1750-1870: Air is defined

Stephen Hales (1677-1761)

So by the 1750s it was well known that air was more than just an element, that it was composed of certain gases.

In 1553, Michael Servetus was the first to speculate that it was the lungs that caused dark blood to become bright red, and not the heart.

In 1640, William Harvey was the first to describe the systemic circulation of the blood through the vessels of the body.

In 1668, John Mayow was the first to speculate that the purpose of the lungs was not to cool the heart, but for the exchange of gases.  He believed a substance in the air -- nitro-aerial gas -- was inhaled into the lungs, and when it entered the blood stream the blood turned from a dark color to a bright red.  This, he speculated, was why venous blood was dark and arterial blood red.

He also speculated that a vapor produced by the blood was exhaled by the lungs. He did not know that nitro-aerial gas was oxygen, and he did not know that the substance produced by the blood and exhaled by the lungs was carbon dioxide. He may have made thes discoveries had he not died at the young age of 35, before any of his works were published.

So, by 1750, investigators had determined that one of these gases was fixed air that was exhaled by the lungs, and the other was a vapor that was inhaled by the lungs.  In the next 50 years the composition of air, and the purpose of respiration, would be well known.

Stephen Hales performed experiments on air and respiration, and he proved that there is no circulatory system in trees like there is in humans and animals.  (4, page 193)

Fixed air was further studied by Joesph Black.  He was the first to recognize that this gas was burned off during the exhalation phase of respiration.   He discovered it "was deadly to animals, and could distinguish a flame." (3) (4, page 193-194)

Joseph Black (1728-1799)

Oxygen was first described in 1740 by Alexander Ferguson, yet it wasn't discovered until 1773 by Carl Wilhelm Scheele (1742-1786).  Scheele would later describe the discovery of a gas (empyreal air) that made candles burn brighter. The problem for him was that by the time he wrote about it someone else had already gotten credit. (2, page 282)

Unaware of the works of Scheele, and unaware that a third man -- Antoine Lavoisier (1743-1794) -- was doing similar research, (1) Joseph Priestly (1733-1804) published a work in 1772 called "Observations on different kinds of Air."

He described experiments he performed, and thus gained the interest of the science community. He "noticed that blood placed in an atmosphere of hydrogen or nitrogen gave off what we now refer to as oxygen. It was in this book that he described his discovery of oxygen, and for this reason he is given credit for its discovery, despite the works of other men.    (5, page 517)

Joseph Priestly (1733-1804)

He also observed that mice living in an environment with supplemental oxygen lived longer than mice who breathed normal air.  This was the first proof of the therapeutic benefits of supplemental oxygen.  (2)

Priestly then concluded the work of Michael Servetus, who noticed that the lungs changed the color of the blood and were the reason arterial blood was a brighter color.  Priestly proved that oxygen is inhaled into the lungs and exchanged from the alveoli to the capillaries and then into the arteries.

I think it's interesting to note why Priestly referred to oxygen as "dephlogisticated air."  It's explained best here:  

(Priestly's) experiments were sound, but his views on respiration were erroneous, vitiated as they were by his belief in the old theory of "phlogiston" introduced by (George) Stahl (1659-1734) in 1697. Phlogiston was the material and principle of fire, not fire itself, and respiration, according to Priestley, was a phlogistic process, whereby the phlogiston absorbed by animals with their food was discharged. Venous blood was phlogisticated, arterial blood dephlogisticated; a clot of blood placed in "fixed" or phlogisticated air became very dark, but regained its red colour when it was transferred to oxygen or dephlogisticated air. This old theory was overthrown a few years later by Lavoisier, who extended and explained correctly the discoveries of Mayow, Black, and Priestley; he showed that there were differences in the so called phlogistic processes. (5, page 476)

Antioine Lavoisier (1743-1794)

Yet while Priestly is given credit for the discoverey of oxygen, it was Lavoisier who was given credit for the name. While each early discoverer gave the new element his own name (Priestly called it "dephlogisticated air), the term "oxygene" was chosen by Lavoisier because he believed his new molecule was the great 'acidifying principle in nature. Oxygen is Greek for generator of acids.(1)
Lavoisier believed oxygen was acidic in nature because of some of the things it did. For instance, Lavoisier discovered that oxygen was involved in the rusting of metals, the formation of dew, as well as the respiration of animals and humans. Because it created such changes he believed it was an acid.

