Monday, November 30, 2015

1600s: Asthma could get you absolved from crimes

How would you like it if someone said to you:  "You're asthma is all in your head?"  If you're like me you wouldn't take it too well.  On the other hand, if having asthma could get you off the hook for a crime you committed, perhaps you'd think differently.

Asthma experts in the ancient world realized early on that life was different for those inflicted with asthma or allergies.  Consider the following:
  • A boy rides a horse and has an asthma attack
  • A boy wrestling in dry dirt has an asthma attack
  • A boy is learning to dig trenches and has an asthma attack
  • A boy learning to ride a chariot has an asthma attack
Obviously the boy will not be fit for battle.  This boy will be forced to stay at home with his mother instead of hanging out with the men.  He will be deemed as feminine and inferior by his peers, an outcast, mentally deranged, weak, and useless.  

Boys like this became the subject of some of the world's greatest minds. Hippocrates, Galen, Ballonius*, Felix Platerus**, and Avicenna*** all mentioned a relationship between asthma and the nerves of the brain.  (2)

It was clearly evident that asthma was a mental disorder.  And this surely didn't help the poor asthmatic boy who just wanted to fit in; who just wanted to be one of the guys.  

Around 400 B.C. Hippocrates wrote a convincing text that linked asthma with an increase in the humor phlegm.  Since asthma involved spasms of the air passages in the lungs, he referred to it as epilepsy of the lungs.  In other words, he linked it with a nervous disorder. 

In the Greco-Roman era, asthma was further linked with the nerves of the mind.

In his 1933 report in the Proceedings of the Royal Society of Medicine, "The History of Bronchial Asthma and Allergy," E. Stoikland described how Galen mentioned in his experiments on monkeys that...
...cutting of the medulla spinalis, the respiration and the voice are affected.  Ballonius, speaking about a patient with renal calculus and dyspnoea, says that there is a 'nervulus' (small nerve) from the sixth pair which penetrates the diaphragm and goes to the kidneys and this may also cause dyspnoea. (2)
Maimonides (1138-1204) may have been the first to define psychosomatic medicine (the mind causes diseases) when he wrote how a patient who is "mentally agitated" caused his physical well-being to suffer and eventually he becomes physically ill.

Maimonaides also explained that "gaiety and joy gladden the heart, and stimulate the blood and mental activity. Excessive indulgence in the pursuit of pleasure, however, is injurious to one's health. The avoidance of illness induced by such excesses is by conducting oneself according to ethical and moral principles."
Felix platerus (1536-1614) was among the first to advocate the treatment of mental patients. He believed that... obstruction in the small pulmonary arteries is the cause of asthma.  But he mentions also that the bigger nerves from the dorsal medulla, when disturbed by defluxions, occassion dyspnoea, e.g., in asthmatics.  He observed the attack when nothing abnormal in the lungs could be found.
In the 17th century, Jean Baptiste van Helmont and Thomas Willis officially introduced the nervous theory of asthma to the medical profession.

Willis described asthma in this way (2):

"Whatsoever makes the blood to boil or raises it to an effervescence, as violent motion of the body, or mind, the drinking of wine, venery, excess of external cold or heat..., any great change of the air or of the year, slightest errors, a thousand other occasions, doth cause asthmatical assault to such as are predisposed.... This kind of dyspnoea, merely convulsive, is excited by reason of the pneumnonoc nerves... It is not to be doubted that the fits of asthma wholly depend on convulsive matter being fallen into the nerves, serving to the stretching forth of the lungs.... Soon the asthmatic attack is finished, no signs of abnormal disposition of the lungs can be found.  Severe attacks of asthma may occur without any notable fault of the lungs."

Van Helmont described many examples that prove psychotic factors can lead to asthma.  He wrote about women who had attacks of the asthma as a result of exposure to flowers.  He describe one situation where a man was pressured to speak and he refused.  The man was so stressed that he had an asthmatic attack and died.  This was all attributable to psychotic or nervous asthma.(2)

So, the idea that asthma was a psychological disorder by the time Paulo Zacchia (1584-1659) and Paul Ammann (1634-91) wrote about the disease.

Zacchia was a Roman physician and a personal physician to the Pope Innocent X and Alexander VII  (3).  He published "Quaestiones Medicolegales" in 1621.  It was published as 11 volumes between 1621 and 1661 and "was considered an important landmark in the history of forensic medicine." (1)  It was mainly a book with legal information about wounds and "jurisprudence about insanity."  (3)

The book displayed an up to date medical advice to be used in legal cases that considered the latest wisdom of science, which included knowledge that there was a difference between adult and fetal lungs, and acknowledged wisdom about the circulation of the blood.  This was a first of its kind legal journal that provided legal advice at a time when science was in its infancy

Paul Ammann (1634-91) was a man of "acute mind and extensive learning, but a restless and irritable disposition led him to engage too much in controversy." For instance, in a time where the writings of Hippocrates and Galen were worshiped by the medical community he "boldly" attacked the systems of medicine they created. (4)

Amman's book "Medicina Critica" was published in 1670 and was a compilation of medico-legal cases decided by the medical facility of Leipzig.  (1)

E. Stolkind said Zacchia and Amman both believed that "as fear can provoke asthma, the asthmatics were absolved from criminal inquiry."

In this way, it was common for asthmatics to be kept out of stressful, and dirty prisons as this might provoke an attack that might provoke a lawsuit.

So, if you had asthma in the 17th century, you may have had to suffer while others breathed easy, and you may have been treated as a psychopath, yet at least you were kept out of prison for fear you might sue.

*Ballonius is a Parisian physician who lived 1538-1616 and is credited for coming up with the term rheumatism to explain vague pains in the external parts (5). To learn more about Hippocrates and Galen click on the links above. ** Felix Platerus was one of the first to advocate the treatment of mental patients. (2, page 30)  *** Avicenna was a Muslim physician and philosopher who lived 980 A.D. 1034.  He wrote 150 treaties on philosophy and about 40 on medicine.  His most famous book was The Book of Healing which was a standard medical text for hundreds of years.

