Asthma is an expensive disease

So I go to the hospital pharmacy to pick up my monthly supply of asthma medicine.  The price: $131.  I pay this much with good health insurance.  I don't have a problem paying this bill because it's for medicine that keeps me functioning.  Although I can think of many other things I could buy for $131 a month if I didn't have this disease.  

Especially during the holiday season, I can't help but to think of all the hardluck asthmatics with no insurance.  The actual cost of the medicine I just picked up is way more than that.  Hold, I'll calculate the actual prices here:   

Medicine	Pharmacy Cost	Charge to me
Ventolin HFA inhaler (X3)	$105.42	$26.00
Singulair #90	29.97	20.00
Tramadol 50 mg Tab #100	1.89	10.00
Omeprazole 20 mg #120	15.24	20.00
Advair 250	220.19	55.00
Total	372.71	131.00

So you can see that my insurance provides me with a reduction in cost for all the above medicines except for Tramadol and Omeprazole, and neither of these are asthma medicines (more like medicines that treat side effects to allergies, asthma, and medicines to treat them).  Yet, even with those prices, I save a total of $241.71 on these medicines. 

Actually, I really don't save anything, because I'm spending $131.  Yet if it weren't for my health insurance, I wouldn't be able to afford $372.71 a month.  Actually, some of the above medicines last more than a month, although the most expensive one is Advair, and this medicine only lasts a month.  So, lacking health insurance, I wouldn't be able to afford it.  

Just think, before the Montreal Protocol that called for the phase out of substances that deplete the ozone, Ventolin inhalers costs as little as $20.  Now they are $73 a pop.  And it's not like you can just buy a Ventolin inhaler, you are also forced to pay the $50-300 for a yearly doctor visit.  It seems the world is not very empathetic to asthmatics.  

1880: The sudden rise of hay fever

Out of the ashes of nothingness, there all of a sudden appeared a disease called hay fever. Almost all the authors on the subject during the 19th century noted that it is a new disease, appearing out of the blue around the turn of the 19th century, and that it also appears to be a disease of the educated class; a disease of the aristocracy.  

Interesting is this theory.  A few years ago I wrote two posts for healthcentral.com: one about the hygiene hypothesis and another about the microflora hypothesis.  Both of these theories are relatively new, and both speculate that modern civilization is the cause of asthma and allergies.  

Of interest is that we think of these theories as new.  Yet as we read the works of those physicians who wrote about hay fever in the 19th century, we learn that this idea that civilization causes asthma is nothing new.  Dr. Morrill Wyman made it obvious by providing statistics, and he and Dr. Charles Blackley wrote about it extensively.  

Dr. Blackley mentions that upon Dr. Wyman interviewing 55 hay fever sufferers, 49 admitted to having an education.  Of his own patients with hay fever, Blackley notes the following:

• Six are clergymen
• Three are relations of clergymen
• Four are medical men
• One is the son of a medical man
• Three are military officers
• One is the widow of a military officer
• One is a school inspector
• Two are lawyers
• One is a professor of music
• Four are merchants
• Five are manufacturers
• One is the son of a manufacturer
• One is a farmer
• Five are engaged in mercantile pursuits which cannot be referred to any of the above classes. 
• The remainder cannot be distinctly classified, but all belong more or less to the educated class.

So you can see why it was easy to deduce that hay fever was not only a modern disease, it was a disease of the educated; the aristocracy.  It brought upon theories such as this by Blackley: 

These statistics of the occupations of hay-fever patients bring out prominently the very curious circumstance that the persons who are most subjected to the action of pollen belong to a class which furnishes the fewest cases of the disorder, namely, the farming class. This remarkable fact may be accounted for in two different ways: it may, on the one hand, be due to the absence of the predisposition which mental culture generates; or, on the other hand, it may be that in this disease there is a possibility of a patient being rendered insusceptible to the action of pollen by continued exposure to its influence. If this latter hypothesis be correct, it shows that, in one case at least, the enjoyment of health does not merely depend upon a high state of vitality, but also, to some extent, upon the acquisition of a certain degree of insusceptibility to the action of the exciting cause of the disease. In this instance I believe that the immunity enjoyed is as much due to the latter influence as it is to the absence of that predisposition which education brings.

Hay Fever is a disease only prevalent in the United States and England, and the reason for it, or so Blackley surmises is the modern way of living.  He makes light of the fact there were a lot of changes in the way people in England lived over the past 5-600 years.  While most people used to live mainly on farms, many people now live in cities, are better educated, and have jobs that require a lot of thought and stress.  (1, page 189)

Hundreds of years ago the majority of people, including most of the aristocracy, were not educated.  By the 19th century there was an increasing number of people involved in industry and manufacturing, and these folks were receiving an education.  Book learning was essential in order to receive an adequate education for  doing industrial work.  Plus, training and "book learning" were essential to "reach certain positions in the social scale than it formerly did." (1, page 194)

The added stress of work required to live in the city provides a predisposition to developing hay fever. Once hay fever is developed, exposure to certain pollen causes hay fever symptoms.  Adding to this dilemma is the increase in hay production in and near the city to meet demand of the increasing population, and so there will be more pollen per square mile in the city as compared to the country.