Stephen Hales (1677-1761)

Lavoisier, working with Pierre-Simon Laplace, determined, in 1780, that the body's heat was a byproduct of combustion that takes place in the body.  So in this way he disproved Galen's theory that a body's heat was produced in the heart. He later determined this combustion took place both in the lungs and other places in the body. It was later proved by others that it was in the tissues that respiration occurs.  So this was the beginning of knowledge of respiratory exchange.  (5, page 476)

The rush to learn more about air was on. Hales continued his research, and he created a device he called a pneumatic trough that he used to collect both carbon dioxide and oxygen, and now he was certain that plants obtained their nourishment from this air. (4, page 193)

Henry Cavendish (1731-1810)

Henry Cavendish (1731-1810) discovered hydrogen, or what he referred to as "inflammable air." He "exploded a mixture of hydrogen and oxygen and thus proved that water was not an element, but a compound of two gases." (4, page 194)

It has since been discovered that oxygen is present in most acids.  So for this reason the name "oxygen" really isn't an appropriate name for oxygen.  Yet the name stuck.  (1)

Experiments on animals by these men, and many other men to follow, proved that oxygen was the essential element of life.

The first reported experiments using oxygen on humans was done in 1783 by Francois Chausier (1746-1848). His experiments involved patients who had consumption (tuberculosis) and were dyspneic. He also used it for asphyxiated newborns. His and other early experiments using oxygen proved oxygen could be therapeutic for respiratory disorders, such as any disorder that caused dyspnea.  (2)

Francois Chaussier (1746-1848)

Realizing there might be therapeutic benefits from oxygen, and perhaps a profit to be made, Thomas Beddoes (1730-1810)  opened up the "Pneumatic Institute" in Bristol shortly after its discovery.  This was the first of what would later be referred to as oxygen parlors, which became common in the 19th century.  (2, page 281)

Beddoes devised a system where any amount of oxygen could be added into the atmosphere of small compartments.  A patient would spend a certain amount of time in these compartments breathing supplemental oxygen.  He described the following as being treated satisfactorily with such oxygen therapy: obstinate ulcers, leprosy, spasms, cancer, dropsy, hydrocephalis, headache, poisoning by opium, paralysis, scofulous tumors, scorbutus, venereal, deafness, white swelling, melancholy, general dibility, continued fever, intermittent fever, and coldness of the extremities.  (2, page 281)

Thomas Beddoes (1730-1810)

Yet despite the therapeutic experiments of Beddoes, oxygen was not accepted by the medical community, perhaps mainly due to the fact there were not efficient and inexpensive devices for making it and delivering it to the patient.  (2, page 281)

Of course there was also no experiment that proved without a doubt the benefits of using it either.  (2, page 281)

After Beddoes oxygen wasn't used therapeutically again until a cholera outbreak in 1832. (2, page 281)

Still, investigators continued to learn more about the microscopic structures in the body responsible for the transfer of oxygen through the body.

In 1840 Hunefeld found crystals in the blood of earthworms, and essentially became the first to observe hemoglobin.  He is therefore the person credited with its discovery.

Hemoglobin is the essential protein on red blood cells that carries oxygen or carbon dioxide in the blood.

In 1862 Hoppe-Seyler described the transport of oxygen on hemoglobin, and in 1864 George Stokes (1819-1903) described why oxygen changes the color of hemoglobin, and therefore darkens arterial blood. (5, page 525)

In 1870, Pfluger described tissue oxygenation.

In 1857 Claude Bernard (1813-1878) described that the color of blood was changed from bright red to dark because the dark blood contained more carbon dioxide. (6, page 239)

Carl Ludwig (1816-1895)and others proved the change in color had more to do with oxygen's attachment to hemoglobin.  When oxygen is attached to the hemoglobin the blood is redder, and when oxygen jumps and carbon dioxide replaces it the blood becomes darker. (1816-1895)

This explanation better explains the difference in color between arterial (freshly oxygenated blood from the lungs to tissues) and venous blood (deoxygenated blood from tissues going back to the lungs).(6, page 239)

It wasn't until the mid 19th century, however,  that oxygen parlors became readily available for use.  They essentially create dan oxygen enriched environment for those who wished to inhale it try it, either therapeutically or for entertainment.  (2)

By the turn of the 20th century physicians knew why breathing was essential to life, and the process of inhaling oxygen and exhaling carbon dioxide was referred to as ventilation.

The first two decades of the 20th century would see an increased effort to determine the benefits of oxygen therapy, and to invent better technology of delivering it to patients.  These efforts would gain urgency due to poisonous gases used in WWI.

