1940s: Stories from National Jewish Health x

The 1940s saw a significant drop in the number of tuberculosis victims.  There must have been a fear that both National Jewish Hospital and National Home for Jewish Children would be forced to close.  However, the idea of "parentectomy" gave birth to a new clientele: asthmatic children.

What follows are three true stories sent to me from these patients.  Keep in mind names will be changed to protect the identity of the patients, although they did submit these stories and would probably love that I'm sharing them here.

National Home for Jewish Children in Denver:
National Home for Asthmatic Children:

From a patient from Huntington Beach, CA (1943-1944)

When I was 12.5 I was sent to Denver for my asthma by the Social Services of Beth Israel hospital in New York.  It happened to be in 1943, in July or August.  It was either called the national Home for Jewish Children in Denver, or the Jewish National home for Asthmatic Children in Denver.  I remember it was a large facility opposite Lake Junior high School which I attended when school started.

I came from New York with another girl named Ellie.  My name was Nina.  I was very lonesome and homesick, but I made friends and was aught up in the daily schedule of making my bed, eating in a large dining room, giving my clothes to be washed  (I think the number they gave me for the laundry was 22.)  I have used that lucky number ever since when I go to Las Vegas!

I remember Sunday School, which I had never gone to before.  Since I played piano, I found a piano teacher close by to go to for lessons.  I remember going down town with a lot of kids to see a movie.  I also remember seeing the Brown Palace hotel from a distance.  I remember trudging through high snow banks to Lake Junior high across the street.

Some of my friends were...  I believe Mr. Cohen was the Superintendent at the time.

I was there when VE Day was declared and everyone was happy.  That was the summer of 1944.  I left the next month in July to go back home

I have fond memories of the Home even though I was very homesick.  Though the years, I have been in touch with some of the kids I met there, and they are very special to me.

National Jewish Hospital:

From a wife of a patient from Tarpon Springs, FL (1943-4):   From a wife whose husband was a resident (1945-47) but is too ornery to share sentimental memories!

By the time I met and married my husband, Tim, he was an active, successful, fun-loving man with little evidence of illness.  It took months of dating before I even realized he used an inhaler.  He eventually explained what asthma was and how it had impacted his early years.  he told me how his time (nearly two years) at the National Jewish Hospital altered his life immeasurably.

He said at that Home he learned how to be "normal" and participate fully in life.  It was there that he became an outstanding athlete.  This was a gift that enhanced his life from high school, where he was a star basketball player, through adulthood, which has included years of organized softball, basketball, touch football, and vigorous racquetball along with years of coaching kid's sports.

Although he never really shared many memories of being sickly, my mother-in-law related to me the anguish of having a child so ill she sometimes thought he would never grow up.  She talked about a neighbor's asthmatic child who had died and the impact that had upon her -- the enduring sadness and fear.  She said she was told that the only chance her son had for living a normal and relatively healthy life was to send him to Denver.  She said it was a very difficult decision to make.

Living in the Bronx, New York, they were working people who couldn't afford to move, therefore sending their nine-year-old to the National Jewish Hospital was their only hope for his future.

The thought of sending her child so far away tormented her.  She said that in order to prepare her -- and Tim -- for this ordeal, they visited a psychiatrist several times who focused on the ensuing separation, (Tim has no recollection at all of seeing a psychiatrist or therapist. I surmise that he was so young, that these visits never registered as therapy sessions.)

Tim recalls leaving his mother, father and little brother and boarding a train for a very long ride to Denver.  (And returning two years later to discover a baby sister, born while he was away!)

He recalls arriving at the hospital and at some point being asked to relinquish his inhaler.  He remembers being overwhelmed by the number of inhalers in this particular room -- shelves, filled with hundreds of inhalers in all shapes, colors, and sizes.

Tim has mentioned fondly a room with a piano, the school he attended, and the wonderful times he had there, better than any other times in his life up until then!  He talks of how he learned to deal with his illness, how he was encouraged to do everything, how he was taught to handle emotions and to take care of himself in nearly every situation he would face.

As a rule, Irving speaks very little of his asthma or of his time in Denver.  He prefers to function as a healthy, ordinary man who had an ordinary childhood.

I personally thank the people at National Jewish who made it possible for me to have a healthy, active, loving, supportive husband who was the absolute best father any children could have!

From a patient from Ft. Collins, CO. (1949-51):  Remembering Mr. G., the many friends and fond memories of my time at the National Home for Jewish Children in Denver.  Hello to all:  (She lists names here).  I once had the nickname, Mousey, in those days.  I remember sneaking out at nights to Bears Stadium, swimming at Washington Park, Elitch's, and of course, Sloan's Lake and Lake Jr. High.

From a patient from Ft. Collins, CO (1941-1945):  Some o fmy memories.  I remember vividly the huge amounts of food available, having just arrived from Germany (no mat, no milk there -- mostly cabbage.)  I gained 20 or 30 pounds in the first month!

I was among the first to receive a phrenic crush with pneumoperiteum (note: phrenic crush is where a nerve supplying the diaphragm is cut off.  Pneumoperiteum is gas in the abdominal cavity.  I am not sure the connection here to asthma, although there were some questionable procedures performed to treat asthma).

I fondly remember Dr. Japha, also Dr. Rosenbloom, and Dr. Kaufman, Medical Director.

