Monday, December 26, 2011

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

So what would life be like for the asthmatic when Jesus and Caesar walked the earth? From my investigations into this era I'd imagine the best remedy might simply be to tough it out, as many of the recommended remedies seem like they'd be worse than the disease. Of course this was true of most medicine prior to the 20th century.

Aurelius Cornelius Celsus was a voluminous writer. While
most of his works have been lost to history, his medical treaties
became one of the most read books during the Renaissance.
The second century A.D. was a very "fruitful era of literature and philosophy." (1, pages xxi, xxii) It is for this reason we have resources available to help us learn what was known about asthma at that time and the remedies to treat it. Among those influential to medicine in this era are Pliny the Elder, Seneca the Younger and Aurelius Cornelius Celsus.

The contributions of Pliney and Seneca will be expounded upon in a separate post. In this post I will shine the light on Celsus.
Although, we must be sure we are shining the light on the right Celsus, for this name was among the most popular of that time. The name Celsus in 2nd century Rome was akin to names like Bob or John in 21st century Europe or the United States of America. (5, pages 32-33)

Our Celsus can be seen as we enter the courtyard of one of the homes, reclining back comfortably on a couch with the tablets set firmly upon his knee. With a pen he writes about asthma today, a symptom he learned about during his philosophic studies. (5, pages 32-33)

Already in his repertoire were treaties on philosophy, architecture, rhetoric, agriculture and war. He also wrote a book called "The True Word," in which he attacked Christianity, the newest philosophy of his era.

Yet all those treaties would eventually be lost to history. The only remaining treaties that we have of his is his Treaties Medicina, of which he wrote about medicine and surgery. The first eight books were on medicine, the first four of which treated internal diseases with diet and regimen. The fifth and sixth dealt with pharmacology, or the drugs used to treat diseases. The seventh and eighth dealt with surgery. (5, page 32-33)(3, page 74)

He was born Aurelius Cornelius Celsus in 25 A.D. to respectable parents in Greece. He was a stoic, meaning he did not believe in an after life. He was also well learned, meaning that he was educated in all the knowledge of the day. His specialty became pharmaceutics, medicine, surgery, war, and architecture, all of which he, as noted above, wrote voluminously about.

His writings were later described as "diligent" and "attentive." (2, pages 425-5) Yet while some say that his skills as a surgeon were "second to none," (1, page xvii) others suspect he may not have practiced what he preached, that he was neither a physician nor a surgeon. (2, pages 425-5)

He rose above his peers by paying attention to all aspects of medicine, rather than just one. For instance, prior to his time medicine was divided into three parts: (9, page 33)
  • Dietetic: Curing by diet
  • Pharmaceutic:  Curing by medicine
  • Chirurgic: Curing by manual operations (knife, cupping, etc.)(5, page 33)
Celsus became the first to preach the importance of all three. (5, page 33)
Perhaps it was for these reason that his medical writings were "ignored by Roman practitioners of his day, and his name is mentioned only four times by the medieval commentators," said medical historian Fielding Hudson Garrison in the 1913 edition of his book "An introduction to the history of medicine." (3, page 74)

Not until 1478 would he get his revenge. In this year his book, De Re Medicina, would become the first medical treaties printed on the Gutenberg Printing Press. The treaties would then pass " through more separate editions than almost any other scientific treaties," said Garrison (3, page 74)
This was partly due to the fact it was a medical treaties, but more due to the fact of the way it was written. "It was due largely to the purity and precision of his literary style, his elegant Latinity assured him the title of 'Cicero medicorum,'" said Garrison. (3, page 74)

Medical historian Thomas Lindsley Bradford, in his 1898 book “Quiz questions on the history of medicine said that his medical treaties was a "test of Latin scholarship, and of a liberal education, for if the student was familiar with Celsus he received the purest Latin of the Augustinian Age." (5, page 33)

Along with his writings on medicine and surgery, he also described the history of medicine, giving descriptions of over 72 medical authors, although all have been lost except for the works of Hippocrates. He likewise provides us with the most precise account of medicine at the time of Jesus, describing both the Dogmatic and the Empiric Schools of medicine. (3, page 74)(5, page 33)

Celsus defended the idea that anatomy was important in medicine, so he was definitely not an Empiric, who, as we will learn later, did not support the notion that anatomy was important to medicine. Despite this, "his knowledge of anatomy was somewhat superficial." (5, page 33)
Regardless of how he was perceived in the past, Celsus remains an important figure in our history of asthma. It is thanks to him that we learn what physicians knew about asthma during the time of Jesus.

