5000 B.C.- 1750: TB spreads across the world

The 18-year-old Egyptian prince sat on the edge of the bed.  He was fiercely coughing, often bringing up blood which he spat on the ground.  The physician stood alongside him, gently touching the young man's shoulder, chanting an incantation.

He was concerned for his good friend who's skin was drawn taught over his ribs. He seemed to be slowly wasting away.  What the physician offered was the only known remedy for such a condition 2,400 years before the Birth of Christ. Yet his remedy didn't work, and the young prince was mummified.

The bacteria (mycobacterium tuberculosis) that causes tuberculosis (TB) has been around since the beginning of time, although it has evolved during that time too.  At first it may have been a harmless little bacteria, yet it evolved and started causing tuberculosis symptoms in animals.

Then, as humans started cultivating those animals about 8,000 to 5,000 years before Christ, they became exposed to Mycobacterium Bovis, the oldest known species of what is now Mycobacterium Tuberculosis. Evidence of TB was was found by paleopathologists (scientists who study ancient diseases) on human remains dating as far back as 8,000 B.C. (9)

A disease that sounds like tuberculosis was described in writing, etched in stone in cuneiform, by the Babylonian monarch Hammurabi.  He ruled from 1948-1905 B.C.

Some believe it's mentioned in the Bible, which was written in the 1000 year period before the conquests of Alexander the Great, in 327-6 B.C., as shachepeth in Leviticus 26:16 and Deuteronomy 28:22 may be pthisis, which is pulmonary tuberculosis. (11)

Some believe the Bible referenced the condition when Moses said (Leviticus 26: 16, Deuteronomy 28: 22):

Then I will do this to you: I will bring upon you sudden terror, wasting diseases and fever that will destroy your sight and drain away your life. You will plant seed in vain, because your enemies will eat it.

A similar reference was made by Moses in another Biblical book (Deuteronomy 28:22)

"The LORD will strike you with wasting disease, with fever and inflammation, with scorching heat and drought, with blight and mildew, which will plague you until you perish."

However, its difficult to accurately interpret the diseases described in the Bible as knowledge of diseases were scant, which made it difficult to describe them.  Mostly symptoms were listed, which requires the interpreter often to assume what disease is referred to.  Likewise, some symptoms in the Bible may be exaggerated for emphasis of what might happen if a person is evil. (11)

The victims of the bacteria didn't always show symptoms right away.  Sometimes they never did.  Yet the ones who did often developed a strong, harsh cough that was often productive of blood.  They often lost weight, had chills, night sweat and became extremely fatigued.  While some lived to tell about it, most didn't.

The malady was given a name when the Hippocratic (466-377 B.C.) writers referred to it as phthisis in 460 B.C.  Phthisis means wasting away. They described phymata, or tubercles in the tissue of humans and cattle, sheep and pigs. (9)  This is neat because phthisis and pneumonia are the only two lung diseases that were not categorized under the asthma umbrella.  

Hippocrates, the great Greek physician, was the first to write about it as a medical condition, although he acknowledged it had been around for a long time.  He wrote that it was "The greatest and most dangerous disease and one that proved fatal to the greatest number." (1, page 1)

Yet the Hippocratic writers considered it to be a hereditary as opposed to a contagious disease. Aristotle considered it to be contagious, which opposed general consensus at the time.  It was once described as "captain of all these men and death." (10) 

Isocrates is often considered as the greatest rhetoricians' in Ancient Greece.  His intent was to improve the speech and writings of individuals by instilling virtues.  He was born in 436 BC, seven  years before Plato was born.  Both Isocrates and Aristotle also mentioned that phthisis was contagious.  (1) 

Galen wrote about the malady too, and he believed it was an "ulceration of the lungs, thorax or throat, accompanied by a cough, fever, and consumption of the body by pus."  He considered the treatment for the malady to be living at high altitudes, like the top of a mountain.

From about 1066 to 1485, which are considered to be the Medieval or Middle ages in Europe, the condition was referred to as King's Evil "because newly crowned kings (and queens, in England) were alleged to cure scrofula, glandular swellings in the neck associated with TB, with their touch." (2)

Fracastonius of Verona (1478-1553) was the first to use phthisis exclusively for tuberculosis of the lungs.  Franciseus Sylvius (1614-1672) observed tubercles in the lungs of people with pthsisis and is credited with coining the term tubercle.  The tubercle described by the Hippocratic writers now had a name.

