly conversing with consumptive patients is seldom or never sufficient to catch the disease."

In 1793 Dr. Matthew Ballie published a book "Morbid Anatomy of Some of the Most Important Parts of the Human Body." (?check year and book)  He provided a description of the lungs and many lung diseases.  He wrote about consumption, and was among the first to note nodules in other organs other than the lungs.

In 1689 Richard Morton (1637-1698) used the term "tubercle" to describe lesions he saw in organs of those who died of consumption.

Rene Laennec was born in 1787 and contacted tuberculosis as a young adult.  He became rapt in studying this disease during the course of his career as a physician.  He is best known for his invention of the stethoscope.  He was also the first to master its use.  He was also the first to see tubercles in lung tissue of those patients?

In 18? he published "A Treatise on Diseases of the Chest, and of Mediate Auscultation."  He
described how to use the stethoscope in assessing and diagnosing patients.  He also discussed the pathology of many disease processes, including what was used it to describe symptoms during various stages of the condition.

Laennec met his demise by the grips of tuberculosis in 1826 at the young age of 45.

Samuel George Morton  (1637-1698) was a pupil of Laennec.  In 1834 he published his own book titled "Pulmonary Consumption."  This would be the first book on the subject published in the United States. (4, page 10).  He recommended that the age old practice of bleeding patients who are coughing up blood was a "plan that has hurried thousands of patients to their graves by destroying the last remains of strength."

However, if the patient was of good strengh with a good pulse, he recommended "ten or twelve ounces of blood, taken rapidly from a large oriface, may divert the current of the circulation and relieve the pulmonary congestion."  (5, page 120).

This would work because the condition resulted in ulcers which dry and the blood becomes congested around these regions causing the ulcers to burst, and this is why these patients spit up blood.  He beleived bleeding prior to this happening would help prevent the congestion.

Other remedies may may also help "promote absorption of the congested blood" include:

• Spirits of turpentine
• Elixer of vitriole
• Common salt
• Opium
• Sugar of lead
• Rest
• Diet of gum water and farinaceous food

He likewise agreed with a Dr. Beddoes who recommended a ride in the fresh air as treatment.  Morton quotes Beddoes:

 "In haemoptysis and pulmonary hemorrhages, I never observed any bad consequence from traveling in a carriage:  on the contrary, I have known these discharges to stop on a journey, though previously they had, for many days, occurred at least once in twenty-four hours."

Johan Lukas Schönlein (1793-1864) wrote relatively little during his life.  He wrote a doctoral thesis and two papers of 1 and 3 pages respectively, although that was it. Still, despite his lack of enthusiasm for writing, it was Schönlein who introduced the terms hemophilia and tuberculosis (1839). The word "tuberculosis" was derived from "tubercle", a word introduced by Morton in 1689 to describe the characteristic lesions of consumption.

The mid 19th century was a time when many scientists and doctors were experimenting with microbes.  In 1843 Dr. Klencke became the first to cause an animal to develop the condition by innoculating a rabit with "portions of miliary and infiltrating tubercules from a man.  Klencke, after accomplilshing this result, did not continue his investigations, and they were consequently soon forgotten."  (6)

Despite all the research that had been done prior to 1865, many physians believed that each case of tuberculosis "rose spontansously in predisposed people."  (2)  Yet it was in 1865 that a French military physician named Jean Antionne Villemin proved that tuberculosis was caused by an infecting organism.

He innoculated cattle with both human tuberculosis and bovine tuberculosis. (6)  He thus proved that two diseases were of similar origin, and he proved that the disease could be transferred form a human to cattle and from cattle to rabbits.  (2)

Regardless of Villemin's work the idea that tuberculosis was a spontaneous condition was ingrained in the minds of many, and they performed many experiments trying to prove Villemin wrong.  Yet in the end Villemin's ideas won out.  Although it took a few years.

Robert Koch (1843-1910) was the next to perform many experiments on tissue from tuberculosis victims to see if he could learn more about it and come up with a cure.  He invented a staining method that allowed him to see the tubercle bacillus.  And, through "artificial cultivation," he was able to grow the bacillus.  He then proceeded to reproduce the characteristics of tuberculosis in animals.  He also identified different forms of the disease in various animals.

Today paleopathologists (scientists who study ancient diseases) are unable to identify tuberculosis by finding the bacteria because they "disappear" shortly after the victim dies.  (8)  Yet some types of the disease effect bones and joints leaving scars that can be identified.

