865-925: Rhazes describes allergies

Rhazes didn't choose to become a physician until he was
into his 40s, and this may have helped the man become among
the most well respected physicians of his era.  He wrote about
asthma, and is thought to be among the first physicians to
describe allergies. 

While allergies were alluded to before him, and would not be defined for the medical community for another thousand years after his death, many medical historians believe the Arabic physician Rhazes was the first to accurately describe allergies. So it's easy to see that he was a physician ahead of his time.

He was born Abu Bekr Mohammed ben Zechariah in the year 865, and is known best by the name of Rhazes. He was born in a town in Persia, in the province of Baghdad, in a town called Rai, "and it is from this that his last name was derived -- Ar-Razi,"  said historian Thomas Bradford in his 1898 book "Quiz questions on the history of medicine."  (9, page 62).

He was originally a musician, playing the flute in his youth. And even while he was a "passionate lover of music," he put this love aside in favor of philosophy and medicine, claiming "that music proceeding from between mustachios and a beard had no charm to recommend it," said V.J. Fourageaud in an 1868 article in the Pacific Medical and Surgical Journal. (1, page 164)(9, page 62)

Yet this turned out to be a great thing for the medical community, as "he is said to have been the ablest physician of his age; a master of all kinds of learning; skilled both in the theory and practice of medicine, said Bradford." (9, page 62)

He started studying medicine in his forties, explained Bradford, and traveled abroad to "Jerusalem, Syria, Egypt, Persia, and Spain, the better to perfect his knowledge by conversing with botanists, oculists and surgeons. Having thus become master of his profession, he settled in Bagdad, and so great was his learning that he was selected from over a hundred eminent competitors as the director-in-chief of the grand hospital in that place.  He is said to have been the ablest physician of his age; master of all kinds of learning, skilled both in the theory and practice of medicine." (9, page 62-63)

By this position he was "director of the hospitals of Ray (the same town he was born in), Jondisabour, and Baghdad, said Fourageaud..  (1, page 164)

Bradford and Fourageaud both said that his reputation was so great as an Arabian professor that students traveled from far away to hear him speak. (1, page 164)(9, page 62)

Edward Withington, in his 1894 book, "Medical history from the earliest times, said he became the "first and most original of the Arab physicians."   (2, page 145)

He is considered by many historians as the most independent thinker among the Arabic physicians.  (5, page 156)  He encouraged physicians to practice by empirical means (experience and observation) and in this way became the first physicians to encourage scientific based medicine. (3, page 31)

He wrote over 150 books, although some say he wrote as many as 220.  He wrote on philosophy, medicine, history, and chemistry, although his passion was medicine.  Unfortunately most of these works are lost to history, said Fred Ramon in his 2006 book "Albacasis."  (8, page 62) (9, page 63)

While he copied many of the idea of ancient physicians, such as Hippocrates and Galen, it's his scientific descriptions of diseases that make him among the most well known of the Arabic writers.

He became famous while being among the few Arabic physicians who did not earn a medical license.  And, despite his fame, he did not become rich, mainly because he chose to practice among peasants who could not afford much.  This type of 'boldness and originality' earned him the title "The experimenter," said Withington.  (2, page 145)

Among the medical community he is best known for writing the "oldest existing treaties on smallpox and measles," said Withington.  (2, page 146)(9, page63) and he is the first to have described fever as a defense mechanism of fighting off diseases.

He's also the first to describe asthma as a specific disease, and the first to mention allergies.  He was a chemist and pharmacist, and by this he gathered a collection of remedies (some of his own too) and recorded them in one of his publications.  Some of the remedies were for asthma, said Ramon. (8, page 70)

As noted by these writings, coupled by his writings about asthma and coryza (inflammation of the nasal passages/ hay fever), he was the first to write a treaties on the diseases of children.  (6, page 175)

During his life he would create voluminous volumes for the medical community.  In his Hawi or Continens, which exceeded the length of the works of his contemporaries (including the Canon of Avicenna) he gives an account of asthma and it's remedies: (2, page 146)

Ben Musue (an Arabian physician of the 8th century) said, 'Let persons troubled with asthma or shortness of breath take two drachms of dried and powdered fox lung with decoction of figs in their drink.'  Galen (De med. simple.) said that many cure asthma with owls blood given in the drink, or by giving owl's flesh with the blood in spidebeg(?), and taking it's blood afterword in wine. I say that owl's blood is not to be given in any case of asthma, for I have seen it administered, and it was useless."

Maimonides wrote of the remedies for asthma, and in doing so mentions Rhazes:

Maimonides endorses a remedy of Rhazes' to clear the lungs of moisture, ease respiration, and eliminate the cough: soak wheat bran over night in hot water, filter, and add sugar and almond oil; place on the first until it resembles a julep and drink when lukewarm.  (7, page 27)

Also of significance is he was the first to write a book about hay fever:  A dissertation on the cause of the coryza which occurs in the spring when the roses give forth their scent.  (3, page 31)(4, page 338)

In his work Essay on the cause of why Abu Zayd al-Bahli is subject to rhinorrhea in springtime when smelling roses, he described the inflammation and runny nose that occurred in the springtime when the roses were blooming.

