1985: My Good-Bye Party

Saturday, January 6, 1985, was a good day.  Nearly every member of my family, including all my friends and the friends of my parents, showed up at our house for my good-bye party.  My cousin Scott and his band played music in our living room.  My Uncle Torrin mocked Willie Nelson in a version of "On the Road Again" by plugging his nose while singing.  I knew there was going to be a good-bye party, but I had no idea it was going to be this big.

At the time I really didn't understand why they were throwing me such a large party.  I was only going to be going away for 6-9 weeks.  Surely this seemed like a long time to me, but it wasn't going to be forever.  Yet, in retrospect, I know now that my parents and those taking care of me were afraid asthma was going to take my life.  They were making a gallant effort to show how much everyone cared.  

And surely they never stopped the effort, as nearly every person who showed up at this party sent me letters while I was on 7-Goodman.  Between all of them, I think I received over a hundred letters in the first three months at the asthma hospital.  It was great back then because it was nice to receive a letter or package every day.  It's also nice now as I'm trying to tell my story, because these letters helps me remember what I was doing back then, and what was happening the rest of the world outside the asthma center.  

x1898: Physician's search for asthma remedies

Physicians in the 19th century were eager to find a good remedy to help their asthmatic patients, especially the children suffering from it.  There were no truly effective remedies for the ailment, although there were a few options that provided at least some relief temporarily.  

I almost like to think of the asthma market in the the 19th century as the weight loss market of today.  Most people are busy and don't have time to exercise.  And with all the tasty foods, they don't want to diet.  So this opens up a market for some type of weight loss gimmick.  

So today we have hundreds of products catering to this market, including pills, elixirs, weights that vibrate, and gadgets that wrap around your body to create perfect abs.  In reality, however, most of these products don't produce the results noted unless the person eats right and does some form of exercise.  

This was how the asthma market was in the 19th century.  Some of the medicines may have provided some relief, but none made your asthma go away.  However, if you avoided what was causing your asthma symptoms, it may appear as though the medicine has cured your asthma.  

And much like the modern person yearns for an article or post in a magazine that describes the latest weight loss craze, the asthmatic and 19th century asthma physicians yearned for the the latest craze in treating this malady.  

One such post was included in the 16th edition of "The Medical World" as a letter to the editor:

Editor Medical World :—I wish we could get some of the able contributors to your valuable journal to contribute their experience in the treatment of bronchial asthma. It has been my lot to have several patients suffering with that disease. Fortunately for me, I have been very successful in treating it. The prescription that I give, with some variations, has wrought wonders in some of my asthmatics. As an example, about six months ago I was called to see a lady who was attacked with malarial fever, and while dosing out medicine for her, my attention was attracted to some one in the adjoining room who seemed to be making a desperate effort to get the breath. On inquiry I learned that the party was the lady's daughter, who had been a sufferer with asthma ever since she was six months old, and that she was then sixteen; and that the attacks were getting more frequent and lasted longer. I am giving the daughter the following prescription. Since she has been taking it she has had two slight attacks, which were promptly relieved by giving the medicine in double doses every four hours. This relieves the attacks generally when the second or third double dose is taken. The following is the prescription:

B Iodide of potassium - - oz. iss

Muriate ot ammonia - - dr. iv

Fid. ext. grindelia robusta - oz. ij

Fid. ext. quebracho - - oz. iss

Fid. ext. jaborandi - - - dr. iv

Ammonia bromide - - oz iss

Simple elixir enough to make oz. viij

M. S. Take a teaspoonful three times during the day and one at bedtime.  S. H. Singleton, M.D.

Similar to today's physicians, each has his own prescription for asthmatics.  The main difference is that today's physicians have access to better asthma wisdom, better asthma remedies, and asthma guidelines.  So while there are still a variety of options for treating asthma, physicians today are less open to playing around with crap shoot remedies as S.H. Singleton was looking for.

And it's not like these remedies, like today's weight loss gimmicks, have never worked for certain people.  For the most part, some people used them with great effect.  Yet what works for one person won't necessarily work for another person.

