Thursday, September 25, 2014

1600-1700: Some abhorent remedies for asthma

So you have asthma in 1618, and you approach your physician about your problem. You sit in a wooden chair opposite his voluminous desk, leaning on his desk to expand your chest, your chest heaving with each slow breath.

As you're explaining your dilemma, in a huffy fashion, he opens a book on his desk.  You observe the title: "Materia Medica."  You wait as he sifts through the pages, and says, "hmmmmm.  Let's see here."  His finger traces what he's reading.  He leans back in his chair.  

He says, "Now, according to this "Materia Medica" we have a few options here.  Do you have anyone who can hunt for you."

You say, "Well, I'd love to hunt for myself, yet the consequences of doing it put me here."  

"I see." He leans back in his chair, puckers his lips as if in deep thought.

"So what do I need to do?" You ask.

"Well, it says here," he picks up the book, turns it so you can see the page, and he points to the heading "Asthma."  You read the section he's pointing to:
  • Worms
  • Lozenges of dried vipers
  • Foxes Lungs
You say, "Well, I think I can find someone to get me a fox, but I'm not sure about the viper.  I think getting one of those would be next to impossible." You look into the doctor's eyes.  "Don't tell me a viper bite will cure me, doctor."

Your comment induces a laugh from the doctor, and you join in briefly.  The laughter induces a cough, and you produce a large amount of sputum.  The doctor reaches into his desk and offers you a handkerchief.

For kicks and grins, here are some of the other remedies in 17th century pharmacopaeas:
  • Powder's of precious stones
  • Moss from the skull of the victum of violent death
  • Human urine
  • Blood
  • Fat
  • Bile
  • Horns
  • Crab's claws
  • Crab's eyes
  • Bones
  • Bone marrow
  • Sexual organs
  • Eggs
  • Excreta of animals of all sorts
  • Spider-webs
  • Fur
  • Feathers
  • Hair
  • Scorpions
No wonder physicians struggled to gain respect.  To their credit, though these remedies offered hope to patients, and there were also many other remedies that had an actual benefit to the patient.  Considering the medical ignorance of the time, physicians who offered such remedies must have felt good about their efforts to help a sick person.

Such remedies were slowly phased out of the pharmacopoeia, mainly due to the works of men like William Heberden (1710-1801) who championed to put "diseases upon a scientific basis," and "who did a most important service to therapeutics by dispelling current superstitions and banishing them forever from the pharmacopoeia" in his 1745 book "Essays on Mithridatium Theriaca."*  (1, page 370)

Obviously most of these abhorrent remedies were slowly phased out of the pharmacopoeia, particularly as better remedies were introduced.  For example, stramonium was introduced to the London Pharmacopoeia in 1721 by Sir Hans Sloane.  A few decades later, the authors of the 5th London Pharmacopeia of 1746 condemned the old practice of astrology and folk medicine, dropping the following remedies: (1, page 408)
  • Human fat
  • Spider Webs
  • Moss from human skulls
  • Unicorn's horn
  • Virgin's milk
  • Bones from stag's heart (1, page 408)
Can you guess what was in your asthma medicine?

*Mithridatium = remedy that cures everything, particularly poisons; theriaca = a compound of 64 drugs believed to be a cure for all poisons)

  1. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1922, Philadelphia, W.B. Saunders Company, page 291

Tuesday, September 23, 2014

1316: Mundinus publishes book of anatomy

So we know that the School of Salerno was a great medical institution from the 10th to 13th centuries, and physicians from all over the world flocked there to get the best medical instruction.  Yet most historians will acknowledge that while it was a great learning place, there were few medical advancements made here. 
One of the great exceptions occured in 1316 when Mundinus of Bologna (1270-1326) wrote a book called "Anathomia."  Although while he wrote it while teaching at Salerno, it was first published at Padua in 1487, and later at Leipzig in 1493 by Martin Pollich-von Mellerstadt. (see figure 1) (1, page 150-151)