After 1492 Europeans started sailing for America.  In America the disease spread too, killing many.  Some believed it was a European disease and the Europeans brought it to America.  Yet evidence of Native American remains show that the disease had made its way to America long before the Europeans. (12, page 13)

So we have a disease that was not prejudiced who it invaded, as the disease was seen all over the world. Most people on the planet had either been inflicted with it, or had seen someone suffer from one or another forms of the disease.  Little was known about it, and there was no cure.  So, for the most part, people saw it as the will of God.  If you didn't catch it, you were lucky.  If you got it, you dealt with it.  If someone you knew got it, you pitied and doted on him.  

The mummy of a 4,412 year old mummy was discovered in a tomb in Egypt.  It was a young prince, perhaps around 18-years-of age.  The mummy was diagnosed by modern experts as having tuberculosis.  This proved the disease has been around for a long, long time.  

By the 17th century the disease was so rampant that that at least one in five death certificates in the city listed consumption as the cause of death.  Yet those statistics would seem small considering what the disease would do to mankind during the following two centuries. (12, page 13)

References:

1. Norris, Charles Camblos, "Gynecological and Obstetrical Tuberculosis," 1921, New York, London
2. Koehler, Christopher W., "Consumption, the great killer," http://pubs.acs.org/subscribe/archive/mdd/v05/i02/html/02timeline.html
3. "History of TB," New Jersey Medical School, Global Tuberculosis Institute, http://www.umdnj.edu/ntbc/tbhistory.htm
4. Klebs, Arnold Carl, "Tuberculosis," 1909, New York
5. Morton, Samuel, "Pulmonary Consumption," 1834, Philadelphia
6. Flenner, Simon, , "Immunity in Tuberculosis," Annual report of the Smithonian Institution, 1907, New York, page 627 
7. "Captain of the Men of Death," Ulster Med J. 1989; 58(Suppl): 7–9.
8. Sigeris, Henry E, "A History of Medicine," volume I, "Primitive and Archaic Medicine," Second Edition, 1955, New York, Oxford University Press, page 53
9. Seth, Vimlesh, SK Kabra, Rachna Seth, "Essentials of Tuberculosis,"  Third ed., Jaypee Brothers Medical Publishing, 2006, page 3-4
10. Jones, Greta, "Ca;ptain of All These Men of Death," 2001, New York
11. Prioreschi, Plinio, "A History of Medicine," 1991, volume I, "Primitive and Ancient Medicine," Edwin Mellen Press, Chapter VII, "biblical Medicine," page 514
12. Landau, Elaine, "Tuberculosis," 1995, New York, Chicago, London, Sydney, Franklin Watts, pages 13-32

Photos:

• 1.  from  http://www.grantvillegazette.com/articles/The_White_Plague

Further reading:

• essentials of tuberculosisi in children

980-1037: Avicenna: The Prince of Physicians

Avecinna (980-1037)

While the Western world slid into the dark ages between the 6th and 12th centuries, with most scientific and medical wisdom being lost, the opposite occurred in the Arabic world where Avecenna was born in Persia in  980 A.D.  He was a famous medieval philosopher and physician, and his book "The Canon" was one of the most well used medical texts for over five centuries.  
His official Arabic name was Abn Ali Al hosain Ibn Abdullah Ibn Sina, yet to the western world he's simply referred to as Avicenna. He was born in Afshena, one of the hamlets of the district of Bokhara in 980 A.D. His father was Abdullah, a local governor, and his mother was Sitareh.  (6)(8, page64)

His parents must have been pretty impressed by their young child, as explained by Fourgeaud said: (7, page 193-194)

His extraordinary memory, his extreme faculty for learning, soon attracted the attention of his father, who spared neither expense nor trouble for his education.  His power of memory were such, we are told by himself, that before he was ten years of age, he could repeat the whole of the Koran, and could converse familiarly on arithmetic, geometry and astronomy.  He repaired to Baghdad to study philosophy and medicine, and so entirely did he devote himself to these sciences, that he is said to have labored day and night, and to have warded off the approach of sleep and excited his exhausted faculties by the use of exhilarating beverages -- and when nature prevailed over all of his contrivances, problems that baffled his waking hours were solved in his dreams. (7, pages 193-194) (8, page 54)

According to his biography, he was so gifted as a student that his father assigned him a special instructor -- al Natali -- to teach him arithmetic, logic, science and astronomy.  In his early teens his interests shifted toward medicine, and when he was only 16 he became a physician. (6)

In fact, Fourgeaud said:

Before he was sixteen he not merely knew medical theory, but by gratuitous attendance on the sick had, according to his own account, discovered new methods of treatment.  By the end of his seventeenth year he had gone the round of learning of his time; his apprenticeship of study was concluded, and he went forth to find a market for his accomplishments." (8, page 64-65)