Blackley further notes that: (1, page 197)

Taking all these circumstances into account, it is highly probable that hay-fever was at one time altogether unknown, and it is tolerably certain that it has not only been much more frequent of late, but that, as population increases and as civilisation and education advance, the disorder will become more common than it is at the present time.

And thus was the theory of why the sudden spike of hay fever sufferer in the 19th century.  It's eerily similar to our modern theories.  So, as Paul Harvey always said, now you know the rest of the story.

References:

1. Blackley, Charles, "Hay fever: it's causes, treatment, and effective prevention," 1880, London, 

Merry Christmas

So it is Christmas morning.  The Christmas tree is lit, with an array of lights brightening up the room.  Christmas gifts wrapped around the tree in anticipation of a children's excitement.  A red paper plate with one half eaten chocolate chip cookie, on top of which is a note:  "Save one or two for Mrs. Clause: Love KK."  

Yes, it's Christmas morning.  It's 5:26 a.m.  All the kids are still snug in their beds, and Santa has made his way to the west coast of the United States.  Hopefully he didn't track pollen into all the allergic and asthmatic homes across the nation.  Hopefully he was able to use his magic to prevent a Christmas day hardluck asthma event.  

The kids were up late last night, playing with the gifts they got from their uncles and aunts.  They must get up this morning because this respiratory therapist must go to work in less than an hour.  And by getting paid time and a half, he surely won't want to leave work early, no matter how slow.  And if Santa has given the gift of health to all in the town, the hospital WILL be slow for every respiratory therapist in the world.  

So have a great Christmas every one and all.  

Oh (no), Christmas Tree (for hardluck asthmatic)

At Walmart my 2-year-old son was so excited to see the lit up Christmas trees he blessed all those around us with a joyful song of "Oh, Christmas Tree. Oh, Christmas Tree."  His simple words and his bright smile cheered up any sad soul.  It's this type of innocent, unquestioning joy that the season of Christmas is all about.  

My children start begging me to put of the Christmas tree as soon as Thanksgiving dinner is done.  Although tradition in my home is to wait until December 13, my wife's birthday, to set it up.  Up until five years ago it was expected of me to unpack the artificial tree and set it up.  We set up a real tree once, yet allergies put an end to that tradition.  Dr. James Thomspson recommends no real Christmas tree for any allergic people.  

I can tell you from my own personal experience real Christmas trees are not fun.  However, I can also tell you from personal experience that you should let someone else set up the artificial tree.  This is not a job for an asthmatic/ allergy sufferer.  It's a job for anyone else.  

The first few years I set up the artificial tree I sniffled and sneezed my way through the job, and for several days thereafter the cold-like symptoms persisted.  So I decided I was no longer going to do this job.  There would be no Christmas tree for this guy, real or fake.  

And, yes, I do feel unmanly when I have to tell my wife she has to do it.  It's one of the nuisances of having these pesky allergies  Yet I suppose it takes more of a man to admit what he cannot do, than one who tries to do what he cannot.   

476-1543.: Medicine survives the dark ages of medicine

Between 476 A.D. and 1543 medicine in western civilizations entered a dark ages.  Except for a few random collections, the knowledge of Hippocrates and Galen was lost and forgotten.  People resorted to primitive methods of using superstition and religion to explain health and disease.  Thankfully, and with due thanks to Arabic physicians, medicine survived these dark ages by a thin thread.

While the Greeks and Romans were concerned with cleanliness, with the Romans connecting cleanliness with good health, peasants of the middle ages had no use for such nonsense.  The lack of the peasants ability to take baths was noted by the Bible as acceptable:    "Does your skin roughen without baths?  Who is once washed in the blood of Christ needs not wash again."  And St. Paul noted: "All things were 'counted dung but to win Christ.'" (2, page 85)

European peasants had no use for performing autopsies, and no time to do it either.  They saw even touching a human corpse as morbid, disgusting and counterproductive.  Again, this was inculcated by the Bible, which preached that the only knowledge that was useful was Biblical knowledge that lead you on your way to heaven.  (2, pages 84-6)

During this period Greek knowledge, and even the ancient Greek language, was unknown in western Europe.  This was unfortunate because "at this time Greek was still the key to all higher knowledge, especially in medicine," writes Withington.  "Latin versions of some Galenic treaties, indeed, existed, yet they were so little known that Constantine the African could boast in the eleventh century that he was the first to translate that author.  Celsus, whose work might have formed an excellent text-book, was almost enriely forgotten." (1, page 176)

With a few exceptions, most people didn't need natural remedies to treat diseases, and they didn't seek to know the diagnosis nor the prognosis of disease.  They lived the hard life, and they prayed to God for health and for healing.  They did not need natural medicine. They did not need physicians.  All they needed, as Osler noted, was the Bible and the Church.

Yet not all was lost of the ancient way of life.  In the old world there were basically two groups of people, the: (4, page 2)

1. Elite or aristocrats:  They controlled wealth, religious institutions, government, bureaucracy. 
2. Peasantry: They did all the work.  They were the farmers, herders, builders and merchants.  They consisted of about 80 percent of the populace. (4, page 2)

In the middle ages this same system was maintained, although it was adjusted slightly.  The elite were called kings and queens, and the peasants were called serfs.  The system was called feudalism.

