Wednesday, September 2, 2015

625-690: Paulus Aegineta writes first asthma history of asthma

The wisdom of Paulus Aegineta was preserved through the works of Francis Adams, who lived in the 18th century.  Adams actually intended to fill a void in medicine by writing a "complete Manual of the Surgery and Medicine of the Ancients." That is, until he stumbled across "The Seven Books of Paulus Agineta."(6)

After reading Aegineta's writings, he realized that what he was reading was the history of medicine, and so he set aside his own ambitions to translate Aegineta's work, thus introducing it to the modern world.  By doing so, he said:
"I would be able to enrich our medical literature with one of the most valueable relics of Ancient Science... I am in hopes that I have been able to present the reader with a work from which he may, at one view, become acquainted with the prevailing opinions upon all the most important matters connected with medical practice during a period of more than fifteen centuries." (6)
The neat thing about Smiths' book is he goes beyond simply transcribing Aegineta's works, he also makes commentary on it.  For instance, along with transcribing Aegineta's opinions on asthma, he lists all the ancient physicians whose writings would have influenced the author.  (6)

1.  Hippocrates:  Many of his ideas were copied by Galen, including that health was determined by a balance of the four humors and that regaining health was a matter of an improved way of life.  Aegineta merely lists him among a variety of other physicians who mentioned asthma in their writings. (6, page 477) 

2.  Aphoris:  Recommends that a "wise and modest physician will never hasten to use medicine but upon urgent necessity, and that sparingly too." (7)  He was among those listed who wrote about asthma (6, page 477)

3.  Galen:  Smith explains that Galen influenced Aegineta's thoughts on asthma the most, and that these ideas are quite...
"...plausible.. It being admitted by our best modern pathologists, that there is no organic alteration of structure in ordinary cases of Convulsive Asthma, it seems likely that the paroxysm is occasioned by thick and viscid humours infarcted in the lungs; or, most probably, in many cases from the system being loaded with such humours which nature casts off by the lungs."
Likewise, he explains that Galen particularly liked squil, pepper, wormwood, opopponox, storax, sulpher, oxymel and millepedes as internal remedies for asthma, along with avoidance of "all things which are either of a very hot or cold nature, as in either case they tend to thicken the humours."  (6, page 477) 

4.  Celsus:  Aegineta didn't write anything specific about him other than noting him in the list of names who wrote about asthma.  He spearheads quest to define asthma.  

5.  Areteaus:  Born in 980 A.D., he became known as a "second Galen" or the Prince of Physicians due to his work "The Canon."  Attributes disease to humid, thick and glutinous material in the lungs. (6, page 478) 

6.  Caelius Aurelianus:  Disproves of burning of the head and strong purging, but recommends bleeding if the patient's strength permits it.  He also recommends clysters, cupping of the breasts, gestation, friction, vociferation, emetics from radishes or hellebore, and vinegar of squills.  6, pjages 478-479)  He also recommended cold baths. 

7.  Aetius:  He wrote a similar account of asthma, providing evidence that they both copied from Galen.  Aetius "strongly praises vinegar of squills, myrrh, pepper, and the like.  In certain cases he advises to apply the Actual Cautery to the head, under the impression that the disease occasioned by a defluxtion from it.  He also speaks of burning the chest in several places for the purpose of making issues; and further recommends strong rubefacients."  (6, page 477)  You can read more about him by by clicking here

8.  Oribasius:  According to Aegineta he simply copied Galen. (6, page 478)  You can read more about Oribasius by clicking here

9.  Actuarius:  Aegineta said he copied Galen. (6, page 478)  

10.  Marcellus the empiric: He recommended vinegar of squills, a remedy almost all ancient physicians recommended for asthma.  (6, pages 477-478)

11.  Nonnus:  Aegineta said he copied Galen. (6, page 478)  

12.  Octavius Horatianus:  He also copied Galen.  He suggested bleeding should not be a remedy, and abstinence should be done frequently.  His internal remedies were: oxymel, gum ammoniac, cator, vinegar of squills, and emetics.  He recommended "stimulant application to the chest, and fomentations and sinapisms.  A long journey, he says, is beneficial." (6, page 478)

13.  Casius:  Aegineta said he "discusses the question why there is a sibilant murmur in cases of orthopnea, and decides that it is because the affection is a contraction and falling-in of the cells of the lungs, and the breath rushing through a narrow passage produces this murmur." (6, page 479)