First I was in the big B'nai B'rith Building, later the Guggenheim Building, and finally, as the sort of caretaker, in the Nurses' Building on the corner of Colorado Blvd. And 14th Ave.

I remember other young patients. (She names three).

References: 

1. "Our Memories," National Jewish Medical and Research Center Patient and Resident Reunion," July 30-August 1, 1999, National Jewish Medical and Research Center, Denver, Colorado, Memories is a packet put together for former patients who visited the institution for the reunion.  Note:  I would be more than happy to send a copy of this little booklet to anyone who requests one.  

30,000 B.C.: Fumigations were the first inhalers

It is probably true that the first inhalers were probably fumigations.  And there's really no idea of knowing when the first fumigations occurred.  As I note many times in this history, it probably first happened by accident; someone tossing poisonous herbs into a fire, accidentally inhaling them, and realizing the enjoyable side effects.

After a while it was probably done on purpose with the intentions of relaxing and listening to visions sent during hallucinations from the gods or spirits.  Medicine men may have experimented with small fires, and then large fires were made at night with the clan surrounding the fire.  This may have occurred as far back as 30,000 B.C. 

Egyptian scribes made the first recordings of fumigations with cyphiac.  Cyphiac was, "according to Dioscorides, a mixture of various drugs, and as the Egyptians had made great advances in the use of spices, balms, and other odorous medicines, it is probable that these entered largely into their cyphi. As soon as men began to use warm baths, indeed, as soon as they made water hot, they would become acquainted with its vapor, and probably notice the soothing effect of breathing steam, and endeavor to turn it to useful account."  (1, page 276)

So early on in human history mankind had access to fumigations of smoke and steam.  While this may have originally been part of religious ceremonies, there came a time in the course of history, perhaps at some point in both Ancient Egypt, where it was realized that smoke could better used for medicinal purposes when the herbs were placed on heated bricks and inhaled this way. Sometime around the time of Jesus poeple in some nations learned how to control smoke by making crude pipes for inhaling herbs. So now people had use of several methods of inhaling medicines, including fumigations of smoke and steam, insents, pipes, and ultimately cigarettes. 

The Ancient Greeks also describe fumigations, as Homer mentions them.  And, much like the Egyptians learned to master smoke for medicinal purposes, the Greeks learned to master steam for medicinal purposes.  Around 400 years after Homer Hippocrates mentions an inhaler-like device of which I describe in detail in this post.

When Greek wisdom made it's way to Rome, this wisdom traveled with it.  When Roman knowledge made it's way to the Arabs, this wisdom traveled with it then too.  So, despite most of our efforts on the study of inhalers made by man, the first inhalers were probably simple fumigations. 

(1, page 276)

References:

1. Prosser, James, "The Therapeutics of Respiratory Passages," 1884, New York, pages 281-282

1808: Reisseissen discovers smooth muscles along air passages

Samuel Thomas von Sommering (1755-1830)
was a German physician and anatomist who,
confirmed Reisseissen's discovery. (6, page 4)

Dr. Franz Daniel Reisseissen (1773-1828) was a German physician who studied the lungs, and proved that smooth muscles line the air passages.  This was a significant discovery, and set the stage for later physicians to prove the spasmotic theory of asthma.

He performed experiments in 1808, and the results were published as essays in Berlin in 1822.  (1, pages 196-197)

W.H. Geddings, in the 1885 edition of A System of Practical Medicine, said Reisseissen discovered...

..."smooth muscle fibres of the bronchial tubes. These fibres are found not only in the large and medium-sized bronchi, but even in those of the smallest calibre." (2, page 185, 193)

Emanuel Aufrecht (1844-1903) attended school
in Berlin and was a student of Ludwig Traub and
Rudolf Virchow.  He graduated from medical school
in 1866.   He became a physician at Magdeburg-
Alstadt City Hospital in 1868, and physician in chief
of Internal Medicine at Magdeburg in 1879. He
worked out the arrangement of the bronchial muscle

 fibres. (7, page 163)  While chief of clinical medicine 

Magdeburg he published a book with his colleagues in

 1902 called "Diseases of the Bronchi, Lungs and Pleura," 

(8, title page)

Gedding said the discovery was "The first step toward a truly scientific theory of the pathology of asthma."

Without his discovery, none of the discoveries that readily proved asthma was spasmotic would have been possible, including those of Charles J.B. William and Francois Longett.

Rene Laennec, in his 1819 book "Mediate Auscultation" said there were various theories as to the structure of the lungs prior to Reisseissen's discovery.  For instance, Laennec said: (3, page 154)

(Marcello) Malpighi conceived that the air cells were formed by the inner membrane of the bronchi being divided, previously to their termination, into cells like those of a sponge. Helvetius fancied that he had ascertained by direct experiment, that the air cells were formed by a simple cellular tissue, disposed without any regular order, and derived from the cellular envelopes of the various vessels by which the lungs are traversed. (Albrecht von) Haller entertained almost the same opinion, which is, indeed, that of the greater number of anatomists. (3, page 154)

M. Varnier confirmed Reisseissen's experiments
that the bronchi may constrict when stimulated.
He believed "irritating fluids or fumes forced
into the lungs caused contraction therof."
There were also various other physicians
who confirmed Reisseissen's experiment,
including: Prochaska, Gotfried, Reinhold,
Treviranus, and Wedemeyer
(6, page 4)(7, page 27)

The speculation ended when, according to Laennec, Reisseissen...

