120-200 A.D.: Galen wonders what causes asthma

Galen (About 120-200 AD)

Claudius Galen of Pergamum was a Greco-Roman physician who lived from about 120-200 AD, or about 500 years after Hippocrates. Galen was the first known physician to ask the question:  What causes asthma?

During the 3rd century there were two schools of medicine competing with each other.  They were:

1. Rationalist:  They believed theoretical assumptions based on observations alone were necessary to provide adequate treatment for patients.  They practiced medicine based on such theories they studied in school.
2. Empiricists:  They believed theories were unreliable and unverifiable, and that a competent doctor gained knowledge based on experience and quantifiable data (1)

In the 4th and 5th centuries both Aristotle, Plato, Hippocrates and Aretaeus believed science couldn't be adequately understood and practiced by experience alone, and instead preferred the use of reason to provide medical knowledge.  These men were rationalists.

Galen, on the other hand, was an empiricist.  While he followed the ideas of Hippocrates Aretaeus, such that disease was caused by an imbalance of the four humors, he believed the best way to learn about medicine was by experience, both with the patient and by dissecting the body. 

It was his philosophy as an empiricist that allowed him to take medicine to the next level.  He relentlessly asked questions and set out as a meticulous and extensive researcher to find answers. (2)

However, the same problem that plagued Hippocrates also plagued Galen:  Dissecting the human body was illegal in Rome as it was in Greece.  For this reason, Galen dissected apes, monkeys and pigs instead of humans.

So it was based on his dissections of animals that Galen wrote books on anatomy and medicine that were so respected by the medical community and made Galen the most revered physician since Hippocrates.

He diligently collected the works of all medical writers who came before him, including the great Greek physician Hippocrates and the founder of the School of Anatomy in Alexandria, Egypt, Erasistratus, and included all of their works -- along with his own --in his books. He was so famous that his ideas about medicine were worshiped for the next 1200 years.(3)

Actually, one of the reasons he was so famous was because he was among the last of the great medical writers prior to the dark ages when all previous wisdom was lost, and medical wisdom actually took a step backwards -- several steps actually. 

Religion and faith took over for science, and most people wouldn't even think about touching a dead body, let along a dead animal.  All medical schools had was the books that Galen wrote, and so they worshipped his books as though they were the medical Bible.  (This was how it was in the Western world, yet thankfully this wasn't so in the East as we'll soon see).

Galen asked many questions and delved into many subjects in his research and writings, yet for the purpose of our project we're mostly interested in what he thought about asthma.  Galen must have become rapt into his investigations on the subject for he wrote extensively on the subject.

He defined asthma as a disease of quick respirations, or a panting, kind of like what happens to people after running a marathon. He believed asthma was caused by thick humors in the lungs that blocked the air passages, yet he was also the first physician to make the connection between bronchial constriction and asthma.

He even attempted to describe asthma as epilepsy of the lungs where instead of a seizure the person has constriction of the air passages.  Yet this thinking was similar to Hippocrates, who likewise related asthma with epilepsy.

Galen also observed that asthma was similar to epilepsy in that between episodes the asthmatic had no symptoms.  Likewise, neither epilepsy nor asthma left any organic lesions or scarring, and no otherwise observable signs of disease.

Perhaps due to this connection he believed incorrectly that the bronchial tubes were somehow connected to the brain.  This may have actually been the first reference of asthma as a nervous disease.

Although Galen never really wrote asthma was a nervous disorder, those who followed him surely did, as you'll soon learn.

Click here for more asthma history.

References: 

1. Pending (link was lost, may have been Encyclopedia Britannica)
2. Pending (link was lost, may have been Encyclopedia Britannica)
3. Parr, Bartholomew Par, M.D., "The London Medical Dictionary," 1809, London, Vol. 1, pagegs 425-5