  1. Clark, Michael, Catherine Crawford, "Legal Medicine in History," 1994, page 105
  2. Stolkind, E., "The History of Bronchial Asthma and Allergy",  (Proceedings of the Royal Society of Medicine, 1933, Vol. 26, part 2, page 1120; 36
  3. Fielding, Hudson Garrison, "An introduction to the history of medicine," 1922, London, page 272
  4. "Amman Paul," Encyclopedia Britannica of a dictonary or arts, science, and miscellaneous literature," 1842, 7th ed., vol. 2, part 2, page 657
  5. The Massachusettes Medical Society, New Englang Surgical Society, Boston Medical and Surgical Journal, "Rheumatisms and Pseudo Rheumatisms," Vol. CXIII, 185, July-Dec., page 38
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Friday, November 27, 2015

1675:Willis narrows asthma definition

Thomas Willis (1621-1675)
In the 19th century Dr. Samuel Gee (1839-1911) made a gallant effort to update the definition of asthma for physicians during his era. He wrote fondly of 17th century physician, Dr. Thomas Willis, giving him credit as "innovator of the doctrines of the ancients." (1)

Gee described, in 1899, that prior to the 17th century, asthma was considered "any kind of panting, gasping, pursy breathing such as follows on running on exertion." (1)

Back then asthma was still considered to be a disease nothing more than a disease caused by the spirits. Yet in 1678, Willis described asthma as "obstruction of bronchi by thick humors, swelling of their walls and obstruction from without." (2)

So Willis was given credit for the evolution of asthma as more than simply a disease of dyspnea and wheezing.  Other doctors may have helped to advance the definition (such as van Helmont), yet it was Dr. Willis who made asthma a unique illness in and of its own, such as Tuberculosis and Epilepsy were unique illnesses treated with unique remedies.

"Hence," Gee wrote, "Asthma and dyspnea were synonyms for most of the older physicians.  A few, such as Celsus (25 B.C.-50 A.D.), signified by asthma the highest degree of dyspnea, but this was all; asthma was never regarded as a special sort of dyspnea." (1)

For Gee, ancient definitions of asthma from Hippocrates to Galen to van Helmont were inaccurate until we get to Thomas Willis of the 17th century.  In his book , "Rational Pharmaceutic," which was published the same year as his death in 1675 (note the trend),  Willis explained that all ancient and modern physicians up to his time acknowledged only one kind of asthma, and this was pneumatic asthma.

Gee explained that pneumatic asthma was described by Willis as when the lungs were "obstructed or not open enough."  Gee said that the ancients regarded all asthma as "pneumatic and dependent on bronchial obstruction." (1)

He said the ancient definition of asthma is of little value in modern times (for Gee modern times would be 1899).  Yet, "It is interesting to note that those most conservative of people, the illiterate, continue to use the word in the sense of Hippocrates and Galen." (1)

However, we must note that it was illegal for the Ancient Greeks and Romans to dissect human bodies, and even in the 17th century it was very risky business to publish ideas that opposed the beliefs of the church or ruling parties (hence the publishing of Willis's works posthumously).

We see this often as we follow the history of science, medicine, and asthma.  It's perhaps this stubbornness of mankind that we can give credit for the slowness to which the term asthma was defined, and why it took until 1901 for good asthma medicine to be discovered.

Orville Harry Brown, in his 1917 book, explained that Willis attributed to the cause of asthma "as some humor in the blood. (5, page 27).

Ernst Shmiegelow, in his 1890 book, said Willis may have been one of the first to explore the idea of the diaphragm as being the cause of asthma, and therefore may also be the creator of the diaphragmatic theory of asthma which will be defined later in this history.  (6, page 4)

Gee said Willis described three forms of asthma: (1, page 817)
  1. Pneumatic Asthma:  Dyspnea is a result of air passages in the lungs being obstructed or not open enough
  2. Convulsive Asthma:  The primary fault of dyspnea comes from the lungs themselves, "in the moving fibres or muscular coats of the air vessels or in the diaphragm and muscles of the chest or in the nerves of the lungs and chest or of the origin of those nerves in the brain."
  3. Mixed Asthma:  Both pneumatic and convulsive.
Gee said that in defining convulsive asthma, Willis pondered all the theories before his time and incorporated them into his newly defined convulsive asthma, which...
...was soon laid hold of.  The term 'asthma' came to be reserved for the exclusive denomination of that form of the disease which was believed to be spasmotic; and this is the sense in which the word is still used by most persons even in our own day.  (1)
I must continue to remind my readers that nervous asthma was generally thought to be synonymous with spasmotic or convulsive asthma.  By this the medical community believed the the fit of asthma was caused by nervous pathways from the brain as a result of something exciting these nervous pathways.

Barry Brenner, in 1999, said Willis also made an "association between food, emotion, heredity, and asthma." In fact, it was in 1672 that Willis described emotion as bringing about an asthma attack.  (3)

Way back in the 12th century, Maimonides described asthma as a nocturnal disease. In the 17th century there were many references of asthma as a nocturnal disease. T.J.H. Clark, in his 1987 book called "Diurnal Rhythm of Asthma, said Willis....
...blamed the heat of the bed as the cause of nocturnal asthma and he advised leaving the bed and sleeping in a chair.  By contrast, Maimonides recommended celibacy. (4)
So, while we know Jean Baptiste van Helmont was the first person to write about nervous asthma, Willis is given credit.  Regardless, the ideas of van Helmont and Willis regarding asthma would grow roots in the minds of the medical community that would impact how asthmatics were treated long into the 20th century.

  1. Gee, Samuel, "Bronchitis, Pulmonary Emphysema, and Asthma,", Lancet, March 25, 1899, page 817
  2. Salvi, Sundeep S., "Is Asthma Really Due to a Polarized T Cell Response Toward a helper T-Cell Type 2 Phenotype," American Journal of Respiratory and Critical Care Medicine, Oct. 15, 2001, vol. 164, no. 8, pages 1343-6
  3. Brenner, Barry, "Emergency Medicine," 1999, New York, page 6 (Brenner wrote 
  4. Clark, T.J.H., "Diurnal Rhythm of Asthma," (American College of Chest Physicians), 1987,  page 1375
  5. Brown, Orville Harry, "Asthma, presenting an exposition of nonpassive expiration theory," 1917, St. Louis, C.V. Mosby Company
  6. Shmiegelow, Ernst, "Asthma, considered specially in relation to nasal disease," 1890, London, H.K. Lewis
  7. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1921, 3rd edition, Philadelphia and London, W.B Saunders Company
  8. Ramadge, Francis Hopkins, "Asthma, its species and complications, or researches into pathology or disordered respiration; with remarks on the remedial treatment applicable to each variety; being a practical and theoretical review of this malady, considered in its simple form, and in connection with disease of the heart, catarrh, indigestion, etc." 1835, London,  Longman, Rees, Orme, Brown, Green, and Longman; Ramadge discusses Thomas Willis's views on asthma on pages 93-94.  He also mentions him various other times in his book. 
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Wednesday, November 25, 2015

1645: Van Helmont narrows asthma definition

Jean Baptiste van Helmont (1580-1644)
Galileo set the way for others to question old scientific and medical superstitions that were regarded as facts, and one such physician/ scientist/ alchemist was Jean Baptiste van Helmont, who, in 1579, was born into the dawn of the Scientific Revolution in Brussels.