...by means of a great many microscopical observations and mercurial injections, has ascertained that the bronchi, at their extremities, are subdivided into a multitude of small canals, terminated by cul-de-sac of globular form, grouped somewhat in the manner of terminal branchlets of cauliflower. (3, page 154)

John Forbes quoted Reisseissen as saying...

... that, although it appears difficult to follow the muscular fibres further, analogy leads us to admit their existence in the smaller branches, and perhaps even in the aircells (later to become known as alveoli)." (4, page 186)

Dr. J.B. Berkart, in the 1878 edition of his book "On Asthma: It's Pathology and Treatment, said that while Reisseissen was aware of muscular fibres surrounding the large and small air passages, their function remained a mystery to him. (5, page 17)

The significance of these muscular fibres has still not been determined as of this writing.  However, the significance of them as far as the pathology of asthma was concerned lead to a massive search that would last the rest of the 19th century.

The task, however, was begun by Charles J.B. William and Francois Longett.

References:

1. Addison, Thomas, J.M. Bourgery, and George Rainey, "On the air cells of the lungs," The Edinburgh Medical and Surgical Journal, volume 69, 1848, pages 192-214
2. Geddings, W.H., author of the chapter on "Bronchial Asthma," in the book  "A System of Practical Medicine," edited by William Pepper and Louis Star,Volume 3, 1885, Philadelphia, Lea Brothers and Co.
3. Laennec, Rene Theophile Hyacinthe, "A treaties on the diseases of the chest, and on mediate auscultation," translated by John Forbes, 1838, New York, Philadelphia, Samuel S. and William Wood, Thomas Cowperthwaite and Company
4. Forbes, John, ed., "The Cyclopaedia of practical medicine," 1833, volume 1, page 186
5. Berkart, J.B., "On Asthma: It's pathology and treatment," 1878, London, J. & A. Churchill
6. Shmiegelow, Ernst, "Asthma, considered specially in relation to nasal disease," 1890, London, H.K. Lewis
7. Brown, Orville Harry, "Asthma, presenting an exposition of nonpassive expiration theory," 1917, St. Louis, C.V. Mosby Company
8. Hoffman, Friedrich Albin, Ottomar Rosenbach, Emanuel Aufrecht, writers, John H. Musser, editor, Alfred Stengel, translator, "Diseases of the Bronchi, Lungs and Pleura," 1902, Philadelphia, New York and London, W.B. Saunders and Company. 

5,000 B.C. -1500 A.D.:The first inhalers

Like the discovery of fire, the first inhaler was probably the product of an accident, or mere coincidental reaction of thinking man.

After playing with certain herbs, they may have been tossed into the fire, and a brief ease of temperament may have ensued by those who inhaled the fumes.  Upon further study it must have been learned that the herb in question, perhaps opium, could be used for recreation -- a gift from the gods, perhaps.

Experimentation must have ensued with other drugs, perhaps by a medicine man.  It was ultimately learned that inhaling the fumes of dried and crushed herbs such as black henbane, strammonium, and belladonna resulted in relaxation of the mind.  Then one day an asthmatic, coincidentally perhaps, noticed his breathing was eased by such an inhalation.

To better direct the fumes, some unknown tinkerer tossed a brick into the fire, took it out while it was piping hot, and tossed the herbs onto this, crouched down upon his knees, placed his nose up close to the fumes, and inhaled.  This was a technique mentioned by ancient Egyptian scribes.

Such technology must have made it's way to Greece, and physicians fine tuned this discovery so the medicine was placed in a simple pot with a hole in the lid.  A hollow reed was inserted into the hole, and the patient placed his lips to the reed and inhaled the fumes this way.  (1)  The "herbs and resins were boiled with vinegar and oil which were drawn into the lungs" through the tube.  (2)

Such a device was mentioned by the Hippocratic writers, and perhaps even Hippocrates himself.
Various medicines would have been experimented with, and trialed for certain symptoms.  You may have tried it for your asthma, although that's not necessarily what Hippocrates himself would have prescribed.

From Hippocrates onward physicians and philosophers and other interested persons obtained the writings of Hippocrates, and they copied him.  Each successive expert on such devices shared this wisdom through their own writings, often plagiarizing previous authors.  The works of most of these authors have disappeared in time, although shared vaguely through works that still remain.

Experimentation and observation educated men that certain herbs helped certain symptoms quicker when inhaled.  It was learned that patients complaining of certain symptoms showed certain signs.  For example, the child complaining of a stuffy, runny nose and breathing trouble had a red and inflamed nasal passage and throat.  These symptoms were eased by directly inhaling certain herbal combinations.

First by word of mouth, and then by texts, this knowledge traveled through time.  Medicine men, and later physicians, learned that the vapours of certain herbs helped patients experimenting symptoms of breathing difficulty and cough were associated with signs such as red, inflamed nasal passages.  Terms such as dyspnea, cough, catarrh, and coryza are recognized over time, treated with various inhaled herbal preparations.

Found in Valencia circa 800B.C.-1200A.D. (6)

By studying the works handed to them, Greek and Roman physicians experimented on their own and came up with adaptations and theories.  In Ancient India various herbs were stuffed into crude pipes and inhaled. (2)

In Rome Galen wrote about such inhalations by means of devices similar to that described by Hippocrates.  So to did Actius (500-600? A.D.).  And so to did Arabic authors such as Rhases, Aegineta, Avicenna and Haly Abbas.  (3, page 7)  Around 1190 A.D. Mamonides recommended the primitive method of tossing herbs into the fire and inhaling.  (1,2)

The medicinal, or recreational, component varied through time.  In ancient Greece and India it may have been Black Henbane, Strammonium,  Belladonna or Indian Hemp, all of which would have provided some hallucinogenic qualities necessary to ease the mind of the sufferer, and to generate mild relief from breathing difficulties.