This, coupled with the fact there really was no truly effective asthma remedy, opened up the market physicians to tinker with the available asthma remedies in search for a product the would better serve their asthmatic patients.   

References:

1. Taylor, C.F., editor, "The Medical World," volume 16, 1898, Philadelphia, page 26

500 B.C.: Pythagoras introduces Greece to philosophy

Even though he made no direct impact on medicine itself, Pythagoras of Samos (570-495 B.C.) may well be the most significant figure to our asthma history.  The reason is because he may responsible for bringing Egyptian and Babylonian philosophy, math, astrology and medicine to ancient Greece.

By no means am I implying here that Pythagoras invented philosophy, for that couldn't be further from the truth, as the quest for knowledge, which is what philosophy was, started long before Pythagoras was even born.

Near the beginning of civilization there were a few sages who pondered in secret about the world around them, and doubted it was all created by the gods.  They asked questions and sought answers, and what they discovered became the first theories.

They studied the stars and planets and became the first astrologers.  They studied numbers and became the first mathematicians.  They studied geometry and became the first architects.  They studied medicine and became the first physicians.

Such wisdom was only privy to a select few members of the priesthood or aristocracy, and what they learned was used to advance civilization.  An anonymous sage in Sumeria invented the potter's wheel to make clay pots, and and another sage learned how to build channels and aqueducts to irrigate the land. Another anonymous sage invented a language and a system of writing.  An anonymous sage in Egypt invented the material and tools for building massive pyramidal structures, and another learned how to mummify the dead to prepare their bodies for the afterlife.

The problem with this early philosophy was that it was far and few between.  The majority of the people, about ninety-nine percent of them, worked a minimum of twelve shifts everyday, seven days a week.  They did not have time to think and ask questions let alone time to learn.  Yet during the 9th century B.C. things were occurring in ancient Greece that would change all this, thus giving rise to the Age of Philosophy in ancient Greece.

No one knows exactly when this occurred, but sometime before the great poet Homer sat down to write his epic poems, gymnasiums were being built near the temples of various gods,and these were dedicated to shaping the bodies of young men.  (1, page 80)

In these gymnasiums young men would exercise, play games, and otherwise prepare their bodies for battle. Occasionally they ventured off to battle, and they won many wars, and they marched home with prisoners of war.  These prisoners were turned into slaves, and by the 6th century B.C. nearly all the citizens of Greece owned many slaves, and these slaves did all the work.  This allowed the citizens of Greece plenty of time to enjoy the pleasures of life.

Some citizens spent their days pondering about the world around them, and they yearned for answers.  So they traveled abroad to Egypt, and Mesopotamia, and India.  In this way, they spent time with the sages of these places, and they expanded their knowledge.

At this time the best medical schools were in Egypt, and therefore it was probably at the schools at Heliopolis that the Greeks came into contact with Egyptian medicine. They must have been very impressed with this knowledge that they took it home and shared it with their fellow citizens of Greece. (7, page 22)(6, page 4)

It was in this way that the Egyptian method of healing at temples morphed into Aeslepion temples in Greece.  Apollo was a god similar to Thoth.  Thoth was worshiped as Hermes.  Other Egyptian gods, such as Isis, were worshiped in Greece, and later Rome, until around 50 B.C. (6, page 2)

Pythagoras is perhaps the man responsible for bringing
Egyptian and Babylonian philosophy, math, astrology,
and medicine to ancient Greece.

So this was the world that Pythagoras was born into in 570 B.C., give or take ten years.  Since nothing was written about him during his lifetime, all we know of him comes from second hand accounts after his death.  It's from these accounts that historians learned his dad was Parthenis, and that he was a descendant of the gods.  His mother was Mnesarchu.  (3, page 7-9)

They learned that an oracle at Pythian told Parthenis that his wife was pregnant with a child who would be blessed with great wisdom and who would be of great benefit to mankind. In recognition of the oracle, the child was named Pythagoras.  (3, page 7-9)

In his youth he must have spent quality time in the gymnasium at Samos, as he became a gifted athlete.  He was also a gifted student who loved to learn, and so must have listened to the stories of the orators, and the lectures of the sages.  At one point he listened to a lecture by the philosopher Phercydes about the "immortality of the soul," and he was "so charmed" that he dedicated the rest of his life to philosophy.  (1, page 81)

To satiate his quest to learn more he began his travels around the world, or so legend has it.  He first traveled to Meletus of Anatolia (modern day Turkey), which was at the time the home of philosophers.  While there he learned of the wisdom of three early Greek philosophers.  

