1095: Crusaders return medicine to Europe

People of all classes joined the crusades for various reasons:
some to take Jerusalem back, some to be freed from landlords,
some to make money, and some to be freed from sin.
Photo from religionwiki.mvcsnow.org

Most people don't realize this, but the Christian crusades that took place during much of the 8th, 9th, and 10th centuries were peaceful. Christians believed the trek would absolve them from their sins, and the Muslims welcomed the Christians. This was a great thing as far as our medical history is concerned, as the Christians returned to Europe, they brought with them medical wisdom.  (1, page 106)

This all went fine and dandy until the 10th century when the caliphs of Palestine imposed a tax on those seeking to visit the Holy Land.  It was this tax that ultimately lead to war between the Christians of Europe and the Muslims of Palestine. This was fine for Pilgrims with money, although the poor pilgrims often had to wait at the gates of Jerusalem for some rich person to pay their tax.  (1, page 106)

Historian Thomas Bradford explained what happened next: 

The sum from this tax was a mine of wealth to the Moslem governors of Palestine. At the close of the 10th century it was thought that the end of the world was at hand, the thousand years of the Apocalypse was near completion, and Jesus Christ would descend upon Jerusalem and judge mankind. Panic seized the weak, the credulous, and the guilty; forsaking their homes, kindred and occupation, they hastened to Jerusalem to await the coming of the Lord, imagining that their pious pilgrimage would free them from sin. The road from the West of Europe and Constantinople became a great highway of pilgrims and beggars; the monks, the almsgivers of the times, were obliged to refuse aid to the hordes; many lived upon berries that ripened on the roadways. Swarms besieged the Holy Land; the Turks were annoyed by the number that overran their country . . . they plundered them, beat them with stripes, and kept them for months at the Holy Gates in lieu of the golden bezant for admission. The day of judgment did not come, and so pilgrims a few at a time returned to Europe and told of their sufferings. These cruelities became the wrongs of Christendom. Fresh hordes now hastened on the difficult journey, sure of gaining the favor of heaven by visiting the holy sepulchre. (1, pages 106-107)

So you can see that the crusades were not an attempt by Christians to force their religion on the Muslim people.  It was merely an attempt to continue visiting the Holy land, something that the Muslims had no problem with for over 300 years.

It was these events that incited the wars.  Bradford said:

In 1095 there appeared one Peter the Hermit, a man enthusiastic, chivalrous, bigoted, and probably crazy. He had been a monk of Amiens, and previous to this a soldier. He had visited Jerusalem and was filled with indignation at the cruel persecutions inflicted on the Christian pilgrims. He returned to his home and began a crusade of wild preaching against the abominations of the infidels and their defilement of the Holy Places of Jerusalem and Palestine. He called upon the people to arm against the infidels, incited the clergy, and aroused the enthusiasm of the people and nobles. Musing in Palestine he planned to rouse the powers of all Christendom to rescue the Christians of the East from the thraldom of the Mussulmen, and the sepulchre from the infidel. Peter told his views to Simeon, Patriarch of the Greek church at Jerusalem, and this good prelate sent letters to the pope and to the monarchs of Christendom telling of the sorrows of the Christians of Jerusalem and urging that arms be taken up in their rescue. Peter now hastened to Italy. Pope Urban II. sat on St. Peter's throne. He listened to the sad story and read the letters and appeals. At the Council of Clermont Urban gave Peter full powers to go forth and preach his holy war to the Christian nations of the world. (1, page 107-108)

The crusade had now become an effort to help the Christians who feared that they would not be saved if they did not reach the Holy Land.  Bradford continued: (1, pages 108-109)

The nations were aroused; eternal rewards were promised to all who assumed the red cross; halt and lame, women and children, the pious, the fanatic, the needy, the dissolute, all enrolled themselves in this remarkable army. Walter the Penniless set out with the first army in the spring of 1096; each one was his own leader. Soon other bands were formed. It is said that 300,000 men, women and children of the lowest of Europe spread themselves over Hungary and Germany. (1, page 108)

They robbed and murdered, and in self defense the Hungarians were obliged to fight with them. Walter straggled on to Constantinople with his horde. Peter the Hermit was not far behind him. He led another rabble, and riot and rapine went with him. It was everywhere; all Europe was mad. This rabble did not conquer the Holy City, but a more orderly and soldierly expedition was organized under certain noble knights, among whom was Godfrey of Bouillon, duke of Lorraine, and count Raymond of Toulouse. Several armies were raised and marching by different routes united at Constantinople. He besieged several cities, among which was Antioch; at this place, when the Christian host were worn and tired, Peter had a vision in which he saw the lance that pierced the side of Christ, and telling where to dig they found it. He had another vision and was directed to carry the spear at the head of the army. Dreaming became contagious; other monks had dreams. So time passed; Antioch was taken, battles were fought, disruptions were prevalent. At last Godfrey set fire to his camp at Archas and set forward in the night. After a march of several hours the sun rose, and before our army lay the sun kissed towers of the holy city. The soldiers knelt upon the ground exclaiming, "Jerusalem, Jerusalem," in pious joy. After a long and bitter siege, on July the 15th, 1099, the city was taken, the Christians were free. (1, pages 108-109)

Bradford said these crusades had a very important impact on medicine.  To take care of the sick and wounded, hospitals were set up, and many were staffed by Jewish and Christian physicians from Europe. After the war many of the crusaders became free from serfdom, and for this reason many "devoted themselves to liberal arts, commerce, science and medicine." (1, page 109)

As the wars came to a close physicians returned to Europe, only they had increased their knowledge of medicine.  With them they brought medical books that were written by ancient Greek and Roman physicians, although these now needed to be interpreted back into European languages. (1, page 109)