One of earliest discovered medicines was opium, and this may also have been inhaled and prescribed by various medicine men in the primitive world and physicians in the ancient world. Opium inhalation was prescribed in ancient China through metal inhalers or incense.  (2)

Arica Inhaler (Northern Chile, Southern Peru, 1500 A.D.)(7)

Other substances, wither herbal or solutions, were experimented on at various times.  Haly Abbas, for example, recommended inhaling vapors of vinegar, camphor, arsenic and other substances.  Avicenna recommended inhalation of pine fruit.  These remedies may also have been recommended for diseases such as asthma, phthisis (tuberculosis of the lung), bronchitis, emphysema and other diseases of the airway (3, page 7)

Paulus Aegineta (930-1037 A.D.) recommended arsenic in "fumigation with resin in chronic cough, when its steam is inhaled by means of a syphon." (5, page 324-5)

Such technology made its way as far as central America by 1500 A.D. as an inhaler of sorts was used in Southern Peru.  It consisted of a small, decorated plate-like device that held a combination of tobacco-like substances that were inhaled through a small, hollowed out wooden mouthpiece.  It may not have been used for medicinal purposes, although it was an inhalation device.  (4)

References:

1. Anderson, Paula J, "History of Aerosol Therapy: Liquid Nebulization to MDIs to DPIs," Respiratory Care, 2005, September, volume 50, number 9, pages 1139-1150 
2. Sanders, Mark, "Inhalation Therapy: An Historical Review," Primary Care Respiratory Journal,  2007, volume 16, issue 2, pages 71-81
3. Scutter, John M, "On the use of medicated inhalations in the treatment of diseases of the respiratory organs," 1867, Cincinnati, Moor, Wilstach, and Baldwin
4. Sanders, Mark, "Arica Inhaler," Inhalatorium.com, page 120,  http://www.inhalatorium.com/page120.html.  Also see  Anderson, Paula J, "History of Aerosol Therapy: Liquid Nebulization to MDIs to DPIs," Respiratory Care, 2005, September, volume 50, number 9, page 1140.  Picture compliments of Inhalatorium.com.  
5. Aegineta, Paulus, translated by Adams, Francis, "The Medical Works of Paulus Aegineta, The Greek Physician, 1834, vo 1, page 325
6. Sanders, Mark, "Ancient Pipes," page 57,  http://www.inhalatorium.com/page72.html, accessed 9/21/12
7. Sanders, Mark, "Arica Inhaler," page 120,  http://www.inhalatorium.com/page120.html, accessed 9/21/12

Asthma History: Part II Introduction

A group of girls learn to sew during a class at the National Home 

or Jewish Children at Denver. The National Home for Jewish Children

at Denver's history began in 1907 as the Denver Sheltering Home for Jewish 

Children, which was a refuge for lower-income children whose parents 

were being treated for tuberculosis, or had passed away 

from tuberculosis.In 1928 the institution changed names to the National \

Home for Jewish Children in Denver.

So far in my history of asthma the story comes from second hand accounts, or historians, or from physicians taking care of asthma patients.  From this point on my accounts of the story of asthma will come from real patients.  If I could I'd make all my asthma history from real life accounts, but unfortunately most asthmatics through time did not, or could not, record their stories unless they so happened to be the physician or historian.  

Of course there were some exceptions.  Teddy Roosevelt and Marcel Proust both kept a journal of their asthma episodes, although in neither case was the intent to create a biography or history of asthma.  Plus Proust was a writer, and Teddy a famous U.S. President. So any attempt to learn about asthma from a lay person will most often lead to a dead end.  In fact, even on the Internet today I have found very few people who do, or are willing to, write about their asthma.  

A group of children in one of the classrooms at National
Jewish Hospital in Denver, Colorado. Teachers
were provided by the Denver Public School System
and young patients were able to complete all grade
and high school requirements while admitted to the hospital.
Children attended the Kunsburg School which was on the
NJH campus. It opened in the 1930s and continues to be open today. I attended the school from January to June of 1985(3)

There are a couple reason's I'd like to speculate on as to why so few asthmatics write about their plight.  First, few want to recollect bad memories, as most asthma remedies are.  When I talked to my Uncle Casimer about his adventures on D-Day he never once willingly told me any stories about it.  It think most people who live through those stressful days simply want to move on from them and focus on the positive memories, and move on from there.  

A second reason, I think, is that most people are modest and don't want to talk about themselves.  Or some of us may simply feel uncomfortable when the light is shining on us, and therefore prefer to stay on the outside of any diary, journal, blog, or book.  Now I'm sure if someone, like a child or grandchild, asked the question a good story would be told, yet most of us prefer to hear stories our children tell as opposed to our own. So good asthma stories stay locked up forever.  

Female juvenile patients playing at National 

Jewish Hospital for Consumptives, ca. 1907 (4)

And even while I spent six months as a patient at National Jewish Hospital/ National Asthma Center from January to July in 1985, I have been able to regain contact with only two of the people I met there, one being my counselor, and another being my gym instructor.  So this brings me to the third reason few asthma stories were told: no way to tell the story.  