Figure 1 --The title page of Mundinus
 "Anathomia," Leipzig, 1493 (1, page 151)
According to Fielding Hudson Garrison in his 1921 book, "An introduction to the history of medicine," "In intention, this book was really a little horn-book of dissecting, rather than a formal treaties on gross anatomy.  (1)

Garrison explains the book was full of "Galanic errors in regard to the structure of the human frame, preserving the old fictive anatomy of the Arabists, with the Arabic terms, this book was yet the sole textbook on anatomy for over a hundred years in all the Medieval schools." (1)

It was people like Mundinus who helped advance medicine through an otherwise dark ages of medicine in the western world.  Surely this was a small achievement, and there may have been no major advancements in asthma and respiratory therapy wisdom as a direct result of this.  Yet had it not been for such small achievements, asthma wisdom would still be in the dark ages, and chronic lungers would continue to be forced to suffer as a result.  

  1. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1922, Philadelphia, W.B. Saunders Company
  2. The John Hopkins Hospital bulleton," (volume XV 1904), "from the epoch of the Alexandria School (300 B.C.)"
  3. "The Ancient Medical School of Salerno,",, accessed 12/4/12

Thursday, September 18, 2014

950 B.C.: Solomon will heal your asthma

He was the son of David, the slayer of Goliath, and he reigned as King of Israel from 970-931 B.C. He is considered one of 48 Biblical prophets, and that means that he had healing powers. As an educated man, he most surely would have received knowledge of health and healing.  What this healing powers entailed no one knows..  

It is known that this man of great wisdom had healing powers, at least according to the Bible.  One example can be found in Acts of the apostles 5: 12-16:
And by the hands of the apostles were many signs and wonders wrought among the people; (and they were all with one accord in Solomon's porch.  and the rest durst no man join himself to them: but the people magnified them. And believers were the more added to the Lord, multitudes both of men and women.) Insomuch that they brought forth the sick into the streets, and laid them on beds and couches, that at the least the shadow of Peter passing by might overshadow some of them.  There cam also a multitude out of the cities round about unto Jerusalem, bringing sick folks, and them which were vexed with unclean spirits: and they were healed every one.
Perhaps among them were folks with asthma, or allergies, or bronchitis, or heart failure, or kidney failure or some other respiratory disorder. Perhaps it was a person who was near death, dyspeic due to failure of the various organs of the body.  All of these would have been healed through the healing powers of the prophet and King Solomon

Tuesday, September 16, 2014

900-1300: The Soporific Sponge

Physicians at the School of Salerno in the 15th century are believed to be the first to provide anesthetics during surgery.  The method used was to turn a simple sponge into an inhaler, what surgeons referred to as the "soporific sponge," according to historian Garrison Fielding Hudson. (1, page 142)

Hudson explains that "surgical sleeping draughts" are referred to as the "soporiphic sponge" as early as the 11th century in "the beautiful Jenson imprint of the Antidotarium of Nicholas of Salerna that was published in Venice in 1471.  (1, page 142)

This was a sponge that was "steeped in a mixture of opium, hyoscyamus, mulberry juice, lettuce, hemlock, mandragora and ivy, dried, and, when moistened, inhaled by the patient, who was subsequently awakened by applying fennel-juice to the nostrils." (1, page 142)

This "prescription" was believed to be derived from earlier treatments of "anodyne applications" used to treat insomnia at the temples of the Aesclepius by the Ancient Greeks and Romans. Later on Mandragora became "preferable to opium and hemlock." (1, page 142)

Could you imagine the stress that a physician wanted to give you such a medicine in an age when it was still greatly feared to be operated on? This type of fear was noted in a poem in Marlowe's Jew of Malta: (3, page 143)
"I drank of poppy and cold mandrake juice. And being asleep, belike they thought me dead."
So the anesthetic may have been taken internally by some, yet it was due to this fear that the anesthetic was not taken "internally by Salernitan physicians." I think this was a wise decision, and this made the "Soporific Sponge" a wise alternative.