His quest did not take long, for he was only 16 when he became a "renowned physician."  Then, at the ripe age of 18, he earned fame and respect when the sultan of Bukhara, Nuh ibn Mansur al-Samai, became seriously ill and the person credited for healing him was Avecenna. As a reward for his services, Avecenna was granted access to the Sultan's library, which was loaded with all the wisdom of the ancient world. Avecenna loved to learn, so this was a great gift for him.   (6)(7, page 194)

He spent many hours studying by candlelight many volumes of books, most of which were those of Hippocrates and Galen, cramming his head with as much information as he could.  By the time he was 21 he had already started publishing volumes, sharing with others all he had learned.  In total he would write hundreds of volumes on a variety of topics, including ethics, logic, philosophy, science and medicine.  (6)

Bear with me now as I allow Fourgeaud and Bradford to tell the story of Avicenna, as I believe this is necessary in order to make a valid point.  When Avicenna was 22 his father died, and soon thereafter 'the reigning dynasty came to an end in the year 1004," said Thomas Bradford. He added:

Mahommed of Ghazni sought to attach the brilliant scholar to his retinue of learned followers, but he declined the honor, and made his way westward to the city of Urdjensh, in the modern district of Khiva, where the Vizier, who was a friend of scholars, gave him a small monthly stipend. But the pay was small, and Avicenna wandered from place to place through the districts of Nishapur and Mero to the borders of Khorasan, seeking an opportunity for his talents. Finally at Jorjan, near the Caspian, he met a friend who bought near his own house a dwelling in which Avicenna lectured on logic and astronomy. For this patron several treatises were written; and the commencement of his great Canon of Medicine dates from his stay in Hyrcania.(8, page 65)

He moved from place to place, writing all along, and "ultimately he," said Bradford:

Went southward to Hamadan, where the prince was established.  He first entered the services of a high born lady, but the Emir (sultan) learned of his arrival called him in as a medical attendant, and sent him back with presents in his dwelling.  He was now raised to the office of Vizier, but the turbulent soldiery mutined against their young sovereign, and demanded that his new vizier should be put to death.  Shems Addula consented that he should be banished from the country.  Avicenna remained hidden for forty days in a sheikh's house till a fresh attack of illness caused the Emir to again call for his physician.  Even during this troubled time he continued to study and teach. Every evening extracts from his great works, the Canon and the Senatio, were dictated and explained to his pupils; among whom, when the lesson was over, he spent the rest of the night in festive enjoyment with a band of singers and players.  (8, pages 65-66) 

He was likewise known as a good politician, yet despite the long-term popularity of his book "The Canon," he did not have much "'pull' with the authorities of his time." (2) 

This is evidenced through the words of Fourgeaud, who added that after he was appointed visier many vicissitudes beset his path. Fourgeaud wrote:

He was thrown into prison, where he remained two years, for being accessory to a conspiracy, or according to some historians, for refusing to administer poison to the nephew of a Sultan. For some time after his release he had to conceal himself, but being discovered he was once again incarcerated for four months, when he effected his escape under the disguise of a monk.  He then made his way to Ispahan, where he was treated with great distinction." ( 7, page 194)

Bradford continues telling the story:

On the death of the Emir, Avicenna ceased to be Vizier, and hid himself in the house of an apothecary, where, with intense assiduity, he continued the composition of his works. Meanwhile he had written to Abujaafar, the prefect of Ispahan, offering his services; but the new Emir of Hamadan, hearing of his correspondence, and discovering the place of his concealment, imprisoned him in a fortress. War continued between the rulers ofI spahan and Hamadan. In 1024 the former captured Hamadan and its towns, and expelled the Turks. Avicenna, after the war, returned with the Emir to Hamadan, and carried on his literary labors; but at length, accompanied by his brother, a favorite pupil, and two slaves, he made his escape fromt he city in the disguise of a Sufite ascetic. (8, page 66)

After a perilous journey they reached Ispahan, and received an honorable welcome from the prince. The remaining ten or twelve years of his life he spent in the service of his patron Abu Jaafar Ala Addaula, whom he had accompanied as physician and general literary and scientific adviser, even in his numerous campaigns. During these years he began to study literary matters and philosophy. But amidst all his study Avicenna never forgot his love of enjoyment. Unusual bodily vigor enabled him to combine severe devotion to work with indulgence in sensual pleasures. His passion for wine and women was almost as well known as his learning. (8, pages 66-67)

