800 B.C. Asthma was sacred disease

Homer (about 850 B.C.)

It's believed the term comes frm the Greek word Aezean which means to exhale through an open mouth.  Asthma is also believed to come from the Greek work panos, which means to pant. Hence, you have your two terms for the disease.  Eventually panos was phased out, and the term asthma evolved to our modern definition. 

One of the more interesting things I learned in my quest to learn more about asthma was that the Ancient Greeks considered asthma, often referred to as panos, as a sacred disease.  They treated those suffering from it with a great deal of respect because it was considered to be an honor to have it.

Robert L. Shook in his book "Miracle Medicines: Seven Lifesaving Drugs and who created them" the Greeks beleived panos or asthma was a sacred disease "that signified a visit from the gods."

It was actually the Greeks who are believed to be among the first to use the term asthma.  It was first referenced by Homer in the Illiad, book XV, line 10:

"He saw Hector lying on the plain, his companions
sitting round him.  Hector was gagging painfully,                                    10         [10]dazed and vomiting blood."

In this scene Zeus wakes up as the Greeks are trying to push a line of Trojans back, and he finds the Trojan leader Hector breathing painfully and vomiting blood. The above is the English translation, although the word Homer used for "gagging painfully" was asthmati.

Homer later made another reference to asthma in book XV, line 290:

"He was just starting to recover,     
to recognize his comrades round him.  He'd stopped                             290 
gasping and sweating, for aegis-bearing Zeushad revived his mind"

In this scene Homer describes Hector as just starting to catch his breath, although Homer used the word asthma instead of gasping.

The Illiad was written by Homer about 800 B.C.

Homer used the word asthma as in being winded as from fighting in a battle, and perhaps the Greeks thought of "asthma" as the result of heroic actions.  However, I'm merely speculating here.

Asthma was first used as a medical term nearly 400 years later by the writers of the Corpus Hippocraticus. There is no evidence asthma was considered a specific disease by Hippocrates, as most evidence suggests asthma was basically a "symptom" of gasping or panting.

Anything that caused these symptoms were classified under the umbrella term asthma, which was how asthma was used until the 17th century.

Another thing to note about the ancient description of asthma, particularly as defined by Hippocrates, is that it was a paraxysmal disease.  This means that it presented with sudden, violent outburst, followed by short or long periods of time where it showed no symptoms at all.

Asthma was considered more severe than simple dyspnea (short of breath).  Asthma's severity was often compared with an epileptic convulsion or ceizure, and, once again, it was considered a divine visitation.

Click here for more asthma history.

2698-1000 B.C.:Asthma in ancient China

 Huang Ti about 1000 BC

While the Eber Papyri provides the oldest account of asthma remedies, it wasn't discovered by the modern world until the 19th century.

That left as the oldest known medical book through most of history as Nei Ching written by Huang Ti about 1000 BC.  He recorded medical descriptions of asthma-like symptoms and possible remedies.

Huang Ti Nei Ching Su Wen was known as the Yellow Emperor who reined over Ancient China from approximately 2697-2598 B.C.  He is known as the Father of Chinese Medicine. (1)

Similar to other ancient civilizations, the Ancient Chinese believed disease was caused by an imbalance of the humors.  In China it was caused by too much of the essence yang and/ or too little yin.  This was a concept believed to have originated with the Shang dinasty of 1600-1100 B.C.

They believed everything could be described by yin and yang, two polar opposites.  For example, a womon is the yin and the man the yang, or cold the yin and hot the yang, or damp the yin and dry the yang.  Any imbalance of these essence's are the cause of any problems that might ensue.

Imbalances of yin or yang are believed to be caused by obstruction of Qi, which may be described as the energy or life force that keeps the humors in balance the and body functioning properly.

So asthma-like symptoms were believed to be caused by an imbalance of yin and yang.  The lungs were believed to be responsible for metabolism and flow of fluids through the body, and an imbalance of yin and yang in the lungs will cause too much phlegm, edema, sweat and cause diseases such as breathing disorders. (2)  This ultimately obstructs Qi.

The main treatment for resetting the ying and yang was herbal medicine, massage or accupuncture.

While Nei Ching is the oldest known recorded Chinese medical treaties, Shen Nung, who lived from 2838-2698 is often considered as the founder of Chinese Medicine as well as the "Fire Emporor."  (3) 


Shen Nung created the Pen Ts'ao, or "Divine Husbandman's Materia Medica."  It's basically a pharmacopoeia describing how to create remedies from drugs and plants to treat various diseases. He was the first to mention using the plant Ma Huang (Now referred to as ephedra) for treating respiratory disorders.