The"Soporific Sponge" is an early, yet primitive, example of one of the first uses of an inhaling device. It is for this reason I mention it here. 
It is also surmised that the Salerno medical community greatly influenced Arabic medicine.  Yet, ultimately, Arabic medicine would grow so that it superseded the old Greek traditions taught at Salerno, and this is believed to be what caused the fall of Salerno from its "high estate."  The School of Salerno met its demise sometime in the middle of the 13th century.(1, page 187)

  1. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1922, Philadelphia, W.B. Saunders Company

Thursday, September 11, 2014

Asthma History: Introduction

According to my mother I was diagnosed with asthma at the age of two, which would be in the year 1972.  Considering she said I was sniffling, sneezing and wheezing even before that, chances are I developed asthma and allergies close to my birth on January 4, 1970.  Despite the claims of my doctors, I never outgrew my asthma.

When I was about ten-years-old, which would be in 1980, my asthma, already bad enough, took a turn for the worse.  While other kids were able to run around and have fun during recess, I was forced to sit on the bench.  While other kids were living normal lives, I was asking the Principal to call my mom because I couldn't breathe.

I remember my mother taking me to many unscheduled visits to Dr. Gunderson, and many more to the emergency room, and most of these for asthma.  Sometime in 1980 Dr. Gunderson introduced me to a small, pocket-sized device that gave me my breath back instantly.  It was an inhaler.  I quickly became great friends with this new object, taking it with me wherever I went.

One day as I was puffing on my inhaler I wondered what life would be like for asthmatics prior to modern medicine.  As I started to investigate this, I ended up on a journey that took me all the way back to the beginning of human existence 2.5 million years ago, and then all the way back to the current world.

I learned that for most of history (perhaps 99.9 percent of it) the asthmatic had to choice but to suffer through an attack.  Once I realized this I likewise realized how privileged I was to have been born in 1970, as compared with 1870 or, worse, 1870 B.C.

I also quickly learned that, as with the warpath of mankind, the path of disease can be traced back to the beginning of human existence.  In fact, disease may go back farther than war itself, as diseases exists regardless of the desires of mankind.  Although, as we learn from the Biblical Cain, fighting began early enough in a quest for selfish gain.

So while most histories follow the path of war, this history follows the path of health and healing, with an emphasis on asthma.  In order to organize this history I will use the following definitions:
  • Prehistory (prehistoric):  Time prior to the first written language, or recorded history, which is generally considered to be around 2700 B.C. 
  • Ancient:  Time after written language, or time with recorded history.  This period lasted from around 2700 B.C. until the fall of Rome in 476 A.D. 
  • Time:  After the birth of Christ people developed a need to keep track of time, and so the birth of Jesus was chosen as the date to begin time.  The date of his birth was estimated and this was chosen as 1 A.D. When a child is born we usually refer to the first year as zero.  With time the first 100 years is considered the first century, and therefore the years 100-199 were referred to as the 2nd century.  It's for this reason why the years 1900 to 1999 were referred to as the 20th century.  This is just how it is.  
This system was created to help people study history and keep track of dates and time.  Whether accurate or not, this is how history is recorded.  I will use this system to categorize this history of asthma:
  • Beginning to 5000 B.C.: Prehistoric people (prehistory)
  • 5000-2700 B.C.: Ancient Societies (Before History and Time)
  • 2700 B.C.-1 A.D.: Ancient Societies (During History, Before Time)
  • 1 A.D.-276 A.D.:  Ancient Societies (Beginning of Time)
  • 276 -1600 A.D.: Middle Ages (The Dark Ages of Medicine)
  • 1600-1800:  Age of Reason (The Age of Enlightenment)
  • 1800-1900:  The Scientific Revolution (the Age of Progress)
  • 1900-2000: The Age of Results
  • 21st Century:  The presents
  • My asthma story
Each chapter in this history is one blog post, and each will focus on one thought.  In this way I am able to keep each chapter pithy and, therefore, easy to read.  While I have done some of my own research, I try to tell this history through the eyes of those who lived it, or those who spent hours studying it.  This will, I think, give you a more complete picture of the history of asthma.  

