Monday, August 08, 2011

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......
  • Wednesday, July 27, 2011

    Toilet seat inhaler

    As I've written many times I lose inhalers left and right.  My son must have found one and was playing with it when I suddenly heard a slam in the bathroom.

    My initial reaction was that he had his hand slammed in the toilet -- again.  Yet upon entering the room he was just standing next to the toilet crying.  I picked him up and end of story.

    Three hours later I'm at work and my wife sent me the following picture.  Apparently he was holding the inhaler when the seat slammed.  I just thought I'd share this with my readers. 

    Wednesday, July 20, 2011

    10 Reasons chronic lungers should work in a hospital

    My dad recommended when I was in high school that I get a job working in a hospital.  He likewise recommended I become a respiratory therapist.  I heeded my dads advice, but didn't go to school to be an RT until I was 25 only because I was afraid I'd fail chemistry.

    Yet working in a hospital sure has it's advantages when you're an asthmatic, or if you have any lung disease for that matter.  So, listed here are the advantages of working in a hospital if you have a lung disease:

    1.  You become better educated about your disease
    2.  You have access to all the best medicine
    3.  You work with doctors and nurses who can treat you if you're ill
    4.  Nurses can suck the excess wax out of your ear
    5.  Observant nurses can observe that your asthma is acting up and that you need help
    6.  Air conditioning
    7.  Clean and safe work
    8.  You can rest often
    9.  You get to hang out with other patients with similar diseases
    10.  You can take treatments at work

    Sunday, July 17, 2011

    Ear wax and infections

    It's seems as though the asthma body leads us from one ailment to another.  If it's not asthma its hay fever.  If it's not hay fever it's a wandering eye.  If it's not burning flat feet it's a headache due to sinus problems.  If it's not that it's an ear ache and a sense of fullness in an ear or two.

    That was my most recent problem.  My right ear has felt full the past several months.  I actually saw my doctor a couple weeks ago and that was the only day my ear wasn't bothering me, and for some reason he didn't check my nose and ears.  

    Yet yesterday my ear totally plugged off, a headache raged through my head, and the ringing was terribly annoying.  Plus I was working.  Then I decided I couldn't stand it no more so I wandered down to the ER clinic room and asked a PA if she'd do me a favor and check my ears.

    I have a history of wax buildup in my ears, and I have a history of ear infections too.  Yes, I know otitis media is a disease that kids get, but I get it too.  I remember as a kid getting ear aches so bad I couldn't stand.  I don't have that problem any more, yet the sense of fullness is equally annoying.

    A few years ago an ER doctor found that I had an ear infection and gave me a prescription of antibiotics.  It's nice to have doctor friends this way.  This time, however, the PA said I had an impaction in my.  She asked a nurse to flush my ear pro bono.  Yes, it's nice to work in a hospital sometimes.  

    Walking back to the RT cave I could hear sounds I didn't even know existed, and that I didn't hear on the way to the ER clinic.  It was so nice to have my hearing back.

    All she did really was flush my ears out with warm water.  She put the warm water into a syringe and squirted it into my ear.  It felt funny but good.  The excess water dripped into a basin.  It's probably a remedy you could do yourself at home.  

    Yet I suppose so long as I have access to such good friends at work why would I need to do such a thing myself. Yes, working in a hospital is nice.  

    Saturday, July 16, 2011

    My review of Dulera, Symbicort

    I will never shut the door on future experiments with newer asthma medicines based on past experience.  I once rejected Serevent, yet Advair ultimately rid me of my infestation of hardluck asthma.  Yet my recent trial with Dulera didn't go so well, and I ended it.

    The problem I encountered was not with the steroid but with the long acting beta adrenergic Foracort.  While it was nice that Foracort was quicker acting as a rescue medicine, it made my heart pound like Alupent used to make my heart pound back in the 1980s.

    There were some nights back in the 1980s where I'd use my Alupent before bed and my heart would pound so hard I was afraid I wouldn't wake in the morning.  When I started using the Albuterol inhaler in 1985 and Albuterol nebulizer solution in 1991 this feeling ended.

    Yet Formoterol brought it back.  There were a few nights, and mornings, after taking Dulera that my heart pounded.  I never once had that feeling with Advair.  So I decided I could no longer take it.  

    I like to think Dulera and Symbicort are basically the same medicine because the LABA is the same in each one (Foracort).  

    I also would like to add here that other than the occasional heart pounding the Foracort caused, I felt really safe using any of these LABAs. I have taken extra puffs from time to time with good results as far as my asthma is concerned.  It's a great medicine and it's safe.

    I like to think the black box warnings are wrong and basically scare people away from using good medicines.  So long as you use them as prescribed, and so long as you treat your asthma appropriately and don't think your Advair or Symbicort or Dulera will cure your exacerbation, I think you'll be okay.

    The first time I tried Advair I basically had to wean myself onto it, and that may be what I have to do with Dulera. Only Advair works so well for me I don't see any point in doing that at this time. However, if you have hardluck asthma and are looking for a good asthma medicine, I highly recommend you try one of the above named medicines.  

    Don't give up if you don't get immediate results or if the side effects hit you. Try one and if it doesn't work try another.  Wean yourself onto them slowly while you wean yourself off extra puffs of your ventolin.  You may find that after using a combination inhaler for a few weeks that your ventolin usage declines, and your side effects go away.

    That's my advice.  What's yours????

    Wednesday, July 13, 2011

    Let'

    Monday, July 11, 2011

    1840: Is asthma just emphysema?

    Even though it had been proven by Dr. Charles J.B. Williams in his 1840 experiments, Dr. George Budd continued to deny that bronchospasm had anything to do with asthma.

    Yet there may have been some bias here. He had done experiments on his own, and even made "Remarks on Emhysema of the Lungs" in 1839.

    As Dr. J. B. Berkart notes in his book, "On Asthma: It's Pathology and Treatment," Budd repeated Williams experiments and failed to repeat the results. Budd "therefore, rejected the theory of a bronchial spasm, and even doubted whether the circular fibres were muscular, as alleged."

    The thing about reading about this in their original works and by the original authors, is that when I was reading about the description of emphysema I was confused. After a while I realized that my problem was because I was going by today's definition of emphysema and not the 19th century definition.

    Today we define emphysema as loss of lung tissue that causes air to be trapped in the lungs, and this results in a barrel chest appearance. In the 19th century emphysema was simply air trapping.


    Berkhart (page 26) describes how one doctor (Dr. Longet?):
    "not only confirmed in the main the results obtained by Williams, but added that in his experiments irritation of teh pneumogastric nerve always produced spasmodic contraction of the brnchi, whereas section of the nerve led to emphysema... since section of the vagus causes emphysema, i.e., distension of the air vesicles, there must be muscular fibres which, if liable to paralysis, are liable also to spasm."

    So you see, emphysema is air trapping. It's air being trapped in the lungs due to narrowing of the bronchioles (air passages in the lungs).

    What both Williams and Budd may have failed to observe was that they were both onto something. Emphysema (air trapping) is secondary to bronchospasm. Yet it may have taken a few more years to juxtapose these ideas.