An interesting facet of this is that despite their overwhelming majority, the peasants or serfs accepted this form of government perhaps because it was all they knew.  And while other forms of government may have been tried from time to time, such as the democracies and republics of Greece and Rome, none succeeded at motivating the populace better than the monarchy. (4, pages 6-7)

Another reason why this "elitist" system was so generally accepted may have been due to the Bible, which encouraged human beings to accept peasantry as your role in life, your part in the scheme of life that God intended for you.  (4, page 2-5)

The feudal system was such that those who obtained the most land, or control of the most resources, obtained the most power.  These are the folks who formed the Aristocracy.  They formed the family of kings and queens who made the laws to organize and motivate the peasants to farm and herd the land, build structures, and sell the merchandise.  The aristocracy represented God, and you were therefore obliged to honor and respect them.  (4, page 6)

Under this system the peasants had no identity.  They worked 12 hour shifts every day year round, and even their kids were trained at an early age to do the work.  There was little time for recreation, and little time to to sit around and wonder of a possible better way of life. It may best be explained by Norman Cantor: (4, page 7)

Some historians describe the ancient structure as a one-class system because other than in fifth-century B.C. Athens (always a significant exception) only one group -- the ruling elite -- had such a sense of identity.  Only the aristocracy had a distinct life-style, justified its own existence, loved itself as a class.  Not until much later did the bourgeoisie begin to develop class consciousness.  In the ancient world, only the elite knew things, knew how to do things, the ruling class was the only literate, conscious group in society.

So one can only imagine how easy it was for this aristocracy to shape the opinions of such a naive and ignorant populace.  And one can also only imagine how difficult it would have been for any knowledge of the old world to have made its way through this era.  Although, thankfully, some ancient works were so voluminous, copied so many times, and saved by some few groups of people, and some few schools, that some ancient works managed to survive.

Yet a thin thread of medicine survived by the following means:

1.  School of Salernum in Northern Italy:  Osler explains that the better educated in Southern Itally continued to speak Greek and understand Latin, and "the cathedral and monastic schools served to keep alive the ancient learning."  Among the most significant was the School of Salernum "which for centuries kept alight the lamp of old learning, and became the centre of medical studies in the Middle Ages; well deserving it's name 'Civitas Hippocratica.'" (2, pages 86-7)

2.  Conquer of Spain allows for the rise of Arabian Medicine:  Ancient Greek and Roman medicine continued to be studied in Spain.  Mohamet was, according to Islam, was the last messenger of Allah, and it was he who encouraged Muslims to learn as much as they could.  So by the conquer of Spain in 720 A.D., the environment in the east had already been created that was conducive to learning.

The Arabs now had access to the wisdom of the ancient sages of Greece and Rome, although they were all in Latin.  Osler explains that by the end of the 9th century the Arabs translated much of the Ancient Greek and Roman writings, and were able to use this knowledge to further advance science and medicine.  A perfect example here is Rhazes who defind smallpox,  Maimonides who wrote a treaties on asthma, and Avicenna who was known as the Prince of Physicians.

Thomas Bradford said medicine started its transfer from the west to the east as early as the time of Charlemagne (742-814), "though it became more marked in the following centuries." (7, pages 74-75)

Beginning with the crusades knowledge started to make it's way back to Europe.  Men like Constantinus Africanus translated the works such as Hippocrates and Galen  from Arabic back into Latin at Salernum.  The works of Rhazes, Maimonides, Avicenna and others were likewise translated for Western Europe.

The Muslims added little knowledge to anatomy considering the Muslim religion also prohibited autopsies, but they did add quite a bit to knowledge of diseases, and provided the Europeans with quite a few additional herbal remedies. (2, page 91- 104)

To learn more about how the Arabs saved medicine click here. 

3.  The rise of universities in the 13th century:  Around the 14th century associations of persons with particular skills started to form during the Middle ages, otherwise known as universities.  These were places where people could share ideas and study.  Universities in northern Italy were mainly controlled by students from various nations.  The students arranged lectures and hired teachers.  Yet those of Paris were controlled by the teachers.

Knowledge of ancient writers, especially Aristotle and Galen, were preserved by such schools in Italy and Spain.  The Arabs gained access to this resource.  Books of Avicenna, Albucasis and Rhazes were also studied.  Study of human anatomy was encouraged for the first time since Galen's day, and a book of anatomy (or at least a book on how to perform autopsies) was published by Mundinus in 1316, "a book that served as a text book for the next 200 years."  It was difficult to get a body for autopsy, and permission was often required, although it was accomplished.  Usually the bodies were those of condemned criminals.  (2, page 106)

Science and medicine were not advanced in the west until around 1543 when a man named Andreas Vesalias published a book called De Humani Corporis Fabrica in 1543.  For the first time in over a thousand years medicine was once again moving forward. Yet that would be a fear years down the road.  For now, the most amazing development during the Dark Ages of Medicine was Arabic Medicine, which will be discussed in an upcoming post.