References:

1. Gray, Alonzo, "Elements of Chemistry:  Containing the Principles of the Science, both experimental and theoretical," 1840, Massachusetts, page 118
2. Brainbridge, William Seaman, "Oxygen in Medicine and Surgery -- a contribution with report of cases," New York State Journal of Medicine, 1908, Vol. 8, June, No. 6, pages 281-295
3. "Carbon Dioxide,"  Scienceclariied.com, http://www.scienceclarified.com/Ca-Ch/Carbon-Dioxide.html#b, observed the site on May 4, 2012 (this information is available at a variety of sources, although I chose to give sciencedaily.com credit)
4. Magner, Lois N., "History of Life Sciences," 2002, 3rd edition, New York, Marcel Dekker
5. Hill, Leonard, Benjamin Moore, Arthur Phillip Beddard, John James Rickard, etc., editors, "Recent Advances in Physiology and bio-chemistry," 1908, London, Edward Arnold
6. Fruto, Joseph S, "Proteins, Enzymes, Genes: The Interplay of Chemistry and Biology," 1999, New York, Yale University

476-1543: The dark ages of medicine

It's amazing how people could go from living amid the flourishing civilizations of Ancient Greece and Rome to living as desolates in a world where learning stopped and knowledge retrogressed.  This is what essentially occurred beginning with the fall of Rome in 476 A.D. 

From the 5th through the 11th century, knowledge of science and literature was limited to a select few, such as the clergy, according to historian Edward Withington in his 1894 book "Medical History from the Earliest Times,"  (1, page 175).

In the meantime, during the dark ages, if you didn't have a need to know, you were left in the dark, literally.  This is one reason the Middle Ages, the Medieval era, is so often referred to as the Dark Ages.  People were kept illiterate and ignorant, and for the most part they accepted this ignorance as the path to eternal life in heaven.

For the most part, and with only a few exceptions, the Ancient Greek language was all but unknown in Western Europe.  This was unfortunate because "at this time Greek was still the key to all higher knowledge, especially in medicine," said Withington.  "Latin versions of some Galenic treaties, indeed, existed, yet they were so little known that Constantine the African (1020-1087) 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 entirely forgotten." (1, page 176)

William Osler, in a 1913 lecture at Yale, explained that "Knowledge other than that which made a man 'wise unto salvation' was useless.  All that was necessary was contained in the Bible or taught by the Church.  This simple creed brought consolation thousands and illumined the lives of some of the noblest of men.  But 'in seeking a heavenly home man lost his bearing upon earth.'" (2, page 85)

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. 
.
While the dark ages for western civilization ended in the 11th century, the dark ages of medicine lingered on until the 16th century.  Thankfully, however, while the west was clouded by the dark ages, the opposite was occurring in the east, where there was a bright cloud, and medicine flourished.

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

1213-1644: The discovery of gases and basic anatomy

Roger Bacon was perhaps the first to conceiveof the idea that a substance,
later called carbon dioxide, was in the air when cellars where grapes
were fermenting. He does not get creditfor the discovery of CO2, however.  

Even though Galen's theories about air held sway over the scientific community, there were various great minds along the way that doubted Galen, and based on their own observations, set out to perform experiments that would prove Galen wrong.

Roger Bacon (1213-1294) was born in Kilchester in Somersetshireto to a wealthy family when Henry III (1207-1272) was the King of England.  He spent 8-10,000 pounds performing his own experiments, went to Oxford, "where his great abilities were soon recognized."  He then moved to Paris, "the center of intellectual learning at the time," said historian Thomas Bradford. (14, page 112)

He was "disgusted with the superficial scholastic methods at the time, and devoted himself to the study of languages and experimental research," said Bradford.  (14, page 112)

Bradford said he ended up back at Oxford by 1250 and found himself a member of the Fransiscan order. (4, pages 112-113)

 "His fame spread at Oxford, although it was whispered that he had dealings in magic and the black arts.  Some doubts of his orthodoxy were expressed, and in 1257 Bonaventura, the General of his orders, forbade his lectures at Oxford, and commanded him to leave the town and place himself under the command of the body in Paris.  There he remained for ten years under constant supervision, suffering great privations, and not allowed to write anything the might be published." (4, pages 112-113)

