Severe and Complex allergy Syndrome (SCAS)

I think most people forget that there's more to asthma than just asthma.  I get people emailing me all the time saying stuff like: You know, if you're using your inhaler more than 2 times in a two week period you don't have asthma control."  I'd like to take those people and smack them right up alongside the face.  Ha, that actually felt good saying.  

Seriously, folks, I think that many people get caught in the flux that all cases of asthma are the same, and they aren't.  I think the asthma guidelines, which created the above definition of control, were describing "pure asthma," or asthma not complicated with anything else.  

Yet most asthma is complicated.  Most asthmatics have something else.  For example, 75 percent of asthmatics have allergies.  When this happens you have extrinsic asthma.  That's what I have.  I have extrinsic asthma.  When I was a kid this was ignored.  Even at National Jewish Health I was diagnosed with "High Risk Asthma."  I think even that definition comes with a flaw.  It ignores the general cause of my asthma: allergies.  

My point of this post is I think most of my doctors ignore the fact that the main cause of my asthma is not asthma, it's allergies.  I think if I had pure asthma it would be generally controlled.  But those dog gone allergies pop up, and wham!!!  When there's a bad allergy season, which it has been the past year, wham!!!

So for the 9 year period from 2002 to 2010 my asthma was great.  But then it took a turn for the worse.  I told my doctor this, and his goal, up to this point, has been to increase my steroids.  Yes, I'm not on Advair 500, which is the severe asthma dose.  Surely this helps, but the asthma is still there, hovering over me like a Japanese suicide pilot on a WWI American Ship in the Atlantic.  

The best example I can give of this was back in 1995 I saw an allergist, and he said, "We're going to do some allergy testing on you."  I said, "No, I don't want to do that again.  All it does is make me itch like crazy because I'm allergic to everything."  He said, "No one is allergic to everything."  I said, "Well, I am."  He said, "No one is!"

Well, as he was performing the test, and as my back was itching like crazy, he said, "Well, I guess you were right.  You are allergic to EVERYTHING! Wow, I've never seen this before."  

So my last doctor had me trial Singulair.  On my own, and based on my own research, I decided to take Singulair and and Claritin every day to treat my allergies, or to try to allay the damage.  Yet my new doctor told me to quit taking Singulair because he hasn't seen it do any good.  Then Wham!!!  So I put myself back on the allergy medicine.  

I also told my doctor I can't clean my house, I can't mow the lawn, I can't go to hunting camp, and he said, "Why not?"  Yes, it's frustrating.  The thing is, my current doctor is the smartest doctor I've ever had, seriously.  He knows his stuff.  So when I told him I put myself back on Singulair, he said, "Okay, whatever works for you."  

"Well, I'm not saying it works for me at all.  I'm saying we asthmatics are stubborn, and when we perceive something's working we like to stick with it."  Still, the main reason I have severe asthma, I think, is because I have severe and complex allergy syndrome, a diagnosis I just made up.  It forces me to do this as opposed to normal things.  While I enjoy doing this, I don't think people understand that I'm not lazy, I just can't do those things.  And it's frustrating.  

It's also frustrating that it's nearly impossible to get people to understand allergies.  Just watching a show like iCarly where they keep making fun of the kids with allergies ads to my frustration.  We live in a society where allergy ridden people are freaks.  And this is funny since we live in a supposed anti-bullying society

When I was 12 I decided I wasn't normal

Bell Curve of Intelligence

I was probably about eleven when I realized I wasn't normal.  Before that time I thought it was normal to not be able to breathe when other people were having fun; to have to remember your medicine before leaving the house; to have to pace yourself when playing sports or otherwise doing things normal kids do, like playing in tents made of old, dusty blankets stored in the dusty basement.

When I did these normal things, I felt abnormal.  My chest would burn, my chin itch, and my breath, well, my breath wasn't very good.  To get air in I had to suck it in, and before I was twelve I thought this was normal.  Before I was twelve I didn't understand why everyone else was having fun at grandma and grandpas house and I wasn't.  At twelve I realized I couldn't roller skate in the basement, and I realized I couldn't, or shouldn't, sleep in the bed by the fireplace in the same room my grandpa slept in. When I was twelve I realized I couldn't play football -- or shouldn't, because I did -- on Thanksgiving day when the snow was blowing and so too was smoke from the wood stove billowing out the chimney.  Yes, while all these things were normal, they made me not be able to breathe, which was, I decided when I was twelve, not normal.

It was also when I was 12 I decided I had a special gift that no one else had, a gift that made me special, and a gift I must never share with anyone.  I can share the product of the gift, yet I can never share the gift.  You see, if you are gifted, if you have a gift that makes you abnormal, you share it at your own risk.  When you share it with others, when you tell them your secret, you will be treated as a quack.  Yet I wasn't a quack, and I'm still not a quack.  Although, I contest, I am not normal (although, and this is a discussion for a later post, normal is also subjective).  

Since most people are normal, I decided I wasn't able to communicate with them my gift.  You see, normal people think of normal things.  Normal people have no incentive to think about deeper, inert things.  Normal people have no incentive to think about how other people feel.  Normal people aren't able to receive telepathic messages from other people.  Normal people have no need to think about any one else but themselves and their family and their survival.  Yet when you have a disease like asthma, you're forced to live different and think different.  You are forced to make changes.  

So I had a gift, and the gift was born out of my asthma.  You see, because I had asthma, and because I was not normal as noted above, I was forced to live my life like abnormal people life their lives.  I, thus, was forced to make changes.  I had to stay inside when the other guys were playing, or hunting, or camping, or what guys do.  I was forced to stay inside and read and think.  I was forced to reach into a deeper part of my mind.  

And anyone who has asthma knows, it's nearly impossible to get people who don't have your disease to understand what it's like to live with a disease.  Even to this day, even though my dad sat with me hundreds of hours in hospital rooms watching me suffer with asthma, he still has no clue that I am forced to be different.  Even though I've told him a thousand times the past year -- 20 years after the last time he sat in an ER room with me -- that I cannot go to hunting camp anymore because there are too many allergens out there, he still keeps begging me to go.  He is normal, and he is able to have fun out there without having to worry about his asthma (do I have my inhaler? do I have a clean pillow case? how will I get home if I can't breathe, etc.).  So he has no clue what it's like when you're not normal.  