Thales of Miletus was perhaps the first Greek Philosopher

1.  Thales of Meletus:  (624-546) He was a Greek citizen who lived in Meletus of Anatolia.  He is often credited as being the first philosopher and scientist.  He was the first who, instead of giving credit of all physical phenomenon to the gods, searched for the true cause.  He asked questions and searched for answers.  The answers were called theories. (3 page 12)

He traveled to Babylon and learned astrology, and used it to predict an eclipse of the sun.  He traveled to Egypt and learned from the Egyptian sages at Heliopolis.  He learned geometry and predicted the height of the pyramids using only its shadow.  He learned Egyptian medicine, which at the time was the best in the world. It's believed that he started the process of blending Egyptian medicine into Greek philosophy. (5, page 89-90)

He concluded that water was the primary element, and that all other elements were derived from it. By his observations he associated life with water.  Of this, historian Henry E. Sigeris said in 1987:

Thales had been in Egypt and saw the Fertilizing effect of water of the Nile that flooded the land periodically. He even ventured an explanation of this natural phenomenon, as Herodotus tells us.  Throughout the East he could see that life was bound to the presence of water.  Where water reached vegetation was abundant, and where it ceased, the desert began. Whatever was alive was moist, and Thales must have noticed that life-giving human and animal sperm was moist.  And so he came to believe that there was a casual relationship between water and life... when water evaporated, did it not become air? Such observations and speculations must have guided Thales in his assumption that water was the primary element.  (5, page 90)

Because of Thales, Meletus is often considered to be the birth place of Greek philosophy. (3, page 12)(5, pages 89-90)

Anaximander was among the world's first scientists, or, among the first
to question why things exist and to seek out answers by empirical means.

2.  Anaximander of Miletus: (611-546 B.C.) He became the pupil of Thales, and together he and his master were the first known philosophers, and therefore the first astrologers, scientists, mathematicians, and physicians. (3, page 12)

He did not believe, however, that water was the primary element.  Of him, Sigerist said:

He believed that the elements commonly thought to constitute the world -- water, earth, fire and air, with their qualities wet, dry, hot or cold -- were derived from one common indeterminate substance.  From this inexhaustible primary substance which 'includes everything in itself and guides everything,' two pairs of elements with opposite qualities were born, which seemed to be in ideal balance. In the beginning of the world these elements were separated with the earth in the center, and covered by a sphere of water. which was surrounded by air and ultimately fire. Everyday experience taught what happens when fire acts upon air, water, and earth. The earth became dry, water evaporated, pressure increased, and the ring of fire burst... Thunder and lightning were not the work of Zeus, but were caused in a perfectly natural way when air was compressed in a cloud and burst forth violently.  All living creatures originated in the water, and some became land animals when the water evaporated.  Man too arose from a fish-like creature. (5, page 91)

Sigerest said Aristotle said that Anaximander said "all things are full of gods."  In this way, Sigerist said, Anaximander began the transition away from believing everything was caused by gods, to the idea that they were caused by naturally occurring phenomena.  (5, page 91-92)

3.  Pherecydes of Syros:  (570-495 B.C.) He was among the first to rationalize Greek mythology.  In this way, he is credited as being the first to establish the idea that the human soul was immortal.  This type of thinking was taught by Pherecydes at the gymnasium of Syros, and it greatly impressed a young Pythagoras. (2)

It is then speculated that Pythagoras traveled abroad, to Egypt, Mesopotamia and India.  It's believed he spent 20 years in Egypt learning from its sages.  Some speculate he even became an Egyptian priest.  He then was taken to Mesopotamia and held captive for 12 years in Babylon. During his time there he learned from Mesopotamian sages.   (3, page 12-14)

Medical historian Max Neuburger said once his travels were done he settled in Crotona, which is now Southern Italy. He said:

(He) founded a guild in Crotona, religious and moral, did pioneer work, not only in mathematics, astronomy and acoustics, but in investigation of the structure of the body, reproduction and development, the functions of the senses and mental activity, as well as in the treatment of the sick. (8, page 105)

Neuburger also said that being that there was also an Asclepion in Crotona, physicians at the medical school at Crotona were probably constantly in touch with the Pythagorean followers, many of whom were physicians. So early on there was a mingling of the different schools of philosophy or medicine. (8, page 106)

His greatest interest was regarding religion, and so he preached that what was learned in this life could be used in the next life when the soul moves on to another body, or to the final resting place.  (3, page 25)

Some speculate he came up with this idea from Phercydes, although some speculate this wisdom came from the Egyptians, who likewise believed the soul traveled into the afterlife.  Although others speculate this wisdom came from the Indians, who believed in reincarnation of the soul, or that once you die you are reborn as another person.

His followers were interested in his ideas about religion, but they were also interested in all his philosophical wisdom.  While historians credit Thales as the first philosopher, Pythagoras was the first person to refer to himself as a philosopher during his own lifetime.

Again, we must understand that philosophy is the quest for knowledge.  So when Pythagoras, and all the later ancient philosophers, lectured, they preached all the wisdom of the day, which included  mathematics, science, astronomy, astrology, music, and medicine.  It wasn't until many centuries later that each of these were extracted from under the rubric or umbrella term philosophy to become natural sciences all of their own.

So by his lectures he shared this knowledge.  His fellow Greek citizens were so impressed that word quickly got out about all the knowledge of Pythagoras, and so he quickly developed a large following. Renouard said his followers became known as Pythagoreans Disciples, or simply Pythagoreans.

Pythagoras established these followers of his into "a well-disciplined school," said Henry Sigerist in his 1922 history of medicine. It was called the Pythagorean Order.  (5, page 94-95)

Renouard said his followers would often sell all they had to dedicate their lives to Pythagoras and the general good.  (1, page 83)  Sigerist said they ate a healthy diet in order to maintain a healthy balance, or equilibrium, within their bodies.

Neuburger said, according to Pythagoras: (8, page 107)

The body was formed from the warm, the breath causes cooling.The causes of disease are bile, blood and phlegm. Predisposition to disease are excess or lack of warmth, nourishment, etc. Inflammation arises from accumulation of phlegm -- in itself warmth producing. (8, page 107)

When they were sick it was because the equilibrium was disturbed, and it was only re-established "physically with medicine, and mentally with music. This was why both medicine and music were greatly cultivated in the Pythagorean school, " said Sigerist. (5, page 96)

Neuburger said:

Health, according to him was a condition upon the equilibrium of materials present in the body (cold, moist, warm, dry, sweet, bitter); sickness results through the predominance of one quality, cure from a restoration of the balance, through the addition of the opposite one. (8, page 107)

Neuburger said he neglected "most surgical procedures, and mostly employed the following as remedies: (8, page 106)

• Simples
• Poultices
• Salves
• Expiations
• Spells
• Magical herbs
• Incantations
• Religious music
• Physical exercise (gymnastics)
• Dietetic measures (such as limited consumption of meat (8, page 106)

Renouard said Pythagoras taught a system of numbers that he probably learned from the Egyptians. (1, page 84)

"He designated God by the figure 1, and matter by 2; so he expressed the universe by 12, because this results from the juxtaposition of the figures 1 and 2."  (1, page 84)

Renouard said he explained the three distinct parts of life, or the three worlds: body, soul, and spirit.  So in this way the universe was in "harmony with the body and the soul," which, according to Pythagoras, were "manifested by three distinct faculties: sensibility, thought, and intelligence."  (1)

Renouard said Pythagoras introduced the Greeks to the significance of the number four.  He preached that there were "four spheres from which are formed each one of its three distinct worlds, (that) correspond to four elementary modifications of inert or amorphous matter. These primitive modifications are called fire, air, earth, and water, and are the elements which constitute all material substance." (1, page 84)

He was the first to establish the idea that the brain was the center of human intelligence. (8, page 106-107)(9, page 83)  This was a major step as far as medicine was concerned because physicians of neither Egypt nor Mesopotamia considered this fact.  Egyptians thought it was the heart, and Babylonians thought it was the liver.

