2nd century A.D.: Medical profession starts to decline

By the 2nd century A.D. there were so many schools of medicine that a person might scratch his head in a dumbfounded effort to actually find a real doctor. Some of the schools around at this time were: (1, page 39)

1. Empiric
2. Dogmatic
3. Methodist
4. Pneumatist
5. Eclectic/ Episynthetics

There were so many schools of medicine, so many "diverse and fanciful opinions" that the medical profession, much like the rest of Rome, was falling apart, said medical historian Thomas Bradford. (1, page 39)

He said the result of this was to "lower the standard of the real medical science. The physicians nowhere aimed at useful discoveries, but simply devoted themselves to making as much money as possible. In fact, medicine like everything else in Rome at this time was fast decaying." (1, page 39)

There was also no requirement to become a doctor, so any quack, trained or otherwise, could claim to be one. This made it so those seeking help were often left confused and deterred.

So, after the death of Galen, medicine collapsed with the rest of Rome.  Of this, Bradford said:

At the death of Galen (the end of the 2nd century) there began a period during which the art of medicine not only ceased to advance, but went backward, and became enveloped in the myth and ceremonies of the priesthood. For a while the schools of philosophy and medicine still existed at Alexandria, but in the year 372 the city was subjected to pillage and fire. The scholars were stripped of their elegant quarters, the buildings were completely destroyed, and the vast collection of manuscripts were used to heat the water in the public baths. (1, page 45)

Western Civilization entered a dark ages of medicine.  Medicine would not come out from under this dark cloud until after the invention of the printing press in 1450.   In the meantime, if you needed help in times of sickness you were on your own.

References:

1. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey

1-1619: Jews, Arabs and Latins practice tracheotomies (and mouth to mouth breathing)

Chances are early tracheotomies were performed with no anaesthetics.  I write this not that I know this for sure, although I would imagine the procedure was generally performed as a last ditch effort to try to save a life of a person who was otherwise suffocating and was probably going to die if nothing was done.

There were, however, medicines that could have taken the edge off, such as opium.  Opium is an opiate that is one of the oldest known medicines known to man.  It is described in some of the earliest writings shared among the medical community.  So if the opportunity presented itself, this or some other medicine could have been taken to ease pain and suffering.

The ancient Jews, after the birth of Christ (around the years 1-650 A.D.) were known to perform surgeries when prayer, magic and natural remedies did not work.  When they did resort to surgeries, they did have certain herbs that were perhaps mixed into a drink that was used as a sleeping draught. (1, page 62)

The Jews were nomads, which means they traveled to many places in search of a home.  They spent time among the ancient Mesopotamians and Egyptians, and in the process they picked up a lot of knowledge about medicine.  Perhaps among the medical procedures they learned about from either of these places was the operation later to be called tracheotomy by the Greeks.  As they traveled they may also have educated other civilizations of the procedure.  This was one of the ways medical knowledge traveled through time.

Renouard explains that "the Arabs, and the Latins of the Middle Ages, had so little anatomical knowledge that they very much exaggerated the dangers of the operation, and, without condemning it absolutely in theory, abstained from its practice." (2, page 449)

Although this was not always the case.

Paulus Aegineta (625-690), as was noted earlier, performed the procedure with regularity, and described the procedure pretty much as Antyllus had several hundred years earlier.  (5, page 521) The operation was not regularly practiced until the 16th century, yet most of what was written was a reproduction of what Antyllus wrote on the subject.

Rhazes (865-925), Mesue (777-857), and Avicenna (980-1037) do not mention the methods of the procedure, but recommend it as a last option in cases of "angina strangulans." (3, page 199)  Avecenna did, however, describe "intubating the trachea using 'a cannula of gold or silver.'" (4pages 222-228) 

In the 12th century Arabian physicians Avenzoar and Albacasis were among the few physicians who dared to perform tracheotomies, although prior to them the procedure was rarely performed. Avenzoar (Ibn Zuhr), who was the most renowned physician and surgeon after Avicenna,  noted experiments of the procedure on goats, although he recommended it not be done unless the physician had knowledge of anatomy.  (3, page 198)  (6, pages 70-71)

Of course anatomical knowledge was rarely obtained by physicians mainly because autopsies were rarely performed, and when they were it must have been an unwholesome event.  Historian Fielding Hudson Garrison, in his 1922 history of medicine, explains that bodies were probably stolen, and both the grave robber and the autopsy performer would have risked an untimely death if caught.  There were a few books describing anatomy, although chances were good the descriptions were from animal dissections: pigs, dogs, apes, etc. (1, page 415)

