Saturday, May 19, 2012

1600s: Asthma could get you absolved from crimes

How would you like it if someone said to you:  "You're asthma is all in your head?"  If you're like me you wouldn't take it too well.  On the other hand, if having asthma could get you off the hook for a crime you committed, perhaps you'd think differently.

Asthma experts in the ancient world realized early on that life was different for those inflicted with asthma or allergies.  Consider the following:
  • A boy rides a horse and has an asthma attack
  • A boy wrestling in dry dirt has an asthma attack
  • A boy is learning to dig trenches and has an asthma attack
  • A boy learning to ride a chariot has an asthma attack
Obviously the boy will not be fit for battle.  This boy will be forced to stay at home with his mother instead of hanging out with the men.  He will be deemed as feminine by his peers, an outcast, mentally deranged, weak, and useless.  

Boys like this became the subject of some of the world's greatest minds.  HippocratesGalen Ballonius*, Felix Platerus**, and Avicenna*** all mentioned a relationship between asthma and the nerves of the brain.  (2)

It was clearly evident that asthma was a mental disorder.  And this surely didn't help the poor asthmatic boy who just wanted to fit in; who just wanted to be one of the guys.  

Asthma was clearly a nervous disorder:

Around 400 B.C. Hippocrates, or at least one of the Hippocratic writers, wrote a convincing text that linked asthma with an increase in the humor phlegm.  This caused a disorder of the mind that resulted in asthma, or gasping breaths.  

In the Greco-Roman era asthma was linked with the nerves of the mind.  In his 1933 report in the Proceedings of the Royal Society of Medicine, "The History of Bronchial Asthma and Allergy," Stoikland described how Galen mentioned in his experiments on monkeys that "cutting of the medulla spinalis, the respiration and the voice are affected.  Ballonius, speaking about a patient with renal calculus and dyspnoea, says that there is a 'nervulus' (small nerve) from the sixth pair which penetrates the diaphragm and goes to the kidneys and this may also cause dyspnoea." (2)

You must consider here that during this time asthma was not defined as we know it today.  Back then asthma was any disease other than pneumonia and tuberculosis that caused dyspnea. Asthma was a complicated disease that was poorly understood.  Those who studied it were prone to speculate as to it's cause, effect and treatment.  

Maimonides (1138-1204) may have been the first to define psychosomatic medicine (the mind causes diseases) when he wrote how a patient who is "mentally agitated" caused his physical well-being to suffer and eventually he becomes physically ill. 

Maimonaides also explained 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."


Felix platerus (1536-1614) was among the first to advocate the treatment of mental patients. He believed that "an obstruction in the small pulmonary arteries is the cause of asthma.  But he mentions also that the bigger nerves from the dorsal medulla, when disturbed by defluxions, occassion dyspnoea, e.g., in asthmatics.  He observed the attack when nothing abnormal in the lungs could be found."

Jean Baptiste van Helmont (1577-1644) and Thomas Willis (1621-1675) are believed by many asthma historians to be the first to write about asthma specifically as a nervous disorder. While others obviously noted the link, Willis is most often given credit for starting physicians thinking along the notion that asthma was nervous -- he launched the idea in the minds of asthma experts seriously attempting to define this disease.

Willis described asthma in this way (2): 

"Whatsoever makes the blood to boil or raises it to an effervescence, as violent motion of the body, or mind, the drinking of wine, venery, excess of external cold or heat..., any great change of the air or of the year, slightest errors, a thousand other occasions, doth cause asthmatical assault to such as are predisposed.... This kind of dyspnoea, merely convulsive, is excited by reason of the pneumnonoc nerves... It is not to be doubted that the fits of asthma wholly depend on convulsive matter being fallen into the nerves, serving to the stretching forth of the lungs.... Soon the asthmatic attack is finished, no signs of abnormal disposition of the lungs can be found.  Severe attacks of asthma may occur without any notable fault of the lungs."