During his life there was much scorn and animosity toward the medical profession and science in general, although somehow he gained the respect of Pope Clement IV (1195-1268) who "wrote to Bacon ordering him, notwithstanding the interdict of his superiors, to write out and send him a treaties on the sciences.  Previous to this he, discouraged, had composed but little; but taking heart of grace and despite of the many obstacles thrown in his way by the jealousy of his superiors and brother friars, he completed in 18 months three large treatises, the Opus Magnus, Opus Minus and Opus Tertium. In 1268, Bacon was released and allowed to return to Oxford, where he continued his labors in experimental science, and in completing his numerous treatises. He wrote a great many works on alchemy, philosophy and physics." (14, page 113)

So Bacon's life is yet another example of how hard it was for great minds in this era to perform experiments, and to get their works published.  However, he made the observation that air in cellars where grapes were fermenting was not normal, and prolonged exposure resulted in mental changes and possibly death.  He determined there was a substance in this that he called gas sylvestre.  This gas later became known as carbon dioxide.

Perhaps among the most significant contributions to science came from Nicolaus Copernicus (1473-1543), who in 1543 discovered that the planets revolve around the sun.  Out of fear of persecution, his works weren't published until after his death, although they had an astounding impact on other great minds, thus opening the door for the scientific revolution that followed.

In 1609 Galileo Galilee  (1564-1642) invented the telescope,  (11, page 255), and continued on to make astronomical observations that supported the works of Copernicus.  He had the courage to face the dogmatic Church, and published his works during his lifetime.  As a result, he was arrested for heresy and spent the rest of his life under house arrest.  His energy, courage and sacrifices, however, made him a significant player in the scientific revolution.  By history, he is considered among the fathers of modern physics and science.

Garrison notes that the works of investigators such as Copernicus and Galileo, and other such great men, also had an impact on medicine.  For example, in 1600 Galileo invented a "rude thermometer or thermoscope, and as early as 1600 (Johannes) Kepler had used pulse-counting to time his astronomic observations."  (11, page 258)

Surely investigators studied the stars and planets, they also studied plants, animals and humans, learning much about anatomy, how life is created and sustained, and about diseases.  Also investigated was the air we breathe, and its relationship with the sustenance of life.

For instance, in 1541 Paracelsus (1493-1541), a Swiss Alchemist, suggested that a substance in air was essential for sustaining life.  (6)  Another great example is Johann (Jan) Baptist van Helmont (1577-1644), a man who greatly appreciated the works of Paracelsus, and who performed tests on this substance, and he "recognized its true origin and defined its principle characteristics."  (1, page 19)

Van Helmont is also the first to use the term 'gas.' as something "distinct from air and water vapor."  (2, page 40) (1, page 19)  He believed that when God created Heaven he thus created water and air.  Van Helmont performed a variety of tests to prove that water was separate from air, and that water could not be turned into air.  He determined that air could be compressed and water could not, and he also deduced that "air could be reduced to one-half of its original volume under pressure."  (3, page 96)  

He likewise observed that water could be metamorphosed into ice, vapor and gas (his new term).  (4, page 64)  He knew he had a substance that was not water and not vapor, and he knew he had to come up with a term to describe it.  So he used the term "chaos," shortened it a bit, and came up with his new term 'gas."  He explained that "I have called this mist Gas, owing to its resemblance to the Chaos of the Ancients." (5, page 179)

Elizabeth Potter, in her 2001 book, explains that "Experimentally, we see that when the flame of a candle burning on top of a water surface and enclosed in a cylinder has consumed the air, the water rises in the cylinder and extinguishes the candle.  Helmont argued that the otherwise empty space within the air contains magnale or spirit of the air.  This Magnale is also a third thing between spirit and matter, and it, not air, keeps us alive when we breathe." (3, page 96-7)

Out of fear of persecution, van Helmont's works weren't published until after his death in 1648 by his son. Van Helmont has since become known as the founder and father of pneumatic chemistry.

Another interesting tidbit about van Helmont was that he is believed by many historians to be the first physician to oppose the Hippocratic humoral theory of disease, that diseases were caused by an imbalance of the four humors: blood, phlegm, black bile and yellow bile.  He was also the first to oppose the four elements so duly championed by Aristotle, of earth, fire, water and air.  Instead, he created some of his own theories based on his experiments.  For example, he believed the two primary elements were water and air.

Robert Hooke discovered the respiration
was not to keep the circulation of the
blood moving.