He was the younger son of a noble family, and his father died in his second year. He entered the University of Louvain (Leuven) at a young age, and graduated from his studies in mathematics, astronomy, astrology, and philosophy at the young age of 17. (3, page 260) (4, page 113-114)(7)

He had an opportunity to become the imperial physician, but he declined it because medicine failed to heal him when he obtained scabies from a girl. Instead he decided to "spend his time by fasting, supplication and prayer, and in poverty. He chose the poverty of Christ, giving to his sister all his worldly possessions." (4, page 115)

He then spent time as a Capuchin friar just prior to studying law, botany and medicine. Once this task was completed, he traveled to Switzerland and Italy (1600-1602) and then France and England (1602-15), and then he received his medical degree in 1599. As a physician he was "unwilling to accept money from his sick fellow-man in return for so doubtful an art." (4, page 114)(7)

He put to use his medical skills during a plague that broke out in Antwerp in 1605. (7) This must have earned him quite a bit of fame.  It was also about this time that he was introduced to a person who introduced him to Paracelsus (1493-1541), and he studied his works "zealously." (4, page 114)

Perhaps due to the fame he earned by his travels and experiences, he was offered many attractive jobs from princes and archbishops, although he turned all of these down in 1609, claiming the he did not want to live in the "misery of my fellow men." (7)

It was that same year, in 1609, that he abandoned poverty and Christ, and married a rich heiress by the name of Margaret van Ranst. Through her he inherited several estates, and he retired to one of them, leaving the medical profession to devote his entire life to "chemical science" and transforming the works of Paracelsus. (4, pages 14-15) (7)

By this he became a chemist, although, more than likely, he was an alchemist, following in the footsteps of Paracelsus, of whom, many agree, was also an alchemist.

Unlike Paracelsus, van Helmont didn't believe in ancient Greek theories.  In fact, he became the first to dismiss the idea that asthma (and diseases in general) was a disease caused by an imbalance of the humors and instead was a disease caused by a narrowing of the pipes in the lungs. It was this view that made him a very controversial person during his lifetime.

 Historian Fielding Hudson Garrison explains van Helmont this way:
Like his master, Paracelsus, van Helmont believed that each material process of the body is presided over by a special archaeus, or spirit (which he calls Blas), and that these physiologic processes are in themselves purely chemical, being due in each case to the agency of a special ferment (or Gas). Each Gas is an instrument in the hands of its special Blas, while the latter are presided over by a sensory-motive soul (anima sensitiva motivaque), which van Helmont locates in the pit of the stomach, since a blow in that region destroys consciousness. (3, page 260)
Bradford explained him as follows:
Van Helmont transmuted the fancies of Paracelsus into a sort of mystic and pious system based on chemical principles. He was a considerable chemist. He thought that air and water were the elements; from the water everything on earth takes its origin—the world is the creation of God.(4, pages 114-115)
In order to prove the basic element of the earth was water he performed an experiment where he grew a tree in a a tub for five years and gave it nothing but pure water. He weighed the tree and soil before the experiment, and in the end the soil weighed the same and the tree had gained 160 pounds. He attributed the weight gain of the tree as being due to water. While his conclusion may not have been completely accurate, some historians refer to him as the father of biochemistry because of this experiment. (9)

Bradford continued:
Disease is something active and is caused by the fall of man. The spirit of man came from God, but on account of the fall became so corrupted that a lesser spirit in man gained control. There was next lower a perceptive soul, and below that a something which he called Archaeus; then there is also Gas which arose by the influence of the Archaeus on water. To Van Helmont we owe this word Gas. (4, page 115) 
The term "gas" he derived from the Greek word for chaos.  Due to his experiments with gases he is considered by many historians as the father of pneumatic (air) science.

One of his most famous experiments was when he burned charcoal and produced the substance carbon dioxide. He explained this was the same product produced from fermenting musk, which rendered the air inside caves as unbreathable. Yet at that time he did not use the word carbon dioxide, he used instead the word gas sylvestre.

He also described other gases, such as carbon monoxide, chlorine gas (prescribed by later physicians as an asthma remedy), digestive gases, sulfer dioxide, and a "vital" gas in the blood that we now refer to as oxygen.

Perhaps one of the reasons van Helmont studied air was that he was an asthmatic.  He generally believed asthma was a physical disease of the lungs caused by factors outside the lungs, such as substances one might come into contact with, substances in the air, and substances affecting the mind.

Orville Brown explains how van Helmont suspected the "archeus" was the cause of asthma: (5, page 27)
"Archeus"—a something—a vital spirit—was enshrined in the stomach, and when disturbed, was responsible for disease by sending forth a peculiar fluid, which, reaching the lungs, caused asthma.  (5, page 27)
To grasp a more complete understanding of this system of van Helmont, I will once again refer to Thomas Bradford, who said:
Van Helmont declared a very mystical and fanciful philosophy; the spleen and the stomach were the rulers over the body. The spleen presided over the abdomen, the sexual organs; the stomach over sleep, waking, and folly. This Archaeus also possessed a great power both in man and in animals. Disease depended on a perverted action of the Archaeus. (4, page 115)
More specifically, Walter Pagan, in his 1982 book about van Helmont, said van Helmont believed asthma was caused when a "specific disease semen has planted its root; in the present case (for asthma) a semen that closes the peripheral pores through which air passes from the lungs into the chest cavity.  It is a semen with the property of causing contraction of members and parts."  (2, page 175-176

That this has occurred, Pagan said of Helmont's theory, "is eveident with the phenomena associated with asthma," such as: (2, page 176)
  • Diuresis
  • Diarrhea 
  • Gurgling of the gut
  • Contraction around the gums (2, page 176)
Pagan likewise said that because the lung contracted, Helmont referred to asthma as "epilepsy of the lungs." (2, page 176)(1, page 216)(8, page 374)

He also called it this because asthma was observed to be "latent for long periods, only to provoke on special occasions attacks of contraction that chiefly concern one organ; in this case the lungs, in real epilepsy the nervous system." (2, page 176)  

Pagan added one other thing about the "specific disease semon" that causes asthma:
Basically, however, neither of these is a localized ailment but one conditioned by the influent archeus, the vital principle of the organism as a while. This is shown by the associated symptoms outside the lungs. But the anatomical changes must be looked for in the lungs, where the poison attacks directly, and where they are produced as at a specific seat. To that extent asthma (as indeed every other disease) is a local and localized affair. Its poison irritates in the same way cantharides do, and is essentially identical with the poison of epilepsy, but not strong enough to produce the latter. (2, page 176)
It is believed by many historians that he was the first to link asthma with hysteria, and therefore should be given credit as the father of the nervous theory of asthma.  But he usually doesn't get this credit, perhaps because of the controversial nature of his work, and the fact hat he fad no followers.