He is also credited with creating the Pythagorean Therum, which states that the square of a hypotenuse of a right angle is equal to the sum of its squares.  He is also credited with being the first to say the earth was a sphere, among other things.

We  must remember, however, that since most of what is known of him was told by second hand accounts after his death, much of what we know of him was probably exaggerated. Much of what was attributed to him was probably actually invented or discovered by one of his contemporaries or peers.  This was probably because Pythagoras lectured mostly in secret because much of what he taught was radical.  His followers were sworn to secrecy.  Perhaps this explains why Pythagoras was credited with all the wisdom of the Pythagoreans.  (3, page 20)(5, page 95)

Sigerist said that another reason for this was because "loyalty to the master impelled his student to attribute every contribution of any importance to him (Pythagoras)."  This was typical, however, of the ancient world, as most people were forced to, or in most cases willing to, make a humble contribution to the the collective.    (5, page 95)

Many historians also believe much of what he is credited with may even have been known for generations before he was even born, such as the pythagorean therum, which must have been when anonymous architects were building many of the structures of the ancient world.  It may have been postulated by Egyptian mathematicians, or perhaps even by an anonymous sage from ancient Sumeria.

Pythagoras was well respected in life, although his ideas on mathematics were generally not accepted until well after his death.  However, the teachings of his school would influence many succeeding generations of Greek philosophers, including Plato and Hippocrates.  In fact, his teachings also continue to influence people to this day.

Pythagoras died sometime around 500 or 490 B.C., although his philosophy lived on for many years by his followers. They continued to lecture, and in this way philosophy was learned by many Greek citizens, including Plato and Hippocrates.  In fact, his teachings continue to influence people even to this day.

Henry E. Sigerist, in his 1922 history of medicine, said that Pythagoras may simply have been a benefactor of the times he was born into, a time when Greek citizens were becoming better educated about the world around them.  He said:

Many people were no longer satisfied with the naive and primitive worship of the Homeric gods and felt shocked by the many scandals mythology reported about them. We saw that the cult of Asclepius developed in this atmosphere, as did a number of mystery religions under Asiatic influence. Pythagoras is one of the exponents of the great Orphic movement." (5, page 95)

So by the 5th century there was such a demand for wisdom that many of the gymnasiums were transitioned to places of learning, thus becoming the schools and universities. (4, page 39) Many believe this system of associating education with a temple was learned from Egyptian and Babylonian sages, as both those nations had a similar system of learning.

The most famous of these Greek schools were associated with temples of the god Asclepius, who was the the messenger of the gods and capable of communicating their wisdom with the citizens of Greece.  These schools became known as Asclepions.

Renouard said these gymnasiums were "surrounded by halls and porticos where philosophers, rhetoricians, artists, and physicians assembled to hold their schools and dispute on questions of art." (1, page 80)

So with a lot of time on their hands, and a burning passion to learn, Greek citizens like Thales, Anaximander, Pherecydes and Pythagoras traveled the world in search of the wisdom of the sages.  What they brought back to Greece inspired its citizens, peeking their interest in philosophy.

It was Pythagoras, and Pythagoras alone, whether this is accurate or not, who is given credit for introducing ancient Greece to philosophy.  Of this, Renouard concludes that Pythagoras was: (1, page 90)

"The last celebrated example of distant peregrinations in search of wisdom..." (after him) "the sages of Greece ceased their journeys in search of light in foreign countries, for their own country became in its turn a center of illumination for all nations." (1, page 90)

Pythagoras gave rise to the Age of Philosophers.  This is key to our asthma history because without Greek ancient Greek philosophy, modern medicine would be ages behind where it is today,if it existed at all.