Yes, back in 1985 there were typewriters and mail, but to use those techniques you had to go out of your way.  Today we have the Internet, and people can stay in touch quite simply.  All I have to do now is find a friend on facebook and make him my Facebook friend.  We can keep in touch forever if we want.  Yet back in 1985, back in 2000, this wasn't possible for most of us.  Back in 1985 the cameras were cheap and developing film expensive.  Writing letters was possible, but letters got tossed out.  

Nurse taking temperature (4)

Thankfully, however, I kept all the letters sent to me while I was at the hospital.  And even while I was doing this my friends and the nurses at NJH made fun of me for this.  Yet I continued to hide them in a bag in the bottom of my dresser, and took them home with me.  Twenty years later I was able to use them to write my story.  And that is basically how my history began, by me reliving my story through letters written to me, and letters I wrote that my mom and grandma saved.  

The other thing that got me going on this history was by simply asking the question: what would it be like if I had asthma before today?  What would it if I lived with asthma before the Alupent inhaler was invented?  I bet it wouldn't have been very fun.  And so my quest began, and so my journey took me all the way back to 30,000 B.C. and then all the way to 1922.  

And so here we are.  From this point on I will tell the story through my own eyes, and through the eyes of people willing to share their stories.  I will, however, keep all names to myself.  And I will also try not to reveal details that will make a person stand out.  Now, I'm sure most of the stories I share are stories people would like to share, yet still I'm keeping names private.  That's the least I can do.  The only name I'm revealing is my own, and even my own name is a pen name.  I too am a victim of difficulty talking about myself, lest I write as someone else.  

The stories told will be from patients from one or another of the following institutions:

• National Jewish Hospital for Consumptives (1899-1925).  This was a hospital opened to provide help for consumptive patients who had no money
• Denver Sheltering Home for Jewish Children (1907-28).  This was a home opened to take care of children who's parents suffered from consumption, or who were housed at National Jewish Hospital.  The name was changed to National Home for Jewish Children in Denver in 1928.
• National Home for Jewish Children in Denver: 1928-1953
• National Jewish Hospital at Denver (1925-1965). This was the new name for National Jewish Hospital for Consumptives.  The hospital accepted both asthmatic children and adults.  There was no fee for this service. (1, page 34))
• Jewish National Home for Asthmatic Children at Denver (1953-1957) This was the new name for the National Home for Jewish Children at Denver.  It was changed because asthma patients started to outnumber tuberculosis patients. It was home to 162 patients and 62 staff members, including physicians, nurses, social workers, psychiatrists, house parents, etc. (2, page 116)  It was changed to CARIH in 1957.
• Children's Asthma Research Institute & Hospital (CARIH) (1957-1973). The asthma center changed it's name to shed light on the changing patient load, and moved into a new facility (2, page 163).  The hospital admitted children 6-15 years for 18-24 months In 1973 the name was changed to NAC.  
• National Asthma Center (1973-1986). NAC. merged with NJH in 1978.
• National Jewish Hospital / National Asthma Center (1978-1985).  
• National Jewish Center for Immunology & Respiratory Medicine (1985-1997). This name change showed the changing role of the hospital as taking care of more than just tuberculosis and asthma patients.  
• National Jewish Medical and Research Center (1997-2008).  This name changed emphasised the role of research as a major part of the hospital.  
• National Jewish Health: 2008- Present.  The new name simplified everything, and pretty much went back to the initial name minus the Consumptive part.  This shows respect to the community that started all the above hospitals, and is a major part of its history.  I think the major reason for the change is that asthma is no longer the main emphasis.  

This story is for all the patients who benefited from the services at any one of these fine institutions.

References

1. Harvey, Robert W, "Changing Times: Kiplinger's Personal Finance," January, 1970, Published by Austin H. Kiplinger, page 
2. Minton, Gregg, "Breathing Space," 2007, 
3. School Class at National Jewish Hospital, Denver Public Library, accessed 11/8/12
4. National Jewish Hospital for Consumptives' Records (B005), Special Collections & Archives (Beck Archives), University of Denver, Penrose Library, http://lib-anubis.cair.du.edu/About/collections/SpecialCollections/NJH/index.cfm, accessed 11/8/12

1808: Corvisart re-introduces chest percussion to medicine

Jean Nicolas Corvisart (1755-1821) was the
mentor and teacher of two men who would go
on to gain fame studying diseases of the chest,
such as asthma: Matthew Baillie and Rene Laennec.
He also earned fame for himself when he
re-introduced chest percussion to medicine.
Another pupil of his was Marie-Francois-
Xavier Bichat, the founder of biology. 

Joseph Auenbrugger introduced the medical community to chest percussion in 1761, although his idea was flat out rejected and rarely used.  Yet it would be another 53 years before his idea would be accepted, and it would take the efforts of a famous physician by the name of Jean Nicolas Corvisart des Merets (1755-1821). 