But his bouts of pleasure gradually weakened his constitution; a severe colic which seized him on the march of the army against Hamadan was checked by measures so violent that Avicenna could hardly stand. On a similar occasionthe 'disease returned; with difficulty he reached Hamadan, where, finding the disease gradually gaining ground, he refused to keep up the regimen imposed, and resigned himself to his fate. On his death-bed remorse seized him; he bestowed his goods on the poor, restored unjust gains, freed his slaves, and every third day till his death listened to the reading of the Koran. He died in June, 1037, in his 58th year, and was buried among the palm trees by the Kiblah of Hamadan. (8 page 67)

I transcribed for you here a synopsis of the life and times of Avicenna to show how difficult it was for a man of his stature during his time.  In order for him study medicine, practice medicine, and write about medicine he had to constantly gain the favor of the sultan. If he wasn't willing to make such a sacrifice, the wisdom of the ancient medical sages would probably be lost forever.

While he did come up with some ideas on his own, his writings mainly save for us the ideas of Hippocrates and Galen, but also the surgical wisdom of Paul of Aegineta, who was perhaps one of the greatest surgeons of the ancient world. Of course he also preserves for us many of the ideas of other ancient medical sages as well, such as Areteaus. (7, page 194) (8, page 68)

Instead, the Canon was translated into Latin in 1492 and would become the medical encyclopedia, or medical Bible, for Europe during the 15th, 16th and 17th centuries. (6, 1)  During these times, the Canon was used at the various universities throughout Europe to teach the wisdom of the medical sages, and it even eclipsed the writings of the other Arabic physicians of his era, including Rhazes, Haly Abbas, and Avenzoar.  (8, page 67) (7, page 194)

Mark Jackson, in his 1987 book "Asthma: The Biography," said the Canon was about: 

"According to Ibn Sina, asthma was a chronic disease in which patients often suffered 'acute paraxysms with similarity to the paroxysms of epilepsy and spasm.  The flow of thick humours from the head to the lungs produced a situation in which 'the patient finds no escape from rapid panting, like the labored panting of one who is being choked or rushed'.  (3, pages 30-31)

Jackson listed Avicenna's recommended treatment for asthma: (3, pages 30-31):

1. Purging
2. Vomiting
3. Blood letting
4. Voice exercises
5. Fats of hares
6. Deer
7. Gazelles
8. Penises of foxes
9. Lungs of foxes (3)
10. Arsenic in a pill with pine resin in a drink with honey water or inhalation (5, page 325)
11. Sulphur in water with soft boiled eggs or inhalation

In 1933 E. Stolkind described Avicenna as not providing much new information as was provided by Galen.  However, Avicenna, along with other physicians of his day, mentioned the relationship between asthma and nerves of the brain.   (4, pages 1121-2) Along with the brain, he also linked asthma with the liver and the stomach.  It's for this reason that he recommended arsenic as a remedy.  (5, page 408)

Some credit his demise to his excessive desire for wine.  (2, page 349)  He died of dysentery at the age of 58 in 1037.

Regarding "The Canon," Fourgeaud said thatJ:

The physicians of the middle ages accepted its teachings with the same faith with which they were accustomed to submit to the laws of the church... medical men were taught that Avicenna was "the Prince of Physicians" -- that he was infallible, that his works contained all the knowledge of the ancients and of the Arabians -- and they believed it; and were satisfied in following his precepts. (7, page 195)

His words were revered in much the same way as those of Galen were.  John Brock said that the Canon, "once translated into Latin, even overshadowed the authority Galen himself for some four centuries." (9, page xx)
  

References:

1. Drake, Miriam, "Encycopedia of Library and Information Science," 2nd ed., 2003, New york, page 1840
2. Michael, J. Edwin, ed., Medical and Chirurgical Faculty of the State of Maryland, "Maryland Medical Journal," May 1891-Oct. 1891, Baltimore, vol. XXV, page 349
3. Jackson, Mark, "On Asthma: The Biography," 2009, New York, pages 30-31
4. Stolkind, E, "The History of Bronchial Asthma and Allergy," Proceedings of the Royal society of Medicine, "1933, Vol 26, part 2, Great Britain, pages 1121-2
5. Aegineta, Paulus, translated by Adams, Francis, "The Medical Works of Paulus Aegineta, The Greek Physician, 1834, vo 1, page 408
6. "Avecenna: Prince of Physicians and Giant in Pharmacology," http://www.afghan-network.net/Culture/avicenna.html
7. 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
8. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey
9. Brock, John, "Galen on the natural faculties," 1916, London, New York, William Heinemann, G.P. Putnam's Sons

Further reading:

1. Check the above and this for aegeneta postssss

Dr. Office Visit Number 3,343,342, or something like that

So I've probably seen more doctors in my life than 90% of the U.S. population.  Better yet, I've seen more doctors than 99% of people my age.  And I still get nervous.