Most historians give Thomas Willis, his contemporary, credit for creating the nervous theory of asthma.  This is usually the case even though Willis mentioned nervous asthma several years after van Helmont did.  Yet this is just the way history is, sometimes giving credit for discoveries to the most popular person as opposed to the correct person.

Bradford said van Helmont's remedies for just about any disease were: (4, page 115)
  • Conjuratoins
  • Charms
  • Prayer
  • Power of god  (4, page 115)
He also used "earthly medicines," such as: (4, page 115)
  • Opium
  • Mercury
  • Antimony
  • Wine (for fevers)  (4, page 115)
Barry Brenner, in his 1999 history of asthma, said:
(Van Helmont) noted that the bronchi were the origin of asthma, and that inhaling dust and fish in certain individuals brought on attacks. He noted that the bronchi would react with spasm to dust, especially from the demolition of houses and temples. He described a monk who, while eating fish fired in oil, fell down, deprived of breathing, "so that he was scarce distinguished from a strangled man." The concept put it in conflict with the official Church view of internal humors as the cause of disease, and he was condemned to death until he recanted. (6, page 5-6)
Once he retired he dedicated about seven years to chemical research, and then he spent the rest of his life in "relative solitude and mostly in peace."  (7)

This was despite the fact that most of what he discovered, and most of what he believed, was contrary to the views of the church.  It was due to such controversies surrounding his work that he waited until he was on his deathbed to give his works to his son to edit and publish. So all of what was described above, all he accomplished in his life, was never published until after he was dead.  (7)

Van Helmont had an illustrious mind, one who decided to do what he thought was right as opposed to what was popular.  Surely this caused some controversy during his lifetime, but it was to the benefit of future generations.

  1. Nulan, Sherwin B, "The mysteries within: a surgeon explores myth, medicine and the human body," 2000, New York, Simon and Schuster
  2. Pagan, Walter, "Joan Baptista Van Helmont: Reformer of Science and Medicine," 1982, UK, Cambridge University Press\
  3. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1921, 3rd edition, Philadelphia and London, W.B Saunders Company
  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
  5. Brown, Orville Harry, "Asthma, presenting an exposition of the nonpassive expiration theory," 1917, St. Louis, C.V. Mosby Company
  6. Brenner, Barry E, author of chapter one in "Emergency Asthma" called  "Where have we been? The history of acute asthma," 1999, New York, Marcel Dekker, Inc
  7. "Jan Baptista van Helmont,",, accessed 11/11/13
  8. Gill, M. H., "Review and Bibliographic Notices: "On the spasmotic asthma of adults," by Bergson, published Gill's book, "The Dublin Quarterly Journal of Medical Science," volume X, August and November, 1850, Dublin, Hodges and Smith, pages 373-388
  9. "History of Chemistry,",, accessed 7/6/14
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Monday, November 23, 2015

1698: Floyer's asthma symptoms, triggers, treatment

Floyer's A Treaties on Asthma (1698)
John Floyer's A Treaties on Asthma provides a neat description of asthma, which probably comes from his own experiences with the the disease.   (4, page 374)

He described himself as having periodic asthma, which is probably more in line with our modern definition of the disease.

About a century after the first edition of his book was published a fellow asthmatic and asthma physician by the name of Robert Bree would quote Floyer's description of an asthma attack as such:
"I have found, that by late sitting up I have put by the fit for a night or two; and I have found it commonly necessary to rise out of bed, especially in the summer time, and to sleep in a chair the first night of the fit.  Two nights before the fit asthmatics want sleep frequently." (2, pages 123-124)
Perhaps it's from his own experience that Floyer decided asthma into four parts, which are basically broken down as: (1)

1.  Symptoms:  A history of the fits or the asthmatic attack. It's generally based on his scientific description of bronchospasm: (1)
  • The attack usually begins at one or two of the Clock in the Night
  • The breath if very slow (early sign)
  • Fullness of stomach (early sign)
  • A slight headache (early sign)
  • Sleepiness (early sign)
  • Feeling rigid
  • Feeling stiff
  • Feeling inflated (head seems to be filled with Fumes or Serous Humour)
  • Began to suck in breath
  • Straitness of breath, seems to be for want of an easie Inspiration
  • Urge to sit in an erect Posture, that the weight of the viscera may pull down the diaphragm
  • Enlarging of the breast during inspiration
  • Muscles of inspiration strive and labour more vehemtly
  • Muscles of expiration cannot easily perform the Contraction of the Thorax, being hindered by the Stiffness or Inflation of the Membranes in the Thorax
  • Expriation is easier than inspiration
  • Expriation is very slow, and leisurely (and wheezing)
  • The patient can not cough, sneeze, spit or speak freely
  • The diaphragm cannot contract itself to move downward
  • Bronchi and trachea has its membranes and nervous fibres contracted which results in wheezing (mainly expiratory)
  • Muscular Fibres of the Bronchia and Vesiculae of the Lungs are contracted adn that produces the Wheezing noise, which is most observable on expiration
  • Convulsive cough before fit (inconsiderable)
  • Phlegm is spit up (inconsiderable) 
2. The nature of asthma as he saw it: Basically based on Galanic principles: (1)
  • A flatulent slimy Caccochymia which is bred in the stomach, and creates inflation there, and gives an effervescence in the blood and an inflation in the membranes in the lungs
  • At 2 a.m. the Chyle is more plentiful in the blood.. and the viscid Chyle and Lymph will not easily circulate through the lungs of the asthmatics
  • The Asthma is a High, Slow, Rare and Laborious Respiration, which depends immediately on the inflation of the Membranes of the Lungs by Windy Spirits, rarefied or propelled through the Glands of the Brain, either by external Accidents or periodic Febrile Effervescence (bubbling) of the Blood. 
3.  Triggers: (Accidental causes) or lifestyle causes or factors that precipitate an asthma attack: (1)
  • Great heats or cold
  • violent motions of the body or mind
  • Excess in eating and drinking
  • Venereal Pleasures
  • Heat of the bed
  • Changes of the weather to rain
  • Snow
  • Change in weather from frost to thaw
  • Alteration of clothes
  • Changes of the air at spring and fall (change in barometric pressure)
  • Moist air (dry air is good for the asthmatic)
  • Heat and smoke of from fires
  • Fumes
  • Perfumes
  • dust
  • Strong liquors and food
  • Exercise
  • Anger (makes humours more viscid)
  • Fear
  • Shouting
  • Excessive study (upset the spirits)
  • Any strong smells (candles put out, Smoak of tobacco, winie fermenting, soap making, burnign metals, etc.)
  • Sadness makes humours more viscid 
4.  Treatment: (The cure of the fit) and preventative measures.  These are probably things he tried out on himself: (1)
  • Light diet (fasting on day of attack with a light diet thereafter)
  • Gentle Exercise
  • Bleeding (performed in small quantities, but only in extreme cases)
  • Blisters (Applied to limbs and shoulders)
  • Narcotics/ opiates (if induced by sleep 'when nerves are filled with windy spirits'/ induce sleep)
  • Abstinance of anger or shouting
  • Emetics (to induce vomiting/  if excessive may bring on asthma/ monthly vomiting recommended)
  • Feather in throat (another option to promote expectoration of viscid sputum
  • Oxymel of squills (to induce expectoration)
  • Clysters (laxitives) or Purges (violent purging should be avoided, but regular purges are recommended)
  • Late sitting up (staying up late)
  • Avoid extreme climate changes
  • Febrifuges and Sudorifics to help fevers that accompany the asthma
  • Diuretics such as millipedes and woodlice
  • Cold water bathing (4, page 110)
  • Apple water (4, page 110)
  1. Floyers, John, "A Treaties on Asthma," 1698, London
  2. Bree, Robert, "A Practical Inquiry into Disordered Respiration Distinguishing the Species of Convulsive Asthma, their Causes and Indication for a Cure," 1810, London, pages 123-124
  3. Floyer, John, "History of cold water bathing," 1722, 5th edition, London, Printod form William and John, Innys, at West-end of St. Paul's Church-yard
  4. Gill, M. H., "Review and Bibliographic Notices: "On the spasmotic asthma of adults," by Bergson, published Gill's book, "The Dublin Quarterly Journal of Medical Science," volume X, August and November, 1850, Dublin, Hodges and Smith, pages 373-388
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Friday, November 20, 2015

