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?

His father, Nico, made sure he received the best education in philosophy and medicine.  By the time he was seventeen:(1, page 149)

"He was placed as a student at the Asclepion of Pergamus, under Satyrius, the pupil and successor of Quintus; and in the course of his studies had the advantage of instruction from Stratonicus, a Hippocratic rationalist, and from AEschrion, an emperic."  

After his dad died he studied philosophy, and later medicine at the "still most celebrated school of medicine" at Alexandria, Egypt.  (1, page 149)  He also traveled to Greece, Asia and Italy "justly regarding such a course as essential to an accomplished physician.  (2, page 77)    
He became an eclectic physician, meaning he incorporated the best ideas of both schools of medicine: dogmatism and empiricism. From Stratonicus he learned to appreciate the theories of Empedocles, Hippocrates and Aretaeus.  From Aeschrion he learned to temper speculation in lieu of experience.  Many credit him with giving birth to experimentalism, or rationalism.  

Like Aretaeus, he believed a vital force called pneuma was inhaled, stored in the heart, and circulated through the body by the vessels.  He believed sickness was caused by a disturbance of the pneuma that could be detected by the pulse. 

He believed in the four elements of Empedocles: fire, air, earth and water.  And that from these were derived the four qualities of the body:  hot, cold, dry and humid.  Imbalances of these resulted in an increase or decreases in one of the four humors described by Hippocrates: (1, page 164)

The Four Humors of Hippocrates
Latin Name	Modern Name	Qualities	Personality/Temperment
Haima	Blood	Red, Hot, Moist	Sanuine
Phlegm	Phlegm	Cold, Humid	Phlegmatic
Choli	Yellow Bile	Hot, Dry	Choleric
Melanchia	Black Bile	Cold, Dry	Melancholy

According to Hippocrates which ever of the humors is dominant in a given person will determine that person's personality, as noted in the fourth column of the graph (I will write about these personalities in an upcoming post).  Similarly, an imbalance of any one of these humors (increase or decrease) results in a disease.  

The way to maintain health is to maintain equilibrium of these four humors, and do this it is essential to have good hygiene, which includes a regular diet and exercise.  Similar qualities of the body should be treated with similar remedies.  Disease is remedied by an increase or decrease in the opposite quality effected.   (1, page 167, 170)

As an empiric he thought diseases had a natural cause: (3, page 23)

As disease, according to Galen, consists in 'vel operationis vel structurae oblaesio,' he urged the importance of tracing the general symptoms to the parts or organs primarily affected.  

He was a meticulous and extensive researcher, and set off on a hunt to learn about the interesting symptom of asthma described by Hippocrates.  He saw asthma in his own patients.  He observed their symptoms of trouble breathing, and heard their wheezing with his own ears.  He set off on a meticulous and relentless quest to find the natural cause of asthma and remedies to cure it.

He relentlessly questioned and assessed his patients.  He'd love to dissect the human body, yet this was forbidden under sentence of death and punishment by the gods.  So he cut into apes, pigs and monkeys instead.  He cut open their chests and observed their lungs.  He cut into these and traced the air passages.  He concluded this was where the vital force of life, the pneuma, enters the body.

He traced vessels from the lungs to the brain.  Perhaps this confirmed his assumption, one Hippocrates had alluded to, that asthma was similar to epilepsy.  Both diseases also displayed no symptoms between attacks, and left no observable traces of disease.

He believed epilepsy was caused by an increased abundance of phlegm in the brain, and this caused seizures. So he concluded asthma was caused by an increased abundance of phlegm in the lungs, and this caused difficulty breathing by blocked air passages.

On his experience he wrote that "if the breathing is rough and noisy it indicates that a large amount of thick and sticky humors in the bronchial tubes of the lungs has accumulated and become annoying because it is difficult to expectorate." (4, page 24)

In this way he is credited by history as being the first to link asthma to the air passages of the lungs, and the first to describe asthma as a disease of obstructed air passages.

Remedies by Galen were meant to restore the balance of the elements and humors.  For example, if you were deficient in one he'd prescribe something to restore it's balance, or add it's opposite humor.  Before dipping into his pot of medicine he'd probably first recommend a bath, a good diet, and exercise.

General remedies prescribed by Galen were copied from the likes of Asclepiades, Musa, Andromachus, Heron, Crito, Menecrates, Archigenes, and Phillipus.  Galen mentioned a treatment borrowed from Asclepiades for orthopnia, a common symptoms of asthma, that contained mellepedes, which were supposed to have a diuretic effect (makes you pee).  (5, page 145)

For asthma he prescribed the following: (6, page 407)

1. Squill (alleviates coughing)
2. Pepper (stimulates digestive system)
3. Wormwood (stimulates digestive system)
4. Opoponax (antispasmotic, respiratory decongestant)
5. Storax (expectorant)
6. Oxymel (expectorant)
7. Sulfer (eases allergy symptoms such as sore throat and cough)
8. Millepedes (diuretic)

He made about 70 references to asthma, sometimes as the symptom of rapid breathing described by Homer and Hippocrates, and sometimes as a disease that caused breathing difficulties.  (4, page 24)

He wrote voluminously and had a great impact on his fellow physicians. Many copies of his works were made.  This was a good thing because while the works of other physicians on this list were lost and forgotten, Galen's were worshiped as the Bible for the next 1300 years.

References:

1. Watson, John, "The Medical Profession from the Earliest Times: an anniversary discourse delivered before the New York Academy of Medicine November 7, 1855," 1856, New York, Baker & Godwini
2. Meryon, Edward, "The History of Medicine," Volume I, 1861, London,
3. Fourgeaud, V.J., "Historical Sketches: Galen," Pacific Medical and Surgical Journal," 1864, Vol VII, San Francisco, J. Thompson & Co., pages 22-29
4. Jackson, Mark, "Asthma: A Biography," 2009, Oxford University Press, the quote from Jackson comes from On the Affected Parts by Galen
5. Young, Thomas, "A Historical and Practical Treaties on Consumptive Diseases:  Deduced From Original Observations, And Collected From Authors Of All Ages," 1815, London, B.R., page 145
6. Adams, Francis, "The Medical Works of Paulus Agineta: The Greek Physician; translated into English with a Copious Commentary," vol. I, London, page 407-8, 1834, Adams gives a long list of ancient physicians who wrote about asthma

Originally published 7/25/2012 and edited and resubmitted on 8/2/2012 by Rick Frea