In 1553 Michael Servetus (1509?-1553) discovered that blood circulates through the body.  He accurately diagrammed the flow of blood through the body, and explained that the lungs cause the arterial blood to be a brighter red in color, and not the heart, as Galen taught.   (7, page 474)

He was also the first to speculate that blood does not cross through a septum (or invisible pores) from the right ventricle to the left ventricle as Galen had suggested, but takes another route. He described that the blood entered the left ventricle during diastole, and this is where the "vital spirit" is formed, and from there it travels to the arteries. (8, page 63-64)

In this way he was the first to suggest that the blood must go through the lungs in order to get to the heart.  For being so brave to announce his suggestions that were opposed to the mighty Galen, he was burned at the stake.  (15, page xxiii)

Severetus's pupil, Andreas Vesaleas, was the first person to publish an accurate anatomy of the body.  He performed autopsies, and had a painter paint what he saw.  He erred in believing that the  purpose of circulation was to cool the blood.  (7, page 474)(11, page 243-4)

Vesaleas also used bellows to push air into the trachea of an animal, and this experiment was later used by Robert Hooke (see below) to prove that artificial respirations could be used to keep a person alive.

Vesaleas is considered by many as the modern father of anatomy, and you can read more about him by clicking here.

Another student of Servetus  was Realdus Columbus (1516-1569).  He was a surgeon and professor of anatomy at Padua from 1544 until his death in1569. He continued Servetus's work on circulation of the blood, describing the passage of blood from the vena-cave to, through the pulmonary circulation, and then through left ventricle and aorta. (8, page 70-71) Columbus also saw that blood changes in the lungs.  (11, page 243)

Andrea Cesalpino (519-1603) was the first to describe the idea that blood circulates through the body.  But he usually doesn't get credit for this observation because he failed to prove it.

William Harvey (11, page 242)

Continuing the work of Servetus was William Harvey (1578-1657).  Bradford said he was born in 1578, at Folkestone in Kent, and by the time he was ten-years-old he was accepted at Caius College, Cambridge, in 1593.  He studied there fore five years, then traveled to France and Germany, and then studied at the "celebrated" medical school at Padua. (14, page 119)

Bradford said that he studied under some of the most renowned anatomists of the era, including Dr. Fabricius.  14 page 91)(15, page xxiii)

Hieronymus Fabricius (1537-1619) studied the venous system of the human body, and discovered membranous folds that he referred to as valves.  He speculated that these allowed blood to flow upward.  Since the blood pressure was lower the farther blood gets from the heart, these valves were necessary to prevent gravity from pulling blood on it's way back up the legs to the heart and lungs from being pulled back down to the lower legs and feet (and thus causing dropsy of the feet). (14, page 92)

In other words, his discovery of valves made Fabricus wonder if the blood circulated as opposed to moved in a to and fro motion as Galen had suggested.  But whether this was true or not would be left to one of his students to determine, and that student so happened to be William Henry. (14, page 93)(15, page xxiii)

Some say he lectured by candle light.  Perhaps it was in this "light" that William Harvey was introduced to veins and valves.  This wisdom, coupled with the enthusiasm of his instructor, inspired Henry to further investigate these veins and valves to learn more about them. "Perhaps," Harvey must have wondered, "Fabricius is right, that the blood does circulate." (14, page 119)

Bradford said he graduated from Padua in 1602 and began a practice in Cambridge in London.  Then, in he became a physician at Bartholomew's Hospital, and in 1615 became professor of anatomy and surgery at the college.  It was here began his own anatomical research.  (14, page 119)

Like Andreas before him, he wasn't satisfied with the current method of just speculating about the movement of the blood and heart, or that assuming it was knowledge only God was privy to. He studied the heart and vessels, and came to the conclusion that the heart was a pump, and it circulates the blood through the body. (9, page 168-169)

Of course, once Harvey published his discovery, his medical practice took a hit, and he was criticized by a dogmatic medical profession.  However, in the end, Harvey would be proved right, and his ideas (of course based on science as opposed to theory) would win out, and he lived long enough to see his theory become accepted, according to Fielding Hudson Garrison in his book "Introduction to the history of medicine." (11, page 246) (also see 14, pages 119-120)

Garrison describes "William Harvey" as the "greatest name in the seventeenth century... and whose work has exerted a profounder influence upon modern medicine than that of any other man save Vesalius.. it was the most momentous discovery since Galen's time." (11, )  However, his view that the purpose of breathing was to cool the blood "retarded the development of the true physiology of respiration for a long time." (11, page 242-244)

Garrison further explains that Harvey's proof that all blood passes through the lungs, and circulates around the body, made it possible for physiology to become a "dynamic science."  It was through this discovery, one that barely eluded so many other eyes, that made it possible, for one thing, later investigators to inject dyes and other solutions into the vessels that resulted in many anatomical discoveries, such as:  (11, pages 244-248)

