1823-1871: Dr. Salter: the famous asthma doctor

#1:  Dr. Henry Hyde Salter

As a kid he suffered mightily from asthma, and when he grew up he made his disease the focus of his life.  As an adult he wrote a book that would become the most famous asthma book in the 19th century.

Who was Dr. Salter?

The man who would become Dr. Henry Hyde Salter was born on November 2, 1923.  Within a few weeks he suffered a bout of whooping cough that ultimately lead him to a lifetime of suffering from asthma (1) (See picture #2 below.  One might wonder if the picture is of Dr. Salter himself.)

As a kid his asthma was severe, and while it was "less troublesome" as he grew older, it continued to plague him for most of his life.

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

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

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

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

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

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

Dr. Salter had an inside take on what it was like to suffer from asthma.  It was from this experience, and  his experience treating asthmatic patients, that made him the preeminent asthma expert during his time on Earth. His descriptions of asthma, and what it was like suffering from the disease, were exemplary.  Such attention to detail, such as sitting by an open window, inhaling the cool breeze to breathe, leaning on a pillow that sets on a table to breathe, may have been incorported from his own suffering.  (quote coming soon)

Through the 1850s he spent a significant amount of time sharing his asthma knowledge through a series of chapters published in medical journals.  The entire collection was eventually published in one volume in 1860 and titled "On Asthma:  It's Pathology and Treatment."

This book became the most sought after book on asthma during the 19th century.  It catapulted him into the most famous asthma expert during his time.  He was even consulted by Theodore Roosevelt Sr. in the 1870s when his son -- a young Teedy Roosevelt  -- was having trouble with his asthma.

Salter was among the first physicians to believe in defining diseases and that these definitions should be based on real life observations and autopsies as opposed to speculation.  For this reason he based his book on his own experiences as an asthmatic, an asthma doctor, and his own asthma studies.

Salter disproves ancient asthma theories

In the opening chapter he provides evidence to put to rest what he believes to be fallacies about asthma.  Dr. Robert Bree, the preeminent asthma expert of the first half of the 19th century, described asthma as the lung's attempt to rid the body of some peccant matter.

Bree was so convincing, wrote Salter, that he had obtained quite a following.  It was for this reason Salter noted he had to spend quite a few paragraphs disproving Bree's theories about asthma.  Dr. Salter explained Dr. Bree's theory was disproved simply with the invention of the stethoscope.

(To read more about this click here.)

Since Hippocrates many asthma experts believed asthma was caused by an imbalance of the four humors. Salter doesn't deny "that in some cases the exciting cause of the attack is humoral; but what I would deny is, that the humoral derangement has any higher place than that of an exciting cause; and what I would insist upon is, that the heart and core of the disease is nervous; that the essential peculiarity of the asthmatic is a vice in his nervous system, a peculiar morbid irritability of it, whereby a certain portion of it is thrown into a state of excitement from the application of stimuli which another person would produce no effect at all, or a very different effect."

Salter likewise disproves the idea that congestion, or phlegm, or mucus, is the cause of asthma because the attack usually ends with the expectoration of phlegm. He wrote:

"We admit the fact to be true, but doubt very much the correctness of the inference; at least it is certain that, in ordinary bronchitis, enormously greater accumulations of mucus take place with comparatively few signs of general obstruction.  We think this position must be admitted by any unbiased observer; and it is, in our opinion, fatal to this theory.

 Given the evidence available to Salter, he is equally as convincing as Bree was.  It is perfectly understandable how he, like Bree, developed quite a following simply by his common sense observations as to what asthma is not.

Yet even more convincing was Salter's account of what asthma is.

Salter proves nervous theory of asthma

Dr. Salter believed asthma was a nervous disease.  He believed the evidence that asthma was nervous was so abounding that it could not be denied (to read more on this topic, click here.)

While nervous asthma was described by previous experts asthma, Salter brought the idea to the mainstream.  He so convinced the medical community that asthma was nervous that this idea became ingrained in the minds of physicians until the 1970s.  Even the famous 20th century asthma expert Frances M. Rackemann was a supporter of Salter's nervous theory of asthma.

Salter didn't deny asthma was a spasmodic disease of the lungs, yet he believed this was the result of a nervous condition of the patient.   He explained "The inflammation or congestion of the mucous surface appears to be the stimulus that, through the nerves of the air tubes, excites the muscular wall to contract."

It was also for this reason he recommended remedies that would soothe the mind of the patient, such as alcohol, cigarettes, morphine, and formaldehyde, strammonium, antimony, antispasmotics, and direct nervous depressants.

His favorite remedy was chloroform because "just a few whiffs, and the asthma is gone; a dyspnea that a few seconds before seemed to threaten life is replaced by a breathing calm and tranquil."  (4, page 33)

Thus, he wrote, remembering that the action of these remedies on the nervous system, "it is impossible to help seeing in this the most conclusive proof that the symptoms are due to a nervous cause."  (4, page 33 & 34)

He described one symptoms of asthma as itching of the skin under the chin.  I personally have experienced this when my asthma has been bad, and I think to this day there is yet no scientific explanation to it.  Yet Dr. Salter was convinced the cause was an "irritation at the roots of these nerves.  (5)

He defined spasmotic asthma as "paroxysmal dyspnea of a peculiar character, generally periodic, with intervals of healthy respiration between the atatcks."  He noted that asthma was more common than believed, yet pure asthma -- "that is, asthma without the slightest organic complications" -- is rare. (4)

If attacks are frequent this may result in "permanent injury on the lungs, and even the heart."  Likewise, he noted that "asthma is not the less asthma because it has produced certain organic changes which complicate it; and many cases are primarily and essentially asthma that ultimately become, and are called, emphysema and heart disease." (4, page 17)

#2:  Asthmatic boy from Salter's book

In his book he provided some of the best and most vivid descriptions of asthma up to that time.  He described the disease in precise detail, and he provided several chapters describing all the best therapies for asthma at that time and which asthma patients should take.  (I wrote about Salter's remedies here).

I personally have always believed that no pain is worse than the feeling of severe dyspnea, which is why I love this quote from salter's book, emphasis added by me:

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

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

Yet even in good health we asthmatics cannot be normal.  We must always be thinking about our disease, and always thinking of what to avoid as to not set off an attack, and always thinking of making sure we have our medicines with us.  Salter sensed this:

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

In 2012 we have many remedies for the acute asthma attack, and we also have medicine to prevent asthma.  Henry Hyde Salter and the asthmatics he treated didn't have such an option.  Salter noted:

"...the treatment is regarded as palliative.  It must be admitted that the remedies for asthma are of very irregular and uncertain operation: that probably there is no single remedy that is not inoperative in a large number of cases; that that which is useful in one is valueless in another; while there are many cases that resist all remedies.  If this intractability of asthma were doubtfull, the large number of remedies that have been suggested would be a sufficient proof of it."

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

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

His book continued to be popular in Europe and the United States until the end of the decade, although it would ultimately become obsolete.  Yet during a time when asthma needed a champion, Saltero stood tall.

Click here for more asthma history.

References:

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