625-690: What did the ancients know of the cardiovascular system?

Sometime during the 7th century A.D. Paulus Aegineta recorded all he knew about ancient medicine.  It is from his works that we can gather a sense for what the ancient physicians thought about the heart and lungs.

The lungs were essential to life, as they provided for the breath that was necessary for the inhalation of a spirit, or pneuma, that was essential for the establishment of life, or a soul.  Yet the main purpose of the lungs were to facilitate the heart with nutrients, and to make sure it doesn't become too hot.

Aegineta noted what he learned about the heart.  I will break down what he said to make for easier reading.  He said:

"These are the marks of an unusually warm heart:

• Largeness of respiration
• Quickness and density of pulse
• Boldness and maniacal ferocity
• The chest is covered with hair, particularly the breast, and usually the parts of the hypochondriac regions adjoining to it
• The whole body is hot, unless the liver powerfully antagonise. 
• And capacity of chest is also a mark of heat, unless the brain in that case antagonise. 

"But an unusually cold heart has the pulse smaller than moderate, and such persons are timid and spiritless, more especially if there be no hairs on the breast.

"Dryness of the heart renders the pulse hard, and the passions ungovernable, fierce, and difficult to quell; and, for the most part, the whole body is drier than usual, unless the parts about the liver antagonise. 

"These are the marks of a more humid temperament: 

• A soft pulse
• A disposition easily roused to anger and easily pacified, 
• The whole body more humid than common, unless antagonised by the parts about the liver. 

"When the temperament is both hotter and drier, the pulse is large, hard, and quick and dense; and the respirations large, quick, and dense. And of all others such persons have the most hair upon the breast aud pnecordia; they are prone to action, given to anger, fierce and tyrannical in their dispositions; for they are both passionate and implacable.

"But, if humidity prevails with heat, such persons are less covered with hair than the afore-mentioned; they are prompt to action, their disposition is not tierce, but only prone to anger; their pulse is large, soft, quick, and dense. 

"But when the temperament is more humid and cold than common, the pulse is soft, the disposition spiritless, timid and sluggish; they have no hair on the breast, and neither indulge in lasting resentment, nor are prone to anger. 

"A cold and dry heart renders the pulse harder and small. Of all others, such persons are least given to anger, but when provoked they retain their resentment. They are also particularly distinguished by having no hair on the breast.

Okay, so the modern reader might read all that and think: what a bunch of bull. What does hair on the chest have anything to do with the heart.  However, when we consider what the ancients thought of the heart, it all makes sense.  Francis Adams, who translated the works of Aeginenta in the 19th century, clarifies what Aegineta wrote.  Adams said:

In the ancient system of physiology, the heart was considered as the seat of the Vital powers, its office being the preservation of the innate heat of the body.

The philosopher, Aristotle, had pointed out the connexion between heat and vitality, and had taught that the heart, as being the centre of heat, is the prime organ in the animal frame. Hence, as his commentator, Averrhoes, remarks, it is the primum movens et ultimum moriens (the first mover and the last dying).

Galen, however, maintained with Hippocrates, that the animal frame is a circle, having neither beginning nor end, and that, consequently, it has no prime organ. He taught that the brain does not, properly speaking, derive its powers from the heart, nor the heart from the brain; but that these organs are mutually dependent upon one another, the heart being in'" 'debted to the brain for supplying the parts concerned in respiration with muscular energy, and the brain being indebted to the heart for its vital heat, without which it could not continue to be the vehicle of sensibility and motion.

We have mentioned in the preceding Section, that the ancient physiologists looked upon respiration as being a process similar to combustion. The heart, then, was supposed to convey heat to all parts of the body, by means of the animal spirits incorporated with the blood in the arteries.

Respecting the contents of the arteries, two hypotheses divided the ancient schools of medicine. The first was that of the celebrated Erasistratus, who maintained, that the arteries do not contain a fluid, but merely certain airs or vapours. The other hypothesis was that of Galen, who keenly attacked this, as he did most of the tenets of Erasistratus, and endeavoured to prove, by experiment, observation, and reasoning, that the contents of the arteries is blood, mixed, indeed, with a certain proportion of heat and airs, but in every respect a fluid, little different from that contained in the veins.