The doctor comes in.  He shakes my hand.  The usual first question he asks is, "How's your asthma?"  Usually I say, "Good."  Today I say, "It hasn't been a good year for my asthma."  Which is true.  It's been a rough year as I note here and here and to a greater degree here.

He listens too me.  My breath quivers, a nervous quiver.  "You sound like you're moving air good.  But you do have a wheeze in your right upper lobe."  Then he sits down in the doctor chair.  

I tell him about my hunting camp experience, and my experience sorting through old VCRs in the basement, and my using theophylline to end an attack -- five year old theophylline.  I keep a bottle in the cabinet as a memento of the day I took that last pill after 30 years of dependence.  I told him how these asthma attacks occur on weekends, and I don't want to use the ER.

I say, "Maybe I should have a script for theophylline."

He says, "Well, I was thinking I'd give you a medrol pack."

I say, "Ah, even better."

Now you'd think that considering I'm a lifetime extrinsic asthmatic I'd have an asthma action plan and a medrol pack on hand all the time, but I've never had one.  I do now.  

He also gave me two samples of Symbicort to try, again.  He did the same last year.  My experience with that stuff was it works fast but it makes my heart beat like Alupent used to.  I tell him I want to try it again.  So we'll see how that goes.

After bantering a bit, small talk about work, he says, "Well, I'll see you in two months.  I want to keep an eye on you for a while."  He starts to walk out.  I know now I have to ask what my wife wants me to ask, and I'm nervous to ask.  But this is my last chance.

"MywifewantedmetoaskyouifIcanhavesomexanax," I say.  "I don't feel comfortable asking for it, but she thinks I need it."

He smiles, and sits back down.  "Sure, I think we can do that.  Do you think you need it?"

"Well, I have four kids."

"Nuff said." He opens his computer pad, writes something.  "Done."

"I had a prescription once before," I say, "and I decided I better quit.  So when my old doctor asked me if I wanted a new script I said no."

"It's a pretty safe medicine.  It has a slow onset and isn't very addictive.  I think it should be okay."

"Thanks."

"No problem."  He stands.  We shake.  On the way to the car I remember he never mentioned my blood pressure.  He never really even touched me, which is fine by me.  I just wonder if it's a good thing.

1849-1919: The father of modern medicine x

Sir William Henry Osler

The turn of the 19th century was the dawn of modern medicine.  So medicine needed a father, and the man to step into that role was Sir William Henry Osler.

Due to the significance and respect for his character, the ideas he wrote about were seriously considered by the medical community, including what he wrote about asthma

The growth of a legend:

Willie Osler was born to a family with a prominent history. His father was an Anglican minister, and Osler's goal was to follow in his father's footsteps, and it was this goal that landed him in 1867 at Trinity College in Toronto.

Yet this was also a time when physicians and scientists were using science to disprove some old ideas about science and medicine.  Charles Darwin proposed an idea that challenged the age old idea of natural selection, and chose to believe science instead.  Science was in direct competition with religion.

Perhaps it was for this reason that Osler's heart just wasn't in the ministry.  He spent most of his free time reading about medicine.  His heart, and perhaps fate,  lead him ultimately to switch from studying ministry to medical school where he excelled.

He started Medical School at Trinity College where the methods of teaching medicine were primitive and left to the desires of each respective professor.  The college hospital admitted only 25 patients at a time, and medical students could only see patients taken care of by their own physician. (3, page 54)

Once Medical School was complete after three or four years young physicians had little experience working with real patients, and the young Olser took acceptance to this.

Osler believed pathology was essential to improving medical wisdom.
Like other physicians before him, he would have been befuddled by the
lack of scarring caused by asthma.  This must have been what caused him
to deduce, as others had before him, that asthma must be nervous.
For this reason, much of the treatment focuses on the nervous component

Much of his time was spent studying and performing autopsies.  He was often so involved in his work that he ate in the same room he performed these autopsies.  His goal was to learn as much as he could about the human body and medicine.

Most of the classes were taught by local physicians, and payment for these classes was given directly to the professor.  Lectures were mainly given  from old medical textbooks and were "flung at us pellmell without word of guidance, and leaving us standing helpless, bewildered, and starved in the midst of what seemed a superabundance of wealth," wrote Osler.  (3, page 54)

He ultimately transferred to McGill University where his writings, research and ideas quickly won the attention of his fellow students and professors.  He continued to study, research and perform autopsies (while eating in the same room).