Read about AndreasVesalias by clicking (to be published 3/28/13).
Read how medicine survived the dark ages by clicking (to be published 1/15/13).
Read the end of the Dark Ages of Medicine (to be published  10/1/13)

References:

1. Withington, Edward Theodore, "Medical History from the Earliest Times: A Popular History of the Art of Healing," 1894, London, The Scientific Press. 
2. Osler, William Henry, "The Evolution of Modern Medicine: A series of lectures delivered at Yale..." page 85
3. Meryon, "
4. Cantor, Norman F, "The Civilization of the Middle Ages: A Completely Revised and Expanded Edition of Medieval History," 1993, first edition, Harper Collins Publishers
5. Cantor, Norman, "The Civilization of the Middle Ages: A Completely Revised and expanded Edition of Medieval history: The Life and Deal of a Civilization," 1993, Harper Collins Publishers, New York
6. Johnston, Harold Whetstone, "The Private Life of Romans," 1908, Chicago, Atlanta, New York, Scott, Foresman and company
7. 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

800 B.C: Asclepius will heal your asthma

This is a statue of Asclepius from the National
Museum at Athens.  The staff of Asclepius
appears to be missing. (2, page 44)

If you lived with asthma ancient Greece around 800 B.C., chances were pretty good you worshiped the god Asclepius for health and healing.  He became the most proficient of all the Greek gods of medicine.

You didn't have to worship him, however, as nearly all the Greek gods had the ability to cause injuries and disease and the power to heal, especially Hermes, Paeon, Apollo, Hercules and Athena.

Yet these gods had other interests they had to concentrate on, so they may not have the time to help you. Their temples were dedicated not only to the sick, but to others who might need help improving their lot in life. (13, page 92)

About the time of Homer "the cult of a special god of healing arose, on whose sole office was the cure of sickness and the preservation of health. This was the cult of Asclepios, whose temples formed the chief and laterally the only seat of theurgic medicine, and were held in such estimation that they survived the Olympian fall," said medical historian Max Neuburger in his 1910 book "History of Medicine."  (13, page 92)

So the god who would become the ultimate god of health and healing was Asclepius, the son of Apollo. He would become "the chief healing god," according to Henry E. Sigerist in his book "A History of Medicine."  (1, page 45-6)

Of Asclepius, Sigerist said:

The rise of Asclepius was possible only because the legend made him the son of Apollo.  In Delphi, Apollo had his famous oracle.  He was seer but also physician...  He (Apollo) is the first deity invoked in the Hippocratic Oath, where he appears as Apollo the Physician. (1, page 45-6)

Neuburger said Apollo was the founder of medicine, but he was also known to bring on "pestilence and death on man by his far-reaching darts (sun rays), who was early identified with Paeon, physician of the gods."  He said Apollo may have taught his son medicine, although more likely this job was left to the Chiron, the son of Saturn.  (13, page 92-93)

Chiron was the only immortal centaur.  He he is
showing Apollo how to shoot arrows with a bow.
He was also the teacher of Apollo's son, Asclepius.

Chiron was another legendary figure whose significance arose the same time as did the Asclepions, after the time of Homer. He was a half horse, half god called a centaur who, according to Sigerist:

"dwelt in a cave on Mount Pelion, in Thessaly, like the other centaurs, deeply skilled in the arts of hunting, music and medicine.  In the history of mythologic founders of medicine, he was considered the discoverer of medicinal properties of many herb... (mastered them), and passed it (his medical wisdom) on to his pupils." (1, page 50)

Chiron obtained his knowledge from Apollo and Apollo's sister Artemis.  Chiron became a skilled surgeon, an excellent musician, and well versed in lore.  These skills made him a gifted and entertaining story teller with the ability to share knowledge of the past and present.  (7, page 76)

Apollo, who some speculate may have been an actual physician around 1200 B.C., wanted to make sure his son was the most proficient physician of all time, and so he sent him to Chiron to be educated.

Sigerist explained that around 700 B.C. Hesiod described one version of the story of the birth of Asclepius:

This statue of Asclepius is from
the National Museum as Saples.
It depicts Asclepius with his staff.
(2, page 45)

In the Boebian Lake, the lake of Phoebus, the beautiful maiden Coronis... was bathing her feet when Apollo saw her and desired her.  She became pregnant with the god's child but her (Corois's) father had promised (Coronis) to her cousin Ischys.  The day of the wedding came when the raven, a white bird until then, brought the evil news to Delphi, Apollo's seat.  The god in his wrath first punished the messenger of evil tidings, who from then on exhibited the black color of mourning and was feared as a herald of disaster.  He then killed Ischys, shooting his darts at him, while his sister hit Coronis and her innocent companions.  But when the god saw the body of his beloved in the pyre, he felt pity for the unborn child, removed him from the mother's womb, and brought him to the cave of Chiron on Mount Pelion (in Thessaly). There Asclepius grew up, instructed by the Centaur in the treatment of diseases with incantations, herbs, and the knife.  He became a famous physician, sought by many far and wide, and became so self-assured that he even resuscitated the dead, whereupon Zeus slew him with his thunderbolt. (1, page 52)

Asclepius and Achilles were the two most famous pupils of Chiron.  However, Sigerist said that Homer never referred to Achilles as a physician hi the Illiad.  Perhaps it was for this reason that Asclepius eclipsed even Apollo himself as the most significant healing god, and Asclepius was worshiped many places around the world, including Ancient Rome where he was referred to as Aesculapius.