I think the best way of describing what it's like to be abnormal is to describe the bell curve of intelligence.  Now, I'm not implying I'm intelligent the way you're thinking, no I do not have a 200 IQ.  No I'm not any smarter, per se, than you are.  Because I don't see intelligence that way.  I believe that we are all smart in our own way.  While you may have the highest IQ in the world, you may not be intelligent when it comes to asthma, or you may be clueless how to write.  You see, we all have a different level of intelligence.  My gift is my ability to think of things, and to write.  You may find this awkward me saying this, but I cannot communicate by words the way I communicate here.  Rush Limbaugh is a good verbal communicator, and in that way he's word smart.  I'm writing smart.  So that's what I mean.  

So let me describe this bell curve.  You take the people at the top who have the highest IQs, and you take those on the bottom with the lowest IQs, and you toss them out.  These we consider rare IQ scores, or abnormally gifted and abnormally stupid people.  Or, perhaps these scores were errors.  Either way, you toss them out.  That gives us a means.  So by using this bell curve, I can describe what I'm discussing in this post.  No, I do not have a high IQ. But, if you use this curve to show asthma intelligence, or writing intelligence, then you can see what I'm describing.  Most people I know have no clue what I'm talking about when I'm talking about asthma.  Most people I talk to are ignorant about asthma.  So, in this way, I MUST be in the top half of the bell curve that was tossed out.  I say this because there has to be a mean, and if I'm in the mean and everyone else in the mean is stupid, then there would be no mean.  So that can't be so, so I MUST be in the top of the bell curve.  

When it comes to gossip intelligence, or people smarts, I'd be in the bottom portion of the bell curve.  I'm not people smart at all.  So I'm gifted.  And most of you guys reading this probably think I'm nuts, that I'm a quack for thinking this way.  Or, you probably think I'm being arrogant.  That's not the case either.  I do, however, have an uncanny interest in history, respiratory therapy, philosophy, writing, and politics.  I find few people enjoy the same interests.  I'm abnormal.  And when you're abnormal living in a world with normal people, you just keep your mouth shut about it, although I'm breaking that rule here.  Yet it was my asthma that made me this way.  So perhaps you can see why I like to tell people asthma was a gift from God.  If it weren't for my asthma I wouldn't have this gift, and you wouldn't know me.

30,000-2600 B.C.: Medicine man wards off black magic

In the primitive world, the medicine man was the person you'd seek
out when you were sick.  He had the ability to communicate with
the spirits, and therefore had the ability to heal. 

Humans migrating to Europe around 30,000 years ago rationalized everything by transcendental forces. When you were sick or injured you were powerless, and you needed the help of the all powerful spirits and gods of healing.  For this reason a medicine man (or woman) was needed to intercede, creating a link between patient and the all powerful supernatural beings.

There were various names for these medicine men and women, such as witches, witch doctor, magicians, sorcerers, seers, shamans, healers, wizards, priests, etc. He would make noise with rattles and drums, chant incantations, and use a variety of magical maneuvers to hide whatever he was doing.  In the meantime, he'd be "pretending (or endeavering) to extract the active principle of the disease by sucking it through a hollow tube," according to Fielding Hudson Garrison in his 1922 history of medicine.  "To prevent future attacks, in other words, to keep the demon away for the future, he provides his patient with a special fetish or amulet to be worn or carried about his person."(1, page 21) 

He would create potions using a variety of plants and herbs, and these were believed to work by their magical qualities, probably provided by the spirits or gods. And over time he developed "a special talent for herb doctoring, bone setting, and rude surgery," writes Garrison. "We find that savages in widely separated countries easily get to know the most fatal arrow poisons—curare, ouabain, veratrin, boundou—as well as the virtues of drugs, like opium, hashish, hemp, coca, cinchona, eucalyptus, sarsaparilla, acacia, kousso, copaiba, guaiac, jalap, podophyllin, or quassia." (1, page 25) 

They also learned about viable remedies for asthma by experimenting with the leaves, stems and roots of the deadly nightshade called belladonna (and strammonium).  And he also must have experimented with the effects of drugs like opium, tea, coffee, and alcohol and learned they caused a sort of "artificial paradise," according to Garrison.  All of these would provide at least some relief to the sick and injured, if for no other reason than to provide some mental relief and relaxation, or to help them forget their misery.  Such relaxing effects may even have ended an attack caused by the spirits. (1, page 30)

And if these remedies didn't work, he might try a remedy called bleeding by using a sharp stone or flint knife to balance the humors of the body. Or perhaps he might try trapanation to let the evil spirits out of the sick man's body by cutting or sawing an opening in the scull.(1, page 26)

Although the emphasis of the medicine man was on more than just a healer of the human body.  Garrison writes: (1, page 23)

Primitive medicine is inseparable from primitive modes of religious belief. If we are to understand the attitude of the primitive mind toward the diagnosis and treatment of disease we must recognize that medicine, in our sense, was only one phase of a set of magic or mystic processes designed to promote human well-being, such as averting the wrath of angered gods or evil spirits, fire-making, making rain, purifying streams or habitations, fertilizing soil, improving sexual potency or fecundity, preventing or removing blight of crops and epidemic diseases, and that these powers, originally united in one person, were he god, hero, king, sorcerer, priest, prophet, or physician, formed the savage's generic concept of 'making medicine.' A true medicine-maker, in the primitive sense, was the analogue of our scientific experts, philanthropists, and "efficiency engineers," a general promoter of human prosperity. (1, page 20-21)

When these "sorcerers" first appeared is unknown, although it's speculated they originated as the smartest, wisest, most sagacious, most knowledgeable, most curious members of the families, clans or societies that grew from the ashes of mankind. These individuals listened to the lyrics told at night, and remembered them.  They asked questions about the human body, and searched for and experimented with the various plants and herbs amid the lands around them until they found the answers.