It was also part of his system, that the right cavity of the heart attracts blood from the liver, and conveys it to the left, from which it is diffused all over the body by the arteries. He taught that, at every systole of the arteries, a certain portion of their contents is discharged at their extremities, namely, by the exhalents and secretory vessels; and that at every diastole a corresponding supply is attracted from the heart. He decidedly inculcates, in opposition to Asclepiades, that it is the expansion or diastole of the artery which occasions the influx of the blood, and not the influx of the blood which occasions the expansion of the artery; or, in other words, that the systole is the function of the heart, and the diastole its return to its natural state.

Though he demonstrated the anastomosis of arteries and veins, he nowhere hints his belief, that the contents of the former pass into the latter, to be conveyed back to the heart, and from it to be again diffused over the body. In a word, his system appears to have been nearly, or altogether, the same as that which was afterwards taught by the unfortunate Servetus.

It is clear, therefore, that Galen had made a very near ap proach to the Harveian theory of the circulation; indeed, Harvey himself candidly admits this. It will be perceived, from what' "' we have stated, that the grand point of difference between Galen and Harvey, and that upon which the theory of the latter mainly rests, is the question whether or not at every systole of the left ventricle more blood be thrown out than is expended on exhalation, secretion, and nutrition. Upon this point Galen held the negative, Harvey, as we all know, the affirmative.\

With regard to the passages collected by the ingenious M. Dutens and others, from the works of Hippocrates, Plato, Nemesius, Pollux, and Theodoret, to prove that the ancients were acquainted with the circulation of the blood, as taught by Harvey, we shall only remark, that, after having attentively considered them, we cannot but draw the conclusion, that some of these authors must have had, at least, an obscure idea of this doctrine, although, in general, these passages may be understood to refer merely to the lesser circulation and the movement of the blood from the centre to the extremities, as maintained by Galen.

The last of these writers, whose minute acquaintance with the earlier works on medicine entitles his opinion to every consideration, after a searching investigation into the state of anatomical knowledge in the days of Hippocrates and his immediate successors, comes to the conclusion, that the germ of the theory of the circulation is, beyond doubt, to be found in the Hippocratic treatises.

In 1553, Michael Servetus (1509?-1553) was the first to accurately describe the circulation of the blood through the body, although he was burned at the stake for opposing accepted opinion.  His pupil was William Harvey (1578-1657), and because he was the first to publish evidence that blood circulates, he is given credit by history.

However, Harvey openly acknowledged that he was not the first to conclude that blood circulates, even going as far to say that the ancients knew of it, or, if not, were very close to knowing it.

Still, Galen described the blood as ebbing to and fro, from the heart to the liver and back to the heart, for example.  This was a common belief until Harvey proved, without a doubt, that the blood did circulate.

Further reading:

• 1213-1644: The discovery of gases and basic anatomy 

References:

1. Aegineta, Paulus, "The Seven Books of Paulus Aegineta," translated by Francis Adams, volume I, 1834, London, Snydenham Society, pages 94-96

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625-690.: What did the ancients know about the pulmonary system?

What did ancient physicians know about the lungs?  What did they think was the purpose of the soft, sponge-like organs that surrounded the heart in the chest?  The best answer to this comes from one of the world's first medical historians: Paulus Aegineta, who lived from 625-690 A.D.

He said:

Not only does the stomach render us thirsty and otherwise, and excite a desire of warm and cold drink, but also the thoracic viscera, namely, the heart and lungs, and likewise the liver. And drinking does not straightway allay the desire, but a small quantity of cold drink will rather allay the thirst than a great quantity of warm. Persons so affected are refreshed by inhaling cold air, which has no effect in alleviating the thirst of the stomach. Thus, also, those who are contrariwise affected, suffer sensibly from breathing cold air; this is the strongest mark of coldness of the lungs; but they also hawk up phlegm, and expectorate it with coughing. Dryness of the lungs is marked by freedom from excrementitious discharges and from phlegm; and humidity, by being excrementitious, and rendering the voice dull and hoarse; and the recrementitious discharge is also very great when they attempt to speak in a louder or sharper tone.

