Monday, August 08, 2011

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

The second century A.D. was a fruitful era in literature and philosophy, among those influential in our quest to investigate the history of asthma are Pliny the Elder, Seneca the Younger and Aurelius Cornelius Celsus.

I will write about Pliny and Seneca in a future post, yet for this day I would like to introduce to you Celsus, who was born of respectable parents, was well learned, and shared with us his wisdom through his many writings. He was a philosopher, physician, surgeon and pharmacist.  Some noted him to be so skilled at his craft that he was "second to none."(1)

Celsus was born in Greece in 25 B.C.  He was a stoic, which meant that he did not believe in an after life.  As an arch opponent of Christianity he wrote "The True Word," which was a well read attack on Christianity, a new philosophy in that era.
He wrote several other books as well, such as "A Treaties on Agriculture" and "A Treaties on Military Tactics," yet what history remembers him best for is his "Treaties on Medicine."

 In his medical writings he emulated Hippocrates, and parts of his book are word per word transcriptions from the "Hippocratic Corpus." In fact, he did this so often that one later author, Nicholas Mondaris, referred to him as the Ape of Hippocrates (2)


Yet he also incorporated into his book the latest wisdom of the day, plus some of his own ideas. This is clearly evident in his writings on asthma.

When asthma was first defined by Hippocrates around 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 was referred to as asthma.  (3)

Celsus, on the other hand, believed asthma was more than just dyspnea, and for this reason he provides us with our first description of asthma as more than simply a blanket term for all that causes dyspnea.
Celsus believed there were three thoracic disorders:
  1. Dyspnea:  Moderate, unsuffocative breathing without a wheeze; it's chronic
  2. Orthopnea:  Breathing only takes place in an erect position; it's acute
  3. Asthma:  Vehement breathing that is sonorous and wheezing; it's acute (3)
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:
(Asthma is caused by)  the narrow passage by which the breath escapes, it comes out with a whistle; there is pain in the chest and praecordia, at times even in the shoulder blades, sometimes subsiding, then returning; to these there is added a slight cough."
Mark Jackson, in his 2009  book, "Asthma: The Biography," explained that Celsus's approach to treating diseases, asthma included, was more aggressive than that of the Hippocrates.  According to Jackson, Celsus advised the following asthma remedies:
  • Blood letting (a standard remedy)
  • Milk (often supplemented blood letting)
  • Clysters (enemas, and often supplemented blood letting to loosen the bowels)
  • Hot forments
  • Plasters
  • emollients to east chest movement
  • Diuretics (to make you pee in order to reduce fluid in lungs and rest of body, although they probably believed the excreted fluids were full of the poisons that caused the humors to be imbalanced
  • Emetics
  • Exercise
  • Massage (to move the poisons around the body to create balance of humors, and to make breathing easier)
  • Drinking hydromel (a mixture of honey and water)
  • Mead containing hyssop or crushed caper roots
  • Sucking white nasturtium seeds mixed with honey
  • Consuming the liver of a fox, dried and pounded into a cupful of wine
  • Eating the fresh, roasted lungs of a fox
While some of the Celsus's remedies were later proved to have medical significance, most were simply palliative.  Still, Celsus's 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 2,000 year effort to define asthma as a disease all its own.     You can decide for yourself if you'd have been satisfied with his remedies for your asthma.  

(Later physicians, such as Sir John Floyer and Robert Bree, would break down these three classifications into three:  continued (heart failure, chronic bronchitis), and convulsive (spasmotic asthma and orthopnea).  

Click here for more asthma history.

References:


  • 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, page xxi, xxii
  • Celsus, ibid, page xvii
  • Good, John Mason, "The Study of Medicine," 1864, New York, page 363
  • Celsus, op cit, page......
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