However, considering the vastness of our history, and the brief time each person lived among it, this history is but a small glimpse of the past.  Most of our history is told by the select few privileged to be able to read and write, so it is nearly impossible to impress upon what life was like among the common folk.

Still, there was just enough evidence to draw a picture of what life must have been like for those who suffered from asthma over the years.

So what was it like to live with asthma in fill in location and year?  To best answer this question, I make a gallant effort to describe the the various cultures.  This, I think, should should allow us to gain a more complete understanding what it would be like to be sick if you lived among them.  

However, I would like you to consider the following quote from historian Henry E. Sigerist:
"We have no evidence whatsoever of any paleolithic medicine." (1, page 107)
I say this because there will be times throughout this history when we must use our imaginations to gain an understanding of what it was like to live with asthma in fill in the year and place.

So what was life like for asthmatics 2.5 million years ago?  Let's go!

  1. Sigerist, Henry E "History of Medicine," volume I: Primitive and Archaic Medicine, 1951, New York, Oxford University Press

Tuesday, September 09, 2014

1871-1900: Pneumatometers as Spirometers

By the 1870s various engineers were tinkering with the Hutchinson Spirometer with the intent of improving upon it  Yet in 1871 Dr. L. Waldenburg invented a device that some physicians believed was better than the spirometer for diagnosing various airway diseases.

The main problem with spirometry was that volumes varied based on height and age.  This problem appeared to be remedied with the invention of the pneumatometer which measured more the force of a patient's exhalation, and therefore gave a better picture of the patients lung muscle strength.

This was a portable device that could be used to provide pressure changes to be used therapeutically to treat various diseases, such as emphysema, croup, bronchitis, and asthma.  The first such device was introduced by Hawke in 1870 called the Hawke Apparatus.  This device was nice because "air in the receiver can be condensed (increase in pressure) or rarified (decrease in pressure), and used in either of these conditions for respiration." (1)

Hawke believed his apparatus would be especially useful in croup and emphysema.  He believed that since emphysema resulted in air being trapped into the lungs, that expiring against rarified air (which was basically suction) this would help empty this air from the lungs. In croup he believed condensed (positive pressure, pressure support) should be inspired. He later recommended inspiration of compressed air for consumption.(1)

After Hawke wrote about his apparatus he received "favorable results," although this type of device wasn't truly accepted by the medical community until Waldenburg improved upon it with his own device, called the Waldenburg Apparatus.  And the neat thing about Waldenburg's apparatus is it had a graduated scale so you could measure the degree of pressure changes.  This was nice for two reasons:
  1. You could measure the amount of pressure used to benefit the patient, which allowed similar settings to be used at future visits or uses, and allowed physicians a guide to setting up future patients.
  2. You could use it as a spirometer to measure the force of a patients exhalation, and to measure vital capacity.
It was likewise different from the spirometer -- even better -- because "spirometry deals with the vital capacity of the chest, which depends chiefly upon the circumference and height of the thorax, whilst in pneumatometry the height of the thorax has no influence." (3)

"U-shaped tube, open to the atmosphere and suitably mounted, is filled with mercury in both branches to the same level, which is marked zero. One branch is connected with a rubber tube and mouthpiece (or mask or nosepiece) used by the person under observation, whose expiratory and inspiratory force is measured by the ascent or descent of the mercury in the other branch, as shown upon a millimetric scale (Fig. 1)." (2, page 25)

So, "When the patient expires through the tube, the column of mercury sinks in the proximal limb of the manometer and rises in the distal, while with inspiration these movements are of course reversed, and in either case the amount of displacement is to be read off on the scale." (3, page 146)

Likewise, "Since the level of the mercury when at rest corresponds in both limbs to the zero of the scale, the reading obtained must, of course, be doubled to represent the true difference in the level of the two columns." (4, page 146)