While that sounds like a bunch of nonsense to the modern healthcare professional, it makes total sense if you understand the lungs from the perspective of the ancients.  Francis Adams (1807-1886), who translated the writings of Aeratus, clarified what Aerateus was saying.  Adams said:

The ancients were of opinion, that the lungs are an accessory organ, made to administer to the heart. "It" is the heart," says Aretaeus, "which imparts to the lungs the desire of drawing in cold air." And in like manner, Theophilus holds that the other organs of respiration were made for the sake of the heart, in order that its innate heat may be cooled, increased, and nourished.

So, the purpose of the lungs was to cool and nourish the heart.   He continued:

The physiologists differed respecting the uses of respiration. Thus, according to Galen, the famous Asclepiades held that it is for the generation of the soul itself, breath and life being thus considered to be identical...

The Asclepiades were temples in ancient Greece where the sick visited, and while sleeping inside the god Asclepius would reveal the cure, which would be interpreted by a priest. These cures were recorded on votive tablets stored inside the temples, and it was from these that some speculate Hippocrates obtained his medical wisdom.

Adams continued:

(The purpose of the lungs, according to) Hippocrates "'for its nutrition and refrigeration; and Erasistratus for the filling of the arteries with spirits. All these opinions are discussed and commented upon by Galen, who determines the purposes of respiration to be twofold: first, to preserve the animal heat; and second, to evacuate the fuliginous portion of the blood. He was aware of the analogy between respiration and combustion, and comes to the conclusion that they are processes of a similar nature: he accordingly compares the lungs to a lamp, the heart to its wick, the blood to the oil, and the animal heat to the flame.

Aristotle gives the name of pneuma to the vital heat of animals, and ascribes the source and maintenance of it to the double functions of respiration and digestion.

The following extract from Alexander Aphrodisiensis will explain the opinions entertained by physicians... of a later age:  "Wherefore there is a natural tepidity, the same I mean as the innate heat, whence springs the origin of the animal, its nature; for it is congenital with the animal, and therefore is called natural, being in the main the instrument of the soul's powers."

The following extract from Haly (Abbas) will show that the opinions of the Arabians on this subject did not differ from those of their Grecian masters, and more especially of Galen: "Respiration is necessary, for the sake of the heart, which is the fountain, and, as it were, the focus of vital heat, whence it is diffused over the rest of the body. It requires some aerial substance to ventilate the heat and ebullition of the heart, and in order to evacuate the fuliginous vapours which are found in it."

So you can see that the ancient Greeks created theoeries regarding the lungs, and the heart too, that were regarded by the medical community long after the fall of Rome in 476 A.D. and the end of what many consider the ancient world.

References:

1. Aegineta, Paulus, "The Seven Books of Paulus Aegineta," translated by Francis Adams, volume I, 1834, London, Snydenham Society, pages 93-94

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625-690: What did the ancients think of colds and allergies?

Viral and bacterial infections, common colds, allergies, hay fever, rhinitis and other such affections of the upper respiratory tract were generally all considered one and the same thing for most of history.

They were generally referred to as coryza, catarrh, and cough.  They were basically symptoms, and therefore the disease.  Coryza being inflammation of the nasal passages, catarrh being increased mucus and discharge in the nose and throat, and cough being a cough.  (1, page 469)

Paulis Aegineta, our Arabic medical historian from the 7th century, said "All these complains have this in common, that they are occasioned by the defluxion of a redundant humour  from the head to the parts below.   (1, page 469)

This basically meant that there was too much phlegm in the brain, and when this occurs it spreads to the nasal passages, mouth, throat, and lungs.  Therefore, the same cause also resulted in diseases of the throat and lungs, including croup and asthma.

Aegineta generally worded it this way:

When, therefore, it seats in the nostrils, the disease is called coryza; when in the pharynx and roof of the mouth, simply catarrh; but when it attacks the larynx and arteria trachea, so as to occasion a roughness of the membrane which lines them, the voice becomes hoarse, and the disease is called branchus, or morbus arteriacus: these terms being applicable not only to the inflammatory roughness occasioned by a defluxion from the head, but also to that arising from vociferation and inhaling cold air. (1, page 469)

It makes sense that they believed it was caused by inhaling cold air, considering people are more likely to catch a virus or bacteria when huddled close together in a warm room due to cold weather outdoors.  Yet they would have associated it with the cold air.