1698: Floyer redefines asthma, upholds supernatural

Sir John Floyer
The early 17th century centered around a struggle by Western men who were losing their enchantment with the old world in favor of truths obtained by scientific progress and thought. John Floyer was born into this world in 1649 and he rejected it.

In fact, it was because he rejected it that he became one of the most interesting and popular personalities of his generation. He put forth a defense against modern logic and a defense for Ancient ideas, yet at the same time he provided a stunningly accurate description of asthma based on his own experience and experimentation

Floyer lived at about the same time as Jean Baptiste van Helmont and Thomas Willis, yet it was Floyer's ideas regarding asthma that were more readily accepted by his generation. The reason was partly because Floyer had asthma and he used his own experiences to describe the disease.  Yet more likely because he disregarded science and accepted old superstitions that were popular, while the other two endorsed science.

Floyer rejected the ideas of van Helmont and Wilson and other "quacks" because they "know little of Anatomy, and the Nature of Animal Humours."

He also accepted the ideas of Hippocrates and Galen that all diseases were caused by some external poison that caused an imbalance of the humors:  black bile, yellow bile, phlegm and blood.
Floyer's Treaties of the Asthma (a)
Since this was the accepted dogma of the day -- a paradigm that medicine was still stuck in at the time -- Floyer's ideas were much easier for other physicians to accept.  

Floyer was born in 1649 in the small town of Staffordshire, England, the same year as the execution of Charles I.  He suffered from asthma as a child and through much of his adulthood, and it was because of this he would later take up the study of asthma. (2, page 248)

He received his medical degree from Oxford in 1680.  Shortly thereafter he returned to Lichfield which was only a few short miles from his birthplace and became an important member of the British society, and he was even knighted by James II in 1686. (2, page 248)

He was an ardent supporter of cold water bathing, and in n 1701 he published "A History of Cold Bathing: Both Ancient and Modern." He would often recommend this book to his patients, including those with asthma.

In 1682 Andreas Cleyer's Specimen medicinae Sinicae introduced the West to the ancient Chinese method of counting a pulse to diagnose diseases.  Floyer liked this idea, and he expanded it and made taking a pulse a routine task when assessing a patient.

To make the task easier he invented a "pulse watch" that had a second hand that ran for one minute.  Alex Sakula, "Sir John Floyer's A Treatise on Asthma (1698)," said that one of the reasons this "pulse watch" was so important for his study was because he believed that each disease was associated with a specific pulse. (1, page 248)

Floyer wrote about his watch in "The Physician's Pulse Watch" volume 1, in 1707.  You can read about it in more detail here.  The pulse watch was advanced many times even during Floyer's own life, and it soon became a popular site to see your neighborhood physician with a pocket watch. The practice of taking vitals, a pulse and respiratory rate, became commonplace.

The art of watching the hands of a watch revolve is often attributed to Sir John Floyer.

When it came to asthma, Floyer was not a fan of modern remedies that were prescribed by other physicians of his day, such as Van Helmont and Wilson. In fact, he flat out rejected many of them, and instead preferred the more supernatural remedies of Hippocrates and Galen.

Yet while he preferred the supernatural, he was also the first asthma expert to make the case for asthma as a separate disease, as compared to the common rubric term for all that is short of breath.  He made this case in his 1698 book "A Treatise of the Asthma."

In this book, Floyer described respiration as...
...preparing the blood or air vessels by tumours or by injury to the muscles of respiration or to the 'spirits, moving those Muscles.'
He described asthma this way:
When the Muscles labour much for Inspiration and Expiration, through some Obstruction, or compression of the Bronchia, &c. we properly call this a Difficulty of Breath: But if this difficulty be by the Constriction of the Bronchia, 'tis properly the periodic Asthma: And if the Constriction be great, it is with Wheezing; but if less, the Wheezing is not so evident; the Pulse being stopt in the Asthma Fit, the Respiration is Rare."
Then he described two forms of asthma:

1.  Continued:  Dyspnea was the result of other diseases such as dropsy, empyema, tubercles in the lungs, thoracic tumors, abdominal tumors, and spinal conditions such as scoliosis.  He used continued the way we use chronic, meaning that the condition is always present.  Chronic bronchitis and emphysema might also be categorized under this category if they were known diseases at the time.

Eighteenth century physician Michael Ryan quoted Floyer:
When the asthma continues for some months, it is a true pulmonic asthma, and depends on some disease in the breast, as dropsy, tubercle, absess, which compress the bronchia; and till that evident cause be removed, it is impossible to cure the asthma fits."  (3, page 8)
2.  Periodic:  This is bronchial constriction due to "windy spirits" occurring after fevers, catarrh (colds), and hypochondriacal fits (nerves) or as what he referred to as "flatulent slimey cacochymia, which is bred in the Stomach."

Floyer described his own asthma as periodic, and it is this type of asthma that covers the majority of his Treaties on Asthma.  Floyer noted that continued asthma is known to take the life of the asthmatic, yet most people with periodic asthma lived a normal life span.  However, periodic asthma did take a life from time to time.