They created various medical recipes, and, by experimentation, learned of their poisonous or healing properties. Many of these sorcerers were seen as healers, and were sought out when needed.  Others were seen as utilizing what was referred to in Egypt as the "black art," and they were punished with death.  So how they were viewed differed from one nation to the next. Although, what is known about them is they were the first physicians, with their specialty in healing, divination, pharmacy, chemistry, and magic. Although many of these specialties evolved over time.

Primitive and ancient people did not have an understanding of the human body, and their curiosities of it were nary satiated because to investigate the human body was considered to be offensive to the gods. What they did learn about anatomy was accumulated by animals they dissected for food and sacrifices, and later by the process of embalming, although due to fear of the ubiquitous gods even the priests performing these duties were fearful to exceed the bounds of the task at hand.

The ancient Egyptians had knowledge of the vessels of the body, and they knew that they originated in the heart.  They knew the heart beat could be felt at various points on the body. And although they had some knowledge of anatomy, they in no way associated this with the various ailments and the remedies used to treat them.  They did not know diseases were caused by germs, or problems with the inner workings of the body, and they did not know that the remedies they created over time had anything to do with their effects on the body.

For thousands of years transcendental forces were at work all the time.  People had to "know prayers, sacrifices, rites, spells," to keep the transcendental forces happy and at balance.  (2, page 270) They were educated about these by the medicine man, and when their own self remedies failed, or when they could no longer tough it out, the medicine man was sought for his wisdom.

By all means, the spirits of the dead were abounding, and they needed to be satisfied and even fed.  If they were not satisfied, they caused diseases and injuries.  Another thing that caused disease was when a person was not pure, or did something wrong.  Often times when a person was sick the rest of the clan would wonder what god or spirit he offended.  And, of course, the only person who had the ability to learn this, and how to placate that god or spirit, was the medicine man; the sorcerer; the priest. He also had the ability to drive out demons, and to counteract black magic that might have been used to cause the ailments.

So the ailments that plagued the various clans, villages and civilizations were not caused by germs or problems with the body, and injuries did not just happen by chance: they were caused by spirits, demons, gods, and black magic.  People, therefore, didn't think of diseases the way we do today.  What we have today are a variety of diseases based on quantitative evidence about various systems of the body. We see diseases such as asthma, allergy, cold, sinusitis, rhinitis, etc.  Through most of history, however, ailments were diagnosed by the symptom.  If more than one symptom persisted, the diagnosis was based on the more prominent.

In other words, your sypmptom was your disease.  In this sense, even while the following may be caused by various disorders, most prehistoric, primitive and ancient people/societies considered them diseases (1):

• Fever
• Coughing
• Dyspnea (shortness of breath)
• Nausea
• Hematuria
• Headache
• Shortness of breath
• Excessive sputum
• Pain

The following definitions will help you understand the role of the medicine man/sorcerer:

1.  Black magic:  This is evil.  The use of supernatural powers for selfish and evil purposes.  An example is casting a spell on someone you don't like to cause a disease or to cause something bad to happen.  It can be as simple as an evil eye, witchcraft, or finding someone to make an evil potion for someone to drink.

2.  Black art:  This was the use of drugs for evil purposes.  This involved the mixing and matching of various drugs and solutions to create potions that were used to evil purposes, such as poisons to kill people you did not like.  Early alchemy, chemistry, and pharmacy was considered to be a black art in the early days of ancient Egypt.  

3.  Omen: Telling the future.  It can tell you if something good or bad is going to happen to you.  If something bad is going to happen you can seek out help in order to prevent it from happening.  

4. Amulet: An object that possesses magic properties to ward off evil spirits. Generally it can be anything from a bone from prey, a rondel (bone chipped away during trepanation of skull), a rabbit's foot, a squirrel's tail, stones, rocks, etc. It may be an object such as an ax, knives, necklace, bracelet, etc. They meet and destroy evil spirits. They catch and neutralize black magic directed toward the owner of the amulet. These are often the chief means of preventative medicine in many primitive and ancient societies. (1, page 40)(2, page ?) They are objects that must be worn at all times in order for their magic to work. Ancient Roman children were made to wear necklaces with amulets made of amber hanging from them. This was so that its magic would protect the child when the parents were not around. (4, page 80)
5. Fetish: An object that is the seat of magic power. It may be the abode of a spirit or may have been charged by the medicine man with the mystic power, mana, or manitou, or whatever it may have been called. It may be an object of worship. The owner of a fetish expects it to act according to his intentions.

6.  Totem:  The totem is usually an animal or other natural figure that spiritually represents a group of related people such as a clan. 

7:  Charm:   Something worn or carried on one's person for its supposed magical effect, such as an amulet, talisman, incantation, conjuration, prayer and even exorcisms.  It could be a bracelet, necklace, ring, or just about anything. It could be anything that provides the magic necessary to ward off evil, either words or some object. It could be words like ABRACADABRA. (1, page 41)

8.  Talisman:  These are amulets or charms that were "closely guarded but not worn." (1, page 41) It could consist of stone, metal, or even parchment paper that has certain characters engraved on it. (4, page 80) The ancient Romans would often have a talisman in their homes in order to protect it, although it would also have the ability to protect the owner too. It's simply any object that possesses magic properties and brings good luck, and does not have to be worn at all times like a an amulet does.

9.  Mascot:  An animated talisman, a person or animal that brings good luck

10.  Incantation: The chanting or uttering of words that are supposed to have magic qualities, as through preventing or healing disease.

11.  Prayer:  Words, a petition, meant to provide protection and healing by calling to the divination for such help.

12. Spells: According to dictionary.com it's "a word, phrase, or form of words supposed to have magic power" which may include a charm or incantation.

The following are what the sorcerer evolved into:

13.  Fumigation: Creating fumes or smoke with fires, incense, pipes, steam, etc., with the intent of healing through inhaling the fumes of burned or steamed herbs or otherwise, and more likely in ancient times, to please or ward off evil spirits to prevent and treat diseases, prevent bad things from happening, etc.