Keeping in mind expiratory pressure is normally greater than inspiratory presssure, Waldenburg (and later other physicians) determined the following normal values for forced inspiratory and expiratory pressures for males and females (3 and 4):
  • Male inspiratory pressure:  70-100
  • Male epiratory pressure:  90-130
  • Female inspiratory pressure: 50-80
  • Female expiratory pressure: 70-80
The diagnostic purposes are as follows (3):

1.  Expiratory pressure is increased in relation to inspiratory in:
  • Phthisis (even at a very early stage), 
  • Stenosis of the air passages
  • Pulmonary congestion
  • Pneumonia
  • Pleurisy
  • Any abdominal affections as impede respiration by pressing the diaphragm upwards.
2.  Expiratory pressure is diminished until it becomes equal to or below the inspiratory in:
  •  pulmonary emphysema.
Other than for diagnostic purposes, this test can indicate: (2)
  1. The power of the respiratory muscles
  2. The mobility of the thorax and expansion of the lungs
  3. Elasticity of the parenchyma of the lungs. 
So, by performing tests on both the Hawke and Waldenburg apparatus's, physicians discerned the following facts: (1)
  1. Emphysema results in imperfect expiration, while inspiration is normal or increased (the natural result of increased use of inspiratory muscles)
  2. Catarrh of small bronchi results in imperfect expiration, and normal inspiration
  3. Phthisis (tuberculosis, consumption) results in a decreased inspiration, and later expiration is imperfect.  
  4. Stenosis of respiratory ducts results in imperfect inspiration, but expiration is normal
  5. Inflammation of lung tissue and pleura results in similar effect as phthisis
There were a variety of similar products on the market, although Waldenbur's continued to be the preferred pneumatometer for both as a pressure apparatus and spirometer, at least through the turn of the 20th century, according to most sources I used as references.  
    1. Rose, A., "Treatment of Disease of Respiration and Circulation by the Pneumatic Method," New York, The Medical Record: A Weekly Journal of Medicine and Surgery, Edited by George F. Shrady, M.D., Volume 10, Jan. 2, 1875 to Dec. 25, 1875, New York, William Good and Co., page 577
    2. Tissier,Paul Lewis Alexandre, edited by Solomon Solis Cohen, "Pneumotherapy: Including Aerotherapy and inhalation methods," volume X, 1903, Philadelphia, P. Blakiston's Sons and Co., pages 296-224.  If the profession of respiratory therapy existed in their era, we would be reading their books.  However, as it was, their books were written for the medical profession. All of the material from this post is from Tissier's book unless otherwise noted in the above paragraphs. Tissier page 72
    3. Brunton, Lauder T, The Practitioner: A Journal of Therapeutics and Public Health, Vol. XVII, July to December, 1876, London, MacMillan, "Pneumotachometry," page 216
    4. Brown, John James Graham, "Medical Diagnosis," 2nd edition, 1884, New York and London, Birmingham and Co., "Pneumotameter," pages 25-26
    5. Effects on the heart are questionable, although most studies conclude the pneumatometer  benefits asthma, bronchitis, emphysema, phthisis

    Thursday, September 04, 2014

    2.5 million years ago: The dawn of empathy

    The first humans walked the earth as early as 45,000 years ago.  Chances are these early people suffered from diseases such as asthma, and so this is where our history must begin. These are the people who ate the apples from the tree of knowledge, and who learned to have empathy for their fellow beings.  They therefore learned to not only feed and nurture themselves, but other people and animals as well.

    Now we don't know if asthma existed back then, but let's assume it did.  Better yet, I'm certain asthma-like symptoms were probably felt by people when they were sick with infections, or perhaps as their heart and kidneys failed.  So let's assume a person 45,000 years ago was short of breath and gasping for air.  Observing his misery, another person would come to his aid, offering any help he could.