During his final year in med school he worked so hard on his graduation thesis on pathologic anatomy that he was rarely seen by his fellow students  His theses would ultimately win accolates "because it was greatly distinguished for originality and research." (1)

It was partly because of this work and the potential in the young Osler that he was offered a job as a teacher at McGill University.  But he declined, choosing instead to attend school in Europe to further his medical wisdom. He did his studies in Vienna and Germany, which were considered to be leading nations in medicine and science at that time.

In 1874 he returned to Canada, and, coincidentally, one of the medical professors at McGill University had resigned.  At the young age of only 25, and with very little experience as a physician, Osler was offered and accepted his first teaching job.  Within a year he was named as a professor of medicine.

He wasn't paid enough money to make a good living as a teacher, so he had to start a practice.  Yet he ultimately became so rapt in his job as a teacher that he gave little attention to his medical practice and other opportunities to make money.  However, he did manage to see patients, including many famous ones. 

His enthusiasm allowed him to get the most out of his students, and he became an instant hit as a teacher.  A year later he became one of the seven founders of the Association of American Physicians, and in 1889 he became one of the first physicians at John Hopkins University.   It was here that his career took off.

A transformation in medicine:

John Hopkins was built on the idea that it would be the best medical hospital in the world. To run its medical school Henry Osler was hired based on his reputation and his bold ideas for the medical profession.

This turned out to be a wise decision, because it was Osler who came up with the idea that medical students learn best when working with actual patients.  He often repeated the maxim:   "Listen to your patient, he is telling you the diagnosis."

While other medical schools were unorganized and offered two or three year programs, John Hopkins would offer a four year program that required a year as an intern working alongside physicians in the medical ward to obtain experience working with real patients.  .

 Osler became rapt in medical wisdom, and loved to share this wisdom.
 Here he is writing "The Principles and Practice of Medicine"

This was the first time this was ever done, and it was a big hit.  It was such a big hit that within a few years many medical school were transforming the way they taught medicine.  No longer would physicians graduate from medical school when their only experience was from lectures, textbooks, and a few random patients.

Through all this time Osler continued to do what he loved best, and that was to study the human body by performing autopsies and reading books.  He spent a ton of time in the morgue, laboratory and library.  He likewise continued to write about what he learned through his experiments and observations.

During his career he wrote over 750 contributions to the medical world of literature, including a the first textbook of Internal medicine published in 1892:   "The Principles and Practice of Medicine."  While he didn't know it at the time, it would end up being the last medical book written by just one person.

Osler would continue his work until his death in 1919, yet not before he became a legend in his own time.  His name was known by physicians throughout much of the world.  The debate had already begun as to whether he was the greatest physician to ever have lived.

Click here for more asthma history.

References:

1. "Sir William Osler At Seventy -- A Retrospect," The Journal of the American medical Association," 1919, Saturday, July 12, pages 106-108
2. Osler, William, "The Principles and Practice of Medicine," 1892, New York, pages 497-501
3. Bliss, Micheal, "William Osler:  A Life in Medicine," 1999, New York

Further readings:

1. Jackson, Mark, "Asthma: The Biography," 2009, New York, pages 211-12
2. Brenner, Barry E, ed., "Emergency Asthma," 1998, New York, pages 212-14

xTreatment of asthma 1901

Marcous Proust was a writer and a lifetime asthmatic.  The year 1901 was the dawn of modern asthma treatment and wisdom.  That was the year adrenaline and cortisone were just being discovered.

According to Mark Jackson the following are the medicines Proust used during his lifetime:

1. Strammonium cigarettes (same type of medicine as atrovent and spiriva)
2. Legras powders
3. Espic powders
4. Epinepherine (adrenaline)
5. Caffeine (same family of medicine as bronchodilator theophylline, not as strong
6. Carbolic acid fumigations
7. Escouflaire powder fumigations
8. Isolation -- cork lined bedroom (staying away from allergens)
9. Opium (relaxes breathing, mild bronchodilator)
10. Morphine (relaxes, mild bronchidilator)
11. Sea, lakeside and mountain resorts  (getting away from allergens, relax)

Jackson quotes Proust's journal entry to his mother:

"Yesterday after I wrote to you I had an asthma attack and incessent running of the nose, which obliged me to walk all doubled up and light asthma cigarettes at every tobacconist's as I passed, etc.  And what's worse, I haven't been able to go to bed until midnight, after endless fumigations..."  (August 31, 1901)

If the Internet were available to Mr. Proust I bet he'd be involved in an online asthma community as this blog is a part of.  While he didn't have the ability to blog, at least he wrote of his asthma experience in letters. 