Now, it is true that you might see the medicine that is described here as poppycock and quack medicine. However, when you think of it, this was probably the best medicine available at the time as it gave people hope and faith. This was observed by Fielding Hudson Garrison in his 1922 history of medicine:

In surveying these different superstitions, one point becomes of especial moment. It is highly improbable that any of the remedies mentioned actually cured disease, but there is abundant evidence of the most trustworthy kind that there have been sick people who got well with the aid of nothing else. How did they get well? Short of accepting the existence of supernatural forces, we can only fall back upon such vague explanations as "the healing power of nature," the tendency of nature to throw off the materies morbi or to bring unstable chemical states to equilibrium, the latter being the most plausible. But, in many cases of a nervous nature or in neurotic individuals, there is indubitable evidence of the effect of the mind upon the body, and in such cases it is possible that a sensory impression may so influence the vasomotor centers or the internal secretions of the ductless glands as to bring about definite chemical changes in the blood, glands, or other tissues, which, in some cases, might constitute a "cure." (1, page 42)

He also wrote:

"The best inspirer of hope is the best physician," an aphorism which contains the germ of the Freudian theory of psycho-analysis—to "minister to the mind diseased" by removing the splinter of worry or misery from the brain, in order to restore the patient to a cheerful state of mental equilibrium... It is also the secret of the influence of religion upon mankind, and here the priest or pastor becomes, in the truest sense, tin Arzt der Seele. In practical medicine, the principle now has a definite footing as psychotherapy... Psychotherapy cannot knit a fractured bone, antagonize the action of poisons, or heal a specific infection, but in many bodily ills, especially of the nervous system, its use is far more efficient and respectable than that of many a drug which is claimed to be a specific in an unimaginable number of disorders. (1, page 33-34)

So while the magic of the medicine man/ sorcerer/ priest may not have healed you physically, it may have provided you with the mental relief, or peace of mind, necessary to buy time for nature to cure what ails you, even the dyspnea caused by asthma.

References:

1. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1922, 3rd edition, Philadelphia and London, W.B. Saunders Company
2. Sigerist, Henry,"History of Medicine: Primitive and Archaic Medicine," volume I, 1951, Oxford University Press, page 322
3. More references will be listed here soon as some of the wording among the lexicon here is not mine.  Sorry for any invonvenience.  Much of the lexicon comes from Sigerist's 1922 history of medicine, and I will update this reference as soon as his book arrives in the mail. 
4. 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

4 ways to cure baby blues when you have asthmatic kids

I have really good kids.  Generally speaking, through most of the day they are happy and go about their way, playing all day, without placing much demand on their parents.  Now, when they get ornery, as with most parents, we generally ask three questions:

1. Are diapers dry (for the baby anyway)
2. Are they hungry?
3. Are they tired?

I think those three questions are true for most kids.  Yet I've decided this morning that in my household I have to add another question to this list:

1. Are they breathing okay?

Yes, three of my kids have asthma.  And asthma has a tendency to cause personality changes in kids.  It causes mood changes.  It cause anxiety, stress, and crying.  It causes grumpiness in older kids.  These signs can often be improved by a simple Albuterol breathing treatment.

So, if you have a child with asthma, or you have a family history of such, consider the following list when your child is fussy:

1. Are diapers dry
2. Are they hungry
3. Are they tired
4. Are they breathing okay?

2,700 B.C.: Imhotep invents rational medicine

Imhotep

If you lived with asthma in ancient Egypt you had the option of seeking a physician or a magician or priest for help.  You had a choice between seeking actual medicine or an incantation, or perhaps both. 

Similar to medicine today, physicains in Ancient Egypt were specialized. If you had asthma you'd seek out a different doctor as opposed to if you fell off your horse and broke your pelvis and leg.  You receive breathing relief from your physician, and the person you thank is the great Imhotep. 

Imhotep (Imhotpu, Emeph, Eimoph, Imothph, Imouthes) lived about 2,650 or 2,600 years before the birth of Christ.  He is known by historians as the most famous non Pharaoh to have lived in Ancient Egypt.  He is also considered as the man who invented medicine, and this why he was called Imhotep, which means "physician."

His birth name was Thosortes or Athotis, and he was the son of Ptah, and was later referred to by the Greeks as the Aesclepius of the Egyptians. An inscription on a shrine devoted to him at "Aesculapius, who is Imuthes, son of Vulcan."  The Egyptians new him as the first priest who became a physician.  He is usually represented with a cap on his head and book on his knee. (8, page 102)

Chances are Imhotep didn't actually invent medicine, and he also wasn't the first priest/ physician.  Many scribes of this era attached what they wrote with a Pharaoh or other significant figure to give such works credibility.  So while the actual scribes may go unknown to history, the writings are credited to such figures, with many medical texts being attributed to Imhotep.

He may, however, have invented medicine for the ancient Greeks, at least the type of medical system that was used by the Greeks.  Yet even to say this is mere speculation. Yet to speculate sort of fits right in with the ancient Egyptian era, where medicine was mainly based on myth (although some of their remedies proved useful to a future generation of physicians).

Proof that he wasn't the first physician when a small tomb was discovered amid the pyramids a Sakkarah believed to be that of Sekhet' enanch, the chief physician of Pharaoh Sahura of the 5th dynasty sometime around 5,000 and 5,333 B.C. (6)

Inscriptions in the tomb describe how he "healed the king's nostrils." What Sekhet' enanch did to King Sahura's nostrils, or what was wrong with them, historians don't know. (4)  Yet inscriptions inside the tomb show the physician was greatly rewarded for his actions, making him the first known physician in the world. (6)

Chances are many people invented medicine.  Some even speculate medicine was invented by his father, and since Imhotep was the Chief Priest at the time of its culmination, he was given credit.   Regardless, Imhotep is considered by many as the inventor of medicine. The true inventor, or inventors, may never be known.

Who is Imhotep?