References:

1. Norris, Charles Camblos, "Gynecological and Obstetrical Tuberculosis," 1921, New York, London
2. Koehler, Christopher W., "Consumption, the great killer," http://pubs.acs.org/subscribe/archive/mdd/v05/i02/html/02timeline.html
3. "History of TB," New Jersey Medical School, Global Tuberculosis Institute, http://www.umdnj.edu/ntbc/tbhistory.htm
4. Klebs, Arnold Carl, "Tuberculosis," 1909, New York
5. Morton, Samuel, "Pulmonary Consumption," 1834, Philadelphia
6. Flenner, Simon, , "Immunity in Tuberculosis," Annual report of the Smithonian Institution, 1907, New York, page 627 
7. "Captain of the Men of Death," Ulster Med J. 1989; 58(Suppl): 7–9.
8. Sigeris, Henry E, "A History of Medicine," volume I, "Primitive and Archaic Medicine," Second Edition, 1955, New York, Oxford University Press, page 53
9. Seth, Vimlesh, SK Kabra, Rachna Seth, "Essentials of Tuberculosis,"  Third ed., Jaypee Brothers Medical Publishing, 2006, page 3-4
10. Jones, Greta, "Ca;ptain of All These Men of Death," 2001, New York
11. Prioreschi, Plinio, "A History of Medicine," 1991, volume I, "Primitive and Ancient Medicine," Edwin Mellen Press, Chapter VII, "biblical Medicine," page 514
12. Landau, Elaine, "Tuberculosis," 1995, New York, Chicago, London, Sydney, Franklin Watts, pages 13-32

Photos:

• 1.  from  http://www.grantvillegazette.com/articles/The_White_Plague

Further reading:

• Essentials of tuberculosisi in children
• Johnson, H.A., "Consumption in the Northwestern States," The Chicago Medical Journal and Examiner, Volume 37, William M. Syford, et al, editors, 1878, pages 133-143

1976: What causes asthma?

So it's 1976 and you're an asthma doctor.  You look into your medical books and magazines to get an update on the latest asthma wisdom.  When you were in medical school in the 1950s you were taught asthma was a disease of bronchospasm that mainly occurred when the asthmatic was anxious or stressed.  You want to know if things have changed.

Ever since the 1850s doctors suspected the mother as a major source of asthma.  In 1976 a report in the Archives of General Psychology noted that most psychologists "generally agree on the mother as one primary cause of childhood asthma.  'Something in the mother's personality sets off a child's dark, hidden fears and anxieties,' the theory goes.  'This in turn produces allergic reaction in the child which constrict the bronchial tubes and make breathing difficult or even painful."  (1, page 125)

Most psychologists agree that the mother is a source of stress for the asthmatic.  When the mother scolds the child this induces an inner anxiety.  Of course mothers may not understand that an asthmatic child may have psychological issues of his own just because he is asthmatic, such as:

• Kids picking on him because he is wheezing, sniffling and sneezing
• Kids picking on him because he is perceived as the wimp because he can't play sports 
• Not being able to do things with his dad, such as hunting camp, hunting, stacking wood
• Not being able to play with his siblings in the dusty basement, fort, outdoors.
• Not being able to play outdoors in cold weather
• Not being able to play outdoors when chimney smoke fills the air
• Humidity:  Yes, that humidifier your mom and grandma used can make asthma worse because it makes the air thicker, and creates a breeding ground for germs

All of this is true, and all of this causes anxiety.  Yet these in and of themselves are symptoms or consequences of asthma, not the cause.  Yes, they can make asthma work, but they do not cause asthma.  Yet, still, asthma experts in the 1970s and 1980s don't quite understand this.  They continue to place a major emphasis on the the theory "it's all in your head," as opposed to looking elsewhere for causes.  

However, and thankfully, the psychological theory of asthma started to fade in the 1970s.  More and more studies seem to disprove it.  Many doctors and psychologists start to doubt this theory, and they start to postulate new ones, such as (1, page 124-127):

• Air pollution causes it.  Studies start to confirm this
• Eczema causes it.  About 50% of kids with eczema end up with asthma 
• Food causes it.  Many kids are showing signs of milk and chocolate allergies
• Infections cause it:  Many kids with colds end up with asthma symptoms
• Emotion causes it:  Yes, it can still trigger an attack
• Family incompatibility:  Yes, stress induced from parents can cause it  Mom's who refuse to get rid of dogs.  Moms who refuse to get rid of indoor plants.  Parent's who refuse to become educated about this disease, and get irritated when their child is different than other kids
• Climate changes:  Living near allergens, hay fields, grass fields

Yes, the asthma experts start to look in other areas, and this is a good thing.  It pretty much sets up the next stage in the evolution of asthma, which takes place in the late 1990s with the initiation of asthma guidelines.

Another idea that still abounds is the removal of the asthmatic from the climate.  If the child lives around a hay field, it may be best to move to a region of the United States where there are no hay fields or other such allergens.  Many are still taking their asthmatics to places of higher altitudes and drier air, such as Denver and Phoenix.

Many asthmatics quit their jobs, or quit school, and moved away from their family and friends seeking a place where their asthma or allergies was improved.  Some left permanently, and others left temporarily. Some were removed from their homes and admitted into asthma institutions like National Jewish Hospital/ National Asthma Center in Denver, Colorado. 