Many consider this the first description of hay fever, or what would eventually be considered as springtime allergies, sinusitis, hay fever, seasonal allergies or rhinorrhea.  In a sense, he may also have been the first to describe allergic asthma.

Fourageaud said that near the end of his life he approached Al-Mansur, the Prince of Chorasan, in Baghdad to present to him a book on alchemy he dedicated to the prince.  The prince loved the work and rewarded Rhazes with a thousand dinars. (1, page 64)

The Prince said, "I wish for you to put into practice what you have laid down in this book."
Rhazes said, "That is a task for the execution for which ample funds are necessary, as also various implements and aromatics of genuine quality; and all this must be done according to the rules of art, so that the whole operation is one of great difficulty."

The Prince said, "All the implements that you require shall be furnished you, with everything necessary for the operation; so that you may be in the practice the rules contained in your book."

Rhazes said he was unable to perform the task, at which time the Prince said, "I should never have thought a philosopher capable of such faleshoods in a work represented by him as a scientific treaties, and one which will engage people's hearts in a labor from which they can derive no advantage.  I have given you a thousand dinars as a reward for this visit, and the trouble you have taken, but I shall assuredly punish you for being guilty of a falsehood." 

The Prince struck Rhazes in the head with a whip and sent him on his way with provisions to complete the task.  Rumor has it this is what made him blind, although some say it was because he was because he ate too many beans.

Believing his blindness was caused by cataracts, an "occultist" was about to operate on him when Rhazes said something like, "How many membranes does the eye have?" 

The occultist had no response.  Rhazes then said something like, "I will not entrust my eyes to someone who is ignorant of their structure."

Later, when further urged to have the operation, he said, "No, for I have seen so much of the world that I am weary of it."  (1, page 64)

So most historians describe his as a very wise man, and Bradford credits him with the following wise sayings: (9, page 63)

• When you can cure by regimen, avoid having recourse to medicine
• When you can affect a cure by a simple medicine, avoid a compound one.
• When a wise physician and an obedient patient, sickness soon disappears.
• Treat and incipient malady with remedies that will not prostrate the strength. (9, page 63)

Exactly when he died remains unknown, although much speculation of modern historians has the date at 925 A.D. Regardless, he was a renowned physician in his day, and was one of the Arabs who helped save medicine while a dark cloud hovered over western medicine.

References:

1. Fourageaud, V.J., "Historical Sketches: XIII: The epidemics of the sixth century, the plague, small pox, and measles.  Ahrun, Bachtishwa, Mesue the Elder, Honain, Serapion, Alkhandi, and Rhazes," Pacific Medical and Surgical Journal,  Medical and Surgical Journal, edited by V.J. Fouregaud and J.F. Morse, Volume VII, 1864, San Francisco
2. Withington, Edward, "Medical history from its earliest times: a popular history of the healing art," 1894, London, The Scientific Press 
3. Colgan, Richard, "Advice to the Young Physician: on the art of medicine," 2009, New York
4. Lehrer, Steven, "Explorers of the body: Dramatic Breakthroughs in Medicine from Ancient Times," 2006, United States
5. Fantini, Bernardino, Grmek Mirko editors, Antony Shugaar, translator., "Western Medical Thought from Antiquity to the Middle Ages," 1998, U.S., 
6. Gee, Samuel, "A Survey of the Literature of the Diseases of Childhood:  An address delivered at the offering of the section of diseases of children at the annual meeting of the British Medical Association in Liverpool, August, 1883, The Medical Times and Gazette, Vol. II, 1883, London, Pardon and Sons
7. Rosner, Fred, translator, "The Medical Legacy of Moses Maimonides," 1998, KTAV Publishing House, U.S.
8. Ramen, Fred, "Albucasis (Abu Al-Qasam Al-Zahrawi):  Renowned Muslim Surgeon of the 10th Century,"  2006,New York
9. 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

476 A.D.: The fall of Rome

Nothing may be more significant to the history of asthma and respiratory therapy, or medicine in general, than the fall of the mighty Roman Empire.  For it is a fact that as Rome fell, so too did all knowledge.  As all knowledge fell, so too did knowledge of science, philosophy, and medicine.