Imhotep (I-em-hetep) became known as a famous Egyptian physician even before Egyptologists had actual evidence of his existence.  He was a man of a brilliant mind, and he was a great architect, medical man, among posessing many other talents.  It was probably due to his brilliant mind that he became vizier (chief advisor), physician and friend of King Djoser (Zoser) of the Third Egyptian Dynasty. Imhotep grew to a "position of wide trust and importance," according to William Osler in his history of medicine. (9, page 10)

Prior to Imhotep, pyramids were build of mud brick and didn't last the test of time.  Imhotep was the first to suggest using stone (or at least he's given credit), and he designed Pharoh Djoser's step pyramid in Saqqara (Sakkara).  He also is said to have invented many of the tools used to make such pyramids and an irrigation system which supplied water from the Nile to fields.  (1)

Thus is was Imhotep who invented the technology -- or at least he is given credit -- that made it possible for the Ancient Egyptians to build the great pyramids that still stand, and are still awed upon, to this day.  For this he is often considered the first known architect.(3)

So while he impressed Egyptians by his architectural skills, he likewise impressed them with his ability to heal.  During his life he had many names, one of which was "Scribe of numbers."  Perhaps this is in reference to the knowledge of numbers required to understand the prescriptions that were recorded, and to have an understanding of the "great many remedies that they employed for diseases of various kinds and many methods of delivering them." (2)

He thus became a very famous physician.  He was also knowledgeable of the Egyptian literature and had the ability to write.  Back then this took special talent, and a person with such an ability was payed well for his services.  The Egyptians didn't have a money system, and so Imhotep must have been paid with gifts from the king.

As a physician he would also have been paid well, both for caring for the king, the wealthy and the poor.  The king would have provided him with boat so he could travel wherever he was needed.  Yet he would also receive gifts from others he treated.  Although it was still rather likely a sick person would have sought out a magician/priest instead of a physician.  (5, page 321, 322)

Among his other writings, Imhotep is known for recording his medical knowledge.  Most may have been intended to share medical wisdom with other physicians, yet some may have been used for teaching those who wished to enter into the medical field.  While these original documents are lost to time, they are referred to by other ancient physicians, such as Galen. So historians are sure of their existence. 

As I will relate many times in my history of asthma, when a scribe such as Imhotep writes down what he knows about a subject, he is writing things that he learned from his parents and teachers by word of mouth.  He is writing down knowledge of illness and remedies to cure them that have been handed down from generation to generation.

Then each physician will want his own copy of Imhotep's wisdom, so they will make a copy of the original by hand.  Then each physician will write in the margins his own experience, his own remedies, and when his text is recopied, perhaps by his children (children were often forced to follow in their parent's steps), the transcriber may add what was in the margins into the texts.  In this way what is handed through time is a copy of a copy of a copy. It is quite a daunting task for historians, I have read, to separate the original works with additions.

While there are no known original texts handed down to us from Imhotep, many believe the contents of a scroll discovered in the 19th century were originally written by Imhotep himself.

A famous Ancient Medical Text:

The Edwin Smith Papyri

During the 19th century two large scrolls were discovered, perhaps between the legs of a mummy  (3), probably in a tomb in the necropolis of Thebes, and ended in the hands of a native dealer.  The dealer sold the scrolls in 1862 to an Egyptologist named Edwin Smith. This native probably had no idea of their historical value. (5, page 304)

The smaller of the two documents was about 4.68 meters long with 21.5 columns of hieroglyphics.  It's believed to be a fragment of an even larger text (or a variety of ancient texts).  It became known as the Edwin Smith Papyri.  A majority of this papyri is a collection of "description of 48 cases, injuries, wounds, fractures, dislocations, tumors, in other words the kind of troubles that fall into the realm of the surgeon," according to Henry E. Sigerist in his 1951 book, "A history of Medicine." (5, page 304)  The document was published in 1930 by James H. Breasted. 

The other papyri was originally purchased by Smith (probably at the same time he purchased the Edwin Smith Papyri), yet it was advertised as a historical document of great historical value, and purchased by Egyptologist Georg Ebers.  This document became known as the Georg Ebers Papyri.  The Eber Papyri is considerably longer, 20.23 meters with 108 columns.  It's basically a series of books about internal diseases and recipes for how to treat them.  You can read about the significance of the Ebers Papyrus to our asthma history by using the links provided below.

Both these documents are believed to have been written around 1,500 B.C. and contain knowledge that goes back as far as 4,500 B.C.  Most of the Edwin Smith Papyri is written by one hand, and it ends abruptly in the middle of a description of the spine.  (5, page 305) Considering it was written around the time of Imhotep, some have speculated that Imhotep himself was the author.  (5, 304)

Many historians once speculated that Imhotep had the privilege of hearing the wisdom of the god Thoth, who is said to be the inventor of the arts and sciences, including medicine.  Imhotep took this wisdom and it is such that allowed him to become so famous.  Among the writings of Imhotep, many historians speculated he was the author of 42 books of the Hermetic texts, and the Eber Smith and Georg Ebers Papyrus were copies, or fragments, from the last six of these books, which included the medical wisdom. However, later historians refuted these claims.

Regardless, these papyri, or others similar to them, would have been used by physicians as a guide for learning about and treating diseases. If you summoned such a physician he would assess you and determine whether there was hope of success. If the physician thought there was no hope for you he might decide to let you die. If this was the case you could still recourse to the magician/priest for an incantation for hope, similar to what we might do today when modern medicine isn't enough to cure us. 

Yet if he decided there was hope for you, he might refer to scrolls such as the Eber Papyrus and treat you by tossing some herbs on a heated brick for you to inhale.  In this way, it is believed that the Egyptian physicians were the first physicians as we would describe them:  people who treat by reason as opposed to by incantation to the gods. (Yet we must recognize that to the ancient Egyptians mythology was reasonable them, as they believed these gods were ubiquitous).