There were actually many theories as to why Asclepius became such an important healing god. Some say he was an actual physician who was so skilled that, like his father Apollo, his legend turned him into a god.

How Asclepius really died may never be known, but legend has it he was "destroyed by a thunderbold of Zeus," said medical historian Fielding Hudson Garrison in his 1922 book "An introduction to the history of medicine."   (7, page 76)

Some speculate that Zeus may have done this because he was afraid the healing methods of Asclepius might make immortals of all the humans.  The result was that Asclepius became the most significant god of health and healing of all time.  (11, page 3)

He even became "so powerful that when Christianity entered the world as a religion that promised healing and redemption, he (Asclepius), of all pagan gods, was the only serious competitor of Christ," according to Sigerist.  (1, page 51)

He was such a significant figure that William Osler, the so called father of modern medicine, said of him during a lecture at Yale University in April of 1913:

No god made with hands, to use the scriptural phrase, had a more successful 'run' than Asklepios -- for more than a thousand years the counsoler and healer of the sons of men.  Shorn of his divine attributes he remains our patron saint, our emblematic God of Healing, whose figure with the serpents in our seals and charters. (2, page 43)

Osler was referring here to the seal of medicine.  Asclepius was such a significant figure that his symbol, of a rod with two snakes wrapped around it, continues to be the symbol (although modified slightly) of medicine to this day.

This symbol probably comes from the many busts and statues of Asclepius that depict him as a sagacious middle aged man with curly hair and beard, and he's usually carrying a staff with a serpent (perhaps the deadly type) wound round it with the head close to the hands of Asclepius, according to Albert Henry Buck in his 1917 book "The growth of medicine from the earliest times to about 1800."  (8, page 62)  

Buck explained that despite the deadly serpent's head being ready to strike, the face of Asclepius is calm and "unconcerned," perhaps representing his ability to remedy things that are known to be a threat to life.  (8, page 62)

Buck said:

"In the estimation of the Ancient Greeks this fearlessness was undoubtedly attributed to the supernatural power which they believed Aesculapius to possess over dangerous serpents as well as over diseases of all kind. "  (8, page 62, 63)

Some speculate the snakes represent the two opposing forces of medicine, sickness and health.  Some speculate the rod is a symbol of authority.  The serpent and the staff were not unique to Greece, as they became symbols of medicine throughout the ancient world.  An evolved version continues to be a symbol of medicine to this day.

Most of the gods had temples dedicated to them at various locations around Greece.  Osler said that it was around the 5th century B.C. that some of these temples were turned into places of learning.  While Asclepius was the most significant healing god at this time, his temples became the most significant of all these medical schools.  (2, page 39)

His temples became known as Asclepions. Garrison said that most of these Asclepions were set into mountainsides, with the most famous being the Asclepions at Cos, Cnidus, Epidaurus, and Pergamus (7, page 76)(13, page 94)

John Watson, in his book 1856 book "The Medical Profession in Ancient Times." said these temples would:

"Serve as schools of instruction, and as asylums for the sick.  They furnished the nucleus for which, in process of time, were developed other institutions and organizations.  As schools, the most ancient of them is said to have been Titane, near Sicyon." (5, page 26)

Neuburger said Asclepius introduced music and gymnastics into medicine. Built near the temples were gymnasiums. He said:

It is remarkable that the Asclepios cult flourished mostly in places which, through climate or hygienic advantages, were natural health resorts. Those favoured spots on hill or mountain, in the helter of forests, by rivers or springs of pure flowing water, were conducive to health. The vivifying air, the well cultivated garden surrounding the shrine, the magnificent view, all tended to cheer the heart with new hope of cure. Many of the temples owed their fame to mineral or merely hot springs. To the homely altars, erected originally by sacred fountains in the neighborhood of healthy-giving mineral springs, were later added magnificent temples, pleasure-grounds for festivals, gymnasia in which bodily ailments were treated by physical exercises, baths and inunctions (rubbing ointment on the skin), also, as in proved by excavations, living rooms for the patients (hostels)."

Renouard said that at some point:

"The gymnasium were no longer, as formerly, places devoted entirely to bodily exercise; they were surrounded by halls and porticos where philosophers, rhetoricians, artists and physicians assembled to hold their schools and dispute on questions of art." (9, page 80)

So Asclepius "became one of the most popular of the gods.  By the time of Alexander it is estimated that there were between three and four hundred temples dedicated to him."  (2, page 49)

Renouard said that aspiring Greek physicians traveled to Egypt and Mesopotamia to learn about medicine, once the schools at the great Asclepions had been established.  He said that "soon the sages of Greece ceased their journeys in search of light in foreign countries, for their own country became in its turn a center of illumination for all nations." (9, page 80)

Potential physicians traveled from near and far to be instructed at these temples, and they were probably sworn to secrecy. Likewise, the sick and injured traveled from near and far to learn the recommended cures of Asclepius.  These patients would participate in a treatment called incubation (process of the god Asclepios revealing the cure).

