Thursday, July 26, 2012

100 A.D.: Aretaeus defines asthma

Somewhere around 100 A.D., during the reign of Emperor Nero, lived an ancient Greek master clinician named Areteus of Cappadocia.  He was responsible for our first clear medical descriptions of diseases such as pleurisy, diptheria, tetanus, pneumonia, diabetes, epilepsy and asthma. He was the first person to recognize asthma as a disease entity of its own, and the only physician among the ancients to do so. (1)(6, page 1)

When he was born, died, and any details of his life are educated guesses.  Some think he practiced medicine somewhere in one of the Eastern Roman provinces,  and was educated in the same manner as Hippocrates: by physicians of Egypt. Only Aretaeus learned at the school of Alexandria in Egypt.  Alexandria at the time was the major center of medical wisdom mainly because it was legal to dissect the human body in Egypt and not in Rome and Greece.  (2, page 110).

All we know of him is what he left in print, which apparently was pretty impressive. John Watson, in his 1856 book, "The medical profession  in ancient times," gives this account of the works of Aretaeus (3, page 145): 
"Aretaeus is one of the most original and elegant writers of antiquity.  For truth and accuracy of description, some have even placed him above Hippocrates.  There is perhaps no modern writer to whom he can be aptly compared than Heberden.  He appears to have written at that period of life when the mind, tempered and enriched by ample experience, is more disposed to rely upon personal observation than on teaching of the schools, and to pay little regard to theories unsupported by the revelations of nature."
Like other Bryzantine physicians after the fall of Rome, he copied the works of the greatest physicians who came before him, particularly Galen, Aetius and Oribasius.  Although, despite his humility, he differs with them from time to time, adding in his own personal observations from his own experience. (4, page 71)

His objective is stated at the beginning of his De Re Medica:
I have composed this work in order to give a compendious course of instruction, and not because there is any deficiency in the works of the old masters in the art, for, on the contrary, everything is handled by them properly and without any omission, whereas the moderns have not only neglected to study them, but have also blamed them for prolixity... I have compiled this brief selection from the works of the ancients, and have set down little of my own, except a few things which I have seen and tried." (4, page 71)
In the time since Hippocrates there were few advances in medical thinking, so Aerateus revived Hippocratic ideas (2, page 110).

Like Hippocrates he believed health and disease were determined by a balance, or imbalance, of the four humors: blood, phlegm, yellow bile and black bile.  He was also a pneumacist (see pneumatism), meaning he believed diseases were caused by imbalances in the gases of the body.

Areteaus described an asthma attack this way:  (1, page 26)
"They breathe standing as if desiring to draw in all the air which they possibly can inhale; and in their want of air they also open the mouth as if thus to enjoy the more of it; pale of countenance except the cheeks which are ruddy; sweat about the forehead and clavicles; cough incessant and laborious; expectoration small, thin, cold, resembling the efflorescence of foam; neck swells with the inflation of the breath (pneuma); the precordia retracted; pulse small, dense, compressed; legs slender; and if these symptoms increase, they sometimes produce suffocation after the form of epilepsy.
But if it takes a favorable turn, cough more protracted and rarer; a more copious expectoration of more fluid matters; discharges from the bowels plentiful and watery; secretion of urine copious, although unattended with sediment; voice louder; sleep sufficient; relaxation of the precordia; sometimes a pain comes into the back during the remission; panting rare, soft, hoarse. Thus they escape a fatal termination. But during the remissions, although they may walk about erect, they bear traces of the affection.
Wolff Freudenthal, in a 1917 article in New York Medical Journal titled "Bronchial Asthma," said the following regarding Areteaus:
According to Areteus its seat is in the lungs, but he also knew that the auxiliary muscles of respiration are called into action as well as the diaphragm. The cause of the disease is a cold or a great deal of humidity in the air, factors which even nowadays are made responsible for many an ailment——mostly, of course, without any scientific basis. Aretaeus describes two forms of asthma: First, one in which there is a difficulty of breathing, as in running, climbing, wrestling, and every kind of hard labor. In order to breathe easier the nose becomes pointed. The description of an attack is very accurate. (6, page 1)
Second, a form called by him “pneumodes or dyspnodes." The differential diagnosis between the two varieties consists in the duration (the latter being more prolonged), in the age of the patient, the free intervals, etc. The chest is round, barrel shaped, but otherwise normal... (6, page 1)
A third form of asthma is mentioned by Aretzeus but not recognized as such, i. e., “orthopnoe.” It seems to us that he mentions this form only to place himself in opposition to Celsus, who, as is well known, had made three divisions, viz., dyspnoe, asthma, and orthopnoe. (6, page 1)
If you were a patient of his he had a new method of assessing you, and you can read about that in an upcoming post as noted below.

Further reading:
  • Dogmatic School of Medicine (2/26/13)
  • 50 A.D.: Pneumatic School of Medicine (5/1/14)
  • 100 A.D. Areteaus assesses the asthmatic (5/6/14)
References:
  1. Aretaeus of Cappadocia," Encyclopedia Britannica, http://www.britannica.com/EBchecked/topic/33531/Aretaeus-Of-Cappadociaviewed on July 26, 2012
  2. Magill, Frank N., editor, "Dictionary of World Biography," Volume I: The Ancient World, 1998, Salem Press Inc., California
  3. Watson, John, "The Medical Profession in Ancient times.  An Anniversary Discourse Delivered before the New York Academy of Medicine, November 7, 1855," 1856, New York, Baker an Godwin, Aretaeus of Cappadocia, page 145
  4. Fourgeaud, V.J, "Historical Sketches:  XL  Medicine from the time of Galen to the Arabic Period," Medical and Surgical Journal, edited by V.J. Fouregaud and J.F. Morse, Volume VII, 1964, San Franciscohed June 9, 2011, pages 60-72
  5. Brown, Orville Harry, "Asthma, presenting an exposition of nonpassive expiration theory," 1917, St. Louis, C.V. Mosby Company
  6. Freudenthal, Wolff, "Bronchial Asthma," New York Medical Journal: A Weekly Review of Medicine, edited by Edward Swift Dunster, James Bradbridge Hunter, Frank Pierce Foster, Charles Euchariste de Medicis Sajous, Gregory Stragnell, Henry J. Klaunberg, Félix Martí-Ibáñez, volume CV, January-June, 1917 (Saturday, January 6, 1917), New York, A.R. Elliot Publishing, Co., pages 1-5

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