To celebrate its 200th anniversary, the New England Journal of Medicine (NEJM) is publishing a series of special articles reviewing progress in medicine since 1812. As part of the series, an article in the March 1, 2012 issue titled “A Patient with Asthma Seeks Medical Advice in 1828, 1928, and 2012” presents a fictionalized series of doctor’s notes on the treatment of a patient with asthma in each of those three years.
The authors, Erika von Mutius and Jeffrey M. Drazen, present their takes on the treatment that would have been offered to “Mrs. A. Smith” — or “Ms. Smith” as she is identified in 2012 — in each of the three years. The physician in 1828, for example, suggests that Mrs. Smith “may benefit from smoking the leaf of Datura stramonium.” The 1928 doctor suggests oral epinephrine in additional to the adrenaline injections she receives for exacerbations and possibly relocating to “a climate where there are fewer proteins in the air to which the patient would be exposed” as a last resort. In 2012, Ms. Smith is using Qvar and Singulair, and her asthma is still uncontrolled. The physician offers several other possible medications, including oral theophylline and Xolair but is unable to offer assurance that the treatments might alleviate her symptoms.
An interactive timeline of asthma treatments from 1812 to the present that accompanies the article includes illustrations of archaic treatments such as asthma cigarettes, inflation of the lung with bellows, and breathing in the air from barns and cowsheds, along with more modern developments in inhaled drug delivery.
Read the NEJM article.