Watson said the temples "were sacred from intrusion, and accessible to the sick only after suitable preparation. The invalid, on his arrival, submitted to purification, by fasting, ablution, and inunction." (5, page 27)

Garrison said the patient was first cleansed in a nearby spring.  (7, page 76)

Neuburger said pregnant women were kept away, as well as the "mortally afflicted." He said those allowed in were "submitted to careful purification, to bathe in the sea, river or spring, to fast for a prescribed time, to abjure wine and certain articles of diet, and they were only permitted to enter the temple when they were adequately prepared by cleansing, innunction and fumigation." (13, page 94)

Watson said the patient would then lie on the stone floors, or sit in the corners, or in some cases sit on couches that were arranged on the floors of the "Hicetas, or common-hall of the temples, said Watson.  They would be entertained by the priests with stories of healing by Asclepius. (5, page 27)

Neuburger said the sick were entertained with stories of patient's with similar symptoms being cured.  Such miraculous stories were told in order to incite hope. (13, page 95)

Buck said that a sacrifice was made, and usually it might be a cock, which was a symbol of "watchfulness," a sign  for the physician to be vigilant.  An owl might symbolize "clearsightedness," the eagle of long life, the hawk skilled in medicine, the ram a symbol of dreams and divination.  These animals were also often depicted near statues of Asclepius.  (8, page 62)

Dr. P.V. Renouard, in his 1867 book, "History of Medicine," transcribes a quote from a comedy of Aristophanes that shows what an incubation may have been like:  (9, page 64)

"The Priests of the temple of Esculapius, after having extinguished all the lights, told us to go to sleep, adding, that if any one should hear a hissing, which indicated the arrival of the god, he should not move in the slightest manner.  Se we all laid down without making any noise; but I could not sleep, because the odor of an excellent broth, that an old woman held near me, agreeably excited my olfactories.  Desiring most ardently to slide along to it, I raised my head very quietly, and saw the sacristan, who took away the cakes and figs from off the sacred tables, going the round of the altars, putting into his sack every thing he could find.  I believed that I had a right to follow his example, so I raised to go to the old woman's pot"  (9, page 64)

Neuburger said the believers thought the god was affecting the cure. But, as was shown by the comedy of Aristophanes, the priesthood "actually performed cures which the half-sleeping or half-intoxicated patient imagined to be dreams." (13, page 95)

Renouard this comic was obviously one of the doubters.  Most people, however, believed in the healing powers of Asclepius.  Although, over time, it must have become quite puerile.  Of this, Neurburger said:

In later times Asclepios refrained from these manual services and only indicated the cure, either clearly or symbolically, to the dreamer of his accepted proxy.  (13, page 95)

Neuburger said that doubting priests may have become the first physicians of Greece. They were taught at the Asclepions and later would travel to the homes of the sick in order to treat them.

Edward Withington, in his book "Medical History from the earliest times," describes the incubation this way:

"The sick person after sacrifice and purification lay down to sleep near the alter of the god, and the mode of treatment was revealed to him either in a dream, or more directly by the priest himself, dressed as to represent the deity. On recovery he presented thank offerings, sometimes including models of the affected part in wax, silver or even gold, and a tablet was put up describing his illness and it's treatment." (4, page 40)

Buck explains that the person would lie down, usually wrapped in coat of a Ram , and then drift off to sleep. (8, page 62)  The god Asclepius would then enter the hostel, remove your skull , and take out the demons.  When you woke up you'd either have an epiphany regarding the cure, or the priest would tell you the cure the god recommended.

Actually, Garrison said that once the patient fell asleep the priests would dress like the god.  If the patient was asleep the remedy would occur to the patient.  If necessary the patient would tell the priests what he dreamed of, and the priests would interpret them, thus relaying the cure.  Some patients would not sleep, and they would come face to face with the god, who would directly relay the cure.  The god may either appear as a vision, or he may have actually been one of the priests in disguise.  (7, page 76)

Watson said the temples were:

"Always filled with patients; and along their walls the tablets (votive tablets) were suspended upon which were recorded the history and treatment of the individual cases of disease." (5, page 27)

Neuburger said the votive tablets were made of wood or stone, "and hung up on posts or pillars." (13, page 95)

As the patient's slept, the priests would review the complains the the patients, and perhaps assess them vaguely.  This information was then used for divination purposes, where the priests would make both a diagnosis and prognosis.  The priests would then refer to the votive tablets for the cure.  (2, page 57)

In looking at the votive tablets, the priests would look for similar diseases. enouard explained the reasoning behind this system:

These persons have constantly in their mouths these words: “ I have seen a disease similar to this cured by such a remedy.” Their reasoning, however gross it appears to us, is based on an incontestable principle, that may be stated as follows: Remedies which have cured a disease, must be equally efficacious in curing analogous cases. (9, page 70)

As noted by Neuburger above, this was mainly done to offer hope to the sick.