13.  Sarapion the younger:  He authored a materia medica which contained all the known knowledge of the Greeks and Arabs prior to his time, with additions of his own.  (8) Aegineeta said he recommended friction, exercise, squills, and fumigations with arsenic for asthma. (6, page 479)

14.  Avicenna:  According to Smith he gives a good account of asthma.  He suggests it's a "derangement of the head, liver and stomach."  He recommends pills and solutions of arsenic. (6, page 479) 

15.  Mesue the younger:  He was a pupil of Avicenna who added upon his predicessors in his works on practice and his materia medica.  (8)  For asthma he was among those who recommended arsenic  (6, pages 477, 479)

16.  Haly Abbas:  Like Galen, he believed asthma was a "collection of gross phlegm about the cells of the lungs."  He also recommends vinegar of squills.  Of interest, he "cautions 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 favoring the cutaneous perspiration.  (6, page 479) You can read more about Haly Abbas by clicking here

17.  Alsaharavius (Albacasis): His birth name was Abul Casem Chalef Ebn-Abbas.  Of his personal life nothing is known.  All that is known of him is he was a famous Arabic surgeon, "and he was of noble mind as a practitioner, and possessed a liberal, dignified and enlightened spirit, and gained the respect and love of his fellow countrymen."  (11, page 69) Aegineta merely lists him as a doctor to reference in the quest to learn more about asthma.* (6, page 477)

18.  Rhazes:  By Aegineta he was merely listed as one physician who wrote about asthma (6, page 477)  We know he was an Iranian physician who lived from 865-924 A.D.  He's known to have provided the first descriptions of allergies, and shortness of breath (allergic asthma) associated from allergies.  (10) Aegineta said he recommends squills and the "tepid bath" and "inhaling the vapours of arsenic. You can learn more about Rhazes by clicking here

19.  Vegetius:  Aegineta said he was a veterinary surgeon and recommended squills with wine, assafaetida and oil, for asthma complaints in cattle. (6, page 479)

20.  Prosper Alpinus:  Aegineta said he suggested by his writings that "the Egyptians were in the practice for the cure of asthma, of applying coins of cotton to the breast, and setting them on fire."  (6, page 479)

21. Georgius Agricola:  Adams said he recommended an arsinecal bath.  

22.  Theodoras de Mayerne:  Adams said he was physician to Charles I of England and recommended inhalation of fumes of tobacco, hyssop, arsenic, etc.  

So you can see that lacking modern anatomical knowledge, ancient theories of our disease lived on for many centuries by one writer copying or expounding upon the theories that originated from Hippocrates and Galen. 

*Albacasis (936-1013) wrote a book on surgical portion of which much of the parts on practice of medicine was copied from the "Continents" of Rhazes.  His practice "flourished" in the 12th century.  He attempted to revive the art of studying anatomy in medicine, yet because autopsies were strictly forbidden he relied on the works of Galen.  Of course Albacasis would have no way of knowing that most of Galen's anatomical descriptions were based on autopsies of animals. (8).  His book became the leading textbook on surgery during the Middle Ages. (9)

  1. Aegineta, Paulus, "The Seven Books of Paulus Aegineta," translated by Francis Adams, volume I, 1744, The Snydenham Society, pages 289-290  (commentary by Adams can be found on pages 407-09)
  2., "Paulus Ageneta: The most important physician of Aegina Greece, Saronic,", accessed June 26, 2012
  3. Gurunluoglu RGurunluoglu A., "Paulus Aegineta, a seventh century encyclopedist and surgeon: his role in the history of plastic surgery," Dec., 2001, 108 (7), 2072-9, based on a review of mentioned article at,, accessed June 26, 2012
  4., "Paulus Aegineta (625-690)," University of Virginia, Vaulted Treasures,
  5. Gurunluoglu, op cit, 2072-9
  6. Aegineta, Paulus, "The Seven Books of Paulus Aegineta," translated by Francis Adams, volume I, 1844, The Snydenham Society, commentary by Adams can be found on pages 407-09.  He wrote about asthma on pages 474-479. 
  7. Junior, Democratus,  "Anatomy of Melancholy," translated by Robert Burton, 1827, London, Longman, Rees, Orme, and co., page 90
  8. 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
  9. Drake, Miriam, "Encycopedia of Library and Information Science," 2nd ed., 2003, New york, page 1840
  10. "Rhazes and the first clinically exact description of hay fever (seasonal allergic rhinitis)," Iranian Journal of Medical Science, 2010, September, vol. 35, no. 3, 263
  11. 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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