Cough pneumonia and influenza were also likely to be caused by the same thing. Aegineta said:

When the complaint is protracted, and the defluxion is carried down to the chest and lungs, it gives rise to bad coughs. And a cough often arises from an intemperament; sometimes a hot one, as in fevers, and sometimes a cold, as in northerly states of the weather, which is rather a dry one. Cough is also sometimes symptomatic of some other disease, such as pleurisy, hepatitis, phthisis, or peripneumonia. (1, pages 469-470)

Another disease would have been chronic bronchitis, which was not officially a disease until many centuries later.  Paulus might have been referring to this when he wrote:

Wherefore Galen relates that, in certain chronic cases of cough, chalazia (hail-stones) have been brought up from the chest. But Alexander relates that a certain heavy stone, like that which forms in the urinary organs, was brought up in a chronic cough, upon which the cough ceased. (1, page 470)

 Paulus lists the following as remedies for coryza and catarrh: (1, pages 470-471)

• Baths, and have a large quantity of hot water poured upon the head
• Foods such as spoon-meats and eggs in a state to be supped, starch, sweet cake, sesame, rice, almonds, the fruit of the cones of pine, and all confections from milk. 
• The wines which are drunk should be sweet and not old.
• A restricted diet is to be observed, and the head anointed with some heating and attenuating ointment, such as that of nard or rue.
• The ointment of iris is not only to be rubbed in, but is also to be injected into the nostrils
• Internally, they are to be rubbed with frankincense and myrrh, with oil; and this more especially when the coryza arises from cold.
• Odoriferous substances with burnt linen, or by gith and cumin burnt and bound up in a linen rag.
• Let them also smell to the cyphi seleniacum, and let it be rubbed into the forehead; and to it let there be added one of the antiphlogistic plasters, such as the Icesian, the Oxera, the Barbarum, and the Athena.
• For catarrh from cold it will be expedient to drink of cyphi, and to rub into the chest the juice of balsam by means of unwashed wool
• Apply calefacients to it (the chest), along with storax, the ointment of iris, or that of dill. 
• Let them also use hot and concocting food. But when the matter is already concocted, a masticatory will answer well with them, and detergent ointments (smegmata) to the head, such as the soap of Constantine, and the like (1, pages 470-471)

For affections of throat and trachea and coughs, the remedies are essentially the same, so I won't go into them.  Chances are none of these remedies did much good anyway, other than to have a placebo effect.

He does, however, offer some recipes for pills that might be useful for catarrh and cough.  He said:

Of storax, of myrrh, of opium, of galbanum, equal parts; mix with must, or pound by themselves in a mortar, and make into pills the size of a tare. Give three, four, or five at bedtime, and swallow with some must. These things are for an acrid and thin rheum.—Another: Of the seed of henbane... of pine-nuts... of saffron.  Mix with rob or with must, and use. An electuary. Of honey  of butter.... Boil together and give; and let the decoction of hyssop, of figs, of pinenuts, and of iris, be swallowed. Pills for more inveterate coughs. Of storax... of myrrh... of turpentine, of galbanum, of opopanax, and of iris, of each..., of white pepper, of nitre, of henbane-seeds, of the juice of poppy, of each... Beat in a mortar without any liquid, form into pills, and use as formerly directed. (1, page 472)

Francis Adams said that most of the other ancient physicians, with the exception of Aretaeus, agreed with Paulus Aegineta regarding his description and treatment of coryza, catarrh, cough and common throat ailments. The same is true of Arabian physicians.  So we have no reason to delve into their thoughts on the subject. However, if you want to learn about them, you can click on the link provided below. (1, page 472)

However, it must be understood that most physicians, no matter what era they are from, have form their own opinions about diseases and their remedies, and so how you were treated would depend on who your physician was.

Don't scratch your head trying to figure out what all these remedies are or what they amount to.  I just wanted to show you what some of the remedies would be if you suffered from the common cold or allergies in the ancient world.  

Chances are, you'd be better off toughing it out, which is probably what most people did.  