Renouard said this was a system similar to that of the ancient Egyptians.  He said the votive tablets "showed the names of the patient, the kind of disease with which he was attacked, and the manner of the cure." (9, page 67)

Renouard said that one votive tablet was found in Rome on the island of Tiber, the site of an ancient Asclapion temple.  He quoted the following from one of these tablets:

"Lately a certain Carus, who was blind, came to consult the oracle. The god required that he approach the sacred alter to perform adorations; at once he passed from the right to the left, and having rested his fingers on the altar, he raised his hand and applied them to his eyes. He recovered his sight immediately, in the presence of the people, who rejoiced to see such marvels accomplished under the reign of our august Antonius." (9, page 67)

“ Lucius was attacked with a pleurisy, and every one despaired of his life. The god ordered that the ashes of the altar be taken, mingled with wine and applied to his side. He was saved, and gave thanks to god before the people, who congratulated him.” (9, page 67)

“ Julian vomited blood, and appeared lost beyond recovery. The oracle ordered him to take the pine seeds of the altar and eat them for three days, mingled with honey. He did so, and was cured. Having solemnly thanked god, he went away.”

“ The god gave this direction to a blind soldier named Valerius Aper: Take the blood of a white cock, mingle it with honey, and make acollyrium, which you are to apply to the eyes for three days. The soldier having fulfilled the direction of the oracle, was restored to sight, and returned to make a public thanksgiving to God.”

The tablets, which were attached to the walls and columns of the temples, were reviewed by the priests when their memories did not allude to a similar case and a cure. (9 page 67).

These tablets were studied by the priests, particularly when they were in training, and were later studied by students of philosophy in schools (gymnasiums) that were attached to the Asclepions.

Neuburger said:

Asclepios enjoined mostly natural cures, such as diet, exercise... hunting, or fencing, also physical means -- listening to song, seeing a play -- less often bleeding or purgatives, at times seemingly ridiculous but really suggestive measures. Success was always ascribed to the credit of the god, failure to the fault of the patient."

Osler said the priests "did not neglect the natural means of healing.  The inscriptions show that great attention was paid to diet, exercise, massage and bathing, and that when necessary, drugs were used."  (2, page 57)

Most of the drugs used were generally to cleanse and purify the body.  Garrison said some common drugs were cathartics (purgatives), emetics, or bleeding.  (7, page 76) Other drugs that may have been used are diaphoretics, stimulants, and sedatives.  

Most drugs consisted of a variety of herbs prepared into pills made of dough that were taken orally or through the rectum.  Some remedies were made into drinks such as wine.    

Sigerist said the rich gave expensive gifts and sacrifices, and the poor gave what they could. Some slept in the temples and some in nearby hostels hoping to be cured by the god in the night.   If you had asthma perhaps you were among the crowd sleeping on the floors.  Or, in your case, slumped over a chair yearning to fall asleep to learn how to get your breath back. (1, page 73 and 3)

Neuburger said the "hostels (shelters) were "undertaken by the keepers of inns and boarding-houses in the neighbourhood." (13, page 94)

Garrison said if you did get better, an offering of thanks, which often included a wax model of the "diseased part," was presented to the god, and the story recorded on the votive tablets for future priests to reference.  (7, page 76)

Some speculate that at some point during the life of the Asclepions medicine was transformed in Greece from mythology and theology to natural philosophy and reason (an early form of science), but at exactly what point this occurred, and how many cases were seen prior to this transformation, are unknown. (9, page 68, 76)

That medicine was practiced at the Asclepions, as opposed in some remote location among the populace, is what allowed medicine to advance.  It is only out of this system, as Renouard quotes Louis Philippe Auguste Gauthier from his 1844 book "Recherches Historiques sur l’Exercice de la Médicine dans les Temples,”

It must be agreed, that in those barbarous times, medicine could make more progress in the hands of a corporation like the Asclepiadae, than if it had been merely a domestic or popular art.  It is not probable that, at a period so remote, when the arts and sciences were still in their infancy, a man of genius could be suddenly raised up, who could elevate medicine to the rank of a science... It is probable that the reading of the inscription in the temples, and the habit of seeing a great number of sick, gave, in the end, a certain amount of medical instruction to the priests." (9, page 76)

Initially this knowledge was esoteric to only the priests of the Asclepions, although, over time, the priests at Cos preferred a more rational approach to medicine. This rational medicine ultimately gave rise to the physicians who worked outside the Asclepions.  (13, page 96)

Sometimes around 400 B.C. a famous physician named Hippocrates, the so called man of genius, transcribed the votive tablets at the temple of Cos into the infamous Hippocratic Corpus, or so some speculate. 

By writing the Corpus, Hippocrates not only helped complete the transformation of medicine in Greece, he also made this knowledge available to the public.  It was for these reasons, as we will learn later, why Hippocrates will forever be known as the father of medicine.