Along with better medical knowledge, and better medicine, the profession of pharmacology made its way to Europe.  Evidence of early apothecaries can be seen in England in the 12th century, said Bradford.  Prior to this time physicians of Europe prescribed the medicine and made the medicine. (1, page 110)

Initially, however, apothecaries weren't much of an improvement, as, according to Bradford, "for the most part, the pharmacies were the places in the cloisters where the monkish physicians stored their drugs and simples."  (1 page 110)

When Constantinople fell to the Turks in 1493, this is credited by many as the beginning of the Renaissance, a time when a dark ages of medicine occurred in the east, and the light started to shine again in the west. When this occurred, many other Greek classics made their way from Byzantine to Europe, thus opening the minds of Europeans. (2, page xxi)

References:

1. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey
2. Brock, John, "Galen on the natural faculties," 1916, London, New York, William Heinemann, G.P. Putnam's Sons

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400 B.C-1600 A.D..: Pneumonia defined as a disease

Hippocrates (460-377 B.C.)

Pneumonia was one of the few lung diseases to have an official diagnosis in medicine, as it was described as far back as 400 B.C. by Hippocrates. Pneumonia was a term to describe "a condition about the lungs."

We know, however, the condition was known prior to the ancient Greeks, as Hippocrates said it was "described by the ancients."

Surely ancient physicians as far back as 1250 B.C. in Egypt would have inspected the lungs of dead men wounded in battle, and observed that they were soft and spongy and pinkish in color.  Yet upon the rare inspection of a person who died of dyspnea, observed the lungs to be hard with a whitish discoloration.

Since the condition presented with obvious scars and obvious symptoms in life-- dyspnea, chest pain, body aches, fever, diaphoresis, coughing, colorful sputum -- it was one of only two lung diseases not to be lumped under the rubric term asthma by the ancient Greeks (the other being phthisis).

Pleurisy is a condition where the lining around the lungs becomes inflammed, thus causing chest pain.  He described the condition in his book "On the Different Parts of man."  He said:

We known an empyema (pus in a cavity of the body, particularly the pleural cavity) by these indications.  A patient at first feels a pain in the side, pus collects, and the pain continues with cough and expectoration of pus, and difficult respiration. If, however, the pus has not yet found an exit, concussion (succussion) of the body renders it perceptible in its fluctuation, by a similar sound to that of fluid shaken in a bottle.  (5, page 239)

In other words, Hippocrates believed pleurisy or empyema could be diagnosed by shaking a patient, which was a routine procedure performed by him when a patient presented with shortness of breath and chest pain.

He continued:

When these signs are absent, and yet empyema exists, it may be suspected from the great oppression and the hoarse voice; the feet and knees swell, principally on the affected side, the thorax curves, lassitude is extreme, universal sweats, alternating cold and hot, the nails become crooked, a sense of heat in the abdomen, all of which are so many indications of an empyema. (5, page 239)

While ancient physicians were sometimes able to differentiate pneumonia from asthma, they were not so gifted at separating chest pain caused by pneumonia from chest pain caused by pleurisy.  For this reason, the conditions were generally looped together as peripneumonia.  (1, page 192)

Of this, Hippocrates wrote:

"Peripneumonia, and pleuricic affections, are to be thus observed: If the fever be acute, and if there be pains on either side, or in both, and if expiration be if cough be present, and the sputa expectorated be of a blond or livid color, or likewise thin, frothy, and florid, or having any other character different from the common."

Hippocrates, in "The Different Parts of Man," section 1 chapter 1, and then again later in the book, said he believed diseases were caused by an imbalance of the four humors of blood, phlegm, black bile and yellow bile. Pneumonia resulted when the brain produced too much phlegm, and this phlegm overabundance of phlegm flowed to the soft tissues of the lungs.  While this might cause various pulmonary disorders, such as pneumonia, phthisis, pleurisy, cough, and thick sputum, he believed peripneumony resulted when both lungs were filled with the fluxation (flow, over abundance) of phlegms. Pleurisy results when one side is affected. (5, page 226, 228, 235, 238)(also see 5, page 268-270)

He believed pneumonia was the more severe of the two affections.  He said:

The pains are greater in the flancs and sides, the tongue is much paler, the throat suffers from the fluxion; the labour and oppression in respiration are extreme on the seventh or eighth day, death ensues from suffocation or weakness, or from both. If the fever, after diminishing for two days, returns on the ninth, death usually ensues, or else an internal suppuration has ensued; but if the fever is delayed, to the fourteenth day, the patient is safe. (5, page 238)

In "On Disease: Book III," he said that if peripneumony that if expectoration was sweetish by the eighteenth day, the lungs were in a state of suppuration (pus), and the condition would continue for a long time.  To diagnose suppuration, he recommended auscultation, which would have been done by placing an ear to the chest, as pus probably made a particular sound with each breath. Treatment for this was incision or cautery. (5, page 257, 260, 263, 266, 267)

The general treatment offered by Hippocrates for peripneumony would depend on the stage of the illness, age of the patient, color of the sputum, and season of the year.  Such remedies might include: (2, page 1)(3, page 481)

• Bleeding
• If fever, the bowels were opened with clysters
• If pain, hot water in a bottle or bladder, a sponge of hot water, or cataplasm of linseed was applied to the hypochondrium
• Linctus containing galbanum and pine fruit in Attic Honey or...
• Sothernwood in oxymel
• Oppaponax (a bitter resin with a garlic taste) mixed in oxymel
• Drink of ptisan made from huskey barley and mixed with oxymel  (2, page 1)(3, page 481)

For pleurisy, especially where pus has formed, Hippocrates recommended paracentesis of the thorax, which was a painful procedure that involved removing pus from the pleural cavity. (5, pages 260, 266)

Hippocrates described how to remedy pleurisy and pneumonia in "On the Different Parts of Man."  First he described how to cure pleurisy.  He said:

The cure of pleurisy is as follows. Do not endeavour to check the fever before the seventh day; prescribe either oxymel or oxycrat for drink, and give it copiously, in order to facilitate expectoration by dilution; heating remedies are to be used to calm the pains, and to favour a discharge from the lungs. On the fourth day the patient must be placed in the bath; on the fifth and sixth he is to be anointed with oil, and on the seventh the bath is to be renewed, unless the fever is diminished, and thereby excite perspiration. From the fifth to the eighth day the most active expectorants are to be employed, if the disease progresses favourably. Should the fever not decline on the seventh, it ought to do so on the ninth, unless some dangerous symptoms supervene. When the fever terminates, we employ the weakest broths; if diarrhoea ensues, the system being still vigorous, we omit the drink, and give barley water if the fever has ceased. (5, page 240)

Second, he described how to treat pneumonia.  He said:

Peripneumony is to be treated in the same manner. In case of empyema, mild errhines, to excite a discharge from the nose, and thereby relieving the head, are to be employed, and such food as will loosen the bowels; if the disease is thereby arrested, and the humours diminish, we are then to promote expectoration, both by medicine and by appropriate food, by means of which coughing is excited. In order to effect this, the food should be of a fatty and saline quality, with wine of a rough character. Phthisical patients are treated in the same way, with the exception of giving less food at a time, and wine more diluted, so that the debilitated system may not be too greatly heated, and an afflux of humours thereby induced. (5, page 240)

He did describe fumigations (5, page 241) and an inhaler of sorts, although he reserved these remedies for non respiratory ailments. For instance, when a woman does not feel her infant moving inside her uterus, one of the treatments for this was, among other things, fumigation (of smoke or steam). Fumigation was also a remedy for pituituos menstration.  It was also a remedy for severe ulcers, among other similar non-respiratory ailments.  (5, page 300)

The point of these therapies was to reduce the amount of phlegm in the body to return the humors to a homeostatic state.

Hippocrates was aware of when the disease was getting better or worse.  He was quoted here by Jock Murray: (2, page 2)

"When pneumonia is at its height, the case is beyond remedy if he is not purged, and it is bad if he has dyspnoea, and urine that is thin and acrid, and if sweats come out about the neck and head, for such sweats are bad, as proceeding from the suffocation, rales, and the violence of the disease which is obtaining the upper hand, unless there be a copious evacuation of thick urine, and the sputa be concocted; when either of these comes on spontaneously, that will carry off the disease."

Plutarch (46-120 A.D.)

Plutarch (46-120 A.D.) recognized that while pleurisy often accompanied pneumonia and may have been responsible for the pleuritic chest pain and fever, it sometimes occurred on its own.  He decided that the term peripneumonia was superfluous, and therefore referred to inflammation of the lungs as pneumnonia, and inflammation of the pleural sac as pleurisy. (2, page 2)( 1, page 191)

Hippocrates noted that death from pneumonia usually occured on the seventh day.  Areteaus of Cappadocia (about 140 A.D.) agreed with this.   He said, as quoted by Murray: (2, page 2)

"But if the lungs be affected, from a slight cause there is difficulty breathing, the patient lives miserably, and death is the issue, unless someone effects a cure. But in a general affection, such as inflammation, there is a sense of suffocation, loss of speech and breathing, and a speedy death. This is what we call peripneumonia, being an inflammation of the lungs, with acute fever, when they are attended with heaviness of the chest, freedom from pain, provided the lungs alone are inflamed."

The cures of Areteaus were similar to those of Hippocrates, although he adds: (6, page 2)(3, page 481)

• Wine (when fever subsides)
• Alkaline substances, such as soda, given in decoction of hysopp
• Rubafacients containing mustard applied to the chest
• Diluent drinks
• Purging (6, page 2)(3, page 481)

Other ancient physicians described pneumonia and its remedies in a similar fashion as Hippocrates, including Celsus (25 B.C.-50 A.D), and Galen (120-210 A.D.) and Aetius (396-454).  Still, it was Galen's remedies  that were were what were copied by most physicians for the next 1800 years, including the Arabic physicians. (6, page 2)(3, pages 481-482)

By the 7th century it was understood that pneumonia was inflammation in the lungs. Paulus of Aegineta described it this way:

Peripneumonia is an inflammation of the lungs, supervening, for the most part, upon violent catarrhs, cynanche, asthma, pleurisies, or other complaints, but being sometimes the original affection. It is accompanied with difficulty of breathing, an acute fever of the ardent type, weight and tightness of the chest, a rale (wheeze), a seizure of the face with great fulness, the morbific matter being determined upwards like fire. Wherefore the cheeks appear red, the eyes swelled, with falling down of the eyebrows, and the cornea appears somewhat glossy.

Aegineta listed the following as his remedies, all of which continue to be similar to those of Hippocrates: (3, pages 480-481)

• Clysters: Injected into the bowels, which are moved with difficulty
• Cupping:  Large cupping-instruments with scarifications may be frequently applied to the breast and sides, but only when there are no contraindications
• Bleeding:  If the peripneumonia was the original affection, and the strength permit, we must open a vein; or if not, we may cup, proportioning the evacuation of blood to the powers of the patient. 
• Drinks: Draughts of the juice of ptisan, or of chondrus with honey, be taken, or from bitter almonds with semilago, or chondrus having some sweet potion mixed with it, such as hydromel, apomel, or hydrorosatum. Fresh butter to the extent of three spoonfuls is also proper. The patient must also drink the propoma of the decoction of figs with hyssop, or of iris boiled in honied water, or of powdered iris, to the amount of two spoonfuls sprinkled upon honied water. This also evacuates downwards. To keep up the strength, he should be made to drink frequently of honied water alone, and with pine-nuts, and the seed of cucumbers. 
• Rubefacients: Cerate of the oil of rue and dried iris; or that made of wax, and rosin, marrow, butter, hyssop, dried iris, and nard ointment, may be applied to the whole chest and sides. 

