1138 -1204 A.D.: Maimonides writes asthma book

Maimonides (1138-1204 A.D.)

While few may know this, the Muslums may be credited as saving ancient Greek and Roman medical theories for modern times.  This is because while the Western world was engulfed in the dark ages, the Eastern world was full of rising societies.

Europeans were so busy feuding amongst themselves and destroying towns and libraries, the Muslims were growing a society in Arabia and Spain.  In essence, through their travels, the Muslums brought Greek and Roman medical wisdom to Spain.

Maimonides was not a Muslim but a Jew who lived from about 1138 to 1204 AD.  He was among the most famous writers, physicians and philosophers of his day.  He was born in Muslim controlled Spain and learned from his father, who was a Jewish teacher and Rabbi.

Fred Rosner, in his book "The medical legacy of Moses Maimonides" explained that Maimonide's father, Maimon, instilled in him an interest in the sciences and philosophy.  He was blessed with a mixture of Ancient Greek, Roman, Medieval Arab and Hebrew wisdom of all ages. (1)

Despite all his writings, he left very little along the lines of opinions about everyday life, so we know little about his life and personality.  (2)

He was born during the the time of the crusades where Christians traveled to the Holy land to free the city of Jerusalem from the Muslims, who captured the Holy lands from the Bryzantines in 638 A.D.  In order to avoid religious persecution in Spain, Maimonide's family fled Spain and ended up in Fez, Morocco.

While in Morocco, Maimonide's became an avid reader of many of the medical writings obtained from the ancient Greek and Romans, particularly those of Hippocrates and Galen. 

He later wrote that Galen observed Hippocrates to be wrong in many areas of his writings.  But instead of saying, "Hippocrates was wrong," he would cover for Hippocrates, even to the point of changing Hippocrate's meaning, or crediting the error to other writers and not Hippocrates himself.

The family ended up in Egypt, and this is where Maimonide's skill as a physician took off.  The author's of Emergency Medicine  write that "he became appointed as the physician to the great Saladin and then became physician to the Saladin's son, Prince Al Afdal Nur ad Din ali, when the Prince assumed the throne at age 40 in 1193." (3)

Maimonide's wrote a lot during his lifetime, and most of his books were written to someone who requested some type of medical advice.  For example, in the last 14 years of his life he was asked by the Prince to provide some advice on how to live with his asthma.  Maimonide wrote to him that asthma was usually started with a cold and advanced to shortness of breath.

Maimonides ended up writing his "Treaties on Asthma," where he recommended against trying any magical cures for any ailments, and any such remedies should treat the cause as opposed to just the symptoms.  Treatment should also be based on age of the patient and the season, as the disease might be seasonal.

He wrote that ultimately during the course of (an asthma attack) the patient later gasped for air and coughed up a wad of phlegm.

Rosner explained that Maimonides might have been the first to describe psychosomatic medicine when he wrote how a patient who is "mentally agitated" causes his physical well-being to suffer and eventually he becomes physically ill. (4)

Rosner wrote that Maimonaides also adds 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."

He likewise noted that asthma usually starts as a cold during the rainy season.  However, modern historians aren't sure if Maimonide's description is asthma or some other similar malady.

He's also perhaps the first to describe how city air pollution may be the cause of asthma.  He writes:

"Town air is stagnant, turbid, and thick; it is the natural result of its big buildings, narrow streets, and garbage... Air winds carry stealthily inside the houses and many become ill with asthma without noticing it.  Concern for clean air is a foremost rule in preserving the health of one's body and soul."

He recommended many herbs to be inhaled and was the first to recommend chicken noodle soup as a remedy for breathing trouble.

Aside from chicken soup, his remedies included:

• Clean air
• Healthy eating (he recommends eating certain foods and avoiding others)
• Healthy drinking
• Controlling emotion (was this an early reference to psychosomatic asthma?)
• Exercise
• Rest
• Sleep
• Wakefulness
• Excretion
• Retention of wastes
• Bathing
• Massaging
• Avoid gas producing foods (causes bloating)
• Chicken soup (acute asthma only and only if patient is afebrile)
• Moderate exercise prior to eating
• No exercise right after a meal
• Dry months
• Small quantities of wine
• Enemas to cleanse the bowels (induce bowel movement and to drain thick juices)
• Emetic (severe cases only)
• Aromic herbs (to fortify the brain and dry out any humidity therin)
• Emetics to cleanse the stomach (cause vomiting)
• Sleeping after bathing is good, yet bath water should be warm and contain salt
• Various compound remedies (5)
• Travel to dry regions 
• Moderation of sexual activity (6)