The leaves and/ or stems of the Ma Huang plant were dried prepared in such a way that it was served as a drink, often as a bitter tasting tea.  Nung  He believed Ma Huang worked by reversing the flow of Qi.

One of the truly interesting things about ancient Chinese asthma treatment is the use of Ma Huang to treat asthma-like symptoms.  The modern world refers to this plant as ephedra, and from it was derived the bronchodilator ephedrine in 1901

Leaves of the plant were crushed and served in a bitter tasting yellow tea. This may actually have provided relief from an asthma attack.

The Nei Chung

Unfortunately this asthma remedy wasn't made available to the rest of the world until 1901 because China was isolated from the rest of the world and communication was poor.  (4)

So while ancient Chinese remedies may have provided only palliative treatment for asthma, some of their remedies may actually have provided at least some relief.  

Click here for more asthma history.

References:

1. Saunders, M, J.B. Dec, "Huang Ti Nei Ching Su Wen -- The Yellow Emperor's Classic of Internal Mediciner,"  Calif Med. 1967 July; 107(1): 125–126
2. "Qi Theory,  damo-qigong.net,  http://damo-qigong.net/qi-theory1.htm
3. Navara, Tova, "The Encyclopedia of Asthma and Respiratory Disorders," 2003, New York, page 177
4. Brenner, Barry E, "Emergency Medicine," 1999, page 2

5000 to 50 B.C.: Asthma in Ancient Egypt

Eber Papyrus showing treatment of asthma

It's a blessing to be alive during a time when there are many options to help us asthmatics.  We have rescue medicine like Albuterol to cure an attack, and asthma controller medicines to prevent asthma altogether.

Yet could you imagine living 5,000 years ago?  How would you treat your asthma in the ancient world?  Thankfully there were a few unknown writers we can thank for preserving ancient wisdom.  

In 1862 a 110 page scroll was discovered between the legs of  a mummy in Thebes.  This 20 meter scroll written in Hieroglyphics was later purchased by Georg Eber and in 1890 transcribed.  It then became the most important medical papyri of all Ancient Egypt, and the oldest preserved medical document of all time.

The Eber Papyrus is believed to have been written about 1500 B.C. and copied from earlier texts dating as far back as 3400 B.C.  

Once transcribed it was learned the scroll contained over 700 magical formulas and remedies for the most common ailments of that time, including asthma. Diseases back then were believed to be caused by an imbalance of phlegm or humors in the body, and remedies were an attempt to balance these humors.


While the word asthma was not used, asthma-like symptoms were described.  Physicians were unable to differentiate between different causes of shortness of breath and cough, so these symptoms were generally grouped as one malady, and the recommended treatment was uniform regardless of the actual cause.

Of interest to note is that your physician may also have been your priest or magician, as there was a vague distinction between these professions.  Duties of your "physician" would be to concoct a potion to treat your asthma, yet he may also provide you with a magic amulet and sing an incantation to the gods to cure you.  

When finished with this task he may also perform religious ceremonies, marriages, embalming, and funeral services.  Your asthma doctor was a busy, multi-tasked man, who may or may not have an actual remedy to aide you in your quest to breathe easier.  


Once you request the services of your physician he may request you eat a balanced diet, bath yourself, or even shave your body hair.  Or perhaps he'd prescribe one or more of the following remedies:

• Enemas (the stomach was believed to be a cause of breathing problems)
• Animal excreta (including crocodile and camel)
• Herbs such as squill and henbane
• Fumes of burned Belladonna leaves (usually heated on brick)
• Eating foods such as figs , grapes, frankincense, cumin and juniper fruit
• Drinking wine and sweet beer

Belladonna plant

Surely the best remedy was the belladonna plant, which was the mother of modern medicines like Atrovent and Spiriva.  It's a mild bronchodilator.  Yet if you're like me, you know neither of these does much to allay an attack of asthma.

Belladonna had many other  uses, one of which was as a cosmetic.  Young ladies placed drops in their eyes to dilate their pupils.  This made their eyes pretty and attractive to young men.  Italians later referred to it as bella-donna, which means pretty lady.

Yet the above were only options if you had access to a physician, who would also be your embalmer, priest and magician.  Perhaps a more common option would be for the priest to give you an amulet to wear and an incantation to say each morning.  Or he might place his gentle palm over your throat or chest and chant a prayer to induce healing and scare away the evil demons that were causing you to breathe heavy.  

One can only imagine how hard it would have been for asthmatics back then.  They were most likely treated as inferior, and the best treatment was to simply tough it out.  Could you imagine?

Click here for more asthma history.

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......

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