Maimonides (1138-1204 AD) was the first physician to describe the signs of pneumonia similar to our modern description.  He said: (4, page 9)

"The basic symptoms which occur in pneumonia and which are never lacking are as follows: acute fever, sticking (pleuritic) pain in the side, short rapid breaths, serrated pulse and cough, mostly (associated) with sputum." (4, page 9)

So while pneumonia was recognized at an early date in history, not much was added to our wisdom regarding this disease, other than the sporadic opinions of the various physicians, until the last few decades of the 17th century.

References:

1. Allbutt, Clifford, ed, A System of Medicine, 1909, Toronto, chapter on "Lobar Pneumonia,"  by P.H. Pye-Smith, pages 191-205
2. Marrie, Thomas J, editor, "Community Acquired Pneumonia," 2002, New York, Kluwer Academic Publishers, chapter one by Jock Murray, "The Captain of Men and Death: The History of Pneumonia."
3. Aegineta, Paulus, "The Seven Books of Paulus Aegineta," translated by Francis Adams, volume I, 1844, The Snydenham Society
4. Rosner, Fred, "The Medical Legacy of Moses Maimonides," 1998, NJ, KTAV Publishing House
5. Coxe, John Redman, translator, "Hippocrates, the Writings of Hippocrates and Galen," 1846, http://oll.libertyfund.org/titles/1988, accessed 7/6/14, also see the book online at Google books, Philadelphia, Lindsay and Blakiston

8000 B.C. Tuberculosis spreads across the world

The 18-year-old Egyptian prince sat on the edge of the bed.  He was fiercely coughing, often bringing up blood which he spat on the ground.  The physician stood alongside him, gently touching the young man's shoulder, chanting an incantation.

He was concerned for his good friend who's skin was drawn taught over his ribs. He seemed to be slowly wasting away.  What the physician offered was the only known remedy for such a condition 2,400 years before the Birth of Christ. Yet his remedy didn't work, and the young prince was mummified.

The disease the prince was infected with was pulmonary tuberculosis.  The pathogen responsible for his death was mycobacterium tuberculosis, although this wouldn't be discovered for another 4,200 years.  The genus has been around since the beginning of time, although it has evolved during that time too.

Thomas M. Daniel, in his 200 book on the disease, said:

Most of its members are water or soil organisms and are not pathogenic for humans. It is possible that such disease causing tubercle bacilli evolved from such saprophytes.  There is reason to believe that M. ulcerans, which causes cutaneous and subcutaneous of people in tropical regions, originated at least 150 years ago on the primitive continent of Goldwanaland.  M. tuberculosis has a nucleotide diversity that is more limited and a frequency of mutation that is lower than those of most other bacteria.  Based on these facts, M. tuberculosis has been estimated to have differentiated as a modern species between 20,400 and 15,300 years ago.  A number of authorities have proposed that M. tuberculosis evolved from M. bovis, the bovine (a species of animals that includes the cow, ox, bull, buffalo, and cattle) organism jumping to humans and mutating to become virulent at the time of the domestication of cattle about 9,000 to 7,000 years ago.  However, this hypothesis is difficult to support in the face of incontrovertible evidence that tuberculosis reached the Americas as primary human pathogen before animals were separately domesticated in Asia Minor and South America. (13, pages 26-27)

Paleopathologists (scientists who study ancient diseases) have discovered human remains dating back to 5,000 or 8000 B.C. that have been discovered to have evidence of tuberculosis spondylitis, a form of the disease that leaves easily recognizable scars on the bones. This form of tuberculosis, or when the disease attacks and scars the spinal vertebrae, would later be referred to as potts disease. When it attacks the lungs it was later called phthisis, which is Greek for chronic wasting away. (9)(13, pages 27-28)

Daniel said that paleopathologists have found evidence from enough mummies around 3,000 B.C. have to speculate a "substantial epidemic of tuberculosis in this early civilization" of ancient Egypt.  It is surmised that it may have lasted "as long as 2,000 years." (13, page 28)

He also said mummification was also practiced in Peru and Chile. He said paleopathologists found evidence of tuberculosis in many of these mummies between 1500 and 500 B.C..  In one mummy of a child, evidence of both phthisis and potts disease were found.  (13, page 28)

He said that skeletal remains found throughout the Americas show evidence at least of potts disease, further evidence that the disease was everywhere. (13, page 28)

The disease is thought to have been "widely dispersed" throughout Europe about 10,000 and 4,000 years ago "as evidenced by skeletal remains with typical bone disease,"  said Daniel.  (13, page 27)  He added:

In fact, by those early times, the disease had become global in its distribution.  It crossed the Bering land bridge to the Americas perhaps as early as 20,000 years ago and certainly no later than about 9,500 years ago when the Bering Strait opened to flood the former land bridge with icy water. (13, page 27)

Daniel said:

It is particularly difficult to envision M. Bovis in the Americas prior to the introduction of cattle to the western hemisphere by early Spanish exporers.(13, page 29)

For this reason, because there was no bovine in the Americas, the only way it could have spread to this hemisphere was by crossing the Bering land bridge. However there are those who dispute this, thus claiming that the disease started from M. Bovine even in the Americas. (13, page 29)

Daniel went on to list possible evidence that tuberculosis was widespread.