As a medical writer Celsus emulated Hippocrates, and parts of his books are word per word transcriptions from the "Hippocratic Corpus."  In fact, Celsus did this so often that one later author, Nicholas Mondaris, referred to him as the "Ape of Hippocrates." (1, pages 259-61)

The Treaties on Medicine written by Celsus would become the first
medical treaties printed on the Gutenberg Printing Press.
 It would go on to pass through more editions than
any other scientific treaties.  
Yet he incorporated into his treaties the latest wisdom of his day, plus some of his own ideas.  This is clearly evident in his writings on asthma.

When asthma was first defined by Hippocrates in 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 were referred to as asthma.

Celsus, on the other hand, believed asthma was more than just dyspnea, and for this reason he provided us with our first description of asthma as more than simply a blanket term.

Celsus wrote the following:
Est etiam circa fauces malum, quod apud Gracos aliud aliudque nomen habet. Orane in difflcultate spirandi consistit; sed haec dum modica est, neque ex toto strangulat, appellator. Cum vehementior est, ut spirare aeger sine sono et anhelatione non possit; cum accessit id quoque, ne nisi recta cervice spiritus trahatur. (4, page 10)
By the above, which is taken from John Charles Thorowgood 1890 book "Asthma and Chronic Bronchitis," we learn that Celsus believed there were three thoracic disorders that resulted in difficulty of breathing, and they varied by their "degree of violence":
  1. Dyspnea:  Moderate, unsuffocative breathing without a wheeze; it's chronic
  2. Asthma:  Vehement breathing that is sonorous and wheezing; it's acute
  3. Orthopnea:  Breathing only takes place in an erect position; it's acute (1, pages 259-61) (4, page 10)
By the order above, Celsus implies that asthma is the "mean" level of difficulty of breathing, with dyspnea being less severe than asthma, and orthopnea being more severe than asthma. (4, page 10)

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:
The symptoms common to these are, that on account of the constriction of the respiratory passage, the breath is emitted with a sibilous noise (whistle or wheeze), there is pain in the chest and precordia (over the heart), sometimes also in the shoulder; and that sometimes departs, sometimes returns; in addition to these a slight cough accedes. (1, pages 260)
His remedy for asthma included any of the following:
  1. Blood letting (common remedy for just about any ailment)
  2. Milk (to relax the bowels)
  3. Purging of the bowels with enemas (clysters) or injections if necessary
  4. Hydromel (honey diluted in water
  5. Head must be kept high in bed
  6. Thorax relieved by fomentations (warm, moist medicincal compress)
  7. Thorax relieved by hot cataplasms (a heated medical dressing, either dry or moist)
  8. Malagma (lotion or salve) or iris ointment after fomentations and cataplasms (these act as emollients to soften skin to make chest movements easier)
  9. Hydromel as a drink (mixture of water and honey)
  10. Bruised root of capers has been boiled
  11. Nitre or white cresses fried, bruised, then mixed up with honey and given as electuary (oral, by mouth)
  12. Honey, galbanum, and turpentine resin boiled together and, when they are coalesced to the size of a bean, dissolved under the tongue daily
  13. Impure sulfur or southernwood triturated together in a glass of wine and sipped warm
  14. Fox's liver dried, hardened and pounded into a powder and sprinkled on a drink (such as wine)
  15. Eating the fresh, roasted lungs of a fox (but you can't cook it with iron utensils)
  16. Gruels (watery porridge) and mild food
  17. Light austere wine
  18. Sometimes a vomit (Emetics)
  19. Anything that promotes urine (diuretics make you pee, but they probably believed they were full of poisons that caused the humors to be imbalanced)
  20. Gentle walking (nothing more) 
  21. Massage (he referred to it as friction; it's done to move poisons around the body to balance the humors and to make breathing easier) (1, pages 259-61)
While some of these were later proven to have medical significance, most were simply palliative, and some were downright barbaric.  Still, his 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 3,000 year effort to define asthma as a disease of its own. You can decide for yourself if you'd have been satisfied with his remedies for your asthma,  or if you would rather have just stayed home and suffered.

  1. 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
  2. Parr, Bartholomew Par, M.D., "The London Medical Dictionary," 1809, London, Vol. 1, pages 425-5 
  3. Garrison, Fielding Hudson, "An introduction to the history of medicine: with medical chronology, Bibliographic data and test questions," 1913, Philadelphia and London, W.B. Saunders company
  4. Thorowgood, John C., "Asthma and Chronic Bronchitis: A New Edition of Notes on Asthma and Bronchial Asthma," 1894, London, Bailliere, Tyndall, & Cox
  5. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey

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