Mr. Jackson is a professor at the Center for Medical History at the University of Exeter in England.  He's written books on asthma and articles on asthma and allergies and COPD.  I will link to some below so you can check them out at your liking.

Click here for more asthma history.

1. Divine Strammonium:  The rise and fall of smoking for asthma
2. Marcus Proust and the global history of asthma (slide show)
3. On Asthma:  A Biography
4. Allergies:  A history of the malady
5. The Oxford handbook of the history of medicine
6. Asthma timeline

1899 bronchitis triggers x

In 1899 Dr. Samuel Gee, in his article, "Bronchitis, Pulmonary Emphysema and Asthma, (The Lancet, March 18, 1889) defined bronchitis as a common disease that causes pulmonary catarrh and has the ability to strike anyone at any age.  It's inflammation that results in irritation of the mucous membranes and causes excessive secretions.

He mentioned as possible causes the following:

• Nitrous fumes
• Inhaled microbes
• Breathing dust
• Grass pollen
• Strong smells (odour of roses)
• Dust from molds
• Dust from fungi
• Influenza
• Typhoid fever
• Common cold
• Unexplained

Was this 19th glass factory poorly ventilated and cause asthma?

The idea that "dusty trades" caused breathing trouble was nothing new, Gee wrote.  He mentioned Ramazzini "two centuries ago developed several chapters of his book "De morbis artificum" to the diseases, chiefly pulmonary, which attend dusty trades."

Regarding dust he describes two types.  One is insoluble dust, such as those emitted from cotton mill smoke.  This type of smoke can cause cause bronchitis that is chronic and slow in developing.  It's a "mechanical irritant to the bronchial membranes." 

Yet he also observed that most people who work in trades where this type of dust is prevalent also smoke and drink alcohol.  So whether the bronchitis is a result of inhaling dust or these other habits is difficult to determine.

Insoluble dust would also include "dust from unclean and ill-ventilated rooms will be very likely to contain morbific microbes and the irritation of the air passages set up by inanimate dust will favour the operations of the many bacteria which are potent to cause bronchitis.  It obviously would be very improbable that these microbes should swarm in impure air and should not be found in the upper air passages of man.  And thus, as a matter of fact, our mouths, noses, and throats harbour many morbific microbes in a latent state; they are there awaiting a favourable opportunity for becoming active and virulent."

Inanimate dust would be your grass pollen which causes hay fever.  This condition results in inflammation (catahrr) of the nasal passages and this ultimately results in inflammation of the lungs (bronchitis). 

He mentions that strong smells, such that of roses, can cause bronchitis.  These flowers might also emit particles small enough to be inhaled.

Yet he also mentions one study where a doctor placed an artificial rose in the presence of a person, that this caused bronchitis.  From this "we have learned how large a part in the production of such a catarrh can be played by the power of imagination."

Dust from moulds and fungi are also considered inanimate dust.  Of interest is he also described two different types of sputum:  mucous and purulent.  He observed that some patients have both types in the spitting pot, and he surmised that "probably the different secretions come from different parts of the bronchial tract."

Today we might think of such patients as either suffering from chronic bronchitis caused by irritants and smoke, yet he may also be referring to asthma irritated by such substances.  Either way, Gee's observations were quite stunning given the knowledge of such diseases known at that time.

Reference:

Gee, Samual M.D., "Bronchitis, Pulmonary Emphysema, and Asthma," The Lancet, 1899, March 18, page 743-747

1839-1911: The infamous Dr. Gee

Samuel Gee (1839-1911)

"I'm punctual and expect the same from you," the philosophy professor said just after the bell rung.  "If you're not here when the bell rings you're not here at all in my eyes, and you'll fail my quizzes and tests."

By his 30 minute lecture on punctuality he scared us all, and earned our respect.  He also turned out to be an impeccable teacher who taught us a valuable lesson juxtaposing timeliness with success. 

While his name has since left my mind, the lesson he taught lives on.  I have this sense of urgency when it comes to being on time, although I wouldn't go as far to say I'm "punctual." 

I can't remember this teacher's name, yet I'm reminded of him as I delve into the life of Dr. Samuel Jones Gee who was well known for his punctuality. 