• He said "there are credible descriptions of tuberculosis from India from about 2,500 years ago when a Brahmin prayer exhorted, 'Oh Fever, with thy Brother Consumption, with thy Sister Cough, go to the people below.'"  (13, page 27
• Chinese writings going back to 4,700 years ago describe a condition that was probably tuberculosis.  An illness described by Chinese physicians "attacked the lungs, causing wasting, cough, and hemoptysis." (13, page 27)
• The code of Hammurabi, dated about 1772 B.C., has an inscription that has historians thinking it is tuberculosis: "a cure, an evil disease." (13, page 27)

Some believe it's mentioned in the Bible, which was written in the 1000 year period before the conquests of Alexander the Great in 327-6 B.C.  The Bible writers of Leviticus 26:16 and Deuteronomy 28:22 referred to it as shachepeth. (11)(13, page 27)

Moses said (Leviticus 26: 16, Deuteronomy 28: 22):

Then I will do this to you: I will bring upon you sudden terror, wasting diseases and fever that will destroy your sight and drain away your life. You will plant seed in vain, because your enemies will eat it.

Moses said: (Deuteronomy 28:22)

"The LORD will strike you with wasting disease, with fever and inflammation, with scorching heat and drought, with blight and mildew, which will plague you until you perish."

Some believe a wasting disease described in Psalm 106 is tuberculosis.

They yoked themselves to the Baal of Peor and ate sacrifices offered to lifeless gods; they aroused the Lord’s anger by their wicked deeds, and a plague broke out among them. But Phinehas stood up and intervened, and the plague was checked. This was credited to him as righteousness for endless generations to come. By the waters of Meribah they angered the Lord, and trouble came to Moses because of them; for they rebelled against the Spirit of God, and rash words came from Moses’ lips. (psalm 106: 28-33)

It may also have been noted by Isaiah:

The LORD will strike Egypt with a plague; he will strike them and heal them. They will turn to the LORD, and he will respond to their pleas and heal them.  In that day there will be a highwayfrom Egypt to Assyria. The Assyrians will go to Egypt and the Egyptians to Assyria. The Egyptians and Assyrians will worship together. In that day Israel will be the third, along with Egypt and Assyria, a blessing on the earth. The LORD Almighty will bless them, saying, "Blessed be Egypt my people, Assyria my handiwork, and Israel my inheritance." (Isaiah 19: 22-25)

However, its difficult to accurately interpret plagues of the Bible as modern diseases.  Knowledge diseases were scanty back then, and this made it difficult to describe them. Mostly symptoms were listed, which requires the interpreter often to assume what disease is referred to. Likewise, some symptoms in the Bible may be exaggerated for emphasis of what might happen if a person is evil. (11)

What we do know is that an infestation of the disease inside the human body causes specific symptoms, such as a strong, harsh cough that often produces blood (hemoptysis). Because of its attack on the body, the person loses weight, suffers from chills, has night sweats, and becomes extremely fatigued.  While some lived to tell about it, most did not.

Such common symptoms caused by a disease that was so widespread would have been easily recognized by any expert in medicine, from medicine men, priests, priest physicians, and even commoners. How to cure it remained a mystery, and this meant that most who caught the disease were doomed, unless the spirits or gods intervened.

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

And this was how it was determined the young Egyptian prince, along with so many of his fellows, died as the result of a killer beast that would later be known as tuberculosis.
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
13. Daniel, Thomas M., "Pioneers in Medicine and their impact on Tuberculosis," 2000, University of Rochester Press

Photos:

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

Further reading:

• essentials of tuberculosisi in children

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980-1037: Avicenna shared his wisdom about asthma

Avicenna (980-1037) was the Arabic prince of physicians who wrote a book, "The Cannon," which was the main medical textbook from the time it was published until about 1500 A.D..  It is from this book that we learn what he knew about asthma, and how he would treat the disease.

So, what did Avicenna know about asthma?  Mark Jackson, in his book "Asthma: The Biography," answers this question.  He said: 

"According to Ibn Sina, asthma was a chronic disease in which patients often suffered 'acute paraxysms with similarity to the paroxysms of epilepsy and spasm.  The flow of thick humours from the head to the lungs produced a situation in which 'the patient finds no escape from rapid panting, like the labored panting of one who is being choked or rushed'.  (3, pages 30-31)

Jackson listed Avicenna's recommended treatment for asthma: (3, pages 30-31):

1. Purging
2. Vomiting
3. Blood letting
4. Voice exercises
5. Fats of hares
6. Deer
7. Gazelles
8. Penises of foxes
9. Lungs of foxes (3)

Other remedies were:

1. Arsenic in a pill with pine resin in a drink with honey water or inhalation (5, page 325)
2. Sulphur in water with soft boiled eggs or inhalation

In 1933 E. Stolkind described Avicenna as not providing much new information as was provided by Galen.  However, Avicenna, along with other physicians of his day, mentioned the relationship between asthma and nerves of the brain.   (4, pages 1121-2) 

Along with the brain, he also linked asthma with the liver and the stomach.  It's for this reason that he recommended arsenic as a remedy.  (5, page 408)

So, if you had access to gazelles and foxes you were probably able to keep your asthma in check.  What do you think about that?

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980-1037: Avicenna: The Prince of Physicians

Avecinna (980-1037)

While the Western world slid into the dark ages between the 6th and 12th centuries, with most scientific and medical wisdom being lost, the opposite occurred in the Arabic world where Avecenna was born in Persia in 980 A.D.

He was a famous medieval philosopher and physician, and his book "The Canon" was one of the most well used medical texts for over five centuries.  

