Thursday, May 08, 2014

100 A.D. Areteaus assesses the asthmatic

Areteus of Cappadocia was one of the first physicians to run you through a complete assessment before he makes an attempt to diagnose you.  If you were a patient of his he would ask you an array of questions, followed by a thorough assessment which included the following: (1, page 112-113)
  • Your chief complaints (your symptoms)
  • Auscultation of the heart (which required his ear to your chest)
  • Palpation of your body (his hands upon abdomen to assess for enlarged organs by feel)
  • Temperature (probably by feeling  your forehead)
  • Your breathing (are you wheezing? are you breathing fast?)
  • Secretions (what color is your sputum?)
  • Skin color (is the skin around your lips blue?)
He'd then analyze the information obtained and come up with a diagnosis, he may refer to his own writings where he'd find that your symptoms resemble that of asthma:  (2, page 158)
"If a difficulty of breathing is produced either from running, excessive exercise, or any other cause, it is denominated asthma, or any other cause, it is denominated asthma: that disease likwise known by the name orthopnea, is called asthma, because the patients during the paroxysms are affected with difficulty of breathing, it obtains the appelation orthopnea from the patients not being able to breathe easily, unless in an erect posture of body, in a reclining state, there is danger of suffocation taking place." 
He'd most assuredly diagnose you with asthma, and realize the cause was "coldness of breath with moisture: the matter consists of thick gutinous humors lurking internally."  Depending on your age and sex he'd determine what to do next, as "Women are more subject to disease than men, because their habit is naturally moist and cold; boys likewise, but they more frequently recover than women from their daily increase in strength, and their nature very powerful in producing heat: men are by no means liable to the affection, but to them it sooner proves mortal.  "(2, page 159)

Plus he'd note that "should the heart suffer, death must inevitably be the consequence, as both respiration and life originate from this viscus." Yet he'd likewise know that "death attacks those slowly whose lungs are warmed by any sort of workmanship, such as the manufacturing of wool (wrapping the asthmatic in warm blankets), the working in calx (blacksmiths), brass, iron (blacksmiths), or the formenting of bath fires (kept fires going that heated bath houses)." (2, page 159)

He'd consider the symptoms: (4, 159-160)
  • Heaviness at the breast
  • Slowness to perform usual business and everything else
  • Difficulty of respiration both in running and walking
  • Hoarseness and coughing
  • Flatulency in the pracordia
  • Eructations without being able to assign any reason (any symptom you don't know what it is is probably asthma)
  • Watchfulness (nervousness)
  • Small obscure nocturnal heat (probably creates the desire to find cool air)
  • Nostrils are sharp and prepared for respiration
He likewise determing if the patient's asthma was severe (if the disease increases): (2, page 160)
  • The Cheeks are red
  • The eyes stand out as in persons that are strangled
  • They snore while they are awake (worse at night)
  • The voice is obscure without found
  • The desire for cold air is great (an open window please?  Fresh air?)
  • They walk abroad
  • No house can suffice the purposes of respiration (desire to get outside)
  • They breathe in an erect posture as if anxious to draw the air possible
  • And open their mouths greedily, still desiring it (air) in greater quantity
  • The skin is pale
  • Except the face, which is red
  • Eyes stand out as in persons that are strangled
  • Snore while awake (early description of wheezing?)
  • The evils become worse at time of sleep
  • Voice of obscure
  • The desire to find cold air is great
  • They walk around -- the house does not suffice
  • Breathe in an erect posture as if anxious to draw in all the air possible
  • They open their mouths greedily
  • Profuse sweak breaks out about forehead and necck
  • Constant violent cough
  • Reject a small, thin, cold matter, somewhat resembling an efforescence of froth (I believe he is describing sputum here, which may be due to increased mucus production or pink froth from heart failure)
  • The neck becomes tumid on drawing the breaths (paradoxical breathing?)
  • The praecordia are revulsed
  • Pulse is small, frequent, and oppressed
  • Legs are wafted
Or if the patient has end stage asthma (if the symptoms still increase):
  • Patient becomes strangled as in the case of epilepsy
Ideally the patient will improve, and go into "remission" providing the patinet with a "more favorable appearance": (2, page 161)
  • The cough is rarified
  • Coughign becomes longer (more continuous?)
  • Excretion of humid matter in greater quantity (increased sputum)
  • Watery substance will be dejected in abundance
  • Urine will flow copiously with sediment
  • Voice will be better formed and more sonorous
  • Attending with refreshing sleep (probably from exhaustion)
  • Remission of the praecordia
  • Pain during remission  in scapula (chest pain due to overworking accessory muscles?)
  • Breathing becomes rare and gentle, (normal respirations, respirations slow back down)
  • Degree of asperity of voice
Regardless, it is "in this manner do the patients escape death, but during the remissions, although they walk about in an erect posture, they have evident symptoms of disease."

Despite his brilliant description of asthma, one can only wonder what he would prescribe as a "cure" for the disease.  Overall he lists few remedies, or "cures," for any maladies, and for asthma he lists none.  Yet since he was an ardent supporter of the Hippocratic doctrine, chances are he'd recommend something along the lines of an improved diet, relaxation, and a bath.

Although, he "makes frequent use of evacuents, emetics, purgatives, and venesection... in the management of acute disease; in these also relying much on regimin, and on cooling and refreshing drinks.  But in the management of chronic disease, his practice is more diversified."

Most important is his advice for "every young physician to study for himself, and not to trust for all his knowledge to the commentaries of his instructors.

An interesting thing about Aretaeus is his writings were lost following his death, never to be seen again until they were found in 1554.  This may explain why Galen's writings were worshipped like the Bible of medicine as opposed to the works of Aretaeus.  (3, page 37)

Further reading:
  1. 1st century: Dogmatic School of Medicine (2/26/13)
  2. 50 A.D.: Pneumatic School of Medicine (5/1/14)
  3. 100 A.D.: Aerateaus defines asthma

References:
  1. Magill, Frank N., editor, "Dictionary of World Biography," Volume I: The Ancient World, 1998, Salem Press Inc., California
  2. Moffat, John, translator, "Aretaeus: consisting of eight books, on the causes, symptoms, and cure of acute and chronic diseases; translated from the original Greek." 1785, London, Logographic Press
  3. Turkington, Carol, Joseph R. Harris, "The Encyclopedia of the Brain and Brain Disorders," 3rd edition, 2009, New York, Infobase Publishing Inc.

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