A little less than 100 years later, Dr. Henry Hyde Salter would further refine Floyer's asthma definition using empirical knowledge known to him, and he referred to pure asthma as periodic in nature, and continued asthma as asthma associated with some type of organic changes, such as chronic bronchitis or enlarged heart.

Floyer became the first to describe seasonal asthma.  Floyer wrote how he kept a "diary of his disease, out of what I can give a more true Account than if I had now recollected what has long since passed."

He observed that he never had any problem with his asthma while he was at Oxford, yet when he returned to Staffordshire he...
...usually visited with a severe Fit or two.  The air of a Town makes the Fits more severe when they happen; but I do not think the Asthmatic so much expos'd to the Accident of the Weather in a City, as in the Country.
He noted that his asthma was worse in the summer than winter, and worse during "the change of the moon."

Barometric pressure can also affect asthma, he proposed, and that is why he recommended changes in weather as a probable cause of asthma.

So he may have been the first to notice the benefits of certain types of air in causing asthma, an idea Salter would later embellish upon.  Such observations may have lead to the later recommendation for asthmatics to move to other areas in order to treat and cure it.

He may also have been the first to describe how tobacco fumes from smoking cigarettes may trigger an asthma attack, yet his reasoning for this was quite supernatural:
"During the Fit of the Asthma, the Smoak of Tobacco is so offensive that it very much straitens the Breath, if it be smoaked the first Day of theFit, and much endangers a Suffocation. There are many Asthmatics that cannot bear the smell of it; therefore its Foetor is injurious any time, its Heat thickens the Phlegm and rerefies their aerial Spirits, making them restless; all the good it can do is to discuss the Windiness after the Fit abates, and to help the coughing up of Phlegm."
Floyer may have been among the first to note that very few people die of an asthma attack, and that between such attacks the asthmatic can live a relatively normal life.  He wrote:
"I have met with some Asthmatics who have been so for Fifty years, as they informed me, and yet in tolerable Health without any considerable Decay of their Lungs, or Disability to perform their usual Employments; which I oft reflect on to encourage my patients, and myself, who yet can study, walk, ride, and follow my Employment, eat, drink, and sleep, as well as ever I could; neither am I yet sensible of any Decay in my Lungs."
Alex Sakula noted that while Floyer's acceptance of Galanic principles would later be proven false, "his treatise shows that he was familiar with the multifactorial basis of asthma -- heredity, occupation, atmospheric pollution, hypersensitivity, infection, exercise, and psychological influences."

Because his theories about medicine were more readily accepted by society in the 17th century, Floyers is often given credit as the first to define asthma as a disease of it's own, more specifically as a disease of bronchospasm, even while this wasn't true.  Regardless, he did play a significant part in defining asthma.

Floyers would die on February 1, 1734, yet his teachings would be studied by physicians for the next hundred years, and his practice of measuring a pulse and respiratory rate became a common medical practice that is still used to this day.

Further reading:
  1. Floyer's asthma symptoms, triggers and remedies by clicking here. 
  2. Floyer establishes spasmotic theory of asthma (will be published 4/17/14)
Click here for more asthma history.

  1. Sakula, Alex "John Floyer:  A Treaties on Asthma," Thorax, 1984, 39: 248-254
  2. Floyers, John, "A Treaties on Asthma," 1698, London, pages
  3. Ryan, Michael, "Observations on the history of asthma, in which the propriety of using the cold bath in that disorder is fully considered," 1793, London, printed by G.G. J. and J. Robinson of Paternoster-Rowe
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Wednesday, November 18, 2015

1666: Dr. Sydenham will cure your asthma

If you lived in Europe and the United States during the course of the 17th century you could take your chances with the botanic physician and his natural remedies. Chances are, however, if you had access to a licensed physician you would heed his advice, and take his remedies, however harsh they were.

While most botanic physicians had no medical degree, the licensed physician would be well educated, and chances are he would have had read, and probably even had a copy of it on his desk, a book called "The Works of Thomas Sydenham M.D."

So you are having trouble breathing, and so you have your son travel on horseback to fetch the doctor.  Chances are, unless he had his remedies memorized, he'd refer to this book, opening it up to page 464.  He would read the following.
1. THERE are three kinds of this disorder: 1. a dyspnoea, which is a dense, quick, and difficult respiration, without'a stertor or rattling, and proceeds from a stuffing of the lungs; 2. an asthma which is a quick and difficult respiration, accompanied with violent motions of the diaphragm, intercostal and abdominal muscles, and a rattling in the throat. In the former species the Kmgs themselves, and in the latter the bronchia are stuffed; 3. an orthopnosa, which is the greatest difficulty of breathing, insomuch that the patient cannot breathe but in an erect posture, and is attended with violent motions of the muscles of the breast and shoulders. 
2. Take away ten ounces of blood from the right arm, and next day give the common purging potion, which must be repeated twice more, once every third day. 
3. On the intermediate days of purging let the following medicines be used:
Take of the seeds of anise, finely powdered, two drams; Locatellus's balsam, enough to bring it into a mass for pills, and make six pills of a dram, three of which are to be taken every morning, and at five in the afternoon, drinking four ounces of the bitter decoction without purgatives, warm, after them. 
4. If the disorder does not go off, let the whole process be repeated. (1, page 464)
In the meantime, you are sitting in a chair at the kitchen table with your elbows hard pressed against the wood table to hold your shoulders high.   A breeze from the kitchen window seems to make your breathing easier, but only slightly.  The breeze feels good upon your sweated brow.

Yet your mind drifts as you try to forget your distress.  Perhaps for one brief moment you feel a panic, and wonder why the doctor is not here yet.  A tear dribbles down your cheeks, although you quickly wipe it away as you don't want your son to see you cry.

You sit, close your eyes, and concentrate on the breeze, and your breathing. You drift back into your fantasy world, perhaps a place where the weather is warm and you're lying on a beach, listening to the soft whisper of waves.

You are awakened from your fantasy by a knock at the front door, and then you hear it open and then slam shut.  You are also instantly reminded of your predicament, and you try to force a breath in that doesn't seem to want to enter. You arduously lift your shoulders up, chest wall out, and stomach in, and this sucks some air into your stiff lungs. Your chest burns.  Your head aches.

You hear the voice of your son and the doctor, and then the doctor appears in the kitchen with his medicine bag.  Your heart skips a beat as you know what he is going to do, and you know that it will bring more grief for you before it makes you better -- if it makes you better.

You watch anxiously as he opens his bag, and pulls out a blade.  He uses it to slice a drain, and you watch as blood dribbles down your arm, landing on the floor. This being done, he bandages the wound and reaches into his bag for a bottle of medicine.