His official Arabic name was Abn Ali Al hosain Ibn Abdullah Ibn Sina, yet to the western world he's simply referred to as Avicenna. He was born in Afshena, one of the hamlets of the district of Bokhara in 980 A.D. His father was Abdullah, a local governor, and his mother was Sitareh.  (6)(8, page64)

His parents must have been pretty impressed by their young child. Of this, Fourgeaud said: (7, page 193-194)

His extraordinary memory, his extreme faculty for learning, soon attracted the attention of his father, who spared neither expense nor trouble for his education.  His power of memory were such, we are told by himself, that before he was ten years of age, he could repeat the whole of the Koran, and could converse familiarly on arithmetic, geometry and astronomy.  He repaired to Baghdad to study philosophy and medicine, and so entirely did he devote himself to these sciences, that he is said to have labored day and night, and to have warded off the approach of sleep and excited his exhausted faculties by the use of exhilarating beverages -- and when nature prevailed over all of his contrivances, problems that baffled his waking hours were solved in his dreams. (7, pages 193-194) (8, page 54)

According to his biography, he was so gifted as a student that his father assigned him a special instructor -- al Natali -- to teach him arithmetic, logic, science and astronomy.  In his early teens his interests shifted toward medicine, and when he was only 16 he became a physician. (6)

In fact, Fourgeaud said:

Before he was sixteen he not merely knew medical theory, but by gratuitous attendance on the sick had, according to his own account, discovered new methods of treatment.  By the end of his seventeenth year he had gone the round of learning of his time; his apprenticeship of study was concluded, and he went forth to find a market for his accomplishments." (8, page 64-65)

His quest did not take long, for he was only 16 when he became a "renowned physician."  Then, at the ripe age of 18, he earned fame and respect when the sultan of Bukhara, Nuh ibn Mansur al-Samai, became seriously ill and the person credited for healing him was Avecenna. As a reward for his services, Avecenna was granted access to the Sultan's library, which was loaded with all the wisdom of the ancient world. Avecenna loved to learn, so this was a great gift for him.   (6)(7, page 194)

He spent many hours studying by candlelight many volumes of books, most of which were those of Hippocrates and Galen, cramming his head with as much information as he could.  By the time he was 21 he had already started publishing volumes, sharing with others all he had learned.  In total he would write hundreds of volumes on a variety of topics, including ethics, logic, philosophy, science and medicine.  (6)

Bear with me now as I allow Fourgeaud and Bradford to tell the story of Avicenna, as I believe this is necessary in order to make a valid point.

When Avicenna was 22 his father died, and soon thereafter 'the reigning dynasty came to an end in the year 1004," said Thomas Bradford. He added:

Mahommed of Ghazni sought to attach the brilliant scholar to his retinue of learned followers, but he declined the honor, and made his way westward to the city of Urdjensh, in the modern district of Khiva, where the Vizier, who was a friend of scholars, gave him a small monthly stipend. But the pay was small, and Avicenna wandered from place to place through the districts of Nishapur and Mero to the borders of Khorasan, seeking an opportunity for his talents. Finally at Jorjan, near the Caspian, he met a friend who bought near his own house a dwelling in which Avicenna lectured on logic and astronomy. For this patron several treatises were written; and the commencement of his great Canon of Medicine dates from his stay in Hyrcania.(8, page 65)

He moved from place to place, writing all along, and "ultimately he," said Bradford:

Went southward to Hamadan, where the prince was established.  He first entered the services of a high born lady, but the Emir (sultan) learned of his arrival called him in as a medical attendant, and sent him back with presents in his dwelling.  He was now raised to the office of Vizier, but the turbulent soldiery mutined against their young sovereign, and demanded that his new vizier should be put to death.  Shems Addula consented that he should be banished from the country.  Avicenna remained hidden for forty days in a sheikh's house till a fresh attack of illness caused the Emir to again call for his physician.  Even during this troubled time he continued to study and teach. Every evening extracts from his great works, the Canon and the Senatio, were dictated and explained to his pupils; among whom, when the lesson was over, he spent the rest of the night in festive enjoyment with a band of singers and players.  (8, pages 65-66) 

He was likewise known as a good politician, yet despite the long-term popularity of his book "The Canon," he did not have much "'pull' with the authorities of his time." (2) 

This is evidenced through the words of Fourgeaud, who added that after he was appointed visier many vicissitudes beset his path. Fourgeaud wrote:

He was thrown into prison, where he remained two years, for being accessory to a conspiracy, or according to some historians, for refusing to administer poison to the nephew of a Sultan. For some time after his release he had to conceal himself, but being discovered he was once again incarcerated for four months, when he effected his escape under the disguise of a monk.  He then made his way to Ispahan, where he was treated with great distinction." ( 7, page 194)

Bradford continues telling the story:

On the death of the Emir, Avicenna ceased to be Vizier, and hid himself in the house of an apothecary, where, with intense assiduity, he continued the composition of his works. Meanwhile he had written to Abujaafar, the prefect of Ispahan, offering his services; but the new Emir of Hamadan, hearing of his correspondence, and discovering the place of his concealment, imprisoned him in a fortress. War continued between the rulers ofI spahan and Hamadan. In 1024 the former captured Hamadan and its towns, and expelled the Turks. Avicenna, after the war, returned with the Emir to Hamadan, and carried on his literary labors; but at length, accompanied by his brother, a favorite pupil, and two slaves, he made his escape fromt he city in the disguise of a Sufite ascetic. (8, page 66)

After a perilous journey they reached Ispahan, and received an honorable welcome from the prince. The remaining ten or twelve years of his life he spent in the service of his patron Abu Jaafar Ala Addaula, whom he had accompanied as physician and general literary and scientific adviser, even in his numerous campaigns. During these years he began to study literary matters and philosophy. But amidst all his study Avicenna never forgot his love of enjoyment. Unusual bodily vigor enabled him to combine severe devotion to work with indulgence in sensual pleasures. His passion for wine and women was almost as well known as his learning. (8, pages 66-67)

But his bouts of pleasure gradually weakened his constitution; a severe colic which seized him on the march of the army against Hamadan was checked by measures so violent that Avicenna could hardly stand. On a similar occasionthe 'disease returned; with difficulty he reached Hamadan, where, finding the disease gradually gaining ground, he refused to keep up the regimen imposed, and resigned himself to his fate. On his death-bed remorse seized him; he bestowed his goods on the poor, restored unjust gains, freed his slaves, and every third day till his death listened to the reading of the Koran. He died in June, 1037, in his 58th year, and was buried among the palm trees by the Kiblah of Hamadan. (8 page 67)

Some credit his demise to his excessive desire for wine, and that he died of dysentry.  (2, page 349)

I wanted to share this synopsis of the life and times of Avicenna to show how difficult it was for a man of his stature during his time.  In order for him study medicine, practice medicine, and write about medicine he had to constantly gain the favor of the sultan. If he wasn't willing to make such a sacrifice, the wisdom of the ancient medical sages would probably be lost forever.

