1543: Vesalius sparks end to dark ages of medicine

So our friend Claudius Claudius Galen wrote his book of anatomy and medicine in the 2nd century, just prior to the end of the Roman era of western civilization.  For greater than a thousand years physicians amid this civilization, instead of thinking on their own and advancing medicine, worshiped Galen as a god of medicine. His writings contained all the knowledge required of medical students.

Surely over the years there were errors observed in Galen's words, although these errors were always overlooked, explained away as "probably nothing."   Medical curiosity was frowned upon, and all was forgotten as the world dipped into a dark ages. 

People were content to remain ignorant until a man by the name of Andreas Vesalius wrote a book that stunned the scientific and medical community back into existence.  

Vesalius was born in 1514, "into a world of physicians, pharmacists and royal patronage," explains Lois N. Magner.  "His father was imperial pharmacist to Charles V and often accompanied the Emperor on his travels.  As a youth, Vesalius began to teach himself anatomy by dissecting mice and other small animals."(4, page 158)

Galen's mighty reign as god of medicine ended almost as soon as Vesalius became a student at the University in Paris.  This is where we find him entering through the large doors, entering a large observatory with a podium in the front and a dissecting table with a fresh corps lying on top of it.  Vesalius seems oblivious of the stench of rotting flesh as he takes a position close to the table and waits for the professor and his assistant to enter.

Within fifteen minutes the room is crowded with students hovering to see a young assistant cut into the chest of the body. Standing behind his assistant, behind the podium which has a copy of one of Galen's books on top of it, we find professor Jacobus Sylvius, who was born in Amiens, France, who began teaching anatomy at Paris in 1531.  (7, page 200)

He reads Galen's words as his assistant displays what Galen is explaining. His voice is strong and powerful, radiating full and strong so even at the rear of the auditorium we can hear his every word.  His assistant usually dissects an animal, we know from our history lessons, but today his students are privy to an actual human dissection. This is something Sylvius did for his students only once a year.  

Historian Kerfoot D. Shute said in 1910, that Jacobus 

Sylvius (1478-1555): "was an uncompromising Galenist.  

He preached Galen in everything, and trusted Galen 

more than he did his own eyes. To him instruction in 

anatomy was reading a chapter of Galen and though he, 

on rare occasions,  made use of imperfect dissections

of the human body these dissections were simply for the 

purpose of illustrating and making the teachings of Galen

and not for the purpose of disproving Galen."(7, page 200)

As Sylvius reads, loud and clear, the one assistant does the cutting, and another points to each part of the body being described by Galen.  It's actually a neat system, and they have it down pat, as though they have done this hundreds of times before. (3, page )

After the dissection is done all the men are clear of the room except Vesaleas and Sylvius

Andreas says, "What you read and what your assistant pointed to did not agree."

Sylvius shouts, "There are no errors in the writings of Galen."

Andreas says, "Galen taught that the liver was five-lobed, that the breastbone had seven segments, that a network of blood vessels could be found under the brain.  You believe every word of it, although those features couldn't be found in the body right under your eyes.  You see exactly what Galen tells you to see!

Sylvius shouts, "Get out!" He points to the door.

"If the corpse and book don't agree, then the error is in the book!"

"If the error and book don't agree, then the error is in the corpse!"

 "God forbid you doubt Galen."

"Get out!" Sylvius points aggressively this time.

"Michelangelo and van Calcar know more about the human anatomy than you, professor!"

"GET OUT!

"Those artists need accurate description of the body!  They study it up and down so they can accurately draw the body.  You guys merely studied Galen!

"YOU ARE A MAD MAN!

"Hmph!" is the noise that escapes Vesaleus, as he rushes out through the large doors, which bang shut in his absence.  We follow his path, and catch up to him as he trudges down the middle of a dirt road, dust spewing as a horse and buggy buz past.  He coughs.