"Take one of these now," he says, handing you a horse pill.  "Then take one again tomorrow.  The draught should be taken, and then taken again tomorrow following the pill.  This will make you feel better."

You take the pill, wondering if the doctor truly believes what he says.  Yet almost as he were reading your mind, he says, in a deep, full and binding voice:
These are the remedies of the great physician Sydenham.  If you had consumption his recommendation was to have the patient ride on a horse.  He was also the first to recommend fresh air, particularly in sick rooms.  The fact you have the window open made me think of this." (2, page 271)
You smile minutely, if only to amuse the physician.  You close your eyes to concentrate on your breathing.  You tune out the physician and don't even notice when he leaves.

So the good doctor arrives at your house carrying his leather medicine bag.  He did not knock, just barged right in, probably with the permission of your son.  You don't mind, because you know exactly who he is, and what he's going

He would set the bag on the table next to the chair you are sitting in.  As you struggled to breathe, you watch as he

He also had ideas that would benefit people with other medical conditions associated with breathing, such as:
  1. He was among the first to recommend fresh air in sick rooms (6, page 271)
  2. He recommended horse back riding for consumptives.  (6, page 271)
  1. Sydenham, Thomas, M.D., "The works of Thomas Sydenham, M.D., on acute and chronic diseases, with their histories and mode of cure, with notes intended to accommodate them to the present state of medicine, and to the climate and diseases of the United States, by Benjamin Rush, M.D., professor of the Institutes and Practice of Medicine, and of Clinical Practice, in the University of Pennsylvania," 1809, Philadelphia, Published by Benjamin and Thomas Kite. 
  2. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1922, Philadelphia, W.B. Saunders Company
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Monday, November 16, 2015

1666: Dr. Sydenham expands medical wisdom

If you were sick with asthma during the 16th, 17th and 18th centuries, who would you want to treat you? You had an option between a botanic physician and his natural remedies, or a licensed physician and his harsh remedies? Dr. T'homas Sydenham would try to convince you to see him, as opposed to some quack doctor.

Back in this era the common folk simply had a bleak image of licensed physicians. Virgil Vogel, in his book "American Indian Medicine," said this was even noted by men like Thomas Jefferson, Thomas Neville Bonner, and Dr. Oliver Wendell Holmes.

Vogel quoted Nevelle as saying: (1, page 114, 115)
The stubborn addiction of most physicians to mercury, bleeding, and calomel was responsible for widespread fear of the medical men and their medicines.  (1, page 114, 115)
Vogel quotes Jefferson as saying: 
"It is part of the medicine that I wish to see reform, an abandonment of hypothesis for sober facts, the first degree of value set on clinical observation, and the lowest on visionary theories."
He also quotes Holmes, who said:
Nature heals most diseases without help from the pharmaceutic art."  
Thankfully, however, there were some well respected physicians, such as Dr. Thomas Sydenham in Britain and Dr. Benjamin Rush in American.  Although, neither did anything to allay the public's bitter perception of the profession.  

Sydenham had published his books in Britain, and there were no copies of them in America. Rush so respected the medical ideas of Sydenham that he self published Sydenham's book in America in 1809, complete with an introduction by himself. This book was aptly titled: "The Works of Thomas Sydenham M.D."

Historian Thomas Bradford said that Thomas Sydenham was born in 1624 at Winford Eagle, in Dorsetshire, England, to a father with a large fortune. He said that little is known about his early life.  What id known is that he started at Oxford, but war interrupted his studies. Some say he ended up as a soldier in the Parliamentary army of 1642. In 1646 he returned to his studies at Oxford. (3, page 118)

Rush said he obtained a Bachelor's Degree in Physic (the art of medicine) at the University of Oxford in 1648 and in the process obtained "some medical knowledge.  (2, page xvi)

A.J. Cain, in his 1999 book, said Sydenham wasn't content, and continued to travel abroad to further his education. He didn't obtain his M.D. until 1676 at Pembroke Hall at Cambridge. (4)

Bradford said he then moved on to the "celebrated" medical school at Montpelier. He received his degree of doctor at Ct Cambridge, and settled in Westminster, London, where he began his medical practice "sometime before 1661. He received his license from the College of Physicians of London." (3, page 118)

Historian Fielding Hudson Garrison said he is credited as reinstating the hippocratic art into medicine, which involved the art and skill of the physician more so than science and theory.  He believed that "the mind is limited and fallible, and to it final causes must remain inscrutable.  Scientific theories are, therefore, of little value to the practitioner since, at the bedside, he must rely upon his powers of observation and his fund of experience." (5, page 270)

Garrison said he was friends with fellow Englishmen Robert Boyle and John Locke.  However, and interestingly, it is generally believed he did not know of the works of many of his contemporaries, such as Andreas Vesalius, William Harvey, Marcello Malpighi, and John Mayow. Among his favorite books were Hippocrates and Don Quixote.  (5, page 269)

Rush said that Sydenham was well aware of the fact that his continued research into physick elevated him above his peers.  Regardless, he continued to have respect for the wisdom of those who came before him.  

To show this, Rush told the story of one of his meetings with Sir Richard Blackmore, who was physician to King William III and a famed writer and poet. (9). 

Rush said:
It is the general opinion, that he was made a physician by accident and necessity, and sir Richard Blackmore* reports, in plain terms, that he engaged in practice without any preparatory study, or previous knowledge, of the medical sciences; and affirms, that when he was consulted by him what books he should read to qualify him for the same profession, he recommended Don Quixote.
That he recommended Don Quixote to Blackmore, we are not allowed to doubt; but the relater is hindered by that self'love, which dazzles all mankind, from discovering that he might intend a satire very different from a general censure of all the ancient and modern writers on medicine, since he might perhaps mean, either seriously or in jest, to insinuate, that Blackmore was not adapted by nature to the study of physic, and that, whether he should read Cervantes or Hippocrates, he would be equally unqualified for practice, arid equally unsuccessful in it.  
Whatsoever was his meaning, nothing is more evident than that it was a transient sally of an inclination warmed with gaiety, or the negligent effusion of a mind intent on some other employment, and in haste to dismiss a troublesome intruder; for it is certain that Sydenham did not think it impossible to write usefully on medicine, because he has himself written upon it; and it is not probable that he carried his vanity so far, as to imagine that no man has ever acquired the same qualifications besides himself. He could not but know that he rather restored than invented most of his principles, and therefore'could not but acknowledge the value of those writers whose doctrine he adopted and enforced. (1, xvi-xvii)
Sydenham wrote a lot about his ideas on the medical profession of his time, and he had several books published in Britain.  None of these survive, so all that we have left of his works is the book published by Rush.  (3, page 118)

Sydenham believed in the four humors of Hippocrates, and that diseases were caused by some form of peccant matter (or "morbific particles") in the air that were inhaled, and disease states were the result of the body attempting  to expectorate the peccant matter.