• Lacteal Vessels by Gasparo Aspelli in 1622
• Thoracic Duct by Jean Pecquet 
• The Pancreatic Duct by Georg Wirsung in 1642
• Circle of Willis in by Thomas Willis in 1664
• Capillaries in the lungs by Marcello Malpighi in 1661 (see below)

While his comrades initially rejected his theory that blood circulates through the body, King Charles "took great interest in these discoveries and witnessed several experiments.  Several years after he made this discovery, and when he was 50 years old, he wrote a book defending his discovery.  Perhaps it was due to his friendship with the king that his ideas were accepted before his death in 1657. (14, page 119-122)

Of course each of these discoveries dispelled some ancient myth about the flow of substances through the body.  For instance, Galen believed the purpose of "veins and lymphatics of the intestines carried chyle to the liver, according to Garrison.  This theory of Galen was disproved by the above discoveries, all thanks to the discovery that blood circulates through the body by Harvey.  (11, page 246-7)

Galen believed the pulse would help determine changes in the pneuma, indicating disease.  Harvey, on the other hand, described that the beating of the heart correlates with the pulse felt at the various points on the body. As the pulse is felt, this is when blood is forced through the many vessels of the body during contraction of the heart. The heart then relaxes, and this is when the heart receives blood. The strength and force of the pulse, therefore, is a direct correlation to the strength and force of the heart.(9, page 168-169)

He generally agreed with Columbus that the right ventricle of the heart pumps blood to pulmonary artery to the lungs where the blood is nourished, and the left side of the heart pumps blood to the various arteries of the body. As quoted by Osler:  (9, page 170)

"I began to think whether there might not be A Movement, As It Were, In A Circle. Now this I afterwards found to be true; and I finally saw that the blood, forced by the action of the left ventricle into the arteries, was distributed to the body at large, and its several parts, in the same manner as it is sent through the lungs, impelled by the right ventricle into the pulmonary artery, and that it then passed through the veins and along the vena cava, and so round to the left ventricle in the manner already indicated." (10)

Marcello malpighi was the first to observe
capillary anastomosis, although he did not
attach importance to it.

While the Fabrica opened the eyes of the anatomist, the discovery that blood circulates inspired the anatomist to learn more about the physiology, or the functions of the body.  In this way, he inspired people to learn more about medicine, and how medicine affects the various organs of the body.  He therefore is referred to by many as the modern father of medicine.  (15, page xxiii)

One of the main limitations that nearly brought his research to a "standstill" was the inability to see the microscopic capillary anastomosis, which are the microscopic connections joining veins with arteries.  (11, page 245)

Marcello Malpighi (1628-1694), professor at the University of Bologna, discovered the alveoli and capillary in 1661, and observed exchange of air from the lungs to capillaries in a frog.  (7, page 474)  (14, page 142)

In 1665 he discovered blood corpuscles, (14, page 142) or what we refer to as red blood cells.  These cells are the main constituent in blood, and their main responsibility to is carry oxygen through the blood stream to the various organs of the body.

Garrison said that this was the missing link that Harvey was looking for regarding the complete circulation of blood through the body.  (11, page 247)

Malpighi's discover was verified by later observations:

• Dublin professor William Molyneux observed the capillary system in lizards in 1683.  
• Anton von Leeuwenhoeck (1632-1723) observed capillaries in the larvae and feet of frogs in 1688
• William Cowper "saw the passage of the arterial into the venous current in the mesentery (membrane that attaches the intestines to the abdominal wall) of a cat in 1687 (14, page 142)

Getting back to Harvey, there was more good than harm that came out of the brilliant mind of Harvey.  For instance, Garrison notes the following, which is significant to our history:

The most brilliant outcome of Harvey's experimental method was in the clearing up of the obscure matter of the physiology of respiration... Before Harvey's day, men still believed, with Galen (and even Vesalius), that the object of respiration was to cool the fiery heart, the purpose of the chest movements being to introduce air for generating vital spirits by the pulmonary vein, and to get rid of the heart's smoky vapors by the same channel. This Galenic notion was not a mere piece of symbolism, as in Richard Crashaw's (1612-1649) poem on St. Teresa (The Flaming Heart), but was part and parcel of actual belief about the physics of the circulation. "Before Harvey's time," says (Sir Clifford) Allbutt (1836-925), "respiration was regarded not as a means of combustion but of refrigeration. How man became such a fiery dragon was the puzzle." Harvey's demonstration showed that the blood is changed from venous to arterial in the lungs, but beyond that point, as even (Samuel) Pepys (1633-1703) has recorded in his Diary, no one could tell how or why we breathe (13, page 266)

