Tuesday, February 12, 2013

625-690: Paulus Aegineta describes asthma

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Paul of Aegineta was a Greek physician who gives us a very early
description of asthma.  He also provided for us one of the first
histories of medicine, thus preserving the thoughts on asthma
of some of the ancient physicians
So how did the ancients define asthma? To get an answer to this question we need look no further than the 7th century A.D. where Paulus Aegineta gives a summary of how physicians during his day viewed asthma (1).

He was born in Aegina in 625, was educated at the University of Alexandria, and grew to become a famous Greek physician.  His name was Paul of Aegina, although he is most known by history as Paulus Aegineta. (2)

He became a very skilled surgeon who provided many achievements in the surgical process.  He was among the first to describe a process called bronchotomy, which was an old term for tracheotomy.  Some consider him the originator of plastic surgery.  (3)
He was among the first to describe a process called bronchotomy, which was an old term for tracheotomy. 

He was also a well known expert on diseases of the heart. (4)

He was also a skilled writer, compiling a condensed account of medicine, from surgery to treatment of diseases such as asthma.  His seven books were interpreted into English in 1744 by Francis Adams titled, "The Seven Books of Paulus Aegineta."  The books not only influenced physicians during Aegineta's era, but subsequent eras including Avecena, Rhazes, Haly Abbas, Albucasis, and Fabricius ab Aquapendente.  (5)

While he is most famous for his surgical wisdom, he does provide accounts of various disease processes, such as asthma, and remedies to treat them.  Most of his ideas were borrowed from ancient writers, which makes him an important figure when trying to compile a history of any disease.

The following is how he, and perhaps the ancients in general, defined asthma.  This comes from his book "The Seven Books of Paulus Aegineta" translated by Francis Adams.  (6)

1.  Definition:  "Those who break thick without fever, like those who have run fast, are said to be asthmatic, that is to say, to pant for breath; and from their being obliged, they are called orthopnic. (6)

2.  Causes:  The affection arises from thick and viscid humours becoming infarcted in the bronchial cells of the lungs. (6)

3.  Symptoms:  Dyspnea is a common symptom which accompanies these and many other complaints. (6)

4.  Treatment:  The indications of cure for asthma is to consume the viscid and thick humour by attenuant and detergent medicines.  Wherefore the vinegar of squills will answer well with them, and the oxymel prepared from it; the baked squill itself will answer well triturated with honey; the antidote called heira, continued purging with drastic medicines, and vomiting from radishes.  And, in like manner, the round birthwort may be drunk, the root of the great centaury, the fruit and root of the cow-parsnip,the fruit of calimint, hyssop, iris, and gith.  Put a sextarius of slaters, into the earthen vessel, roast upon the coals; when whitened, pulverize, and, mixing with boiled honey, give a mystrum thereof before and after food.  If there be any urgent necessity, before doing all these things, open a vein and evacuate proportionably to the patient's strength; and stimulate the belly by clysters.  Externally to the chest we may apply cataplasms from figs, the flour of iris, and of barley, containing rosen, wax, and honey; and iris and manna may be sprinkled upon them.  Some benefit may also be derived from raw barley-flour with rosin, wax, iris, and manna.  We may use the more heating ointments, which as those of iris, dill, and rue.  But the following application is particularly proper: Of pumice stone, p.j; of burnt lees of wine, p.iv; of arsenic, p.j; of the schenanth, p. ij; of alcyonium, p.j; of aphronitrom, p.ij; pound, sift, mix with the ointment, and with it rub the parts about the chest, and use emollient ointments for attracting the humours. (6)

So while he is mostly known as being a prolific surgeon, he also gave us some pretty interesting descriptions of diseases, including asthma.


References:
  1. Aegineta, Paulus, "The Seven Books of Paulus Aegineta," translated by Francis Adams, volume I, 1744, The Snydenham Society, pages 289-290  (commentary by Adams can be found on pages 407-09)
  2. Greeka.com, "Paulus Ageneta: The most important physician of Aegina Greece, Saronic," http://www.greeka.com/saronic/aegina/aegina-history/aegina-paul-of-aegina.htm, accessed June 26, 2012
  3. Gurunluoglu RGurunluoglu A., "Paulus Aegineta, a seventh century encyclopedist and surgeon: his role in the history of plastic surgery," Dec., 2001, 108 (7), 2072-9, based on a review of mentioned article at Pubmed.gov, http://www.ncbi.nlm.nih.gov/pubmed/11743404, accessed June 26, 2012
  4. Virginia.edu, "Paulus Aegineta (625-690)," University of Virginia, Vaulted Treasures, http://exhibits.hsl.virginia.edu/treasures/paulus-aegineta-625-690/
  5. Gurunluoglu, op cit, 2072-9
  6. Aegineta, Paulus, "The Seven Books of Paulus Aegineta," translated by Francis Adams, volume I, 1744, The Snydenham Society, commentary by Adams can be found on pages 407-09
  7. Junior, Democratus,  "Anatomy of Melancholy," translated by Robert Burton, 1827, London, Longman, Rees, Orme, and co., page 90
  8. Fourgeaud, V.J, "Medicine Among the Arabs," (Historical Sketches), Pacific medical and surgical journal, Vol. VII, ed. V.J. Fourgeaud and J.F. Morse, 1864, San Fransisco, Thompson & Company,  pages 193-203
  9. Drake, Miriam, "Encycopedia of Library and Information Science," 2nd ed., 2003, New york, page 1840
  10. "Rhazes and the first clinically exact description of hay fever (seasonal allergic rhinitis)," Iranian Journal of Medical Science, 2010, September, vol. 35, no. 3, 263

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