The theory that asthma is all in your head starts to fade in the 1950s, and the idea that asthma is caused by other things, such as pollution, also start up at this time.  But convincing a dogmatic medical community often takes time.  Yet once new causes are understood, this can often lead to better treatment, and a better life for the asthmatic.

New ideas have to be taught to a new generation of medical students, and the older doctors either have to accept change, admit they were taught fallacies, or we just have to wait for them to retire.  New ideas like the ones above slowly grew in the medical community by the process of assimilation. 

References:

1. "The Encyclopedia of Common Diseases," by the staff of Prevention Magazine, "What makes children asthmatic?" 1976, United States

1654: Bennet describes the inhaler

The Bennett Inhaler (3)

While the inhaler isn't invented until the 19th century by Dr. Stern and Dr. Mudge, Dr. Christopher Bennett (1617-1655) is the first to draw up an illustration of an inhaler for the medical community in his book "Theatri Tabidorum," that was published in 1654.  His was essentially the first method of inhaling medicine aside from primitive methods such as inhaling smoke from a pipe.  (1, page 173)

Bennett was an English physician who had tuberculosis.  He "gave us four woodcut drawings of an inhalation device, with measurements enabling the reader to have their own inhaler made.  The treatment was balsam.  There is no evidence that Bennett's inhaler was ever manufactured.  Bennett succumbed to tuberculosis the following year."  (2, page 530)

He was only 38 when he died.  (3)

References:

1. Korting, Monika Schafer, editor, "Drug Delivery," 2010, Germany, Springer-Verlag Berlin Heidelberg
2. Smyth, Hugh D.C, Anthony J. Hickey, "Controlled Pulmonary Drug Delivery," 2100, Springer New York Dordrecht Heidelberg London
3. Sanders, Mark, "Bennett's Inhaler,"  http://www.inhalatorium.com/page162.html, the picture is also compliments of Sanders.  

1976: How to treat asthma?

By 1976 asthma physicians have a much better grip on this disease called asthma.  The age old theory that an asthma attacks occur when one is exposed to an asthma trigger is now engraved in stone.  The reaction is contraction of the airways that results in air trapping and trouble breathing.  The other age old theory that asthma is all in your head, starts to fade away.

Yet it's still a very stressful time for asthmatic children and their parents.  There are still mysteries about the disease, and fears that medicines that help adults will harm children.  The basic plan of attack is to treat acute symptoms.  If you are having an attack you're to use your rescue inhaler (which was Alupent back then) and to start taking your inhaled corticosteroid (which was beclomethasone).  

There was a fear abounding that if you took your inhaled steroid every day it would cause the same side effects that taking systemic steroids cause.  So I imagine it was based on this fear that one of my discharge papers from a hospital discharge in 1981 was this:  "Use your Vanceril (Belclomethasone) until you start to feel better, and then use it when you have trouble breathing." 

There were other medicines, such as theophylline and Alupent syrup.  These were the medicines I was prescribed.  My doctors were probably scared that my heart wouldn't be able to take the Alupent, so they never prescribed it for me.  I think this was a grave mistake that resulted in many miserable nights for me and other asthmatics like me.  

Because doctors were scared, this lead many moms and dads to go to bed at night worried that they would have to get up in the night to watch their child suffer.  And there were asthmatics like me who suffered and didn't tell their parents because they didn't want to bother them.  Or, perhaps we suffered alone because we were simply children and didn't know any better.  We were so used to having asthma symptoms it was just a normal part of life for us.  

I think the staff of Prevention Magazine say it best when they wrote the following (1, page 124):

In hundreds of thousands of homes across the United States, parents go to bed each night fully aware that they might be awakened in the hours before dawn by a child wheezing and gasping for breath.  No matter how experienced they become in the ways of an asthmatic child, parents never really get over the terror of these moments.  To forestall further asthma attacks, they will consult one doctor after another, move out of the state, buy expensive drugs and special foods.  They reluctantly forbid their child to play outdoor games and veto the purchase of a family pet that could trigger future attacks.  

Yet parents who are poorly educated missed the signs not realizing their lack of asthma wisdom is the problem.  Doctors are unable to help because they are likewise in the dark regarding the latest research. At this time, the most well educated physicians were those associated with research hospitals such as National Jewish Hospital/ National Asthma Center (NJH/NAC) in Denver, Colorado.

The wisdom of this era was close to being complete, but not quite there yet.  In order get the best asthma relief, asthmatics would have to visit one of the leading asthma hospitals, such as NJH/NAC.  Regional doctors simply weren't up to speed, and not quite able to help parents help their children to tackle the asthma beast.

In the meantime, for those asthmatics unable to gain control by seeing a regional physician, and those unable to seek the asthma experts research hospitals, they continued to suffer.  As they are forced to watch their children suffer, parents suffer to.

References:

1. "The Encyclopedia of Common Diseases," by the staff of Prevention Magazine, "What makes children asthmatic?" 1976, United States, page 124