360-460 B.C.: What did Hippocrates think about asthma?

Hippocrates

If you peruse ancient writings you'll find many references to asthma, or at least asthma-like symptoms. The ancient Egyptians, Greeks, Chinese and even Japanese all recorded asthma-like events and the remedies to go along with them.  Yet it was Hippocrates,  particularly in his book Corpus Hippocraticum, who made asthma a household name.

By his writings Hippocrates is considered to be the father of medicine.  His father was a physician, and he learned much of his skill, technique and work ethic from his father.  During his career he practiced medicine in Greece and Asia minor, and he spent considerable time teaching at the School of Cos.

According to Plinio Prioreschi in his book, "A History of Medicine:  Vol . II -- Greek Medicine," We don't know his size, stature, or even his personality.  In fact, we don't even know if all the treaties attributed to him in the Corpus were even his ideas.  Likewise, most of the statues of him weren't even created until after his demise.

When Hippocrates walked the grounds of Greece from about 460-360 BC, or the 5th and 4th Centuries BC, many physicians believed disease was caused by the gods and evil spirits, and often treated them with potions or chants meant to rid the body of evil spirits.  Yet Hippocrates and his family of physicians had other ideas. 

Another interesting thing for doctors to do during ancient Greek times was to take bribes to kill their patients. When one person wanted to get rid of a rival, he would bribe a doctor to create a poison to kill that person.  Hippocrates frowned upon this act. 

Hippocrates was born on the island of Kos at around 460 BC, and visited Egypt as a young man to study medicine.  After his studies he believed diseases had a natural cause, and he studied the human body to learn the cause, and he questioned his patients to learn as much about them and their condition as possible.

He became one of the most popular and famous physicians of his day, and is still to this day considered one of the best doctors of all time.  He was very skilled at his craft, was among the first to preach good bedside manner, and he preached that no physician should do harm to his patients.

Plinio writes that there were three schools of physicians competing among themselves (the Cos, Cnidian and Italian), with Hippocrates being a member of the School of Cos.  The Cnidian and the Cos medical schools were near each other and were competing "in knowledge and effectiveness in curing disease."

Prioreschi notes one theory that each school was stuck in it's own paradigm and had different methods of treating illness, and since the Cnidian and Cos were in close proximity (20 miles apart),  the Corpus Hippocraticum was therefore the result of a koinon, or an association between the two schools.  The Corpus Hippocraticum is basically a Treaties whereby the two schools compromised on how to treat medical conditions.

In total, Hippocrates and his family of physicians composed about 60 treaties on various medical conditions, their causes, symptoms and possible remedies.  His medical writings were followed by physicians through Medieval times, and his Hippocratic Oath, although modified, is still used to this day.

While there is no evidence Hippocrates did any of the writing himself, he is given credit. This might be due to his hard work, method of teaching, and skillful medical technique.  Plato (Hippocrates died when Plato was about 55), wrote that Hippocrates was the "famous physician."

Thus, Greek medicine has been dubbed by history as Hippocratic Medicine.  There is also evidence all of the writings are anonymous, and many were written before and even after his life.  Yet most were written during his life, and thus he has received the historical credit, perhaps out of respect to him more so than anything else.  He has thus been dubbed by history as the Father of Medicine.

Some experts believed the Cnidian may have had another belief about illness, yet the Con belief about the four humors is the one that won out by the time the book was written.  Humors is the medical term for bodily fluids.  Hippocrates believed an imbalance of the humors caused disease, and also determined our personality.

Yet what we do know is the idea that all illness caused by an imbalance of the four humors became a paradigm physicians had a hard time getting away from even up to the 1850s when blood letting or bleeding was still practiced by some to balance the humors.

In fact, it is common wisdom that George Washington was believed to have contracted pneumonia at the end of his life, and to balance the humors Washington's doctors bleed him.  Yet while they thought they were helping the first President, we now know this remedy probably helped to speed up his demise.

In essence, as noted by Barry E. Brenner in Emergency Medicine, the Hippocratic writers "separated scientifically proven medicine with superstition and infused scientific spirit and ethical principles into medicine."

So what did Hippocrates know about asthma?   It's important to note here that the definition of asthma to ancient societies may have been completely different than what we think of asthma today. In fact, the actual term "asthma" was derived from the Greek word aazein, which means to exhale with an open mouth or to pant.  Actually, asthma is derived from the Greek word Panos which means panting.

The first reference to asthma was Homer's epic poem the Iliad about 800 BC. Although Homer used it more as a term to describe gasping or air hunger at the end of life, or exhaustion from fighting in a battle (I wrote about Homer in more detail here).

The first appearance of this term as a medical reference was by the Corpus Hippocratacum. Yet whether Hippocrates (or his team) used the term to refer to a symptom (shortness of breath) or as a particular disease is difficult to tell.

Hippocrates didn't have any particular remedies for asthma, as he pretty much thought of all diseases as an imbalance of the four humors: blood, yellow bile, black bile, and phlegm. Any particular diseases were thought to be the result of some poison that caused an excess or depletion in one of the humors.

His remedies were generally basic, and focused on avoidance of things that made a person sick, which included a good diet, exercise, plentiful sleep and cleanliness.  Yet if disease was persistent he relied on such remedies as bleeding, massage, herbs and purging. All of which were meant to maintain a balance of the humors.

Asthma was believed by Hippocrates to be an excess of phlegm. An increase of phlegm in the brain caused epilepsy, and seizures were the result. Many asthma experts of old believed that asthma and epilepsy were related, thus asthma being a seizure of the respiratory muscles.

Pneumonia and catarrh were described in his writings, with catarrh being what we might think of as nasal allergies. Everything else, for the most part, was asthma. Any dyspnea (the feeling of air hunger) was asthma. Anything that caused wheezing or increased sputum was asthma.

Exhaustion after exertion was asthma. Dyspnea due to heart failure was described as asthma. Dyspnea that occurred near the end of life was asthma. Foreign bodies that block the upper airway resulting in dyspnea was asthma. Trouble breathing because the air was humid was asthma. Bronchitis was asthma. Emphysema was asthma. Asthma was asthma.

Hippocrate's Aphorisms noted that asthma was more common in the middle aged and in the fall season. One of the neat things about Hippocrates is that he correctly identified asthma as a disease of bronchospasm, while many asthma experts (as noted here) all the way to the 1980s thought asthma was a psychological (nervous) disorder.

Hippocrates also described asthma as a disease associated with those persons who participated in certain occupations.  Yet that idea was scrapped and until Bernardino Ramazzini scooped it back up in the 17th century.  Occupational asthma was never taken seriously until the turn of the 20th century.

Hippocrates also accurately described asthma as a disease inherited along the family line, and while this was supported by a few experts along the historical line, it wasn't proven until modern times.

So it's quite obvious that many theories have been proposed over the years about asthma, and most of them are poppycock theories. Yet when one idea gains fame, it becomes part of the mainstream.  As is normal with human thought, once an idea is adopted, it becomes part of the paradigm.  Hippocrates idea of asthma as an imbalance of the humors was one such paradigm that gripped the medicine until the 20th century. 

One thing you will realize as you study the history of asthma, or medicine as a whole, is that physicians tend to be dogmatic in their beliefs, even when they are wrong.  It's for this reason that many people still to this day believe that all dyspnea is asthma. 

In 2500 years since Hippocrates walked the earth theories about asthma have spun in several different directions, and every direction was mentioned at one point by the Hippocratic writers.  Hippocrates was such a brilliant and influential physician that he continues to influence medicine to this day, which makes it easy to fathom how he's often considered the father of medicine.

Click here for more asthma history.