References:

1. Renouard, Pierre-Victor, "History of Medicine: from it's origin to the nineteenth century," 1867, Philadelphia, Lindsay and Bakiston
2. "Pythagoras," Encyclopedia Britannica.com, http://www.britannica.com/EBchecked/topic/485171/Pythagoras, accessed 11/1/12
3. Harkins, Susan Sales and William H. Harkins, "Biography from Ancient Civilizations, Legends, Folklore, and Stories of Ancient Worlds: The Life and Times o Pythagoras," 2007, Mitchell Lane Publishers
4. 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,
5. Sigerist, Henry E., "A history of medicine," 1987,
6. Sandwith, Fleming Mant, "The Medical Diseases of Egypt: part I," 1905, London, Henry Kimpton
7. Withington, Edward, "Medical History from the earliest times," 
8. Neuburger, Max, writer, "History of Medicine," 1910, translated by Ernest Playfair, Volume I, London, Oxford University Press
9. Garrison, Fielding Hudson, "An introduction to the history of medicine," pages 80-83.  

1st century AD.: The four schools of medicine

By the 1st century A.D. there are four schools of medicine competing with each other throughout Greece and Rome: 

1. Rationalism (dogmatism):  They attempted to rationalize disease and made up theories to explain it. Click here to learn more about this school or sect. 
2. Empericism:  They came to conclusions about disease based on their own experience. Click here to learn more about this school or sect. 
3. Methodism (Atomist, Sodomist):  They believed disease was caused by the arrest of molecules through invisible pores.  Click here to learn about this school or sect. 
4. Eclectic:  They accepted the best ideas of all the other schools.  A good example of such a physician is Claudius Galen.  Click here to read about Galen. 

124 B.C.: The Methodist school of medicine

Over time a third school, or sect, of medicine evolved that gained popularity in ancient Greece and Rome and had a significant affect on the remedies provided to patients. In fact, it was by following the opinions of this school that helped one famous physicians convince the Romans to accept Greek medicine.

The motto of this school went something like this: 

A pathological theory we must have, but let it be simple."  (8, page xiv)

It is believed to be started with Anaxagoras of Clazomenae (50-428 B.C.), who preached that there was a distinction between mind and body. (5, page 15)

It also might have started with Parmenides of Elea (born about 540 B.C.?), who:

argued that it is impossible for there to be change without something coming from nothing. Since the idea that something could come from nothing was generally agreed to be impossible, Parmenides argued that change is merely illusory. (10)

Archelaos of Athens (born about 500 B.C.?) was a pupil of Anaxagoras who added to his master's ideas the "fundamental principle of air."  Diogenes of Apollonia (lived around 420 B.C.?) made "air endowed with reason the origin of bodily and mental life. "  (9, page 110)

Around 450 B.C., Democritus (460-370 B.C.), who was a contemporary, although about 40 or 50 years younger, of Anaxagoras, "acknowledged the distinction, and describing both mind and body as composed of atoms or corpuscles, differing only in their nature and arrangement." (5, page 15)(9, page 109) (10)

Because he believed the body was composed of atoms he was referred to as an atomist.  The school hat ultimately formed based on his ideas was called the atomist school, although later scholars referred to it as the methodist school.

Still others referred to it as the solidist school because of the belief that diseases were formed by the solid living forms of the body as compared to fluids or humors of Hippocrates.  .

The teacher of Democritus was Leucippus, and very little is known of him. It is believed that Democritus reorganized his teachers works, and then formed the anatomist theory. 10)

Sylvia Berryman, who wrote about Democritus in the 2010 Stanford Encyclopedia of Philosophy, said:

Ancient sources describe atomism as one of a number of attempts by early Greek natural philosophers to respond to the challenge offered by Parmenides... In response, Leucippus and Democritus, along with other Presocratic pluralists such as Empedocles and Anaxagoras, developed systems that made change possible by showing that it does not require that something should come to be from nothing. These responses to Parmenides suppose that there are multiple unchanging material principles, which persist and merely rearrange themselves to form the changing world of appearances. In the atomist version, these unchanging material principles are indivisible particles, the atoms: the atomists are said to have taken the idea that there is a lower limit to divisibility to answer Zeno's paradoxes about the impossibility of traversing infinitely divisible magnitudes. (10)

Berryman explained that Democritus wrote about a world that was composed of atoms and voids.  The atoms were of varying sizes and shapes, and they were perfectly solid and, aside from changing location, were unchangeable or indestructible. Each atom also had a hook to allow it to attach to other atoms.