The Surgeon Lanfranchi of Milan (1250-1306), Garrison explains,  was a surgeon at the School of Salerno in Northern Italy who may have been the first physician to mention intubation.  He became involved in the "squabbles of Guelphs and Ghibellines and was exiled.  He arrived in Paris in 1295, where he introduced the French to Italian medicine.  So it's highly likely the French also had knowledge to the technique of intubation.  (1, page 144)

Renouard continues:  "Anthony Benivieni, a physician of Florence, who lived at the end of the fifteenth century, saved the life of a patient by opening the trachea, and giving issue to the pus of an abscess that was formed within it. This is the first account we have of a tracheotomy, after an interruption of twelve hundred years; but its author does not state the manner in which he performed it, and it does not appear that he employed this method in other cases." (2, page 449)

Along with tracheostomies, mouth to mouth breathing also is mentioned in the fifteenth century.  It was documented to have been performed in Italy to revive newborn infants stunned at birth and not breathing on their own. This would have been a major effort on the part of the caregivers to save the life of a newborn infant stunned at birth who otherwise would have had no chance at life.  (5 need reference)

Fabricius d’Aquapendente (1537-1619), Renouard said, "is the first among moderns who gives a detailed description of this operation. He proves that it may be executed without injury to any other important organ; and that by it, we may often save a patient from impending death. The invention of the canula has been attributed to him, which has usually been left for some time in the artificial opening thus made. (2, pages 448-449)

In 1596 Sanatorius became the first to use a trocar to insert a cannula into the stoma, "and left a canula in the opening for three days."  Fabricius ab Aquapendente, in order to prevent the cannula from falling into the airway, added a cannula with wings.  Later later his pupil, Casserius, "made a very important improvement in introducing a canula with a curve corresponding to the arc of the quadrant, and he also tied in position the canula with tape.  The improvement in the shape of the instrument, however, was soon lost sight of, and the straight tube long remained in use." (5, page 521)

So knowledge of how to create an airway made it's way through the dark ages of medicine in the west, and the bright ages of medicine in the east.  Now it would make it's way to the Renaissance, where improved anatomical wisdom would help speed up the advancement of medical wisdom.

Note:  Spelling within quotes is that of the original author

References:

1. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1922, Philadelphia, W.B. Saunders Company
2. Renouard, Pierre-Vincent, "History of medicine: from its origin to the nineteenth century,"
3. 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  (referenced to page 198-9)
4. Szmuk, Peter, eet al, "A brief history of tracheostomy and tracheal intubation, from the Bronze Age to the Space Age," Intensive Care Medicine, 2008, 34, pages 222-228
5. Mackenzie, Morrell, "Diseases of the throat and nose, Volume I, 1880, Philadelphia, Presley Blakiston
6. 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

62 A.D.: Seneca's view of life helped him cope with asthma

I am in love with Seneca the Younger.  He was an asthmatic with allergies just like me, only he suffered with the disease over 2,000 years ago.  His descriptions of the disease were simply amazing, yet more impressive was the way he learned to cope, and the way he wrote about how asthma made him a better person simply for having experienced it.   

And even more amazing is the methods that he developed to conquer his asthma. He wrote that you cannot dwell on the past and say things like, "Oh why me?" You cannot say things like, "No one had ever been in such a bad state." You cannot say things like, "The torments and hardships I endured." These thoughts should be banned, he wrote, because they are of little use. Dewlling on what ailed you in the past does you no good. (1)

Seneca

Likewise, he wrote that you cannot worry about an asthma attack that will strike you in the future either, because that will do you no good.  What you need to do is try to make the best of your life right now.  You need to clear your mind of such evil thoughts.

In his 78th letter to his friend Lucius he wrote that those who suffer through the battle of an asthma attack are like the boxer who suffers even during the trials of training. He wrote that a boxer does this for wealth and fame. He wrote, "Let us too overcome all things, with our reward consisting not in any wealth or garland, not in trumpet calls for silence for the ceremonial proclamaiton of our name, but in moral worth, in strength of spirit, in a peace that is won for every once in any contest fortune has been utterly defeated." (1)

He wrote this over 2,000 years before I wrote my post The Seven Benefits of having Asthma and Seven Ways Asthma has Benefited my Life. I wrote pretty much what Seneca wrote to his friend Lucius, only I wrote it before I ever even discovered who Seneca was.
To manage his asthma he didn't rely on witchcraft, or magic, or prayer, nor did he rely on remedies based on some poppycock superstitions or false logic. The way he learned to cope with his disease was by eating well, staying in shape, and by having many friends, diverting your mind so you don't think about the pains in your life. He generally wrote about the importance of relaxing and soothing your mind to remedy pain or dyspnea or any physical ailment. Today we refer to this as relaxation exercises.