References:

1. Aegineta, Paulus, "The Seven Books of Paulus Aegineta," translated by Francis Adams, volume I, 1844, The Snydenham Society, pages 469-475 

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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)

References:

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. Greeka.com, "Paulus Ageneta: The most important physician of Aegina Greece, Saronic," http://www.greeka.com/saronic/aegina/aegina-history/aegina-paul-of-aegina.htm, accessed June 26, 2012
3. Gurunluoglu R, Gurunluoglu 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 Pubmed.gov, http://www.ncbi.nlm.nih.gov/pubmed/11743404, accessed June 26, 2012
4. Virginia.edu, "Paulus Aegineta (625-690)," University of Virginia, Vaulted Treasures, http://exhibits.hsl.virginia.edu/treasures/paulus-aegineta-625-690/
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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625-690: Paulus Aegineta describes asthma

2

Paul of Aegineta was a Greek physician who gives us a very early
description of asthma.  He also provided for us one of the first
histories of medicine, thus preserving the thoughts on asthma
of some of the ancient physicians

So how did the ancients define asthma? To get an answer to this question we need look no further than the 7th century A.D., where Paulus Aegineta gave us a summary of how physicians during his day viewed this ailment (1).

He was born in Aegina in 625, was educated at the University of Alexandria, and grew to become a famous Greek physician.  His name was Paul of Aegina, although he is most known by history as Paulus Aegineta. (2)

He became a very skilled surgeon who provided many achievements in the surgical process.  He was among the first to describe a process called bronchotomy, which was an old term for tracheotomy.  Some consider him the originator of plastic surgery.  (3)

He was also a well known expert on diseases of the heart. (4)  Considering heart disease often caused dyspnea, it was generally thrown under the category of asthma.  

He was also a skilled writer, compiling a condensed account of medicine, from surgery to treatment of diseases such as asthma.  His seven books were interpreted into English in 1744 by Francis Adams titled, "The Seven Books of Paulus Aegineta."  The books not only influenced physicians during Aegineta's era, but subsequent eras including Avecena, Rhazes, Haly Abbas, Albucasis, and Fabricius ab Aquapendente.  (5)

While he is most famous for his surgical wisdom, he does provide accounts of various disease processes, such as asthma, and remedies to treat them.  Most of his ideas were borrowed from ancient writers, which makes him an important figure when trying to compile a history of any disease.

The following is how he, and perhaps the ancients in general, defined asthma. This comes from his book "The Seven Books of Paulus Aegineta" translated by Francis Adams.  (6)

1.  Definition:  "Those who break thick without fever, like those who have run fast, are said to be asthmatic, that is to say, to pant for breFath; and from their being obliged, they are called orthopnic. (6)

2.  Causes:  The affection arises from thick and viscid humours becoming infarcted in the bronchial cells of the lungs. (6)

3.  Symptoms:  Dyspnea is a common symptom which accompanies these and many other complaints. (6)

4.  Treatment:  The indications of cure for asthma is to consume the viscid and thick humour by attenuant and detergent medicines.  Wherefore the vinegar of squills will answer well with them, and the oxymel prepared from it; the baked squill itself will answer well triturated with honey; the antidote called heira, continued purging with drastic medicines, and vomiting from radishes.  And, in like manner, the round birthwort may be drunk, the root of the great centaury, the fruit and root of the cow-parsnip,the fruit of calimint, hyssop, iris, and gith.  Put a sextarius of slaters, into the earthen vessel, roast upon the coals; when whitened, pulverize, and, mixing with boiled honey, give a mystrum thereof before and after food.  If there be any urgent necessity, before doing all these things, open a vein and evacuate proportionably to the patient's strength; and stimulate the belly by clysters.  Externally to the chest we may apply cataplasms from figs, the flour of iris, and of barley, containing rosen, wax, and honey; and iris and manna may be sprinkled upon them.  Some benefit may also be derived from raw barley-flour with rosin, wax, iris, and manna.  We may use the more heating ointments, which as those of iris, dill, and rue.  But the following application is particularly proper: Of pumice stone, p.j; of burnt lees of wine, p.iv; of arsenic, p.j; of the schenanth, p. ij; of alcyonium, p.j; of aphronitrom, p.ij; pound, sift, mix with the ointment, and with it rub the parts about the chest, and use emollient ointments for attracting the humours. (6)

So while he is mostly known as being a prolific surgeon, he also gave us some pretty interesting descriptions of diseases, including asthma.