Dr. Syndenham describes diseases as follows:
DISEASE,  in my opinion, how prejudicial so ever its causes may be to the body, is no more than a vigorous effort of nature to throw off the morbific matter, and thus recover the patient. For as God has been pleased so to create mankind, that they should be fitted to receive various impressions from without, they could not, upon this account, but be liable to different disorders; which arise either from such particles of the air, as having a disagreement with the juices, insinuate themselves into the body, and mixing with the blood, taint the whole frame; or from different kinds of fermentations and putrefactions of humours detained too long in the body, for want of its being able to digest, and discharge them, on account of their too large bulk, or unsuitable nature.(2, page 1)
In the introduction to the book, Dr. Benjamin Rush (1746-1813) wrote the following:
"The works of Dr. Syndenham are singular, in being alike, celebrated and neglected by modern physicians.  They owe their fame to the invaluable truths that are contained in them; and the neglect with which they have been treated, to certain errors, which have been refuted by modern discoveries and improvements in medicine." (2, page III)
Dr. Rush did little to improve upon the image of the profession, as his methods differ by only a slight degree from those of Sydenham.  For example, Dr. Rush did not believe that "morbific matter" was the cause of disease, nor that the expulsion of this "morbific matter" would cure the disease. (2, page IV)

For the most part, however, Rush supported the medical views of Sydenham.  Dr. Rush said:
To enumerate the many truths that are contained in the following work, would be to transcribe, with the exception of a few pages, nearly every part of it. His histories of acute diseases; his details of the laws of epidemics; his intuitive discernment of old diseases, entangled in new ones; his defence of cool air, and pf depleting remedies, to which millions owe their lives; his sagacity in discovering the precise time, and manner of administering his remedies, and the difference of his practice in the same disease in different seasons, constitute a galaxy of medical knowledge, and mark that rare assemblage of discriminating and combining talents, which have elevated him above the claims of the century and nation in which he lived, and rendered him the physician of all ages and countries. The same talents, employed upon subjects of more general and popular inquiry, would probably have placed him upon the same grade with sir Isaac Newton, in a scale of human intellect... Indeed, so convinced have later times been of the validity and accuracy of his descriptions, that they are considered as the unrivalled delineations of nature; so universally have they been esteemed for their exactitude and truth, that poets never made freer use of, or stole more from Homer, Pindar, or Virgil; satyrists from Juvenal, Persius, or Horace; orators from Demosthenes, Quintilian, or Cicero; nor dramatists from Shakespeare, than physicians have from Sydenham."  (2, page VI)
Dr. Rush believed all medical students should study Sydenham, who believed it was the job of the physician to offer medicine to guide the body in its attempt to rid the body of the peccant material.  For example, Sydenham said of gout:
What is the gout, but the contrivance of nature to purify the blood of aged persons, and, as Hippocrates phrases it, to purge the recesses of the body? And the same may be said of many other diseases, when they are perfectly formed. (2, page 1)
What is impressive here is that the same philosophies of medicine written about by Hippocrates in 400 B.C. were still inculcated in the 17th century, and even still during the 18th century.  This, in essence, should explain some of the harsh remedies -- such as purging and bleeding to expel some peccant matter -- amid the licensed medical profession of the 17th and 18th centuries.

Amid a society that was growing skeptical of the harsh remedies of the licensed medical profession, it only makes sense that a gullible populace would seek the natural alternatives offered by the root and herb doctors, or the botanic physicians.
Chances are, however, that if you had access to an esteemed gentleman physician such as Dr. Sydenham, you'd probably have faith in his remedies.  Of this, Dr. Rush said:
What was his character as a physician, appears from the treatises that he has left, which it is not necessary to epitomize or transcribe; and from them it may likewise be collected, that his skill in physic was not his highest excellence; that his whole character was amiable ; that his chief view was the benefit of mankind, and the chief motive of his actions the will of God, whom he mentions with reverence, well becoming the most enlightened and most penetrating mind. He was benevolent, candid, and communicative, sincere and religious; qualities which it were happy if they would copy from him, who emulate his knowledge, and imitate his methods. (2, page xx)
He was among the most well respected physician of his era, influencing medicine well into the next century.  By his method of studying diseases by direct examination of the living, he is often cited as the founder of clinical medicine.  By his belief that it was important to understand diseases in order to better control them, he is often cited as the father of epidemiology. (6)(7)(5, page 270)

He also lived in a era where the various elements of science were first being categorized.  He believed, as Garrison said, "that each disease belonged to a certain definite species, which could be described and classified as a botanist describes plants. (5, page 270)  

Garrison said:
His theory of medicine was simple.  The human mind is limited and fallible, and to it final causes must inscrutable.  Scientific theories, therefore, are of little value to the practitioner since, at the bedside, he must rely upon his powers of observation and his fund of experience. (5, page 269-270)
Perhaps due to his Puritan beliefs, he rejected pathological anatomy, or using the microscope to learn more about the causes of internal diseases. He believed it was better for a physician to assess his patient and use his senses to determine proper treatment, as opposed to trying to learn about internal causes. (8)

Bradford said, "His model was Hippocrates, and he thought that we should follow nature; he differed from him in attempting to arrest the natural course of disease by giving specifics," said Bradford. (8)(3, page 118)

He continued to practice until 1789 when he died at the age of 65. He was so esteemed by his fellow British physicians that "a monument was erected to him by the college of physicians... (posthumously) he was called the English Hippocrates," said Bradford. (3, page 118)

  1. Vogel, Virgil J., "American Indian Medicine," 1970, London, Oklahoma University Press
  2. Sydenham, Thomas, M.D., "The works of Thomas Sydenham, M.D., on acute and chronic diseases, with their histories and mode of cure, with notes intended to accommodate them to the present state of medicine, and to the climate and diseases of the United States, by Benjamin Rush, M.D., professor of the Institutes and Practice of Medicine, and of Clinical Practice, in the University of Pennsylvania," 1809, Philadelphia, Published by Benjamin and Thomas Kite. 
  3. 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
  4. Cain, A.J., "Thomas Sydenham, John Ray, and some contemporaries on species," Archives of Natural History, 1999, volume 26 (1), pages 55-83,
  5. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1922, Philadelphia, W.B. Saunders Company
  6. "Thomas Sydenham,",, accessed 6/9/13)
  7. "Clinical Medicine," The Free Dictionary By Farlex,, accessed 6/9/13
  8. "Thomas Sydenham (1624-1689),",, accessed on 7/5/14
  9. "Sir Richard Blackmore,", accessed 6/9/13
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