In the meantime, many historians have noted that ancient Greece was well ahead of other ancient societies in regards to medicine.  The best evidence of this is the accumulated knowledge obtained from the votive tablets stored in the Asclepions.  Of this, Meryon said:

"And this opinion appears to be supported by the fact that from the earliest time of which any historic record exists, the Hellenic physicians were in high repute at the court of Babylon; so that, although the origin of Grecian medicine is involved in the most profound obscurity, the resources at the Asclepiades were obviously appreciated over and above the appliances of the Persians, which were chiefly derived from astrology and magic." (6, page 20)

While some may think of such "asylums" as the first hospitals, Watson notes this wasn't necessarily true.  He said:

"The temples bore no inapt resemblance to the hospitals and infirmaries of modern times; into which, in fact, some of them were ultimately converted. (5, page 26)

Thomas Bradford, in his 1898 book "Quiz questions on the history of medicine," said the Asclepions were converted into hospitals when Constantinople made Catholicism the official religion of Rome in 312 A.D.  It was Helena, the mother of Constantine, who was the primary champion for this conversion. (12, page 49)

Even after their demise, even after the glorious physicians of the Grecian era were long gone, the sick could still travel to the Asclepions for health and healing. Even as the medicine was transformed from philosophy back to theology, at least the sick were offered the best mode of treatment in the ancient and primitive worlds, and that was hope.

References:

1. Sigerist, Henry E, "A History of Medicine," 1961 edition, Volume II: Early Greek, Hindu, Persion Medicine," Oxford University Press, page 44
2. Osler, William, "The Evolution of Modern Medicine: A series of lectures at Yale University on the Silliman Foundation in April, 1913," New Have, Yale University Press, 1921,
3. Templesuk.org, "Asclepius," http://healing.templesuk.org/asclepius.htm
4. Withington, Edward Theodore, "Medical History from the Earliest Times," 1894, London
5. Watson, John, "the Medical Profession in Ancient Times," 1856, New York, 
6. Meryon, Edward, "The History of Medicine: Comprising a narrative of its progress from the earliest ages to the prestne and of the delusions incidental to its advance from empericism to the dignity of a science," volume I, London, 1861
7. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1922, 3rd edition, Philadelphia and London, W.B. Saunders and Company
8. Buck, Albert Henry, Williams Memorial Public Funds, "The growth of medicine from the earliest times to about 1800," 1917, London, Oxford University Press
9. Renouard, Pierre-Victor, "A History of Medicine from its origin to the nineteenth century," 1867, Philadelphia, Lindsay and Blakiston
10. Bradford, Thomas Lindsley, "Quiz questions on the history of medicine: form the lectures of Thomas Lindsley Bradford, M.D," 1898, Philadelphia
11. Strathern, Paul, "A Brief History of Medicine from Hippocrates to Gene Therapy," 2005, U.K. Avalon Publishing
12. 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
13. Neuburger, Max, writer, "History of Medicine," 1910, translated by Ernest Playfair, Volume I, London, Oxford University Press

How does this asthmatic control his asthma/allergies

You know what I think is neat is the way I write about asthma and allergies on my log is similar to the way physicians wrote about the disease in the 19th century, in medical journals.  Much of what was written about asthma and allergies were based on the experience and observation of the physician writing about it.  

Every physician who wrote a book about hay fever in the 19th century had asthma with the exception of Dr. Phoebus, and he made his observations based on only one patient of his own.  What made his writings credible was because he performed a questionnaire for hay fever sufferers and compiled the date in his book.  His book, therefore, was a compilation of all the data up to the time his book was written in 1859.  

Yet pretty much all the other experts were interested in the disease they wrote about because they had the disease.  Most of their experiments were performed on themselves, and this includes the experiments performed by Charles Blackley, the physician who proved that hay fever wasn't caused by hay but by pollen.  

So if I were a physician in the 19th century I'd recommend what worked for my asthma.  I would recommend every asthmatic take the following every day, especially when he felt good:

• Advair 250 or 500 (am and pm)
• Singulair  (pm)
• Claratin (pm)
• Prilosec (am and pm)
• Ventolin inhaler (as needed)
• Ventolin solution (as needed)
• Ultram (for headaches due to anxiety and sinusitis)
• Prednosone (on hand just for those emergencies)
• Xanax (for anxiety due to family members who don't understand)

Of course I'd also have to recommend to my patient to avoid cigarette smoke and avoid your asthma triggers as best you can.  It is best that you avoid things that trigger your asthma even if you are pressured to do those things  For example, even though your friends and family pressure you into going to hunting camp, you must not go.  

You must also, to the best of your ability, avoid dust mites.  You must have someone else put together the fake Christmas tree.  You must have someone else do the drywall.  You must have someone else do the wiring in the dusty basement.  You must have someone else pull dusty boxes from the basement closet.  

Now I know that it's impossible to avoid all your triggers.  It's not possible to live in a bubble. You have to do some things even when you know they'll bother you, but you must to the best of your ability try to avoid these things. But if you can't, that's what the Advair 500 and, if necessary, the prednisone are for.  It's also what the ventolin is for.  

The problem with living this way is you'll have to live with the stress and anxiety of living a life contrary to what a normal person would do.  You are going to have people, most of them, who have little empathy for you.  Even your wife will get annoyed and even angry with you because  you can't do simple chores around the house.  That's what the xanax is for.  

So there you have it.  That's how this guy happily makes his way through life.