Vesalius stops in front of a fountain and says, perhaps talking to us:

I am not content to just believe everything Galen writes.  The best teacher of the human body is not Galen but the human body. I stole a skeleton and studied it, yes I did.  I learned the human breastbone did not have eight segments as Galen described, it had only three parts.  How could a teacher as magnificent as Galen have gotten it wrong?" 

Andreas Vesalius (1514-1564)

There is a long pause as Vesaleas appears to be gazing at his shadow waddles in the twinkling water. 

Then by chance one day I dissected an Ape.  It occurred to me:  Galen never even dissected a human body, otherwise he would have known the human sternum had only three parts.  For thousands of years doctors treated diseases based on the anatomy of apes not of humans."  

Vesalius turns to look our way, as tough he knows we are real, although we know he's actually looking at Sevalius as he exits the observatory.  Sevalius does not stop, perhaps pretending he does not hear the young Vesalius as he says:

"I have a mission.  I hope you read of my discovery for history's sake!"

Vesaleas smiles.

Back in the time machine we sit and think about the day's events.  To Galen's defense we must remember  in both ancient Greece and Rome it was considered sacrosanct and illegal to dissect a human body.  In fact, it was illegal to even touch a corpse except for preparing it for burial.  Even in the 16th century it was illegal without permission. While Sylvius probably obtained a legal corpse, most dissections were performed on bodies stolen from cemeteries.

By his coming out in the open with his discovery, Vesaleas came head to head with his colleagues in the medical community.  His fellow physicians ridiculed him to the point he had no choice but to leave Paris without a degree. (4, page 158)

Surely this set him back for a while,but it did not slow him down. Surely there were other men like Vesalius who had suspected Galen of being wrong, although Vesalius had access to something that none of those men had: the Gutenberg Printing Press.  It was invented in 1448 by Johannes Gutenberg, but by 1537 the press had become commonplace, and just about all great minds eager to publish a book had access to it.  Vesalius needed it big time in order to return medicine to western civilization.

Vesalius was hired as professor at the University of Padua in 1537 (3,4) and decided to dissect the bodies himself. His colleagues wondered why he would waste his time considering Galen had described the human body so perfectly.  Learning from dissecting is a waste of time, they said, and all that was needed could be learned simply by opening up one of Galen's books. (3, page)

Later that same year he becomes a medical doctor and was appointed to "lecturer-demonstrator" of anatomy and surgery.  From sun up to sun down, three days a week, he demonstrated and lectured about the human body in front of ever growing crowds of medical students.  (4, page 158)

To mark his independence from Galen, Vesalius arranged a public dissection lecture in which he demonstrated over 200 differences between the skeleton of apes and humans, while reminding his audience that "Galen's work is based on the dissection of apes."

His fellow professors, including his old instructor, cried foul.   Sylvius wrote letters explaining how crazy Vesaleas was, and even called him a "mad man." (2, page 159)

Yet despite their cries, it would be Vesaleas who laughed last.  He was the one who was noted to be correct by history. He was the one who became famous for his observation.  He would become so popular that within a few years he would have enough money to hire an artist by the name of jan Stephen van Calcar to draw the human body as it was being dissected by him.  

Andreas Vesalius published the first accurate book of anatomy on the
printing press at Basle in 1543.  While the book in and of itself was
controversial, the title page shown here shows an engraving of
the teacher and his students examining a cadaver. (6, title page)

This book was published in the year 1543 in Basle when Vesalius was only 28.  This first accurate book of the human anatomy was called De Humani Corporuis Fabrica, or "The Fabric of the Human Body." It consisted of 700 pages, and the title page consisted of the teacher and his students studying a cadaver, which in itself must have been controversial.  (5, page 89)

This was a major scientific breakthrough, and the spark that would end the dark ages of medicine and the dawn of the scientific revolution.  From this point on human anatomy would be taught based on accurate pictures and descriptions, as opposed to Galen's ignorant descriptions. 

He continued to meet fierce opposition from his fellow professors with chants such as: "You are ruining our reputation!" They shouted such filth at him in the halls of the university he worked.  They accused him of crimes.  Many wrote books against Vesalius.  Instead of completing more medical work, he spent the next 20 years fighting to get others to recognize the importance of the Fabric.