Per Garrison, Pepy's wrote regarding respirations:

But what among other fine discourse pleased me most was Sir G. Ent about Respiration; that it is not till this day known or concluded among physicians, nor to be done either, how the action is managed by nature, or for what use it is." (13, page 266) 

Giovannin Alfonso Borelli (1608-1679) was the first to describe muscular activity, the beating of the heart, and the function of the lungs, and digestion as purely mechanical acts, thus dispelling ancient theories. He also discovered that arteries were elastic,

Conrad Victor Schneider (1614-1680) studied the membranes in the nose, and became the first to recognize that phlegm was secreted by this membrane, what is now known as the Schneiderian Memberane.  Before his discovery, it was believed that phlegm was formed in the brain during some disease processes and merely drained into the nasal cavity and into the lungs.  Schneider's observation, which was made in 1664, was among several necessary in order to slowly, ever so slowly, put an end of the age old Grecian theories holding back the medical profession.  (14, page 124)

In 1636 Robert Boyle (1627-1691) discovered the presence of gases in the blood, and is therefore perhaps the first to describe an element.  He found that "fresh defibrinated blood gave off bubbles of gas when it was exposed to the vacuum of an air pump."  A few years later John Mayow (1640-1679) thought the gas was nirto-aerial gas, or what we now refer to as oxygen.  (7, page 517)

He was, therefore, the first to prove that there was more to life than the four basic elements (Earth, Air, Water, fire) were not the only essential elements of life.  Of course Van Helmont was considered to be a madmen by the scientific community and the medical profession.  It was not appreciated during this time to oppose accepted doctrine.  (2, page 40)

Of course Boyle is also famous for a law of physics named after him called Boyle's Law.  This states that at a constant temperature the pressure of a gas has an inverse relationship to it's volume. This law would become very significant to many of the later researchers.  This law explains why we breathe, why popcorn pops, why a tea kettle whistles,  and why a balloon bursts when you blow too much air into it.  The same law would later be used by physicians to explain why inventions like Robert Hooke's bellows might cause trauma to the lungs, as you will see in a moment.

In 1665 Robert Hooke (1635-1703) invented the compound microscope, and this would ultimately play a significant role in both science and medicine.  (11, page 256).  In 1667 Hooke discovered that respiration was not to maintain circulation, as had previously been thought.  Interestingly, Hook took the trachea of a dog and connected it to a "pair of bellows, and the ribs and diaphragm were removed;  the dog was seized with convulsions and appeared to be dying, but revived when air was blown into the lungs.  Small punctures were now made into various parts of the lungs, and by means of two pairs of bellows the lungs were kept fully distended with fresh air; the dog remained quiet and its heart beat regularly. The circulation continued although there was no alternate expansion and collapse of the lungs; moreover, a further experiment showed that even when the lungs were allowed to collapse the blood continued to circulate for some time. " (7, page 474)

By his experiment, Hooke also proved that "by blowing a bellows briskly over the open thorax of a dog, that artificial respiration can keep the animal alive without any movements of either chest or lungs. The experiment, which had been performed by (Andreas) Vesalius (1514-1564), proved that the essential features of respiration is not in its intrinsic movements, but in certain blood changes in the lungs." (11, page 267)

Also in 1665 Richard Lower (1631-1691) performed the first successful blood transfusion, taking the blood of one animal and inserting it into the animal of another.  Then, in 1669, he "lower injected dark venous blood into the insufflated lungs, and concluded that its consequent bright color was due to the fact that it had absorbed some of the air passing through the lungs."  (11, 267-268)

John Mayow -- He was the first to discover
Oxygen, although never received credit because
he died at the young age of 35, before his writings
were published, and therefore his discoveries
were forgotten by history until the 20th century.  

Jan Swammerdam (1637-1680) became an expert in dissecting animals, studying them with the stethoscope, and describing their anatomy.  He was the first to describe the anatomy and life cycle of bees and other insects.  In 1658 he discovered red blood cells in the blood of frogs.  He postulated that an element (later found to be oxygen) could be carried by blood to the various muscles of the body.  (11, page 251)(12, page 366)

In 1664 he discovered that fetal lungs of mammals sink before a breath has been taken, and float after respiration has taken place. He also demonstrated that a frog leg could be made to contract, and this proved useful by later investigators.  His works were published posthumously by Herman Boerhaave in 1737. (11, page 251)(12, page 366)

Antonj van Leeuwenhoek (1632-1723) had a collection of over 247 microscopes which he used to study plant, animal and even human specimens.  He was the first to accurately describe the anatomy of a red blood cell in 1674.  He also saw the capillary anastomasis previously described by Malpighi.  It was through Malpighi and Leeuwenhoek "which finally completed Harvey's demonstration."  (11, page 251)

Antonj van Leeuwenhoek observed and
described capillary anastomosis, and in this
way finally proved that Harvey was right,
that blood circulates through the body. 