J.F. Halls Dally, in a 1941 article, said Corvisart was born February 15, 1755, to Pierre Corvisart, an advocate and attorney to the Parliament of Paris. For part of his childhood he lived with an uncle who was a priest at Vimille.  He then started college at Sainte-Barbe at the age of 12, where he was a "mediocre pupil who favored of outdoor sports. (1, page 239)

Of his childhood education, Dally said: 

He is said to have left the college almost as ignorant as when he went in, with no reputation but that of an incorrigible idler. Thus the childhood of Corvisart gave no promise gave no promise of his brilliant future. (1, page 239)

Later on he started as a law student, but after spending time at medical clinics of Paris he became interested in medicine. He became particularly interested in the speeches of Dr. Anthony Petit, a professor of anatomy and medicine. It was this reason "the young Corvisart recognized the profession for which he was designed. He longed to study the animal economy, and for this purpose he determined to be a physician," said Baron Cuvier in his 1830 memoir of Corvisart. (2, page 81) (1, page 23)
Surreptitiously, as he didn't want his father to be disappointed, he attended the lectures of the most famous physicians of the day, including Petit and Pierre Joseph Desault, said Cuvier. His father ultimately found out and approved of his transfer to the medical profession. (2, page 81)

Dally said he paid his way through medical school by becoming a male nurse at at Hotel Dieu, the oldest hospital in Paris.  It was here he became greatly influenced by the surgeon Pierre Joseph Desault, chief surgeon of the Hotel Dieu. Corvisart observed diseases with him and and examined bodies.  He also delivered his own lectures on anatomy and physiology, and these were well received.  He soon became well liked by his fellow students and physicians. (1, page 239)(2, page 81)

He was offered a job as physician at Necker, although he declined this position because all who held it had to wear a particular wig that had been handed down for decades.  Other clinics had given up this tradition, but it was still alive at Necker.  When he was offered a choice of taking the job and wearing the wig, or keeping his hair, he said he'd prefer to keep his hair.  This was a minor set back, however, because other opportunities awaited him. (1, page 240)(2, page 81)

It's interesting to note that while medicine in other areas of Europe had moved forward by leaps and bounds, Cuvier said medicine in France remained much as it was in the middle ages when the Faculty of Paris was formed. He said:

Besides, there were no public lectures at the beds of the sick. In order to see a few patients, the students accompanied the elder physicians in their visits; afterwords, when these physicians were unwell, or too much busied with practice, they acted for them, and thus they continued, till at length they, too, slowly attained their professional rank. (2, page 81)

In 1788 he became elected as physician at Necker hospital. His predecessor was Desbois de Rochfort (1750-1786), (Rochfort had passed away) chief physician at Le Charite, who was the "real creator of clinical medicine in France.  The pupil thus succeeded the master, and the glory of the master gained added lustre.  Corvisart took over the clinical teaching and from that moment his reputation, already established among his colleagues and students, began to spread outside the confines of the hospital." (1, page 240)(2, page 81)

However, unlike his predecessors, he believed it was best to diagnose diseases by their signs and symptoms and pathological anatomy, as opposed to guessing what might be found on autopsy.  (1, page 240)

Then things change for the worse in France. Although the end result would benefit the medical profession of France.  Dally said:

In 1793 the Reign of Terror began.  The medical schools were shut, anyone could call himself a doctor and treat the sick.  Medical education was three centuries behind the times. But out of the Revolution grew modern medical education.  In the new schools of Paris laboratories were instituted for scientific study; students were taught at the bedside in hospital after the manner of Sydenham.  And it was Corvisart -- formerly rejected because he wore no wig, who taught, who for he had now become the leading professor in France. He acquired the natural history of disease by collecting observations, and when possible, following the example of Morgagni, he noted from dissection and from autopsy the changes in the body that caused symptoms of disease.  His chief lectures were given at the Necker hospital, and subsequently over a term of fifteen years at Cochin Hospital." (1, page 240)

Corvisart, whose reputation increased daily, lived in close contact with the most illustrious men of the time.  In 1795, on the criterion of the first school of medicine in Paris, he was unanimously elected to fill the Chair of Clinical Medicine, for the first time included as part of public education in France. Two years later, in 1797, he was made Professor of Medicine at the College de France. (1, page 240-241) 

While Corvisart was professor of medicine at the Charite Hospital in Paris, he studied the works of Auenbrugger and found the technique of percussion useful in diagnosing his own patients.

He championed for percussion when he re-published Abenbrugger's booklet about percussion Inventum Novum  in 1808.  While he didn't have to, he humbly gave credit for the discovery of percussion to Avenbrugger.

He wrote:

"I could have raised myself to the rank of an author by remodeling the work of Auenbrugger and publishing a work on percussion.  But by that I would sacrifice the name of Auenbrugger to my own vanity; that I do not wish to do: it belongs to him, it is his beautiful and rightful discovery which I wish to bring to life." (1, page 242-243)

While Corvisant supported Avenbrugger's general technique, he adjusted it slightly so that "he used the palmar surface of the extended and approximated fingers," said Alex Sakula. (6, page 576)

Corvisart used the technique to help diagnose patients with tuberculosis and other diseases of the chest.  Based on the sounds emitted he would be able to tell how large or small the tubercles inside a patient were, along with their locations. (3)

Corvisart and his students -- one of whom was Rene Laennec -- were believed to be the only physicians in the world who used percussion. Perhaps this was because Corvisart was among the few physicians who studied Auenbrugger's work.

The use of percussion was among the diagnostic techniques used by Corvisart.  He used percussion, took a pulse, listened to the patients lung sounds by placing his ear on his patient's chest, watched the patient's breathing, felt for a temperature, observed sputum and perspiration, color of the patient's skin, changes in the voice, etc.  (2, page 81)

This was the new medical diagnostic practice that had already engulfed the medical profession throughout much of Europe, all but for the exception of chest percussion and, maybe also, vocal fremitis.