While it makes for a good story that Imhotep wrote the Smith Papyri, or that he wrote the Ebers Papyri, or that he wrote the Hermatic texts, most historians do not believe this is true.  Sigerist explains that the Smith Papyri was a "work of a surgeon.  There is good internal evidence, however, that the book was a manual of a war surgery or rather that the experience it reflects was gained to a large extent from war injuries," Sigerest explains.  "It is not very probable that the vizier of a great Pharaoh would have acted as an army surgeon." (5, 310)

Other experts speculate the Ebers Papyrus was not a book in itself, but an encyclopedia of random recipes from random scrolls.  The chances it was written by Imhotep are also highly unlikely.

The legacy of Imhtep:

Regardless of who the first physician really was, Imhotep is given credit by many historians, and Hollywood, as the first physician, and he's often labeled as such.  He was so famous, and such a great healer during his life, that after his death he became a legend.  And in the ancient world, many legends become gods in and among themselves.

In fact, many must have believed that he was so good at whatever he did that he must have had more than human knowledge (some speculated he communicated with the god Thoth), and so they worshiped him as the god Imhotep.  He was, therefore, worshiped as one of the health and healing god, along with Thoth, Isis, Sekhmet, Heka, Serket, Ta-Bitjet.

During the time when the Greeks ruled over Egypt, around 500 B.C, he was worshiped as a deity for good health and healing.  Temples in Memphis, Thebes and Pilae were built in his honor, as well as many statues.  (4)

He was so famous he was often "associated with the Greek God of healing, Asclepius," according to Egyptpast.com (1)  If you were sick, if you're asthma acted up, the first things recommended for you might be to worship Imhotep in the hopes that he will cure you. Check out the links below for more on how asthma may have been treated in ancient Egypt.

Further reading:

• 5000-50 B.C.: Egyptian gods educate physicians
• 5000-50 B.C.: The role of the Bible in medicine
• 5000-50 B.C.: The Ebers Papyrus: the first asthma remedy? 
• 800 B.C.- 800 A.D.: Asclepius will heal your asthma

References:

1. "Imhotep," Egyptpast.com, http://www.egyptpast.com/pyramids/imhotep.html, reviewed May, 26, 2012
2. "The First Physician," Journal of the American Medical Association, August 19, 2009, 302 (7), page 807
3. Dunn, Jimmy, "Egypt: Imhotep, Doctor, Architect, High Priest, Scribe and Vizier to King Djoser," touregypt.net, http://www.touregypt.net/featurestories/imhotep.htm, referenced May 26, 2012
4. Lambert, Tim, "A brief history of medicine," localhistories.org, http://www.localhistories.org/medicine.html, observed May 26, 2012
5. Sigerist, Henry E "A History of Medicine," vol I, "Primitive and Archaic Medicine," 1951, New York, Oxford university Press
6. Withington, Edward Theodore, "Medical History From the Earliest Times: A Popular History of the Art of Healing," 1894, London, The Scientific Press, page 14-15 (Chapter IV: Medicine in Ancient Egypt)
7. Wilder, Aleander, "History of Medicine," 1901, Maine, New England eclectic Publishing
8. Sozinskey, Thomas S., "Medical Symbolism in connection with historical studies in the arts of healing and hygiene," 1891, Philadelphia and London, F.A. Davis Publisher
9. Osler, William, "Evolution of Modern Medicine: a series of lectures at Yale University to the Silliman Foundation in April 1913, 1921", New haven, Yale University Press

30,000 B.C.: The dawn of medicine

The first humans in Europe were cro magnums.  They are thought
to have marched into Europe sometime around 40,000 B.C. 

So humans must have developed empathy early on, and they would make sacrifices to help the suffering in any way they could.  Perhaps this meant something as simple as pulling out a splinter, or sacrificing a meal to feed a child.  Or perhaps it means pulling an arrow you accidentally shot into your brother, or providing a sympathetic shoulder to your mother who was having trouble breathing.  By around 30,000 B.C. such empathy would reach a culmination of sorts, into an era that many refer to as the dawn of medicine.

Once again, it's hard to know what internal ailments man suffered from 2.5 million years ago, let alone 30,000 years ago.  It's highly probable, or so I would think, that heart and kidney failure have plagued mankind since the beginning, and Lord knows these ailments cause shortness of breath, even air hunger, or what the ancient Greeks referred to as asthma (and what later was referred to as dyspnea, allowing the term asthma to take a different route).

It's hard to imagine what it would be like to suffer from heart failure, bronchitis, tuberculosis, pneumonia, or any such respiratory disease 2.5 million years ago, let alone 30,000 years ago.  The asthmatic boy leaned up against a tree or rock and dealt with the agony as best he could, trying hard to keep up with his clan, performing the duties expected of him.  But as his breathing worsened, or failed to get better, he'd more than likely become a burden to his clan, and they'd have to go out of their way to help him, to guide him along, to feed him, to provide him with drinks, to provide him with incantations and magical words of healing. Of he died it was because he was poisoned, if he lived it was because of the magic.

By pondering about the world around them, by learning from such events as this that they observed and experienced, and speculating about that of which they could not learn by empirical means, these people created the first myths about what happened before birth, and what happened after death, and why a person got sick.   Perhaps it was by this means that fears of the unknown lead to evil spirits abounding all around, peering amid the trees, and in the dark crevices of caves, and in the fields, and in the sky, even lurking in dreams. Some of these possessed friends and family members, and no doubt one of these had entered the asthmatic boy.  Other spirits became real beings in the Heavens, and these turned into the first gods, and these gods became the first physicians who were responsible for health and healing.