The atoms moved about in the void, often colliding with one another, and often becoming attached by their hooks to form clusters of varying shapes, sizes and colors that were the various objects (kosmoi)of the world, such as humans, animals, and trees. (10)

After a period of time the atoms relocate, change location through the voids, and attach to other atoms to form new kosmoi.  This process is ongoing for eternity. (10) 

Many of the principles of the school were established by Cleophantus of Alexandria and taught to his followers in creating a new school.  One of his students was Asclepiades. (3, page 92)

In the first century A.D. Asclepiades was an Atomist who made many "innovations" to this school, although he was originally considered a rationalist. (3, page 110)

He ultimately opposed the Hippocratic doctrines, supported the atomist hypothesis of Democritus, and added to it the the doctrine of "Strictum et Laxum" which states that disease is caused by excessive relaxation and tension of its solid particles, hence the term "solidism".  The school became known as the solidist school of medicine.  (7, page 73)

The desciple of Asclepiades was Themison of Laodicea.  Both of these physicians are often credited with forming the Methodist School of Medicine, which competed with the rational and empirical schools of medicine. (5, page 39-40)

Unlike the rationalists, they didn't try to find causes of disease. Unlike the empiricals, they didn't try to treat diseases based on their symptoms. Instead, "Themison declared that the physician should observe what symptoms various diseases have in common. He would then find that in all, or nearly all cases, there was an increase or dimunition of the secretions and extretions, and adapting this to the theory of Asclepiades, Themison argued that all diseases were due to a relaxation or a constriction of the 'pores.'" (2, page 85-6)

However, like the rationalist they believed "that the physician might reason from the seen to the unseen, e.g., from the state of the secretions to that of the pores."  From the empirics they "taught that diseases are to be judged from their symptoms, and not from their causes." They also agreed with the emperics that knowledge of anatomy irrelevent to treating diseases, "though it might be useful to know the names of the parts."  (2, page 86)

So the location of the disease was not important.  What organ caused a disease was not important.  The reason is that they considered a disease to be a general ailment of the body.  The cause wasn't important either, because they all either cause relaxation or constriction.  In other words, they believed that "constriction and relaxation are the same wherever they occur and require the same treatment." (2, page 86)

Medical historian John Brock describes it this way:

They held that molecular groups constituting the tissues were traversed by minute channels (pores); all diseases belonged to one or other of two classes; if the channels were constricted the disease was one of stasis, and if they were dilated the disease was one of flux. Flux and stasis were indicated respectively by increase and diminution of the natural secretions; treatment was the opposite by opposites -- of stasis by methods causing dilation of the channels, and conversely. (8, page xiv-xv)

Followers of this school treated diseases based on what was in the past effective in treating that disease, as opposed to treating patients based on speculation and superstition. "Their remedies were naturally divided into relaxants and astringents... They inculcated the use of gymnastic exercises, not only as remedial agents, but also as a means of counteracting the bad effects of increasing luxury and indolence." (5, page 41)

Astringent remedies used were "cold air and water, vinegar, decoctions of various herbs, especially the plantain, and the minerals, alum, lead and chalk, which were used externally.  The laxitive remdedy used most often was bleeding by venesection, cupping or leeches.  They did not use purgatives.  (2, page 86)

Their remedies tended to be gentler than dogmatic remedies, and perhaps for this is the reason Asclepiades was successful changing the Roman opinion of Greek medicine.

According to Brock "the vice of the Methodist teaching was that it looked on a disease too much as something fixed and finite, an independent entity, to be considered entirely apart from its particular setting."

Regardless of it's flaws, this school provided another option for physicians to follow and learn from, and some of the knowledge obtained later benefited the medical community in general.