There was a time when Romans believed their empire would last forever.  In a sense, they may even have taken it for granted.  The reason for the decline is still being debated to this day, although the following are often credited:  (5, page 41-2)

1. Rome was too large to be managed.  Rome was so spread out it was difficult to communicate  with people and inspire them to join the military, participate in government, or create industry.  
2. Christianity distracted leaders from problems of the empire, which required intense concentration to remedy.  
3. Able and educated men became Bishops rather than become military leaders in a defunct military or become governors in a nation that was falling apart.  Fixing the government seemed a hopeless task.  
4. Population declined markedly between 250-400 A.D. mainly due to the bubonic plague.
5. Rome had a weak economy, weakened more by population decline.  The economy worsened as markets shrank, and international trade declined.  
6. The inability to form a industrial technology to support nation (no specialization)
7. Regions became more dependent on themselves, weakening the whole (the Empire)
8. Taxes were high, and an alienated populace didn't want to pay them
9. Slavery.  Before 200 A.D. there were wars and slaves captured to do the work.  When wars were no longer needed, the number of slaves declined, yet by then Roman aristocracrats were so spoiled they were too lazy to do the work themselves

Many scholars provide most of the blame for the fall of Rome, and eventually the decline of science and medicine, to the rise of Christianity, which started in Rome as a secret society and grew to be a credible institution. 

Yet Historian  Edward Withington claims this theory is far overblown.  He said:  (1, page 119)

It must be admitted that the triumph of our holy religion, though by no means so responsible for the decline of medicine as is sometimes asserted, nevertheless tended to hasten than to hinder the downfall; but by means of one great institution it has, in the long run, done far more to further the healing art than it ever did to injure it."

Withington explains that various Christians, out of their good hearts, established some of the world's first hospitals and even an ambulance service.  He said:

"There is, I believe, no certain evidence of any medical institution supported by the voluntary contributions of the people, or by private munificence, till we come to the Christian days.  The primitive Church, as we learn from the Acts of the Apostles, cared for it's poor from the earliest time, but we find no definite notice of any special buildings for the reception of the sick till the close of the fourth century.  St. Jerome, writing about 400 A.D., says, that Fabiola, a noble Roman lady and his own friend, was the first to build a hospital."

 Withington proceeds to list various Christian hospitals. (1, page 119)

Christianity enveloped western Europe, and in 476 A.D., German barbarians crushed Rome to a pulp, destroying libraries and places of learning. Germans and Christians intentionally cast away all "the gifts of Athens and Alexandria," because the material world that evolved through technology was the antithesis of an eternal life with God in heaven. (2, page 84)

William Osler, in a 1913 lecture at Yale, said:

"Knowledge other than that which made a man 'wise unto salvation' was useless.  All that was necessary was contained in the Bible or taught by the Church.  This simple creed brought consolation thousands and illumined the lives of some of the noblest of men.  But 'in seeking a heavenly home man lost his bearing upon earth.'" (2, page 85?)

Other historians provide most of the blame for the fall of Rome on slavery.  In the early days of Rome there were only a few slaves, with most of them working on farms.  Most Romans were farmers in these days, and they were the people recruited to fight wars.  As Rome continued to win wars, the number of slaves skyrocketed.  It got to the point that there were more slaves than Romans who work for hire.  It got to the point that there were even more foreigners than Romans fighting Roman wars, according to historian Harold Johnston.  (6, page 87)

The country was almost completely run by foreigners, many of whom were better educated than their Roman masters.  Johnston explains said:. (6, page 87)

Ruinous as were the economic results of slavery, the moral effects were no less destructive. It is to slavery more than to anything else that is due the change in the character of the Romans in the first century of the Empire. With slaves swarming in their houses, ministering to their luxury, pandering to their appetites, directing their amusements, managing their business, and even educating their children, it is no wonder that the old Roman virtues of simplicity, frugality, and temperance declined and perished. And with the passing of Roman manhood into oriental effeminacy began the passing of Roman sway over the civilized world.

You can see how easy it was for the average Roman to become dependent on the slaves.  It got to the point that when the economy collapsed, it was difficult to get the average Roman excited about doing the work.

By the beginning of the 5th century German Barbarians were allowed to live in peace with the Romans in Rome.  So between slaves and Germans, foreigners far outnumbered Romans.  So, in 476 A.D., when the German Barbarians attacked Rome, there was little the natural born citizens of Rome could do to stop them.

These barbarians wanted to completely demolish Rome and all it stood for, and so they destroyed the libraries and places of learning.  While watching these places burn, the Germans were watching the demise of all knowledge.  It would all be lost for over a thousand years.

References:

1. Withington, Edward Theodore, "Medical History from the Earliest Times: A Popular History of the Art of Healing," 1894, London, The Scientific Press. 
2. Osler, William Henry, "The Evolution of Modern Medicine: A series of lectures delivered at Yale..." page 85
3. Meryon, "
4. Cantor, Norman F, "The Civilization of the Middle Ages: A Completely Revised and Expanded Edition of Medieval History," 1993, first edition, Harper Collins Publishers
5. Cantor, Norman, "The Civilization of the Middle Ages: A Completely Revised and expanded Edition of Medieval history: The Life and Deal of a Civilization," 1993, Harper Collins Publishers, New York
6. Johnston, Harold Whetstone, "The Private Life of Romans," 1908, Chicago, Atlanta, New York, Scott, Foresman and company

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