He wrote that to think about the misery you put up with in the past, or to fear the future is senseless and will only increase your anxiety and make your disease and your life even worse; that fear and anxiety will only bring on an attack of "gasping for breath" or catarrh. (1)

He said, "'I am suffering from pain,' you may say.  'Well, does it stop your suffering it if you endure it in a womanish fashion" (1)

He continued, "Plus there are men who have suffered greater sufferings than you have and survived.  In this way you should consider yourself fortunate.  You could have something worse, like "having your arms stretched on a rack or burnt alive... There have been men who have undergone these experiences and never uttered a groan... Surely pain is something you will want to smile at after this." (10

"But my illness has taken me away from my duties and won't allow me to achieve anything," he wrote as another example of a common complaint of the suffering. (1)

He said:

"It is your body, not your mind as well, that is in the grip of ill health.  Hence it may slow the feet of a runner and make the hands of a smith or cobbler less efficient, but if your mind is by habit of an active turn you may still give instruction and advice, listen and learn, inquire and remember.  Besides, if you meet sickness in a sensible manner, do you really think you are achieving nothing?  You will be demonstrating that even when one cannot always beat it one can always bear an illness.  There is room for heroism, I assure you, in bed as anywhere else.  War and the battle-front are not the only spheres in which proof is to be had of a spirited and fearless character:  a person's bravery is no less evident under the bed-clothes. There is something it lies open to you to achieve, and that is making the fight with illness a good one.  If its threats or importunities leave you quite unmoved, you are sending others a signal example.  How much scope there would be for renown if whenever we were sick we had an audience of spectators!  Be your own spectator anyway, your own applauding audience." (1)

In essence, he is saying that you are alive and therefore you have a gift to offer to the world if you see it and if you use it.  Your job is to bring yourself up, rise up, and make something of what you have left in life.  Use what is not ailing you: your brain, your ability to speak or listen, your ability to read and write and to communicate ideas. 

The benefits I wrote about are perspective on life and an appreciation for every breath, a sense of vulnerability in that you know that you will not live forever and that you must get what you can out of life, and give what you can give while you are here.  You know that you might die tomorrow, so you live forever today.  You touch as many people as you can.  You read instead of doing things that might trigger your asthma. You write and communicate what you learn.  And, in this way, you are in effect making a difference in the world with the faculties you have left.

He said:

"Moreover, even if death is on the way with a summons for him, though it comes all too early, though it cut him off in the prime of his life, he has experienced every reward that the very longest life can offer, having gained extensive knowledge of the world we live in, having learnt that time adds nothing to the finer things in life.  Whereas any life must needs seem short to people who measure it in terms of pleasure which through their empty nature are incapable of completeness." (1)

We must never let the things that ail us set us back.  We must continue on and give what we can in this life.

References:  

1. Campbell, Robin, Lucius Annaeus Seneca, "Letters from a Stoic: Epistulae morales ad Lucilium, " Penguin, 1969, letter LXXVII.

62 B.C.: Seneca the asthma philosopher

 Sculpture of Seneca by Puerta de Almodóvar in Córdoba, Spain

During the last three years of his life, Seneca the Younger spent much of his time writing down his thoughts about the world around him, including his thoughts about asthma and how it impacted his life.  He also gave his advice to other people suffering from this disease.

He said:

"What in fact makes people who are morally unenlightened by the experience of physical distress is their failure to acquire the habit of contentment with the spirit. They have instead been preoccupied by the body... so do not go out of your way to make your troubles any more tiresome than they are and burden yourself with fretting." 

Like the writings of Pliney the Elder, Seneca's writings became well read, and Seneca became one of the most well known philosophers.  In one of his letters to Lucilius, a friend and correspondent of Seneca's, Seneca provided a description of asthma, although he doesn't use the term asthma.