This engraving shows Vesalius displaying the the muscular system of
a human arm.  This was among many engravings displayed inside his
book that were created by jan Stephen van Calcar 

This is just the way it was in the 16th century: statements of scientific fact did not come without a fight.  Yet it was a fight worth fighting.  Thanks to the courageous acts of Vesaleas a spark was lit under the medical community that would grow into a full and flourishing flame within a few years.  

Historians like John Hudson Tiner now recognize Vesaleas's discoveries about Galen's lies as one of the top ten most important medical discoveries of all time.  Yet unfortunately Vesalius never lived to see its acceptance into modern medicine.  His later travels took him out of Europe and nothing is known about when nor how he died.

Although there are theories.  In his history of medicine, the father of modern medicine, William Henry Osler, explained one theory:  (2, page 160).

"The story is that he had obtained permission to perform a post-mortem examination on the body of a young Spanish nobleman, whom he had attended.  When the body was opened, the spectators to their horror saw the heart beating, and there were signs of life!  Accused, so it is said, by the Inquisition of murder and also of general impiety he only escaped through the intervention of the King, with the condition that he make a pilgrimage to the Holy Land.  In carrying this out in 1564 he was wrecked on the island of Zante, where he died of a fever or of exhaustion, in the fiftieth year of his life."

Regardless, Vesalius is a hero in every medical history. Actually, it wasn't Vesalius alone who saved medicine, as there is another hero in our story, and his name was Johannes Gutenberg.  Gutenberg provided the method, and Vesalius used it to create a spark.

Shortly after his death ancient Greek medicine returned west, was transcribed from Arabic back into western languages.  Yet along with the old wisdom came a plethora of new remedies and a young pharmaceutical profession. (5, page 75, 82)

Click here for more asthma history.

References:

1. The John Hopkins Hospital bulleton," (volume XV 1904), "from the epoch of the Alexandria School (300 B.C.)"
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. Tiner, John Hudson, "Exploring the History of Medicine," (the conversation in this post is based on the writings of Tineralthough the actual words are made up by me). 
4. Magner, Lois N, "A History of Medicine," page 160
5. 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
6. Vesalius, Andreas, "De Humani Corporis Fabrica Libre Septem," 1555,
7. Shute, D. Kerfoot, "The life and works of ndreas Vesalius," Old dominion journal of medicine and surgery, Tomkin, Beverly R. Tucker, Douglas Vanderhoof, Murat Willis, R.H. Wright, editors, 1910, Richmond Virginia, The Old Dominion Publishing Corporation, pages 195-211

My medicine history

Sometimes I wonder how many asthma medicines I've downed since January of 1070.  I was diagnosed with asthma in 1972, but I'm sure I had trouble even before that.  I remember mom pouring this nasty tasting medicine from a pink or purple bottle in the medicine cabinet onto a spoon and making me down it.  It tasted nasty.  Was that Sustair? or was it some form of Alupent solution?  I may never know.

The following are all the medicines I recollect taking for my asthma over the years:

1. Susphrine:  I wrote my experience with this medicine here.  
2. Terbutaline:  This was a rescue medicine.  My only memory with this was at the asthma hospital in 1985.  It made my blood pressure spike, so my experience was only temporary.  
3. Alupent inhaler:  My old buddy.  I wrote about my experience with this medicine here.
4. Alupent solution:  I was introduced to this in 1985 at the asthma hospital and used it until 1991 when I was introduced to Ventolin solution.  It made my heart pound, but boy was it a lifesaver in its day
5. Cromolyn:  This was the famous spinhaler dry powder inhaler.  The powder sometimes made me cough, and this made my asthma worse.  I used it from sometime around 1983 until around 1990 when I just quit taking it.  I don't know if it ever did any good.
6. Theodur:  I was chronically dependent on this for over 30 years, although it was an awesome bronchodilator I think doctors are now afraid of but shouldn't.  I wrote about it here.  
7. Sustair:  It's the syrup version of theophylline.  It tasted like yuck. 
8. Aminophylline:  IV version of theophylline they give you when you're admitted to the hospital.  I don't think it's used anymore, though.  
9. Atropine solution:  It's a mild bronchodilator, although it's used more as a preventative medicine because it has a slow onset of action.  It's the same medicine that used to be available in asthma powder and asthma cigarettes.  I generally mixed it into my Alupent solution and inhaled the treatment for 10-15 minutes about four times a day.  
10. Atrovent:  It's the factory made Atropine-like product that's available as an inhaler.  I took this from the late 1980s until the early 1990s when I simply quit taking it.  It was also available as a solution for my nebulizer.
11. Vanceril:  The infamous beclomethasone inhaler.  There were various brands and generic names, although Vanceril was the one I usually found in my bedroom.  
12. Azmacort:  I started taking this when I was admitted to the asthma hospital in 1985 and I took it until 1998 when I was switched to Flovent. It was a good inhaler, although 4-6 puffs 4 times a day made it so compliance was a major issue. 
13. Broncosol:  Actually the predecessor of terbutaline. Thankfully I only had to take it a few times 'cause boy did it make my heart pound.
14. Prednisone or Medrol:  Good old systemic steroids.  I have been on these so many times I cannot count the days.  I was on them most often in 1984 and 1985, so much that there were concerns of side effects.  I was on them in 1998 and 2012 for short term.
15. Solumedrol:  The IV version of systemic roids you get in the hospital.  The last time I needed it was in 1998.
16. Flovent:  This is the best steroid I started taking in 1998.  I switched to Advair in 2005, although Flovent is one of the contents.  
17. Serevent:  I also started taking this in 1998 when I started taking Flovent.  I didn't like the side effects so I was on and off it for the next seven years until I started taking Advair
18. Drixoral:  I started taking this in 1985, and my doctor wanted me to take it daily to control my 200 allergies.  When I got home from the asthma hospital my mom wouldn't let me use it because it was too expensive. 
19. Xanax:  The old mind relaxer.  It's an anxiolytic. I was first on it for about six months in 1985, and then again for a while in 1998.  These were when my asthma was the worse.  I just started on it again as needed in April of 2012.
20. Antibiotics: Many different kinds and many different times.
21. Nasal irrigation:  In 1985 I was supposed to take this salt water and drain out my nasal passages with it.  I hated it, and it was discontinued to be replaced with Ocean Spray.
22. Ocean spray:  (I was on this for a while in 1985 and 1986.  It was another medicine used to clean out my sinuses.  It was another medicine my mom didn't want to pay for.
23. Nasalide:  It was another allergy medicine I was on in 1985. 
24. Dulera:  It has Azmanex and Formoterol in it.  It's a long acting beta adrenergic I trialed in 2011.  I determined the Formoterol was was nice in that it was fast acting like Albuterol, but too strong.  It made me too jittery, so I stopped the trial
25. Symbicort:  It has Pulmicort and Formoterol in it.  I trialed it in April October of 2012.  I liked it for the same reason I like Dulera, and stopped taking it for the same reason too. 
26. Albuterol tablets:  Sometimes around 1987 or 88 I took these pills.  I never found them to be effective.  Apparently neither did anyone else, as the product was soon thereafter removed from the market

The following are asthma medicines I'm currently on:

• Advair 50/250: The combination inhaler with Serevent and Flovent.  It's been a lifesaver.  
• Advair 50/500:  I take this when my asthma is acting up, and more often I've been taking it regularly.  I usually alternate it with the other Advair
• Ventolin inhaler: The best asthma medicine ever in a handy pocket-size version
• Ventolin Solution:  Used mainly for exacerbations and when the inhaler can't be found
• Prilosec:  It's not uncommon for asthmatics to have stomach problems
• Singulair:  Liekotriene Antagonist basically used to control allergy symptoms.  Take it daily
• Claritin:  Antihistamine used to control allergy symptoms.  I now take it daily
• Ultram:  Allergies, sinusitis and asthma anxiety cause headaches, and this works