    Now let us take this a step further.  While a human is a human is a human, there were human-like people who roamed the earth long before us.  Whether or not we evolved from them is up to you to decide, but there is a ton of evidence that they existed.  There is evidence they were able to adjust to various situations, and to make their own tools.  There is also evidence that as their brains grew, they developed the ability to ponder about the world around them, and to, well, love and have empathy.

    Scientists have placed the first humanoids (something that resembles a human) as first appearing on earth as early as 7 million years ago, with the first human-like humanoids walking the earth 2-3 million years ago. The first human-like humanoids were called Home or Homo Habilis, meaning "handy or skillful," writes Patricia Netzley in her 1998 book "The Stone Age."   These humanoids were the first to adapt to their surroundings by inventing and using stone tools.  These tools were used for "scraping or sawing wood... cutting meat... cutting grass stems or reeds," writes Netzley. (1, page 9, 12)

    They were the first to joint together at a "home base," where they shared food.  Food sharing, it must be understood, is among the first signs of empathy for people other than yourself.  It must have been a major challenge to not eat the food you hunted for yourself, and carry it to the base camp for someone else to eat.  Helping others by feeding them must have been the earliest form of healthcare or medicine. (1, page 41)

    About 1.8 million years ago was a more human-like humanoid called home erectus, which means "upright man."  He walked the earth until about 300,000 years ago.  This was the first humanoid to experience a population crisis, and this meant that there were too many people in a given area for the available food.  This provided an incentive for them to migrate to where food was available.  This meant they were forced to adapt; to discover new lands, to find new food sources, to invent new tools, and invent new methods of living.  All of this would have been necessary in order to adapt to their new surroundings. (1, page 43-47)

    The changing climate also forced them to migrate to places where it was cold, and they therefore were the first to discover the importance of fire sometime around 400,000 years ago.  At first they took advantage of natural fires that occurred due to lightning or lava, although eventually they learned to control fire themselves, and ultimately make it by themselves. (2, page 27)

    While sitting around the fire home erectus had time to experiment, and he learned that meat could be cooked, and that this made food more tender and easy to chew.  They also experimented by cooking various plants, and learned that plants that were stiff or horrible tasting made for good food when cooked.  (2, page 27)So with less need for strong facial muscles to chew raw meat, some speculate fire may have contributed to the thinning out of the face and jaw (those who believe in the theory of evolution believe this anyway).

    The first home sapiens, or "wise humans," first started walking the earth around 500,000 years ago.  Among the most well known of the home sapiens were the Neanderthals (Neandertals) who lived in small groups of about 25, mainly in caves, although they did have the ability to make crude shelters of materials they gathered from the woods. They had mastered the use of fire, and perhaps it was because of the fire that encouraged small groups of men and women to band together as small families or tribes, replete with men, women and children who worked together for a common cause (or so we can speculate). (1, page 52-60)

    People who mastered the skill necessary to make and control fire were among the most important members of the family or tribe.  The knowledge they obtained often meant the difference between keeping warm or freezing; life or death.  The fires allowed them time to socialize, and to fall in love with other members of the family or tribe.  This is evidenced by the fact they buried their dead in decorated grave sites, and provided the dead with gifts to take with them to the next world. (2, page 27)

    Neanderthal men, and the women who were without child, searched for food during the day, and they brought this food back to he cave to share with the women, children, and the sick.  Yes, there is evidence Neanderthals took care of the sick.  (1, page 52-60)  One burial site was discovered of a man with no right arm, and there is evidence he managed with one arm for many years before he died, probably aided by his fellow men and women. (3, page 37)

    Some speculate that the fact Neanderthals took care of the sick and performed burial rituals, and celebrated the life of the dead following these rituals, is evidence they had traditions.  The fact they had traditions is evidence, some suggest, that they had language.  This would have allowed one generation to communicate with the next, perhaps by easy to remember lyrics, or perhaps they just grunted (we just don't know). (1, page 61-63)

    What we do know is Neanderthals thrived in Europe through hot and cold temperatures.  Their short, stocky frames required about twice as much food as we eat, and to do this they "lived around the edges of forests where they hunted large animals like red deer, horse and wild cattle. The forests gave them firewood, and materials to construct shelters and spears," according to science and nature. (3)