From his 54th letter to his friend Lucius (who also had asthma and catarrh), we get Seneca's description of asthma from "On Asthma and Death" as translated by Richard M. Gummere:

My ill health had allowed me a long furlough, when suddenly it resumed the attack. "what kind of ill-health?" you say. And you surely have a right to ask; for it is true that no kind is unknown to me. But I have been consigned, so to speak, to one special ailment. I do not know why I should call it by its Greek name; for it is well enough described as "shortness of breath." It's attack is of very brief duration, like that of a squall at sea; it usually ends within an hour. Who indeed could breathe his last for long? I have passed through all the ills and dangers of the flesh; but nothing seems to me more troublesome than this. And naturally so; for anything else may be called illness; but this is a sort of continued 'last gasp.' Hence physicians call it 'practising how to die." For some day the breath will succeed in doing what it has so often essayed (breath will succeed in doing what it is supposed to do). (2, page 361)

In letter 65 he wrote about his catarrh and the catarrh of his friend Lucius (1):

"I am all the more sorry to hear about your constant catarrh, and the spells of feverishness that go with it when it becomes protracted to the point of being chronic, because this kind of ill health is something I have experienced myself. In its early stages I refused to let it bother me, being still young enough to adapt a defiant attitude to sickness and put up with hardships, but eventually I succumbed to it altogether. Reduced to a state of complete emaciation, I had arrived at a point where the catahhral discharges were virtually carrying me away with them altogether. On many an occasion I felt the urge to cut my life short there and then, and was only held back by the thoughts of my father who had been the kindest of fathers to me and was then in his old age. Having in mind now how bravely I was capable of bearing the loss, I commanded myself to live. There are times when even to live an act of bravery." (1)

This was probably saying a lot back then, because I can imagine living in a state of shortness of breath.  And I can imagine this coupled with the misery of allergies on top of that.

Yet I cannot imagine what those two ailments would be like when there was no cure and no remedy that really provided any relief.  It must have been pure hell to live like that.  I can understand how he might be compelled to think about just ending the misery right "there and then."

Yet life is special, and there are few who get to enjoy this special gift.  Seneca realized this.  He used his father to provide himself the courage to go on. 

In letter 65 he described to his friend Lucius what he did to survive the attacks of asthma and catarrh (1). 

"Let me tell you the things that provided me consolation in those days, telling you to begin with that the thoughts which brought me this peace of mind had all the effects of medical treatment. Comforting thoughts contribute to a person's cure; anything which raises his spirit benefits him physically as well. It was my Stoic studies that really saved me. For the fact I was able to leave my bed and was restored to health I give the credit to philosophy. I owe her -- and it is the least of my obligations to her -- my life. But my friends also made a considerable contribution to my health. I found a great deal of relief in their cheering remarks, in the hours they spent at my bedside and in their conversations with me. There is nothing, my good Lucius, quite like the devotion of one's friends for supporting one in illness and restoring one to health, and for dispelling one's anticipation of dread and death. I even came to feel that I could not really die when these were the people I would leave surviving me, or perhaps I should say I came to think I would continue to live because of them, if not among them; for it seemed to me that in death I would not be passing on my spirit to them. These things gave me the willingness to help my own recovery and endure all the pain. It is quite pathetic, after all, if one has put the will to die behind one, to be without the will to life.

Another remedy he later adds...

"is to turn your mind to other thoughts and in that way get away from your suffering. Call to mind things which you have done that have been upright and courteous; run over in your mind the finest parts that have been played. And cast your memory over the things you have most admired."

No potions.  No magic.  No herbs.  Seneca might have been one of the first asthma experts to recommend, mainly due to his own experiences, the importance of relaxing to control your asthma.

"There then are your remedies," he said.

Click here for more asthma history.

References:

1. Campbell, Robin, Lucius Annaeus Seneca, "Letters from a Stoic: Epistulae morales ad Lucilium, " Penguin, 1969, letter LXXVII.
2. Seneca, Lucius Annaeus, "Seneca Ad Lucilium epistulae morales: Books I-LXI," translated by Richard M. Gummere, 1917, "The Epistles of Seneca," letter LIV "On Asthma and Death," New York, London, William Heinemann, G.P. Putnam's Sons, pages 361-363

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25 BC-50 AD: Celcus spearheads quest to define asthma

So what would life be like for the asthmatic when Jesus and Caesar walked the earth? From my investigations into this era I'd imagine the best remedy might simply be to tough it out, as many of the recommended remedies seem like they'd be worse than the disease. Of course this was true of most medicine prior to the 20th century.