Van Helmont described many examples that prove psychotic factors can lead to asthma.  He wrote about women who had attacks of the asthma as a result of exposure to flowers.  He describe one situation where a man was pressured to speak and he refused.  The man was so stressed that he had an asthmatic attack and died.  This was all attributable to psychotic or nervous asthma.(2)

John Floyer (1649-1734) likewise followed the ideas of van Helmont and Willis.  William Cullen (1710-90) believed asthma was a disease of airway constriction of the muscular fibres that wrap around the lungs and also that it was triggered by psychological factors.  Irritation of the mind by certain odors, smoke, and dust trigger the asthmatic response. 
So there was plenty of evidence to link asthma with the mind.  Yet it truly wasn't until the 17th century A.D. (the 1600s) that asthmatics caught a break. They still may have been mocked by society, but at least something went their way.

A big break for asthmatics:

Paulo Zacchia (1584-1659) was a Roman physician and a personal physician to the Pope Innocent X and Alexander VII  (3).  He published "Quaestiones Medicolegales" in 1621.  It was published as 11 volumes between 1621 and 1661 and "was considered an important landmark in the history of forensic medicine." (1)  It was mainly a book with legal information about wounds and "jurisprudence about insanity."  (3) 

The book displayed an up to date medical advice to be used in legal cases that considered the latest wisdom of science, which included knowledge that there was a difference between adult and fetal lungs, and acknowledged wisdom about the circulation of the blood.  This was a first of its kind legal journal that provided legal advice at a time when science was in its infancy

Paul Ammann's (1634-91) was a man of "acute mind and extensive learning, but a restless and irritable disposition led him to engage too much in controversy."  For instance, in a time where the writings of Hippocrates and Galen were worshiped by the medical community he "boldly" attacked the systems of medicine they created. (4)

Amman's book "Medicina Critica" was published in 1670 and was a compilation of medico-legal cases decided by the medical facility of Leipzig.  (1) These men were provided with the evidence that asthma was a nervous condition (some of which you read above) and perhaps had to defend asthmatic criminals in a court of Roman law.

Zacchia and Amman both believed that "as fear can provoke asthma, the asthmatics were absolved from criminal inquiry,"  according to E. Stolkind in his article "  In this way, it was common for asthmatics to be kept out of stressful, and dirty prisons as this might provoke an attack that might provoke a lawsuit

As we continue on in our quest to learn about the history of asthma you will find many references of asthma as a nervous disorder.  We'll pick this theme back up as we travel to the 19th century and meet Dr. Todd an Dr. Salter.

Click here for more asthma history.

*Ballonius is a Parisian physician who lived 1538-1616 and is credited for coming up with the term rheumatism to explain vague pains in the external parts (5). To learn more about Hippocrates and Galen click on the links above. ** Felix Platerus was one of the first ot advocate the treatment of mental patients. (2, page 30)  *** Avicenna was a Muslim physician and philosopher who lived 980 A.D. 1034.  He wrote 150 treaties on philosophy and about 40 on medicine.  His most famous book was The Book of Healing which was a standard medical text for hundreds of years.

References:
  1. Clark, Michael, Catherine Crawford, "Legal Medicine in History," 1994, page 105
  2. Stolkind, E., "The History of Bronchial Asthma and Allergy",  (Proceedings of the Royal Society of Medicine, 1933, Vol. 26, part 2, page 1120; 36
  3. Fielding, Hudson Garrison, "An introduction to the history of medicine," 1922, London, page 272
  4. "Amman Paul," Encyclopedia Britannica of a dictonary or arts, science, and miscellaneous literature," 1842, 7th ed., vol. 2, part 2, page 657
  5. The Massachusettes Medical Society, New Englang Surgical Society, Boston Medical and Surgical Journal, "Rheumatisms and Pseudo Rheumatisms," Vol. CXIII, 185, July-Dec., page 38

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