References:

1. Aegineta, Paulus, "The Seven Books of Paulus Aegineta," translated by Francis Adams, volume I, 1844, The Snydenham Society, pages 289-290  (commentary by Adams can be found on pages 407-09)
2. Greeka.com, "Paulus Ageneta: The most important physician of Aegina Greece, Saronic," http://www.greeka.com/saronic/aegina/aegina-history/aegina-paul-of-aegina.htm, accessed June 26, 2012
3. Gurunluoglu R, Gurunluoglu 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 Pubmed.gov, http://www.ncbi.nlm.nih.gov/pubmed/11743404, accessed June 26, 2012
4. Virginia.edu, "Paulus Aegineta (625-690)," University of Virginia, Vaulted Treasures, http://exhibits.hsl.virginia.edu/treasures/paulus-aegineta-625-690/
5. Gurunluoglu, op cit, 2072-9
6. Aegineta, Paulus, "The Seven Books of Paulus Aegineta," translated by Francis Adams, volume I, 1744, The Snydenham Society, commentary by Adams can be found on pages 407-09
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

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625-690: Would nausea cure your asthma?

Paulus Aegineta, along with many other physicians prior to the 20th century, recommended a good vomit as a remedy for asthma, along with many other ailments.  In his book "The Cannon" he described how to induce a good vomit.

Since to those who vomit with difficulty many disagreeable consequences are apt to happen, it will be proper to explain by what methods one may be made to vomit readily; for this operation evacuates phlegm and lightens the head, and prevents a person who may have eaten immoderately from suffering indigestion, and one who has taken too much wine from being hurt thereby.

Let the substances which are taken be neither sour nor dry, but part of a sweetish and liquid nature, and part acrid. Among these the radish is deserving of praise, and also the rocket, and old pickle, green marjoram, and a small quantity of onion and leek.

Vomiting is likewise promoted by ptisans (according to dictionary.com, this is a nourishing decoction said to have medicinal qualities) of pulse containing some honey; by soup of bruised beans and the fat of flesh; but one must not only take the juice, but swallow whole lumps of it; and one must not spend much time upon mastication (chewing); but these things ought to be soft from boiling.

It is clear, also, that it is the sweetish kinds of wine which ought to be preferred, for such are aptest to swim upon the stomach; and tepid drink ought to be used. It is proper also to eat almonds dipped in honey, also sweet cakes, and the moistened seed of the pompion and cucumber pounded with honey.

The root likewise of the cucumber rubbed with honey has some effect. Those who wish to use more powerful medicines, mix some wine with a decoction of the bulb of the narcissus.

Vomiting is also produced by the ointment of iris, if one will smear one's fingers in it and tickle one's throat. It is also to be attended to in vomiting not to intermit after vomiting is once begun; and to bathe the face and wash the mouth with sour wine or water, for this is beneficial to the teeth, and relieves the head.

Francis Adams said, in 1844, that what Aegineta wrote about vomiting was an abridged version of Oribasis.  He said that Aegineta, along with other ancient authors, including Galen, Diocles, Archegenes and Celsus all probably formed their opinions on the matter from Oribasius.

Adams said that Aetius recommended vomiting as a "cure of arthritic diseases, dropsy, and jaundice. One of his simplest emetics consists of the decoction of radishes, with the strained infusion of dried figs. He mentions the oil of privet as a most effectual emetic."

Adams said that Avicenna's "information on the subject" was very similar to Aegineta's, although "he properly states that the too frequent repetition of emetics hurts the stomach, is prejudicial to the chest, the sight, the teeth, in chronic pains of the head, unless arising from sympathy with the stomach: and in epilepsy, when the cause of it is seated in the head."

If this discussion wasn't interesting enough on it's own, consider the following, as noted by Adams.  

According to Avicenna and Averrhoes, the proper season for emetics is the summer. Rhases says that much vomiting hurts the liver, breast, eyes, and lungs, occasioning haemoptysis. He directs the person to bind a compress on the forehead before taking an emetic; and to wash the mouth and face with hydromel after its operation. He adds that persons who have long necks, prominent chests, and who are lean, ought to abstain altogether from emetics.

Haly Abbas, on the other hand, said Adams, completely forbade emetics for diseases of the head or chest, especially in cases of phthisis.

Considering a good vomit was recommended by 19th century asthma physician Henry Hyde Salter, who was also the physician to a young Teddy Roosevelt, one can only wonder why he might have written in his diary that asthma remedies often made him feel worse.

1. Aegineta, Paulus, "The Seven Books of Paulus Aegineta," translated by Francis Adams, volume I, 1844, The Snydenham Society, pages 52-54

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