Aurelius Cornelius Celsus was a voluminous writer. While

most of his works have been lost to history, his medical treaties

became one of the most read books during the Renaissance.

The second century A.D. was a very "fruitful era of literature
and philosophy." (1, pages xxi, xxii) It is for this reason we have resources available to help us learn what was known about asthma at that time and the remedies to treat it. Among those most influential to medicine were Pliny the Elder (23-79 A.D.), Seneca the Younger (4 B.C.- 65 A.D.) and Aurelius Cornelius Celsus.  (25 B.C. to 45 A.D.)

We have already delved into the philosophical writings of Seneca, and the works of Pliney will be discussed in a future post.  Today I would like to shine the light on Celsus, whose contributions to our term asthma were quite significant.

Although, we must be sure we are shining the light on the right Celsus, for this name was among the most popular of that time. The name Celsus in 2nd century Rome was akin to modern surnames such as Garcia, Rodriguez, Martinez, Smith, Williams, Jones, Hansen, Andersen, or Johnson. (5, pages 32-33)

Perhaps because there were so many by the same name that we know so little about our Celsus, whos can be seen as we enter a courtyard of one of the homes of some unknown Roman village, reclining back comfortably on a couch with the tablets set firmly upon his knee. With a pen he writes about asthma today, a symptom he probably learned about during his philosophic studies. (5, pages 32-33)

Already in his repertoire were treaties on philosophy, architecture, rhetoric, agriculture and war. He also wrote a book called "The True Word," in which he attacked Christianity, the newest philosophy of his era.

Yet all those treaties would eventually be lost to history. The only remaining treaties that we have of his is his Treaties Medicina, of which he wrote about medicine and surgery. The first eight books were on medicine, the first four of which treated internal diseases with diet and regimen. The fifth and sixth dealt with pharmacology, or the drugs used to treat diseases. The seventh and eighth dealt with surgery. (5, page 32-33)(3, page 74)

He was born Aurelius Cornelius Celsus in 25 A.D. to respectable parents in Greece. He was a stoic, meaning he did not believe in an after life. He was also well learned, meaning that he was educated in all the knowledge of the day. His specialty became pharmaceutics, medicine, surgery, war, and architecture.  He wrote voluminously on all these subjects.

His writings were later described as "diligent" and "attentive." (2, pages 425-5) Yet while some say that his skills as a surgeon were "second to none," (1, page xvii) others suspect he may not have practiced what he preached, that he was neither a physician nor a surgeon. (2, pages 425-5)(7, page 5)

He rose above his peers by paying attention to all aspects of medicine, rather than just one. For instance, prior to his time medicine was divided into three parts: (9, page 33)

• Dietetic: Curing by diet
• Pharmaceutic:  Curing by medicine
• Chirurgic: Curing by manual operations (knife, cupping, etc.)(5, page 33)

Celsus became the first to preach the importance of all three. (5, page 33)

Perhaps it was for this reason that his medical writings were "ignored by Roman practitioners of his day, and his name is mentioned only four times by the medieval commentators," said medical historian Fielding Hudson Garrison in his 1913 book "An introduction to the history of medicine." (3, page 74)
Not until 1478 would he get his revenge. In this year his book, De Re Medicina, would become the first medical treaties printed on the Gutenberg Printing Press. The treaties would then pass " through more separate editions than almost any other scientific treaties," said Garrison (3, page 74)

This was partly due to the fact it was a medical treaties, but more due to the fact of the way it was written. "It was due largely to the purity and precision of his literary style, his elegant Latinity assured him the title of 'Cicero medicorum,'" said Garrison. (3, page 74)
Medical historian Thomas Lindsley Bradford, in his 1898 book “Quiz questions on the history of medicine said that his medical treaties was a "test of Latin scholarship, and of a liberal education, for if the student was familiar with Celsus he received the purest Latin of the Augustinian Age." (5, page 33)

Along with his writings on medicine and surgery, he also described the history of medicine, giving descriptions of over 72 medical authors, although all have been lost except for the works of Hippocrates. He likewise provides us with the most precise account of medicine at the time of Jesus, describing both the Dogmatic and the Empiric Schools of medicine. (3, page 74)(5, page 33)

Celsus defended the idea that anatomy was important in medicine, so he was definitely not an Empiric who did not support the notion that anatomy was important to medicine. Despite this, "his knowledge of anatomy was somewhat superficial." (5, page 33)  Some say he more fittingly belonged to the eclectic school, or a combination of dogmatic and empiric. (7, page 6)

Regardless of how he was perceived in the past, Celsus remains an important figure in our history of asthma. It is thanks to him that we learn what physicians knew about asthma during the time of Jesus.