400 B.C.-200 A.D.: A history of 'vital air'

Air has existed since the beginning of our existence, that we know for sure.  Without air we wouldn't have life, and people must have figured that out at an early date.  They also must have figured out early that breathing is necessary for life, considering when people stop breathing life end.  (7, page 473)

Primitive people and ancient societies didn't know about air, let alone oxygen, per se.  However,  as far back as 1000 B.C., ancient Hindu physicians who wrote the Charaka and Sustrata recognized both the presence of the lungs and the 'prana vayu,' a substance in the air that many historians believe was oxygen. (5)

"Charaka (500 B.C.) mentions the head, the chest, the ears, the tongue, the mouth and the nose as the seat of 'prana vayu.'  Sustrata (1000 B.C) spoke of 'prana vayu' as flowing in the mouth. What else can this 'prana vayu' be identified with," writes S.K. Jindal in his 2008 book, "Oxygen Therapy." (5)

Anaximenes of Miletus (585-525 B.C.) believed that air "was the primary principle," and he referred to is at the pneuma, or "the breath of life," explains William Henry Osler, the father of modern medicine. He explains that the "pneuma was described by Anaximens as the "psychic force that animates the body and leaves it at death -- 'our soul being air, holds us together'" (9, pages 38-39)

Yet it was Empedocles (490-430 B.C.), a pre-Socratic Greek philosopher, who first conceived the idea that air contained a substance that was vital to life.  He defined air as one of the four basic elements: air, water, earth and water.  Everything that we see is made up of these substances, and health of animals and humans was determined by the equilibrium of these four substances. (9, page 40)

He was also the first to describe respiration:

"As soon as that humidity, of which there is a great store on the first formation of the foetus, begins to be diminished, the air insinuating itself through the pores of the body succeeds it; after this the natural heat, by its tendency to make its escape, drives the air out, and when this natural heat enters the body again the air follows it afresh. The former of these actions is called Inspiration, and the latter Expiration."  (1, page 47-48)

He described how with the inspiration air entered into the body, and that it was circulated through the body by the "continuous motion" of the blood, and that it nourishes the heart and the mind.  Empedocles explains that the heart "nourished in the sea of blood which courses in two opposite directions: this is the lace where is found for the most part when men call Thought; for the blood round the heart is Thought in mankind." (2, page 186)

He also may have been the first to observe of the "faetus in utero" that "respiration commenced before birth."

Aristotle (384-322 B.C.), a Greek philospher and student of Plato (and teacher to Alexander the Great), mentioned "air" as one of the essential elements of life.  He observed that air had weight when he wrote that "a bladder filled with air was heavier than an empty bladder." (6, page 19)

He did not know that there was a difference between arteries and veins, although he did know that both were filled with blood. He also knew that the heart was the key to "circulation" of the vital spirit.  He actually came up with the term vessels as he noted the vessels contained the blood as in a vase. The lungs inhaled the spirits and pneuma from the air from the trachea (which he referred to as the arteria, because it contained air. Hippocrates also referred to the trachea as the arteria. (9, page 72)

Praxagoras of Athens (born 340 B.C.) believed that "pulsation was only in the arteries, and maintained that only the veins contained blood, and the arteries air," writes William Henry Osler.  "As a rule the arteries are empty after death, and Praxagoras believed that they were filled with an aeriform fluid, a sort of pneuma, which was responsible for their pulsation."  He was among the first to study the pulse. (9, page 72)

Archimides (287-212 B.C.), a Greek mathemetician and stronomer, wrote that "air is weighed in air." (6, page 19)

In the 3rd century B.C., Erasistratos (335-280 B.C.) of the School of Alexandria, in Egypt, recognized the relationship between air and blood and that air was essential for life to exist.Around 294 B.C. Erasistratos "taught that arteries carried blood to the various parts of the body; those vessels carried air and air only, and the blood was carried in the other vessels, the veins."  (7, page 473)