While he did come up with some ideas on his own, his writings mainly save for us the ideas of Hippocrates and Galen, but also the surgical wisdom of Paul of Aegineta, who was perhaps one of the greatest surgeons of the ancient world. Of course he also preserved for us many of the ideas of other ancient medical sages as well, such as Areteaus. (7, page 194) (8, page 68)

The Canon was translated into Latin in 1492 and would become the medical encyclopedia, or medical Bible, for Europe during the 15th, 16th and 17th centuries. (6, 1)  

During these times, the Canon was used at the various universities throughout Europe to teach the wisdom of the medical sages, and it even eclipsed the writings of the other Arabic physicians of his era, including Rhazes, Haly Abbas, and Avenzoar.  (8, page 67) (7, page 194)

Fourgeaud said that:

The physicians of the middle ages accepted its teachings with the same faith with which they were accustomed to submit to the laws of the church... medical men were taught that Avicenna was "the Prince of Physicians" -- that he was infallible, that his works contained all the knowledge of the ancients and of the Arabians -- and they believed it; and were satisfied in following his precepts. (7, page 195)

His words were revered in much the same way as those of Galen were.  John Brock said that the Canon, "once translated into Latin, even overshadowed the authority Galen himself for some four centuries." (9, page xx)
  

References:

1. Drake, Miriam, "Encycopedia of Library and Information Science," 2nd ed., 2003, New york, page 1840
2. Michael, J. Edwin, ed., Medical and Chirurgical Faculty of the State of Maryland, "Maryland Medical Journal," May 1891-Oct. 1891, Baltimore, vol. XXV, page 349
3. Jackson, Mark, "On Asthma: The Biography," 2009, New York, pages 30-31
4. Stolkind, E, "The History of Bronchial Asthma and Allergy," Proceedings of the Royal society of Medicine, "1933, Vol 26, part 2, Great Britain, pages 1121-2
5. Aegineta, Paulus, translated by Adams, Francis, "The Medical Works of Paulus Aegineta, The Greek Physician, 1834, vo 1, page 408
6. "Avecenna: Prince of Physicians and Giant in Pharmacology," http://www.afghan-network.net/Culture/avicenna.html
7. Fourgeaud, V.J, "Medicine Among the Arabs," (Historical Sketches), Pacific medical and surgical journal, Vol. VII, ed. V.J. Fourgeaud and J.F. Morse, 1864, San Fransisco, Thompson & Company,  pages 193-203
8. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey
9. Brock, John, "Galen on the natural faculties," 1916, London, New York, William Heinemann, G.P. Putnam's Sons

Further reading:

1. Check the above and this for aegeneta postssss

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960 A.D.: Haly Abbas writes mammoth book

This is a copy of one of Abba's books,
Liber Totius Medicine Necessaria
Continens Quem Sapientissimus...
published in 1523.
It was listed for sale at christies.com
as of June 28, 2014.
Estimated price: $3000-5000.
Abbas claimed this medical text
was the only one worth reading.

Haly Abbas wrote a mammoth book, and somewhere on these pages was a description of asthma.

Born Ali Ibn al-Abbas al-Majusiin in Persia sometime around 930 A.D. Haly Abbas is the Latin version of his name. (1, page 158)

He was a physician, and he was a critic of most medical books available at the time, including those written by fellow Arabic physicians Rhazes, Oribasius, Serapion, and Paulus Aegineta. (1, page 158)

So he set out to write a book of his own, one that was not as voluminous and costly as the Continent of Rhazes, and not as concise as the writings of Hippocrates.(1, page 158)

Speaking of Hippocrates, Haly Abbas even criticized his Hippocratic Corpus.  Abbas said:  

Hippocrates who is the prince of the medical art and the first physician who ever wrote a book on this art, is the author of many treaties on all sorts of medical topics. But he writes in such a very concise manner that much of what he says is obscure, and as a consequence the reader, if he wishes to understand him, is obliged to seek the aid of a commentary." (1, page 158)

So Abbas gathered as much medical knowledge as he could obtain, which included the books of his Arabic contemporaries and the same ancient books they used in writing their books, and created, in 400,000 words, "a well organized medical encyclopedia of medical knowledge in the tenth century."
 (1, page 158)

Historian Thomas Bradford said he called the book Almaleki (the Royal Book), although he also referred to it as Liber totius medicinae (the whole book of medicine) (4, page 69)

In the past many physicians obtained all their wisdom from books, and Abbas preached against this:

It is incumbent that the student of this Art should consistently attend hospitals and sick houses; pay unremitting attention to the conditions and circumstances of their inmates, in company with their most acute professors of Medicine; and enquire frequently as to the state of the patient and the symptoms apparent in them, baring in mind what he has read about these variations, of what they indicate of good or evil."  (1, page 158)

Historian Thomas Bradford said of him:

His reputation for learning was so great that he was named the sage, and so almost supernatural were his powers and skill in healing that he was also called the magician.  It is (he) who left us the fullest account of medicine among the Arabians, and the names of their medical writers. (4, page 64)

He wrote about many diseases in his book, and he also wrote about asthma (which is where our interest lies).  While his book is difficult to come by, his account of asthma is described by Paulus Aegineta:

"Haly Abbas, like Galen, refers to asthma as a collection of gross phlegm about the cells in the lungs. His remedies are of an attentuant and incisive nature, and he particularises the vinegar of squills.  He cautious asthmatics to be aware of indigestion, and, therefore, forbids exercise after food, but recommends it before a meal.  After exercise he enjoins hard friction, no doubt with the intention of favouring the cutaneous perspiration." (3, page 479)

Not a bad analysis for asthma considering the era.  He lived most of his life in Baghdad and died around 982-994 A.D. 