As a medical writer Celsus emulated Hippocrates, and parts of his books are word per word transcriptions from the "Hippocratic Corpus."  In fact, Celsus did this so often that one later author, Nicholas Mondaris, referred to him as the "Ape of Hippocrates" or the "Latin Hippocrates." (1, pages 259-61)(7, page 5)

The Treaties on Medicine written by Celsus would become the first
medical treaties printed on the Gutenberg Printing Press.
 It would go on to pass through more editions than
any other scientific treaties.  

Yet he incorporated into his treaties the latest wisdom of his day, plus some of his own ideas. This is clearly evident in his writings on asthma.
When asthma was first defined by Hippocrates in 400 B.C., it was often difficult to distinguish between the causes of dyspnea, and therefore they were grouped under the umbrella term asthma. Thus, all that caused dyspnea were referred to as asthma.
Celsus, on the other hand, believed asthma was more than just dyspnea, and for this reason he provided us with our first description of asthma as more than simply a blanket term.

Celsus wrote the following:

Est etiam circa fauces malum, quod apud Gracos aliud aliudque nomen habet. Orane in difflcultate spirandi consistit; sed haec dum modica est, neque ex toto strangulat, appellator. Cum vehementior est, ut spirare aeger sine sono et anhelatione non possit; cum accessit id quoque, ne nisi recta cervice spiritus trahatur. (4, page 10)

By the above, which is taken from John Charles Thorowgood 1890 book "Asthma and Chronic Bronchitis," we learn that Celsus believed there were three thoracic disorders that resulted in difficulty of breathing, and they varied by their "degree of violence":

1. Dyspnea:  Moderate, unsuffocative breathing without a wheeze; it's chronic
2. Asthma:  Vehement breathing that is sonorous and wheezing; it's acute
3. Orthopnea:  Breathing only takes place in an erect position; it's acute (1, pages 259-61) (4, page 10)

By the order above, Celsus implies that asthma is the "mean" level of difficulty of breathing, with dyspnea being less severe than asthma, and orthopnea being more severe than asthma. (4, page 10)

He was also the first to describe asthma as a specific condition involving constriction of the air passages in the lungs, and he was likewise the first to describe a wheeze. He described an attack of asthma this way:

The symptoms common to these are, that on account of the constriction of the respiratory passage, the breath is emitted with a sibilous noise (whistle or wheeze), there is pain in the chest and precordia (over the heart), sometimes also in the shoulder; and that sometimes departs, sometimes returns; in addition to these a slight cough accedes. (1, pages 260)

His remedies for asthma included any of the following:

1. Blood letting (common remedy for just about any ailment)
2. Milk (to relax the bowels)
3. Purging of the bowels with enemas (clysters) or injections if necessary
4. Hydromel (honey diluted in water)
5. Head must be kept high in bed
6. Thorax relieved by fomentations (warm, moist medicinal compress)
7. Thorax relieved by hot cataplasms (a heated medical dressing, either dry or moist)
8. Malagma (lotion or salve) or iris ointment after fomentations and cataplasms (these act as emollients to soften skin to make chest movements easier)
9. Hydromel as a drink (mixture of water and honey)
10. Bruised root of capers has been boiled
11. Nitre or white cresses fried, bruised, then mixed up with honey and given as electuary (oral, by mouth)
12. Honey, galbanum, and turpentine resin boiled together and, when they are coalesced to the size of a bean, dissolved under the tongue daily
13. Impure sulfur or southernwood triturated together in a glass of wine and sipped warm
14. Fox's liver dried, hardened and pounded into a powder and sprinkled on a drink (such as wine)
15. Eating the fresh, roasted lungs of a fox (but you can't cook it with iron utensils)
16. Gruels (watery porridge) and mild food
17. Light austere wine
18. Sometimes a vomit (Emetics)
19. Anything that promotes urine (diuretics make you pee, but they probably believed they were full of poisons that caused the humors to be imbalanced)
20. Gentle walking (nothing more) 
21. Massage (he referred to it as friction; it's done to move poisons around the body to balance the humors and to make breathing easier) (1, pages 259-61)

While some of these were later proven to have medical significance, most were simply palliative, and some were downright barbaric.  Still, his ideas were studied and followed for many years after his death.