He advises against the following common "excessive" remedies from other physicians because they "involve strenuous physical and emotional exercise.":

• Sexual intercourse
• Blood letting
• Hot baths
• Urine stimulation (such as diuretics)
• Purgation (never on healthy people because it doesn't preserve health)
• Sleeping immediately after meals is harmful
• Washing with cold water after meals is harmful
• Excessive bathing during acute attacks (due to wet climate created)
• Opiates (except in severe cases (7)

Possible triggers:

• Wet seasons
• Excessive drinking
• Pollution (8)

Maimonides makes a point to emphasize what Hippocrates noted years earlier, which is to put your life in the hands of someone who bases his wisdom and remedies on scientific training as opposed to someone who treats based on superstition or faith. Worded another way:  Science is better than quackery.

 Likewise, in many instances it may be better to do nothing than to risk greater harm to the patient.

References:

1. Rosner, Fred, "The medical legacy of Moses Maimonides," Chapter 2, "A Treaties on Asthma,"   page 13
2. Yellin, David, "Maimonides," Israël Abrahams, Jewish Publication Society of America, Philadelphia, 1903, page 3
3. Brenner, Barry E, editor, "Emergency Asthma," 1998, New York, page 13
4. Rosner, op cit
5. Rosner, op cit
6. "Asthma History -- Through the Ages," Medical News Today
7. Roster, op cit
8. Roster, op cit

What is the blog "Hardluck Asthma" all about?

Your humble question:  If you were in an elevator and someone asked you about your blog, what would you tell them? 

My humble answer:  On my Hardluck Asthma blog I write about what it's like to live with asthma.  What are the day to day challenges of being an asthmatic?  I also write a lot about the history of asthma.  I try no write from a unique perspective of the disease as to not make my blog a repeat of other asthma blogs, although I sometimes fail at that.  I have three other blogs, and this one is my ME blog.  This is where I get to write about me, my asthma, and how it effects me personally.  I also spend some time writing my asthma story, or what it was like living with asthma when I was a kid.  I had it bad, so bad in fact that I once made over 17 visits to an ER one year, and once spent six months in a hospital.  I like to write about that and a whole lot more asthma stuff.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

Heed the warnings on asthma medicine

Task for the day:  Open a book.  Point to a page.  Free write for 10-15 minutes on that word or passage.  Post without editing if you can.  

My response:  I'm looking at a page in "Asthma:  The Biography," by Mark Jackson.  This is a remarkably thorough read about the history of asthma.  The page I'm looking at discusses fatal asthma.  

In the 19th century many doctors wrote that they rarely ever observed any one dying of true asthma.  It was a disease that caused some suffering for a few days, yet usually let up eventually.  My asthma is like this.  I have an attack, it can be terrible, yet in a few days I know I'll get better whether or not I take medicine for it.  The difference between now and the 19th century is today we have medicine to relieve our suffering.  No one should have to suffer from a bad asthma attack anymore.

Yet no one died from asthma back then.  That changed in the 20th century.  It changed when epinepherine was used to treat asthma in 1900.  Asthma deaths spiked again after the rescue inhaler was invented in 1952, and the first long acting rescue medicine was invented in the 1970s.  

The first impression of asthma doctors was to blame the same medicine that helped asthmatics.  They believed the medicine was killing asthmatics.  The main cause of death was considered to be due to the cardiac effect of the medicine.  This usually resulted when patients would abuse the medicine.

I think this may have contributed to some deaths, yet I think these scientists got it all wrong.  I think the reason asthma deaths started to rise in 1900 is because more people were diagnosed that weren't previously diagnosed.  I think one of the reasons is that you had medicines to help asthmatics if they were diagnosed.

Even recently Advair is blamed for killing some asthmatics.  Yet I don't think that medicine would kill a fly.  The medicine in Advair is no different that ventolin, it's just the longer acting version of ventolin.  I've used an entire inhaler of Ventolin plus taken extra hits on my Advair and still survived.  

I think the reason Advair gets blamed for asthma deaths is because the EMTs arrived at the person's home and saw the Advair clutched in the hands of the asthmatic. So the Advair was given the blame for the death.  Yet the true reason was because instead of calling for help the asthmatic relied on the medicine.  The medicine wasn't working, but by the time the patient realized this it was too late.