The Catholic Encyclopedia  notes that Corvisant may have been the first to describe the technique of vocal fremitis, which is where a hand is placed over the patient's chest, and the patient is asked to make a sound, such as "a" or "e."  The physician then notes the vibratjions (fremitis) felt as the person made these sounds. Corvisart found this to be another very useful procedure in diagnosing diseases of the chest.  (5)

So, in this way, Corvisart was able to add to the list of diagnostic tools used by other European physicians of his era.  By using these tools, Corvisart, and based on his studies of bodies, he was able to match changes on the outside of the body with changes that might be occurring inside the body.  He was, therefore, able to use observation and science to diagnose.

In this way, he was able to use observation and science to diagnose patient, as opposed to using theory and just guessing.  Perhaps it was this that most impressed the emperor of France.

Napoleon Bonaparte was a famous military leader and
emperor of France.  

The technique of chest percussion may not even have been adapted by the medical profession at all if not for Emperor Napolean Bonaparte (1769-1821) selecting Corvisart as his own personal physician.  (4)

Dally said Corvisart was recommended as physician to Bonaparte because he was impressed that Corvisart used a scientific technique instead of simply guessing what was wrong, as other physicians of his era did.

Some speculate it was Boneparte who convinced Corvisart to write his first book, a treaties on diseases of the heart.  This work was significant to our history of asthma because it was among the essential steps needed for future physicians to pluck cardiac disorders that caused dyspnea out from under the umbrella term asthma. (1, page 243)

Of this, Dally said:

It is said that cardiology as such did not exist prior to Corvisart's work. He really created cardiac symptomatology, and established differential diagnosis between cardiac and pulmonary disease, as well as between functional and organic heart disease." (1, page 243)

Corvisart later wrote his commentaries on Auenbrugger, which was also well received by his peers. (1, page 241)(2, page 82)

Thanks to the writings of Corvisart, and later Rene Laennec, Auenbrugger's discovery would become readily accepted shortly after his death in 1807, and Auenbrugger would eventually go down as one of the great minds in medical history.

Auenbrugger did, however, live "just long enough to witness the beginning of a proper recognition of his discovery," said Dally. (1, page 243)

Of course Corvisart himself would also go down as one of the great minds in medical history, not just because he re-introduced chest percussion to medicine, but because was a great physician overall who left an indelible impression on the medical profession.

He developed apoplexy (stoke symptoms) that took away his ability to perform his job, but not his mind.  He then suffered a cardiac arrest on September 18, 1821. He left behind no family, although he left much to his family of physicians.  (2, page 82)

Further reading:

1. Laennec, the inventor of the stethoscope
2. Auenbrugger introduced chest percussion to medical profession

References:

1. Dally, J.F. Halls, "Life and times of Jean Nicolas Corvisart (1755-1821)," Proc R Soc Med., March, 1941, 34 (5), pages 239-246
2. Baron, Cuvier, "Biographical Memoir of M. Corvisart," Literary Port Folia, Thursday, March 18, 1830, No. 11, Philadelphia, pages 81-82
3. "The Catholic Encyclopedia, "Leopold Auenbrugger," http://www.newadvent.org/cathen/02072a.htm
4. Williams, Henry Smith, "The Century's Progress in Scientific Medicine," Harper's Magazine, 1899, page 3
5. "The Catholic Encyclopedia, "Leopold Auenbrugger," http://www.newadvent.org/cathen/02072a.htm
6. Sakula, Alex., "Pierre Adolphe Piorry (1794-1879): pioneer of percussion and pleximetry," October, 1979, Thorax ( 34(5): 575–581).  

1492: Columbus discovers tobacco

Effigy Pipe similar to what Columbus may have seen (4)

It's 1492 and Christopher sets off on a journey across the Atlantic seeking the Indies, China and gold to take back to the king.  He was promised a 10 percent profit, and fame.  While he obtained the fame, he did so by discovering tobacco for the Old World, not by finding any gold or other riches.  

He was introduced to dried leaves that he later learned were tobacco leaves.  And he later learned what the natives, of whom he referred to as the Indios because he believed he was in the Indonesian Islands, (2, page 4) were using the tobacco leaves.  When he and his men were first introduced to the leaves they had no idea what they were, nor what to do with them, and basically cast them away to the dismay of the American Natives  (1, page 16). 

A few months into his journey, now convinced he was in China, he set two of his men -- Luis De Torres and Rodrigo de Xerex -- off on a journey to meet the Great Khan.  They never found the Khan because they were not in China.  What the two men did find was later recounted by Spanish writer Bartoleme de las Casas: (2, page 16)  

"The two Christians met many men and women who were carrying glowing coals in their hands, as well as good smelling herbs. They were dried plants, like small muskets made of paper that children play with during the Easter festivities.  They set one end on fire and inhaled and drank the smoke in the other.  It is said that in this way they become sleepy and drunk, but also they got rid of their tiredness.  The people called these small muskets tobacco."

In this way, even while they weren't aware of it, Christopher Columbus introduced the Old World to tobacco, and the inhalation of tobacco.  Although in his journal the night Torres and Xerex returned from their journey, Columbus merely marked the events off as trivial, writing:  (2, page 18)

"My two people met many people crossing their path to reach their villages, men and women, carrying in their hand a burning brand and burning herbs which they use to produce fragrant smoke."