He also believed the heart contained no blood (8, page 94)  In fact, Osler explains, it's for this reason arteries got their name, as the term "artery" comes from the Greek term arteria, or air.  The trachea was referred to as the windpipe, or arteria tracheia, also known as "the rough air tube." (9, page 72)

Erasistratos contested that air contained a substance (a pneuma) that, once it entered the body, it was transformed into this "vital pneuma" that was essential for life.  This transformation was performed in the "left ventricle of the heart and, together with blood, results in heat, energy, and life.... a part of the vital pneuma enters the brain where it turns into 'psychic pneuma.'  This psychic pneuma processes sensory perceptions and renders possible understanding and knowledge."  (3, page 8)

Osler adds that this "vital pneuma"  was also the cause of the heart beat, "the source of innate heat of the body, and it maintained the processes of digestion and nutrition." It's sent to the brain where an animal spirit is formed, and this spirit is sent to the nerves of the body to give the person emotion and sensation and motion. Osler explains that when we use the terms "high spirits" and "low spirits," these terms come from the views of Erasistratos and other ancient Greek philosophers.  (9, page 73)

By 70-160 A.D. Athenaeus of Cicilia opened what was called the "pneumatic school" of medicine that "flourished" for many years.  The pneumatic theory held that there was a pneuma in the air that was inhaled, transported to the heart by vessels, and then transported to the rest of the body by vessels.  This pneuma was therefore essential for good health and life, for maintaining a balance of the four humors by maintaining an appropriate level of heat and moisture. (2, page 291)

Aretaeus of Cappadocia (130-200 A.D.), a physician from ancient Greece, believed the heart was "the exciting cause or principle of respiration," according to Hamilton, "being seated in the centre of the lungs, which it inspires with a desire for fresh air. The lungs he did not believe to be susceptible of pain, from being composed of a loose sort of substance like wool; rough cartilaginous arteries, according to him, were dispersed throughout them; they were unprovided with muscles, and furnished only with some small and slender nerves, by means of which their motion was produced." (1, page 32)

Middle Ages diagram of Galen's concept of blood flow

Aelius Galen (130-200 A.D.), a famous Greco-Roman physician, studied the heart extensively  Osler notes that he "studied particularly the movements of the heart, the actions of the valves, and the pulsatile forces in the arteries.  He observed venous blood was darker, and believed it provided nutrition to the body. Arterial blood was thinner and brighter, and this was because it contained an abundance of "vital spirit," or vital air.  Arterial blood was warmed in the left ventricle, and this heat was sent to all the organs of the body.(9, page 80).

Galen also observed, as did Erasistratus, that the veins and arteries communicate by small pores and small vessels that allows for the mingling of spirits and blood. He did not, however, know the blood circulated, as he though it made it's way to the organs by small pores. However, some historians, including Osler, believe he was very close to figuring this out, and if given more time he probably would have. He did not see the heart as a pump, but as a fireplace, notes Osler. (9, page 80)

He believed the purpose of the heart was to warm the blood.  He believed the left ventricle purified the blood and sent pure blood to the vital organs, such as the liver.  (7, page 473)

It should also be known that, according to Phillip Crampton in his 1839 "Outlines of the history of medicine, nothing remains of the writings of Erasistratos, so much of what we know about his anatomical discoveries comes from the writings of Galen. Crampton said that Galen described Galen's view of the passage of blood and air through the body this way:

According to him, the air passes from the lungs to the heart, which performs the functions of a smith's bellows, attracting the air by the dilatation of the left auricle ; from the left auricle it passes by the arteries which contain air, or rather animal spirits, to every part of the body. The veins contain all the blood, and according to this supposition, fever and inflammation are the consequence of any portion of blood passing, by an error loci, from the veins into the arteries. (10, page 519)

Galen supported this view and added to it.  Crampton explains it was Galen who was perhaps the first to describe human respiration:

Some notion of the state of experimental philosophy in the time of Galen, may be formed from the account which he gives of the experiment by which he Convinced the assembled physicians and philosophers of Rome, that air was contained within the cavity of the chest, between the lungs and the pleura costalis; he says he explained to them the manner in which the air passed from the lungs through the cribriform plate of the sethmoid bone into the ventricles of the brain, in which a true respiration was performed, the organ rising and falling in correspondence with the motions of the chest, and the air escaping through the sutures and the palate (10, page 520)

So Galen supported the views of Erasistratos and then expanded upon them. He agreed with Erasistratus that some pneuma in the air was inhaled, warmed in the heart, and sent to the body by a series of vessels and cannals and pores.  He also believed something of waste was exhaled.  He actually proved by experiments Erisistratos wrong when he asserted the arteries contained air not blood.  Galen proved arteries contained blood.  (7, page 473)(9, page 82)

Arthur John Brock, in the introduction of his 1916 translation of some of Galen's works, explains Galen's thoughts on how blood and air flowed through the body:

In his opinion, the great bulk of the blood travelled with a to-and-fro motion in the veins, while a little of it, mixed with inspired air, moved in the same way along the arteries; whereas we now know that all the blood goes outward by the arteries and returns by the veins; in either case blood is carried to the tissues by blood-vessels, and Galen's ideas of tissuenutrition were wonderfully sound. (10, page xxxvi)

He also explained that the "spongy flesh of the lungs acts upon the air we inhale converting it to a subtler product, pneuma.  This refined breath passes through very find 'pores' into branches of the pulmonary vein, and thence is 'attracted,' with blood, by the attractive faculty into the left ventricle of the heart, where it encounters more hot blood and becomes metamorphosed into life giving, i.e. 'vital' pneuma." As the pneuma is 'transported' to the various parts of the body it is further metamophosed.  (4, page 45)

Why were there two sets of vessels for the same fluid? Galen wondered.  And he speculated, as historian William Hamilton notes that:

the great vein (vena cava) was the great reservoir of the blood, while the aorta was the recipient of the spirits, and that, notwithstanding the proximity of the mouths of the veins and arteries to each other, the blood, during the continuance of health, did not enter the vessels in which the spirits flow; but, when this arrangement happens to be disturbed by any violence, that the blood forces its way into the arteries, and occasions more or less disorder of the system. The only use which he assigned to the process of respiration was to supply the arteries with air (what he referred to as vital air).

Yet this is all just speculation, and there were many theories as to what this 'vital air' contained.  Regardless, Galen was so well respected by the medical community that his theory grabbed a hold and held a prominent position in the minds of physicians for the next 1,900 years.  This theory held strong even when better wisdom became available.

References:

1. Hamilton, William, "A History of Medicine, Surgery and Anatomy," 1831, Vol. I, London, New Burlington
2.  Prioreschi, Plinio, "A History of Medicine: Greek Medicine," Vol. II, 1994, 2004, 2nd ed., NE,  Horatius Press
3. Tesak, Juergen, Chris Code, "The History of Aphasia: Theories and Protagonists," 2008, New York, Psychology Press
4. Wilson, Nigel, "Encyclopedia of Ancient Greece," 2006, NY, Taylor and Francis
5. Jindel, S.K.,Ritesh Agarwal, "Oxygen Therapy," 2009,2nd ed., Jaypee Brothers, pages 5-8
6. Tissier, page 19
7. Hill, Leonard, "Recent Advances in Physiology and bio-chemistry," 1908, London, Edward Arnold
8. Garrison, Fielding H, "An introduction to the history of medicine," 3rd edition, 1922, Philadelphia and London, W.B. Saunders Company, page 95
9. 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,
10. Crampton, Phillip, "Outlines of the history of medicine from the earliest historic period to the present time, intended to illustrate the connextion between the progress of anatomy and the improvements of the healing arts," read before the Royal College of Surgeons on November 29, 1838, published in The Dublin Journal of Medical Science, 1839, Volume 14, Dublin, Published by Hodges and Smith, pages 504-533
11. Galen, writer, Arthur John Brock, translator, "Galen: On the Natural Faculties," 1916, London and New York, William Hienemann and G.P. Putnam's Sons

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.