References:

1. Robinson, Victor, "The Story of Medicine," 158-60
2. Fourgeaud, V.G., "Medicine Among the Arabs: Historical Sketches, XIV, Haly Abbas, Avicenna, Albucasis, Avenzoar, and Averrhoes," volume 7, edited by V.G. Fourgeaud and , pages 193-4
3. Aegineta, Paulus, "The Seven Books of Paulus Aegineta," translated by Francis Adams, volume I, 1744, The Snydenham Society, 
4. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey

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1070-1162: Avenzoar mentions the Bezoar Stones

A rare Benzoar Stone probably from a goat or camel
This one is dated from the 17th or 18th century.
Photo from onlinegalleries.com

While medicine was at its peek amid the Arabians at the beginning of the 10th century, many patients feared to seek the help of a physician because they were so prone to poison their patients.  It was because of this fear that Avenzoar (1091-1161) was the first physician ever to mention the Benzoar Stone.

Avenzoar was born Abou Merwan ben Ardel Melek ben Zohr, or Ibn Zuhr. Thomas Bradford, in his book "Quiz questions on the history of medicine, said the following about him. 

Of his personal history nothing is known, except that he was a man of noble mind as a practitioner, and possessed a liberal, dignified and enlightened spirit, and gained the respect and love of his fellow countrymen. He is now considered to have been the most eminent of all the Arabian surgical writers. He wrote a very celebrated work on the operations of surgery, also a work on the art of healing. This last was a synopsis of the medical practice of the day, and was made up of quotations from previous medical writers. But the work on surgery is his most important work. At the time of Albucasis (936-1013) surgery was almost a lost art among the Arabs.(1, page 70)

 Bradford continues:

(Avenzoar) lived in the magnificent capital, Seville. He was born near Seville, about 1070. He was said to have been the most renowned physician and surgeon after the learned Avicenna. His father and grandfather were renowned physicians, and from them he inherited his medical knowledge and skill. His son was a physician after him. Avenzoar began the study of medicine at an early age, his father, Abd-el-Melek beginning to teach him when he was ten years old. When he had finished his course in Seville, his father bound him by an oath never to administer poisons. In that day poisoning was among the Saracens a fine art, and would have delighted a De Quincey. He was a very learned man. He was an accomplished scholar and linguist, being familiar with Hebrew, Syriac and the Arabic languages. His reputation extended over the whole land, and he was in correspondence with the most celebrated physicians of his time, by whom he was considered to be a second Hippocrates. He was also known as a philosopher and poet. He was physician to Ali ben Temin, king of Seville. He performed a brilliant cure on the brother of the king, who was count of the royal stables. As a reward, he was cast into prison, where he remained until released by Joseph ben Tachefyn, prince of Morocco, who drove Ali, with a horde of other small tyrants, out of Spain.

Bradford continued to explain that, as with other Arabian physicians of the era, he lead a tumultuous life, even spending some time in prison.  Yet this doesn't necessarily mean he was a bad person, only that he, at times, disagreed with someone of the ruling class, such as the sultan.

Given that his father was a physician, Avenzoar learned much of his medical knowledge from him.  He later did the same for his own son, who also became a physician. Bradford said Avenzoar shared his wisdom through his book " Teisser," or "The Introduction." Of this work, Bradford said: (1, pages 70-71)

This work treats of the remedies and diet for most of the diseases (and probably asthma too) which were then known.  From it we learn that Avenzoar at one time had charge of a hospital. (1, page 71)

Bradford said he also wrote another book called the Antidotarium "containing the methods of preparing medicines and diet."  (1,page 71)

While he may mention asthma in his book, the fact that no historian visibly mentions this book is probably proof that he added nothing new regarding our disease.

As is typical of this era, in order to gain respect among the community he had to gain the respect of the ruling class. Likewise helping his reputation must have been that people trusted that he would not poison them.

Bradford said that Avenzoar was a respected physician, surgeon, and pharmacist. He typically prescribed what we'd refer to as rational remedies, and was opposed to quack medicine, such as the healing powers of astrology (something that was popular in this region of the world since the days of Babylon). (1,page 71)

Despite these truths, he did still believe in charms and amulets.  So this may explain why it was through Avenzoar that people learned of the powers of Bezoar Stones,which, according to thefreedicitonary.com, were: (1, pages 71- 72)(2)

A hard indigestible mass of material, such as hair, vegetable fibers, or fruits, found in the stomachs or intestines of animals, especially ruminants, and humans. It was formerly considered to be an antidote to poisons and to possess magic properties. (2)

Perhaps due to his ability to avoid poisons he lived to the year 1162, passing at the ripe old age of 92. Yet long after his death people continued searching for such stones. 

Bradford says that at one point the "Palace of Cordova was given  for one of these stones.  It was believed that no poison, no eruptive pestilential or putrid disease, could resist its influence."

This really bears no relevance to our asthma history, although I would imagine if you lived in Seville at this time, and you wanted to see a doctor for your asthma, you might be interested in finding a bezoar stone. That way you' d have insurance in the case the asthma remedy proffered to you was actually a poison.

Or, more likely, possessing such a stone might cure you of your asthma.  Seeking for the stone might be a better option for you than complaining about such a minor ailment as asthma.  If you had enough time and money (which you probably did not), you'd be able to pay someone to go on the hunt for you. Or, better yet, if you were a prince you could trade your palace for one.

References:

1. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey, pages 70-72
2. "Bezoar," The Free Dictionary By Farlex, http://www.thefreedictionary.com/Bezoar+Stones, accessed 11/9/13

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