A young girl was excited to see her mother give birth, and after her brother was born, her mother became very sick and she died.  That night the girl did not sleep, instead she was haunted by the creepy sounds in the night.  She decided the sounds must have been made by her mother, who died too soon.  Her mother was now a ghost or spirit, and she was ever present and probably very unhappy because she died too soon.  She might protect her family, or she might be too blind sighted by her own death and haunt those show loved when she was alive.  As noted by Henry Sigerist in his 1951 history of medicine: (6, page 137)

Particularly feared are the ghosts of people who died without having fullfilled their mission on earth, young children, brides, women in childbirth or childbed. they more than any other dead must be eager to return to life or, feeling lonely, they may wish to kill some who were close to them so as to enjoy their company in the world of the spirits. (6, page 137)

One early man or woman realized a sharp bone could be used to slice into prey, and another learned to attach this sharp object to a stick to be used as an ax for killing prey or cutting down brush or trees for making shelter.  By cutting up food the heart was found to still be beating, and the heart was learned to be the best target when hitting prey with a knife, spear or arrow.  The head was learned to be the best target for the blunt ax as it shattered the skull. As noted by Plinio Prioreschi in his 1999 history of medicine: (5 Prioreschi, page 29)

Neolithic man must have noticed that the results of the wounds inflicted by the two kinds of weapons were quite different. Deep wounds of the abdomen and chest inflicted by piercing weapons were always mortal either soon or after, or some time later (in the later case because of infection -- e.g. peritonitis). On the other hand, head blows delivered with blunt weapons often had strange results: the animal (or the enemy) would immediately fall "dead" and whereas sometimes it (or he) would stay dead, sometimes, after a short period, it (or he) would revive, that is, would become "undead." The individual who became "undead" after a head blow had always a small head wound, whereas those who failed to revive usually showed a massive injury. (5, page 29)

It must have been assumed that the "undead" was a person with magical powers, or who was blessed by the demons, spirits or a god.  He was thus "brought back from the dead." He was "cured." Those who came into contact with this "cured" person were blessed. This was probably where superstitions and religion were started. Yet it was also by these observations where people learned what weapons were best for what purpose.  In this way, people learned by trial and error, and they speculated, and they came to conclusions.

People learned early the benefits of bathing in the rivers, lakes and streams to keep themselves clean and pure, because purity was the way to keep the body in balance and to keep the evil poisons out of your body.  This may have been the first observation that cleanliness resulted in better health; the first hygienic practices.  Some men washed daily, and maybe had their wives check them for ticks and fleas or whatever bugs crawled onto them while they were busy hunting in the forest.

Slowly the tree of knowledge blossomed and grew.  Mankind learned that by working together they could accomplish more in life, and as part of working together they learned how to socialize.  They therefore learned to have empathy for a fellow human who was suffering, as was evidenced by the efforts to emphasize and help the ailing boy.  They learned they could make a difference in the lives of others by the love they offered, or simply by offering a kind shoulder to lean on.  Although the earliest help was primitive indeed, this was the beginning of medicine. (1, page 2)

Perhaps a dad provided pressure on a cut to stop bleeding, or made a splint out of stick to aid the healing of a broken finger, or used wool of a sheep to produce a basic bandage, or used a sharp stick or stone to pluck out a sliver.  When the cause of suffering was unknown, incantations were chanted to suck out the evil spirits and demons.

So while allaying illness may have originally been a personal task -- each man or woman for him or herself, it eventually became a task of the many.  People developed consciences; they learned to love, care and appreciate the people in their lives.  They cared for and doted the sick, young and old.  Each person becoming pseudo nurses, physicians and respiratory therapists. So in essence, all of these jobs were born amid the primitive or prehistoric world by savage humans.

An elderly man, perhaps, found relief for his ailing back when he stood by the hot fire.  He learned that by removing the splinter of wood in a boy's hand this would speed recovery of the wound. Perhaps by the quest to find food when hungry, early humans discovered the poisonous and medicinal properties of various herbs.  An elderly lady must have mixed some herbs with berries and learned it didn't make such a good meal, although later she rubbed some on her skin and found it to have soothing or healing properties. (6, page 115-116)

Perhaps by such experimentation, these early humans came up with the first herbal remedies, creating the first recipes that turned into salves, ointments,  potions, pills and even inhalents. Perhaps, just perhaps, an elderly lady was experimenting with poppy seeds.  It is believed by many historians that poppy seeds, or opium, was one of the first remedies used by mankind for its hallucinogenic and pain relieving effects.  Perhaps this was one of the most important drugs of the primitive world (5, page 7), as it relieved pain and suffering.

Perhaps she experimented with the leaves and roots of a belladonna plant, and she laid them out in the hot sun for days to dry, and then after they dried she tried to make food or a potion from them, and she learned that when ingested the result was soothing to the mind, definitely a gift from the gods.  And one day, when the asthmatic boy was huffing and puffing over the fire, she inadvertently discarded the remaining roots and stems into the fire, and the smoke created by them was inhaled by the boy, and his breath instantly, his mind at ease by the hallucinogenic effects.

The boy's father investigated this remedy, and he remembered the recipe, creating easy to remember lyrics so the recipe could be shared from one generation to the next.  By trial and error, in this way, they learned what remedy works best for what ailment.  If an elderly lady was sick, for example, her husband, or sister, or friend, used knowledge obtained by lyrics sung by the campfire late at night to help in any way they could.  Perhaps an elderly sister rubbed salves on her aching back, or made her drink a soothing potion (perhaps containing a drug such as opium). And it was rationalized these remedies had powers of healing because they were gifts from the gods above. (5, page 35)  

If the magic available to these folks didn't work, it was time to call for the medicine man, who was able to form a link between the patient and the spirits, demons and gods. He was the wisest member of the tribe, the one who remembered all the recipes, and held all the esoteric knowledge of the privileged few. He was the earliest magician/ sorcerer/witch/priest/physician all rolled into one, who had the ability to create a link between the sick and the spirits, demons and gods that were ubiquitous and invisible.  He would dress in animal skins to mimic a spirit or demon, he'd use rattles and drums to set the milieu, and he'd suck out the evil spirit from the sick woman. He had different names in different places of the world, although some called him Shaman or Seer, because he had the ability to "see" into the netherworld. (3, page 22)

If this magic didn't work, there were other options the medicine man, or woman, might experiment with, and one was was called trepanation. Experts have shown this can be easily done using flint knives and "scratching the (parieetal) bone (of the scull), or by making a circular incision that was gradually deepened, or finally by drilling a series of small holes arranges in a circle and then cutting the bridges between them." (6, page 110-113)