The Historic Hospital Admission Records Project described Dr. Gee this way: 

"His reputation as a teacher was second to none, and his punctuality the stuff of legend. He was leaving his house in a cab one day, when a patient detained him. As the conversation continued, the door of the vehicle swung open, hit a tree, and fell off its hinges. He insisted on carrying on to Bart’s minus the cab door, so that he would not be late." (1)

He was born in 1839 and developed a love for history, and because of this he became proficient in many languages, including Ancient Greek.  His ability to read and write in Greek would eventually benefit children around the world, as it allowed him to compare ancient accounts of diseases with what he observed during his own personal assessments and examinations on autopsy.

He attended college at University College School in London and studied medicine at the University College Hospital.  He impressed as a student enough to be hired as house surgeon at University College Hospital where he worked until 1865 when he earned his medical degree.

He was then hired at the Hospital for Sick Children, Great Osmond Street where he would eventually serve as pediatrician and pathologist.  He was passionate about learning about diseases and how to treat them, and he loved performing autopsies.

While his main job was working at the children's hospital, he also worked at St. Bartholemew's Hospital and managed to maintain a private practice.  A private practice back then involved the doctor traveling to the patient's home instead of the other way around as it is today.  So, while lucrative, it was a lot of work, and often quite risky.

He wrote 2 books and published 46 papers in St. Bartholemew's Hospital Report, with almost all of his writings on pediatric diseases -- which include asthma, bronchitis and consumption (tuberculosis).   HHARP mentions that one of the biggest complaints against him is he didn't write enough. (1)

What he is best known for is a lecture he gave in 1887 in which he gave the first modern day description of coeliac disease, a condition that affected many of the children he treated.  He described the condition this way:

“There is a kind of chronic indigestion which is met with in persons of all ages, yet is especially apt to affect children between one and five years old. Signs of the disease are yielded by the fæces; being loose, not formed, but not watery; more bulky than the food taken would seem to account for; pale in colour, as if devoid of bile; yeasty, frothy, an appearance probably due to fermentation; stinking, stench often very great, the food having undergone putrefaction rather than concoction".

He learned a lot about this disease by reading ancient accounts written by Aretaeus of Cappaocia who was a master clinician about 100 A.D.  Areteaus is known for providing some of the first descriptions for many diseases, such as pleurisy, diphtheria, tetanus, pneumonia, diabetes epilepsy and asthma.

He was also the first to describe the symptoms of coeliac disease, although he referred to it as coeliac diathesis.  Gee chose to respect Areteaus and referred to the condition as the coeliac affection.  Today we refer to the condition as coeliac disease. (2)

The condition causes it's victims to become pale, weak and appear to be wasting away, symptoms similar to tuberculosis.  Aerateaus believed it only occurred in adults, yet Gee recognized it could affect anyone, yet was most common among children aged 1-5, which was one of the main reasons Gee became so enthralled by the disease.

Gee was the first to differentiate between coeliac disease and tuberculosis, and he brought coeliac disease to the mainstream in the medical world.  He was also the first to suggest the cause and cure might be in the diet. 

Coeliac disease is similar to asthma in that neither disease causes any changes in their respective organs.  Of Coeliac disease Gee wrote, "Naked-eye examination of dead bodies throws no light upon the nature of the coeliac affection: nothing unnatural can be seen in the stomach, intestines, or other digestive organs."

Aerateus had a theory as to what caused asthma, and he likewise had a theory for coeliac disease.  He believed a "natural or indwelling" heat was needed for proper digestion, or "pepsis" as he referred to it.  Pepsis was the natural breaking down of food which occurred in the heat.  (2)

Aeratus explained that Coeliac affection was caused by a "chilling of the natural heat needed for 'pepsis.'"

Gee didn't agree with this, although he didn't pretend to know a cause or remedy.  A cause and treatment of the disease alluded the medical world until the 1950s when the condition was linked to the consumption of gluten in the diet.  Like asthma, coeliac disease is now considered an autoimmune disorders. 

Dr. Gee passed away in 1911, yet many of his publications are still available thanks to Google Books.  In our history of asthma and bronchitis I must make mention of him from time to time as so much of what he wrote is available to us thanks to Google.

Click here for more asthma history.

References:

1. "Dr. Samuel Jones Gee, "Historic Hospital Admission Records Project,  http://hharp.org/library/gosh/doctors/samuel-jones-gee.html
2.  Dowd, Brian, John Walker Smith, "Samuel Gee, Areteaus, and the Coeliac Affection," 1974, British Medical Journal, April 6, page 45
3.  Gee, Samuel, "Bronchitis, Pulmonary Emphysema, and Asthma,", Lancet, March 25, 1899, page 817