So I believe the reason for the rise, at times, in asthma deaths is due to lack of education.  It has little to nothing to do with the medicine.  And I think that black box warnings on such inhalers, or taking them off the market, does more harm than good.  It prevents asthmatics from getting the medicine they need to help them.

So thus is my unedited rant.  

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

Do asthmatics have a barrel chest?

Your humble question:  Do asthmatics have a barrel chest?

My humble answer:  During an acute exacerbation of asthma you will have air trapped in your chest, and this can give you a barrel chest.  

What is a barrel chest:  The mayo clinic defines it best:  The term describes a rounded, bulging chest that resembles the shape of a barrel.  Barrel chest isn't a disease, but it may indicate an underlying condition.

Is a barrel chest permanent:  When I was a kid I often was told I had a barrel chest, but I do not have one now.  For asthmatics it's only temporary until the asthmatic attack is resolved and the excess air is allowed to escape from your chest.  In this way, part of the definition of asthma is that it is completely reversible, either with time or medication.  However, patients with emphysema may have permanent lung destruction that results in air being permanently trapped in the lungs.  This may result in a permanent barrel chest. 

If it's not broke don't fix it.

I love blogging.  I love blogger for providing me with access to blogger for free.  I think the gift of blogs is among the greatest give ever to both the writer and anyone who loves to read, learn and share ideas in the arena of ideas.

There are some people who want to tax profits made on blogs.  There are many who want to tax profits made on the Internet.  Yet all the money I make on my blog goes right back into my blog.  It's a minuscule profit at best, and taxing blogs would make it so fewer people would share ideas.

So if it ain't broke, don't fix it.  Leave the Internet alone.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

How to improve charitable givings

Your humble question:  What do you consider to be the best way to get people to become more involved in the community?  What do you think needs to be done to get people to donate more of their time and money to help those in need?  

My humble answer:  I'm going to get a little complicated here, yet bare with me.  

Statistics show that in the 1980s charitable givings increased by the greatest margin in U.S. history.  The reason for this was, I believe, is because the top marginal tax rate was cut from about 70 percent to about 20 percent.  Plus regulations were slashed.  People had more money left over in their paychecks when their bills were paid, and this resulted in more money available to donate.

I believe that one of the best ways to increase charitable givings is to allow people to keep more of the money they earn.  This would entail cutting back on government regulations that cut into the profits of companies (small and large) and provide them with more leeway to either hire more workers or provide better benefits and pay.

I believe that this would also improve the value of the dollar.  When someone earns a dollar and 50 cents goes to taxes, that leaves only 50 cents left to pay the bills.  After the bills are paid, that might leave that person or company with only 20 cents to spend in the marketplace.  

In this way, while a dollar might have bought a loaf of bread in 1980, it would only purchase a quarter of a loaf of bread in 2011.  This is referred to as a reduction in the value of the dollar.  So instead of a buck buying one loaf of bread, it takes four bucks to purchase a loaf of bread.

What this means is that the dollar travels less.  It purchases less goods and services.  With a dollar that went further, this would allow people with more money to save and invest in such things as charities.  So, by improving the value of the dollar, charitable givings would increase.  

This whole process starts by cutting back on entitlement programs, cutting taxes, and freeing companies and individuals from all the regulations that act as a disincentive to do anything.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

Tooting my own horn

Your question:  As a health activist you are a front-facing leader.  What do you imagine you look like to your readers?  What qualities do you possess.  It's ok to toot your own horn today -- you hav efull permission to indulge.  And don't hold back.  

My humble answer: I think the best description of my writing comes from my good friend and former co-worker Jane Sage.  She put it best when she wrote:

"First of all, John doesn't see himself as a health activist.  He sees himself more of as a philosopher.  He comes up with ideas for others to use in their activism.  His is a fun, pithy writer.  He's to asthma what Mitch Album is to the sports column.  Album is a pithy, fun sports writer.  He was the most award winning sports writer of his era, winning sports columnist of the year for over a decade.  Rick's readers see Rick as having the ability to make complex things about asthma simple.  His readers also see me as having a knack for finding humor and optimism in an otherwise life altering disease we call asthma.  If there was an annual award for best lung blog, Rick would most surely win."

For the above I am most truly humbled.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J