Many such sculls have been found by archaeologists in various parts of the world,  and no one knows exactly why this procedure was performed, although many speculations have been made.  Perhaps the patient was driven insane or possessed by demons, and this was a last ditch effort to cure the person. Perhaps the person was seizing due to epilepsy.  Perhaps the person had end stage emphysema, or was having a severe, prolonged asthma attack. (Lord help help the boy with asthma if this was the remedy.)(6, page 110-113)

The medicine man may provide the sick lady, or her family, with an amulet and an incantation to recite at various times of the day.  An amulet was blessed with magical powers of healing, and could be made of the teeth of animals, claws of eagles, knives, axes, dried rabbits heart, dried rabbits foot, the bone fragment from trepanation (called rondelles), or just about anything. He may also provide such an object as a talisman, and these would be for good luck, to keep you healthy, and to keep you alive. Such objects may also be just about anything, from a wood carving or replication of an eye, heart, liver, kidney, liver, arm or leg. It could be a dried rabbits foot, necklace, bracelet, etc. (6, page 145)

In times when suffering and death inflicted several members of the clan, in times of epidemics of disease, the medicine man would use his magic on the entire family or clan.  They would gather around the fire at night, under the moon-lit sky, and the medicine man would shake his rattles and beat his drums and hum magical incantations and prayers, and he would toss the dried and crushed herbs of opium or belladonna onto the fire, and the smoke would be inhaled, and the recipients would sit around the fire and hallucinate about the world around them. These hallucinations would surely be revelations from the gods, and they would be interpreted by the medicine man.  These were the first mass inhalations, or fumigations.  In times of trouble, in times of great plagues, such fumigations would provide an explanation for the suffering, and a divination of the end of the suffering, or what could be done to end it.  

Much of this knowledge had matured into a flourishing tree by 30,000 B.C.  Knowledge that was slowly picked up by previous generations was now habitual.  Basic methods of maintaining health, and for offering healing, were standard.  The cause of illness, and the reason for healing, was by the wishes of the ubiquitous spirits, demons and gods.  Some historians consider this period as the dawn of medicine.

References:

1. Wilder, Alexander, "History of Medicine, a brief outline of medical history and sects of physicians, from the earliest historic period; with an extended account of the new schools of the healing art in the nineteenth century, adn especially a history of the American eclectic practice of medicine, never before published," 1901, Maine, New England Eclectic Publishing Co.
2. Netzley, Patricia D, "World History Series: The Stone Age," 1998, San Diego, CA, Lucent Books
3. Garrison, Fielding Hudson, "An Introduction to the history of medicine," 1921
4. Unknown reference
5. Prioreschi, Plinio, "A History of Medicine: Primitive and Ancient Medicine," Vol. 1, 1999, reprinted edition, originally published 1995, Horatius Press
6. Sigerist, Henry E "History of Medicine," volume I: Primitive and Archaic Medicine, 1951, New York, Oxford University Press
7. Suter, Joanne, "Fearon's World History," 2nd edition, 1994, U.S., Globe Fearon Educational Publishing

Harold Beck's Asthma Story

I'm so excited this morning.  On the very first day I decided I was going to work on an asthma history, about five years ago,  I came across an article by an elderly man who described how he survived asthma in the early 21th century.  He wrote that he even needed to have facial reconstruction surgery because people in one nation, with a certain facial configuration, had a low incidence of asthma.  Yet for the life of me I couldn't re-find this article.  By mere coincidence I found it this morning, and I'm thrilled.  I want to add his story to my history because it pretty much shows the plight of asthmatics prior to the advent of modern medicines.

Maybe you've read the article before by Harold Beck.  If not, click on over and check it out.

Update February 26, 2016: Sad to say, the link is no longer available. I wish I had printed off and saved the article, because it was extremely interesting. 

I was, however, able to salvage some of his story. Here it is.

I was about 4 years old when I was in a Convalescent Home in Ventnor which puts it around 1928.

I recall that the Home was high up overlooking the sea. I probably arrived on Guy Fawkes night for I was taken to see fireworks some distance away, looking out over a large garden. I have an image in my mind of watching the display standing by a huge stone bowl on a massive pedestal - though since I was quite small the garden ornament may actually have been of no great size. I also remember that my father visited me once during my time there - he brought gifts, which were probably Christmas psents. I imagine my mother was tied to the home in London during the run-up to the appearance of my next brother or subsequently.

In 2008, while on a holiday in Ventnor, I identified the Home as St. Catherine's and there is little doubt that I was accommodated in Elm Grove, a property high up on the hill overlooking Ventnor and with extensive grounds, which was acquired by St. Catherine's in 1923.
For many years the nursing of patients and the running of the Home had been placed in the hands of the Sisters of East Grinstead, an Anglican Order in Surrey. At the time I was there a Sister Kathleen was in charge and she instituted a policy that the children in her care should remain at the Home full time, including holidays. In essence the Home became a School as well as providing nursing care. Apparently it was also Sister Kathleen's policy that the children should brave the elements when walking from Elm Grove to other buildings in the Home and School complex and in expeditions in and around Ventnor. 

A Note on the History of St. Catherine's Home.

The climate of Ventnor was considered very beneficial for recovery from pulmonary conditions and in 1859 the Royal National Hospital for Diseases of the Chest was was built on the Western outskirts of Ventnor close to sea level and with all rooms facing South. The Hospital expanded rapidly and was especially used for the treatment of tuberculosis, which was rampant in all sections of the population at that time.

Some 10years later, on the initiative of the wife of the Vicar of St. Catherine's Anglican Church in Ventnor, a charity was established to provide care for people with pulmonary conditions, the idea being that treatment should be provided for the less well-off sufferers.

St. Catherine's Home expanded rapidly with properties being purchased and facilities provided as funds became available. Soon after 1910 the Home took in children suffering from asthma and under nourishment and a little later came the policy that the children should remain at the Home full time, including holidays. In essence the Home became a School as well as providing nursing care. In 1923

Elm Grove was bought and in 1926 this became the place of residence for the youngest boys and girls.

What was St. Catherine's Home is now a residential Special School for children and young people with speech, language and communication impairments.