It's possible by writing "fragrant smoke," Columbus was referring to the use of smoke in Europe mainly as a means of producing good smells.  It's also possible the men explained the natives blowing the smoke in their faces, which may have been a showing of respect to the men of whom they believed were gods.  (2, page 18)

On many occasions Columbus mentions the natives standing around watching them and smoking the leaves of tobacco with their muskets.  Yet there is no mention of whether or not Columbus brought any of the stuff back with him to Spain.  But Rodrego de Xerex stuffed some tobacco into his pockets, made his own musket for smoking it, and became addicted.

As a side story here, Xerex was seen smoking by the Spaniards, who believed he was smoking because he came back cursed.  He was stripped of his riches and thrown into jail.  Yet it wouldn't be long after the death of Columbus that more Europeans would become addicted to tobacco

Others set sail to the New World.  Amerigo Vespucci is mainly known as the first person to describe American Natives chewing tobacco.  Spanish historian Gonzalo Fernandz de Oviedo y Valdes later described from Haiti:

"The caciques, or principle men, have hollow sticks about a span long less than the thickness of the smallest finger.  These tubes have two channels, merging into one.  And these they put into their nostrils and the other end in the smoke of the burning herb …. And they breathe in the smoke, once, twice, thrice, or as often as they can, until they lose their senses, and for a great space they lie stretched out on the ground without intelligence and stupefied as in a dream.  It is to this instrument with which they inhale the smoke that the Indians gave the name tobacco and not to the herb or the resulting stupor, as some have believed.” (3, 4)

Another method described of inhaling tobacco smoke was by inhaling it:  "The smoker would use a hollow, Y-shaped cane, similar in appearance to a slingshot but not as wide across the top.  He would pack the top ends into his nostril and place the bottom at the tip of his musket, breathing in the smoke through this device, working up a holy buzz."  (1, page 17)

Throughout the 16th century various native tribes in both South and North America were observed inhaling the smoke of tobacco via pipes.  Joseph C. Winter, in his book "Tobacco use by Native North Americans," explains that in 1518 tobacco seeds made their way back to Spain, and soon thereafter tobacco was "rapidly taken around the world." (5, page 3)

Winter explains that tobacco is among the genus Nicotiana, "which along with 95 other genera, belongs to the Solanaccaea family of plants.  This large and important family has given humanity dozens of useful plants in addition to tobacco, such as potatoes, tomatoes, chili peppers, eggplants, petunias, jimsonweed, henbane, mandrake, beladonna, and many other edible fruits, vegetables and tubers, as well as ornamentals, drugs, and medicinal plants." (5, page 3)

He also explains that tobacco is indiginous to both South and North America, and that it was "probably domesticated many thousands of years ago in South America, then slowly carried north from one Indian campsite to another through Central America and Mexico all the way to the eastern woodlands of North America, where it arrived by about A.D. 160.  It appears to have been introduced into the southwestern United States by A.D 720, if not earlier.  Seeds of what is probably this very important species have been discovered througout the eastern woodlands, as well as in the U.S., Southwest and Mexico.  It is mainly smoked in pipes and cornhusk cigarettes." (5, page 4)

By 1545 Iroquois tribes were observed smoking tobacco pipes.  (5, page 2)  Virgil J. Vogul notes that the "Menominees inhaled tobacco smoke to induce a narcotic state.  The blowing of tobacco smoke into the ear for earache was reported in this century among the Chickahominys, the Mohegans, and the Malecites... Louisiana Choctaws blew tobacco smoke on snakebites."  (2, page 380-385)

Various tribes throughout the Americas participated in smoking rituals, some of which involved in passing the pipe (carved out of either stone or wood) from warrior to warrior as a peace offering.  There is no knowledge as to when tobacco was first inhaled in the Americas, and therefore no proof that native Americans were the first to inhale smoke from an pipe, which, for all practical purposes, is an inhaler. (6, page (380-385)

Winter also notes that Jimsonweed and other relatives of the datura family of plants were also smoked by various tribes, producing a hallucinogenic effect, although tobacco continued to be the most common plant smoked in the Americas.  (3, page 31)  Some Americans recognized, as had the ancient Egyptians and natives of India, that these agents also have a mild bronchodilating effect, working well for people with breathing difficulties, such as asthma. 

Regardless, this was how the inhalation of smoke made its way from the Americas to Europe.  It wouldn't be until the 18th century that inhalation of medicinal smoke would be introduced from India to Europe and America.

References:

1. Burns, Eric, "The Smoke of the Gods: A Social History of Tobacco," 
2. Davis, Kenneth C., "Don't Know Much About History: Anniversary Edition: Everything You Need To Know About American History But Never Learned," 2011, New York, Harper Collins
3. Castiglioni, Arturo, Ciba Pharmaceutical Products, Inc., "Tobacco: Volume 4," 1943, 31 pages (need better reference), also this quote can be found on reference #4 below (jimmausartifacts.com)
4. Maus, Jim, "An Extraordinary NC Raven Effigy Pipe," jimmausartifacts.com, http://www.jimmausartifacts.com/nc-raven-effigy-pipe/, accessed 9/22/12
5. Winter, Joseph C., "Tobacco use by Native North Americans," Joseph C. Winter, editor, 2000, The University of Oklahoma Press
6. Vogel, Virgil J., "American Indian Medicine," 1970, London, Oklahoma University Press