John Mayow (1664-1679) learned by his many experiments that dark bloooyd turns bright red upon taking up certain particles in the air, and he referred to these particles as "nitro-aerial gas."   He also learned that blood exposed to a vacuum gave off bubbles, and he believed this to "nitro-aerial gas."  He was right, and the substance, as later proved, was oxygen. While he did not discover oxygen, he was that close. (7, page 475) (11, page 268)

However, he did learn there was indeed a substance in the air, what he called "nitro-aerial gas," that was "necessary for all forms of life," and it was inhaled during the process of respiration.  He thus concluded that respiration was not to cool the blood as previously thought, but for the exchange of gases.  Substances in the air were were inhaled into the lungs and absorbed by the blood in the lungs (thus changing its color from dark to bright red).  Another function of respiration was "the removal of vapors arising from the blood." (7, page 475)

If that wasn't enough, he also discovered that maternal blood supplies an unborn fetus with not just food, but also with "nitro-aerial gas." While he proved that respiration was not to cool the blood, he also proved the blood is not the source of its own heat.  Instead, he proved that heat was produced by the activity of the muscles of the body.  (11, page 268)

Mayow's works were  published in 1668 and 1674, although he died at the early age of 35 before his works were published.  So he was was never recognized until the turn of the 20th century.

So while he doesn't get credit by history, Mayow may actually have been the first person to discover oxygen.  Yet, unfortunately, history doesn't give credit for the first to do something, but the first to publish their discovery or invention.  This truth will play out many times in world history.  (7, page 474-5)

By the 1750s this substance was called "fixed air."  While performing his own experiments in 1757, Joseph black proved Van Helmont was right. Ultimately Van Helmont would get true credit for his discoveries, and would be referred to as the father of pneumatic chemistry.

References:

1. Tissier, Paul Louis Alexandre, “Pneumotherapy including aerotherapy and inhalation methods and therapy,” volume x, 1903, Philadelphia, P. Blakiston’s Sons & Co., page 19
2. Lagerkvist, Ulf, "The Enigma of Ferment," 2005, Singapore, World Scientific Publishing
3. Potter, Elizabeth, "Gender and Boyle's Law of Gases," 2001, Indiana University Press
4. Newman, William R, et al, "Alchemy Tried in the Fire," 2002, University of Chicago
5. Lehrs, Ernst, "Man or Matter," 1958, Great Britain, Whistable Litho Ltd.
6. Jindel, S.K., "Oxygen Therapy," 2008, pages 5-8
7. Hill, Leonard, Benjamin Moore, Arthur Phillip Beddard, John James Rickard, etc., editors, "Recent Advances in Physiology and bio-chemistry," 1908, London, Edward Arnold
8. Hamilton, William, "A History of Medicine, Surgery and Anatomy," 1831, Vol. I, London, New Burlington
9. Osler, William Henry, "The evolution of Modern Medicine: A series of lectures delivered at Yale University on the Sillman Foundation in April, 1913," 1921, New Haven, Yale University Press
10. Osler, ibid, pages 170, reference referring to William Harvey: Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus, Francofurti, 1628, G. Moreton's facsimile reprint and translation, Canterbury, 1894, p. 48. 20 Ibid., p. 49.
11. Garrison, Fielding Hudson, "Introduction to the history of medicine," 1921, London, 
12. Baker, Christopher, editor, "The Great Cultural Eras of the Western World: Absolutism and the Scientific Revolution 1600-1720: A biographical dictionary," 2002, CT, Greenwood Publishing; Herman Boerhavve published Biblia Naturae (Bible of Nature) in 1737, which was a two volume compilation of the works of Jan Swammerdam. Can you read Latin?
13. Garrison, op cit, 266; (Samuel) Pepy's Diary, Mynors Bright's ed., London, 1900, v, 191
14. 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
15. Brock, Arthur John, "Galen on the natural faculties," 1916, London, New York, William Heinemann, G.P. Putnam's Sons

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