Tuesday, November 15, 2011

1138 -1204 A.D.: Maimonides writes asthma book

Maimonides (1138-1204 A.D.)
While few may know this, the Muslums may be credited as saving ancient Greek and Roman medical theories for modern times.  This is because while the Western world was engulfed in the dark ages, the Eastern world was full of rising societies.

Europeans were so busy feuding amongst themselves and destroying towns and libraries, the Muslims were growing a society in Arabia and Spain.  In essence, through their travels, the Muslums brought Greek and Roman medical wisdom to Spain.

Maimonides was not a Muslim but a Jew who lived from about 1138 to 1204 AD.  He was among the most famous writers, physicians and philosophers of his day.  He was born in Muslim controlled Spain and learned from his father, who was a Jewish teacher and Rabbi.

Fred Rosner, in his book "The medical legacy of Moses Maimonides" explained that Maimonide's father, Maimon, instilled in him an interest in the sciences and philosophy.  He was blessed with a mixture of Ancient Greek, Roman, Medieval Arab and Hebrew wisdom of all ages. (1)

Despite all his writings, he left very little along the lines of opinions about everyday life, so we know little about his life and personality.  (2)

He was born during the the time of the crusades where Christians traveled to the Holy land to free the city of Jerusalem from the Muslims, who captured the Holy lands from the Bryzantines in 638 A.D.  In order to avoid religious persecution in Spain, Maimonide's family fled Spain and ended up in Fez, Morocco.

While in Morocco, Maimonide's became an avid reader of many of the medical writings obtained from the ancient Greek and Romans, particularly those of Hippocrates and Galen

He later wrote that Galen observed Hippocrates to be wrong in many areas of his writings.  But instead of saying, "Hippocrates was wrong," he would cover for Hippocrates, even to the point of changing Hippocrate's meaning, or crediting the error to other writers and not Hippocrates himself.

The family ended up in Egypt, and this is where Maimonide's skill as a physician took off.  The author's of Emergency Medicine  write that "he became appointed as the physician to the great Saladin and then became physician to the Saladin's son, Prince Al Afdal Nur ad Din ali, when the Prince assumed the throne at age 40 in 1193." (3)

Maimonide's wrote a lot during his lifetime, and most of his books were written to someone who requested some type of medical advice.  For example, in the last 14 years of his life he was asked by the Prince to provide some advice on how to live with his asthma.  Maimonide wrote to him that asthma was usually started with a cold and advanced to shortness of breath.

Maimonides ended up writing his "Treaties on Asthma," where he recommended against trying any magical cures for any ailments, and any such remedies should treat the cause as opposed to just the symptoms.  Treatment should also be based on age of the patient and the season, as the disease might be seasonal.

He wrote that ultimately during the course of (an asthma attack) the patient later gasped for air and coughed up a wad of phlegm.

Rosner explained that Maimonides might have been the first to describe psychosomatic medicine when he wrote how a patient who is "mentally agitated" causes his physical well-being to suffer and eventually he becomes physically ill. (4)

Rosner wrote that Maimonaides also adds that "gaiety and joy gladden the heart, and stimulate the blood and mental activity.  Excessive indulgence in the pursuit of pleasure, however, is injurious to one's health.  The avoidance of illness induced by such excesses is by conducting oneself according to ethical and moral principles."

He likewise noted that asthma usually starts as a cold during the rainy season.  However, modern historians aren't sure if Maimonide's description is asthma or some other similar malady.

He's also perhaps the first to describe how city air pollution may be the cause of asthma.  He writes:
"Town air is stagnant, turbid, and thick; it is the natural result of its big buildings, narrow streets, and garbage... Air winds carry stealthily inside the houses and many become ill with asthma without noticing it.  Concern for clean air is a foremost rule in preserving the health of one's body and soul."
He recommended many herbs to be inhaled and was the first to recommend chicken noodle soup as a remedy for breathing trouble.

Aside from chicken soup, his remedies included:
  • Clean air
  • Healthy eating (he recommends eating certain foods and avoiding others)
  • Healthy drinking
  • Controlling emotion (was this an early reference to psychosomatic asthma?)
  • Exercise
  • Rest
  • Sleep
  • Wakefulness
  • Excretion
  • Retention of wastes
  • Bathing
  • Massaging
  • Avoid gas producing foods (causes bloating)
  • Chicken soup (acute asthma only and only if patient is afebrile)
  • Moderate exercise prior to eating
  • No exercise right after a meal
  • Dry months
  • Small quantities of wine
  • Enemas to cleanse the bowels (induce bowel movement and to drain thick juices)
  • Emetic (severe cases only)
  • Aromic herbs (to fortify the brain and dry out any humidity therin)
  • Emetics to cleanse the stomach (cause vomiting)
  • Sleeping after bathing is good, yet bath water should be warm and contain salt
  • Various compound remedies (5)
  • Travel to dry regions 
  • Moderation of sexual activity (6)
He advises against the following common "excessive" remedies from other physicians because they "involve strenuous physical and emotional exercise.":
  • Sexual intercourse
  • Blood letting
  • Hot baths
  • Urine stimulation (such as diuretics)
  • Purgation (never on healthy people because it doesn't preserve health)
  • Sleeping immediately after meals is harmful
  • Washing with cold water after meals is harmful
  • Excessive bathing during acute attacks (due to wet climate created)
  • Opiates (except in severe cases (7)
Possible triggers:
  • Wet seasons
  • Excessive drinking
  • Pollution (8)
Maimonides makes a point to emphasize what Hippocrates noted years earlier, which is to put your life in the hands of someone who bases his wisdom and remedies on scientific training as opposed to someone who treats based on superstition or faith. Worded another way:  Science is better than quackery.

 Likewise, in many instances it may be better to do nothing than to risk greater harm to the patient.

References:

  1. Rosner, Fred, "The medical legacy of Moses Maimonides," Chapter 2, "A Treaties on Asthma,"   page 13
  2. Yellin, David, "Maimonides," IsraĆ«l Abrahams, Jewish Publication Society of America, Philadelphia, 1903, page 3
  3. Brenner, Barry E, editor, "Emergency Asthma," 1998, New York, page 13
  4. Rosner, op cit
  5. Rosner, op cit
  6. "Asthma History -- Through the Ages," Medical News Today
  7. Roster, op cit
  8. Roster, op cit

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