We asthmatics should be thankful to Celsus for spearheading -- although he didn't know it at the time -- a 3,000 year effort to define asthma as a disease of its own. You can decide for yourself if you'd have been satisfied with his remedies for your asthma,  or if you would rather have just stayed home and suffered.

References:

1. Celsus, Aurelius Cornelius, "De Medicina," translated by L. Targa, London, pages xiiv-xxiii, "The Life of Cornelius Aurelius Celsus," by J. Rhodius and translated from Almeloveen's Lugduni Batavorum
2. Parr, Bartholomew Par, M.D., "The London Medical Dictionary," 1809, London, Vol. 1, pages 425-5
3. Garrison, Fielding Hudson, "An introduction to the history of medicine: with medical chronology, Bibliographic data and test questions," 1913, Philadelphia and London, W.B. Saunders company
4. Thorowgood, John C., "Asthma and Chronic Bronchitis: A New Edition of Notes on Asthma and Bronchial Asthma," 1894, London, Bailliere, Tyndall, & Cox
5. 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
6. Celcus, Aurelius Cornelius, "The Eight Books of on Medicine of Aurelius Cornelius Celsus with a Literal and Interlineal Translation on the Principles on the Hamiltonian System Adapted for Students in Medicine," volume II, 1830, London 
7. Bell, John, editor, "Retrospection in Medicine," The Eclectic Journal of Medicine, November, 1836, volume 1, number 1, Philadelphia, Haswell, Barrington, and Haswell

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4 B.C. to 65 A.D.: Seneca learns to cope with asthma

Seneca (4 B.C. to 65 A.D.)

I wasn't expecting this, although as I started reading the works of Seneca the Younger a tingle rushed up my spine: he was describing exactly how I felt when I was suffered from asthma.   It was one of those "Wow! moments, as though I had a special connection with this guy who lived more than 2,000 years before me.

He said:

"My own advice to you -- and not only in the present illness but in your life as well -- is this: refuse to let the thought of death bother you: nothing is grim when we have escaped that fear."

In fact, even before I read Seneca, I wrote an article called "The Seven Benefits of Asthma," and "Seven Ways Asthma Benefited My Life."  It was neat to learn that someone who suffered from asthma so many years before me came to some of the same conclusions that I did: that suffering from a disease can actually be a blessing.

Seneca the Younger was another fellow asthmatic who walked the Earth while Jesus did.  Seneca is by far my favorite historical asthmatic, mainly due to his vivid descriptions of what it was like living with this disease 2,000 years ago when treatment for it was basically a crapshoot.

He was born in Greece but was a Roman at heart.  He lived from 4. B.C. to 65 A.D. and, like Pliney the Elder, he chose to use "difficulty of breathing" rather than the Greek term asthma.  He was a vivid -- very vivid -- writer through much of his life, and he wrote about his asthma because his asthma pretty much set the course of his life -- much like myself.

Robin Campbell, in his 1969 book, "Letters from a Stoic: Epistulae morales ad Lucilium," wrote that Seneca was born in Cordoba and lived while Jesus walked the Earth.  He suffered from "severely ill health, particularly asthma," throughout his life."

Mark Jackson, in his book, "Asthma: The Biography," explained that Seneca spent several years in the drier climate of Egypt during his childhood. He also suffered from chronic catarrh, which is a description in many older books to describe the symptoms inflammation of tissues lining the respiratory tract (mainly the nose) resulting in increased secretions. We now call it hay fever, nasal allergies, or rhinitis.
He paid careful attention to his diet, and was a teetotaler. He was likewise a Stoic, in that he believed there was no life after death, and his time in this life was all that he had. He studied law, and later became a Senator.

Campbell further explained that in 37 A.D when Caligula succeeded Tiberius as Roman Emperor, Seneca had worked his way to leading speaker of the Senate, and the emperor was so jealous of him that he called for Seneca to be executed. Yet Seneca was rescued by a woman close to the throne who said Seneca was "suffering from tuberculosis and it would not be long before he died."

It's difficult to know whether Seneca had tuberculosis or asthma, although many historians believe he had neither: they think he had cardiac asthma, which is heart failure.

Seneca was expelled from Rome for eight years for committing adultery. 

Later, in 49 A.D. Seneca was recalled to Rome and became tutor to a boy named Lucius Domitius Ahenobarbus, who later became the emperor Nero.  This was about the same time Alexander the Great was being tutored by Aristotle.