    Then "About 45,000 years ago, the climate of Europe went through a burst of very sudden switches between warm and cold conditions that would have transformed the Neanderthals' environment. The forests on which they depended began to recede, giving way to open plains.  On these plains, Professor Shea believes, the Neanderthal thrusting spear and ambush strategy wouldn't have worked. So Neanderthals retreated with the forests, their population falling as their hunting grounds shrank," according to science and nature.  (3)

    When humans migrated to Europe around 30,000 years ago, their "better brains and more sophisticated tools" were no match for the Neanderthals, who shortly thereafter became extinct. Human  tools and methods of adjusting made them better able to hunt amid and survive amid the the landscape created by mother nature.(3)

    Now, where did these humans come from.  Those of us who are Christians believe they were placed on this earth by God.  Others believe they evolved from the Neanderthals or some other humanoid species.  Others believe in some combination of these two theories.  Believe it or not, there are many Christians who believe there is far too much evidence to prove evolution, and therefore believe there is room for both Christianity and evolution.  So, then, if this is the case, then God created the earth and the humanoids long before the Biblical date for the creation of time, which is pegged by some to be around 4004 B.C. (I will delve into this date more later).

    I'll let you believe as you wish.  All we are concerned about here is what would asthma be like if we lived among these people?  We have no idea.  There is no written record, and there is no evidence of asthma left behind.  Asthma doesn't make its way to bones, which is mainly all we have left of these prehistoric people.  As a matter of fact, asthma leaves no visible scars, not even among the living. So what was it like to live with asthma 2.5 million years ago?  What was it like to live with asthma among the Neanderthals?  All we can do is speculate.

    The truth is: we don't even know when asthma began to appear as a disease. What we can, I think, speculate accurately, is that people probably did get short of breath, or winded, since the beginning of time.  I can imagine that early humans had bodies that wore out early on in life.  Their kidneys started to shut down, and their hearts started to fail, and this would have caused you typical signs of respiratory distress; they would gasp for air, what the ancient Greeks would call asthma (more on the ancient Greeks later also).

    It's also highly probable that many of the bacteria and viruses that plague humanity to this day irritated humanoids and early humans who walked the planet.  These germs entered the air passages, or were ingested by dirty hands, and made their way to places in the body they don't belong.  Prehistoric immune systems worked overtime to expectorate these germs, and this resulted in inflammation, including inflammation of the respiratory tract.  This would cause a runny and stuffy nose, itchy and watery eyes, scratchy throat, and even shortness of breath.

    So in a world where humanoids and humans became increasingly empathetic toward their fellow men and women, in a world where they grew dependent on one another, in a world where they grew attached to one another, in a world where they fell in love with one another, they would most assuredly have felt sad when a parent, brother, sister, or friend, became ill in this way.  They would want to help out.  They would hunt and bring back food and water.  They would speculate as to the cause, and provide what they thought was the remedy.  Sometimes what they did would work, and the remedy would be remembered.  More often, however, the remedy would fail, and sadness would ensue.

    So we can see here that as far back as 2.5 million years ago such people had the ability adapt to their surroundings, and they had the ability to make stone tools and use them to hunt and prepare food. Human-like people as early as the lower paleolithic (2.5 million to 126,000 years ago) had the ability to adapt to their surroundings, and to ponder about the world around them.

    1. Netzley, Patricia D, "World History Series: The Stone Age," 1998, San Diego, CA, Lucent Books
    2. Roberts, J.M., "The illustrated History of the World: Prehistory and the first civilizations: volume I," 1999, New York, Oxford University Press
    3. "Neanderthal: Their bodies were well equopped to cope with the ice age, so why did the Neanderthals die out when it ended,", Science and Nature,, accessed 4/4/13
    4. Garrison, Fielding Hudson, "An Introduction to the history of medicine," 1922