Ironically, Nero had an older brother named Brittanicus who many think had an allergy to horses, which made him unable to do many of the things necessary of a king, making him inferior to his younger brother.  So, when Claudius died in 54 A.D., Nero succeeded Brittanicus to the throne.  Some suspected Seneca as the killer, although there was never any proof of this found.

One would think that with an instructor with allergies and asthma, and a brother with the same maladies, that Nero would have had empathy for his brother.  Yet this was not the case, as it's believed Nero had Brittanicus poisoned to death.

Seneca is mentioned in the writings of Pliney the Elder, and it wasn't until the last three years of his life that Seneca dedicated to philosophy and writing full time.  In 65 A.D. a plot to kill the emperor Nero was uncovered and this resulted in the deaths of many close to the king. 

Seneca was asked to commit suicide, and he did.  It ended up for Seneca being a long and painful death by suffocation from fumes and bleeding.  Tomorrow I will delve into the interesting thoughts of Seneca regarding life with asthma.

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400 B.C.: Hippocrates and the four humors

Humors are the fluids of the body, and Hippocrates, around 400 B.C., believed there were four humors: blood, phlegm (pituita), black bile and yellow bile. When these were in balance throughout the boy good health resulted.  Therefore, an imbalance resulted in disease.

The entire theme of Hippocratic medicine is based on creating a balance, or homeostasis (balance), of these four humors, or re-establishing a balance that has been broken.

The basic idea of the four humors is explained by Hippocrates in his book "On Disease: Book IV." He said that the humors are formed by the food or drink taken in.  There are five places in the body where humors are made: stomach, head, heart, spleen and galbladd.  Each of these organs "attracts is congenerous humour to itself." (1, page 269, 270, 271)

Phlegm comes from pituitous food and drinks, and is attracted to the head. When phlegm is in abundance it causes headache. (1, page 269)

In his book "On the Different Parts of Man," he explains that when too much phlegm is produced or attracted to the brain, so much so that the brain cannot contain it, the fluid flows down one of seven pathways to cause disease.  It could flow to the nose and cause catarrh and coryza.  It could flow to the lungs and cause pulmonary disease. It could flow to the spine and cause spinal tuberculosis, or Pott's disease.  (1, page 228-235)

Other pathways are the eyes and ears, where the various diseases of these organs are formed, including deafness an blindness. It could also flow to the muscles where it causes dropsy, the joins where it causes gout, sciatica and edema. (1, page 227)

He explains that yellow bile is produced by bilious food and drinks, and is attracted to the gallbladder. When "retarded" it results in pain. (1, page 269)

Black bile is also produced by bilious food and drinks, and is attracted to the spleen.  When in excess diseases such as melancholia and hypochondria may result. (1, page 269)

Blood is attracted to the heart, and its excess results in many diseases, such as dropsy, hydropsy, and fever.  (1, page 269)

A common way to resolve problems of excessive blood is to perform an operation with a blade called venesection or bleeding. However, Hippocrates rarely recommended the procedure.

Regardless of the what humor is in excess, a common way to re-establish homeostasis is by evacuating fluids from the body, such as in purging.  This allowed for any impurities to exit the system in order to cleanse the body.  There are essentially four pathways for this to occur: mouth, nose, rectum and urethra. (1, page 269, 271)

The way to produce purging, therefore, is to cause vomiting, expectoration, bowel movement, and urination.  Another method of evacuation was to cause diaphoresis, or sweating.

The best way to cause purging in cases where a disease is caused by excessive phlegm was to cause vomiting.  (1, page 282)

Causes of too much or too little of any of the humors was sometimes the result of the organ attracting too much to it, although most often it is the result of the food or drink consumed. Diseases may also arise from the air, atmosphere and season. They also arise from excessive temperatures:  too hot or too cold.   (1, page 226)(1, page 270, 271)

Hippocrates believed he best way to maintain homeostasis of the humors was to pay close attention to diet. He also recommended exercise and bathing.  He also recommended these in ill health, and only when these simple methods didn't work did he recommend other remedies, such as purging and bleeding.

References:

1. Coxe, John Redman, translator, "Hippocrates, the Writings of Hippocrates and Galen," 1846, http://oll.libertyfund.org/titles/1988, accessed 7/6/14, also see the book online at Google books, Philadelphia, Lindsay and Blakisto

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