References:

1. "Rationalism (philosophy), Encyclopedia Britannica.com, http://www.britannica.com/EBchecked/topic/492034/rationalism
2. Withington, Edward Theodore, "Medical History from the Earliest Times," 1894, London 
3. Watson, John, "Medical Profession in Ancient Times," 1856, New York, Baker and Godwin 
4. Magill, Frank N., editor, "Dictionary of World Biography," Volume I: The Ancient World, 1998, Salem Press Inc., California 
5. Meryon, Edward, "History of Medicine: comprising a narrative of its progress from the earliest ages to the present and of the delusions incidental to its advance from empericism to the dignity of a science," volume I, London, 1861, 
6. Adams, Charles, Kendall, editor, "Johnson's Universal Cyclopedia: A new edition," volume V, A. Johnson Company, New York, 1894 
7. Garrison, Fielding Hudson, "An introduction to the history of medicine: with medical chronology, Bibliographic data and test questions," 1913, Philadelphia and London, W.B. Saunders company 
8. Brock, John, "Galen on the natural faculties," 1916, London, New York, William Heinemann, G.P. Putnam's Sons
9. Neuburger, Max, writer, "History of Medicine," 1910, translated by Ernest Playfair, Volume I, London, Oxford University Press
10. Berryman, Sylvia, "Democritus," from the book "The Stanford Encyclopedia of Philosophy," http://plato.stanford.edu/entries/democritus/, 2010, accessed 12/22/13

x1913: Cauterize your nose, cure your asthma

Another interesting concept of Adams is that he denied that most asthmatics had allergies, although he associated abnormalities in the nasal cavity with asthma.  He noted that Henry Hyde Salter cursorily mentioned the relevance of the nose in cases of asthma, when such knowledge was known since 1844 when Herck of Freiburg noted the association of sneezing and asthma. (1, page 89)

Later, Adams noted, Voltolini, in 1872, claimed to have "relieved eleven cases of asthma by removal of nasal polypi.  This idea received further impetus when Lazarus, Brodie and Dixon and others showed that electrical stimulation of the nasal mucosa caused bronchial spasm."

Ernst Schmiegelow explained that Voltini noted that no other asthma physicians prior to him noted the link between nasal polypi and asthma.  And while polypi are not always associated with asthma, there are noted cases where, upon removal of the polypi, the asthma disappeared. Although, if asthma has existed long enough so that it is chronic, removal of the polypi will not make the asthma disappear. Schmiegelow notes that Voltini's opinions were confirmed by Hanisch. (2, page 14)

Schmiegelow notes that "Hanisch thinks that as not all nasal polypes cause asthma, there must be a certain debility of the whole organisation or at least of the organs of breathing. In the nasal polypes themselves he finds sufficient ground for the weakened state of the organisms and lungs, as the insufficient breathing, the restless sleep, the buccal respiration, etc., must be considered capable of causing the general weakness."  (2, page 14)

B. Frankel and Weber also confirmed the findings of Voltini, and they also believed that chronic catarrh could also cause asthma. They believed irritation of the nasal mucous membrane passed a message down the pneumogastric to the pulmonary fibres, causing asthma, and "the result of the reflex was always a bronchospasm.". (2, page 15) Henry Hyde Salter previously mentioned this, and referred to is as reflex asthma.  

Schmiegelow also mentions a Dr. Wilhelm Hack, who "supported by casuistic observations, considered a number of different nervous diseases from the same point of view. Hack's principal object was to show that in the swollen cavernous mucous membrane in the foremost end of the inferior turbinated bones, different nervous states of irritation originate, and these reflex neuroses can be caused experimentally, and they disappear entirely as soon as the places in question are operatively removed. The filling of the cavernous membrane is, according to Hack, the essential in the pathogenesis of these reflex neuroses."

Adams notes that other physicians were so focused on the other theories of asthma, particularly that asthma was neurotic, that they were overlooking the true cause: that there was a problem with the patient's nasal passage causing the asthma, or that there was a toxaemia in the blood causing asthma as I discussed in this post.

Adams emphasises the following: (1, page 89-90)

"I have seen patients with noses absolutely ruined, mere shells of what they should have been—their asthma remaining the same, but promptly clearing up on simple antitoxaemic treatment, except in the case of a poor woman who owed an opium habit to her doctor. Francis cauterises the septal tubercle of all asthmatics—sometimes a valuable temporary procedure; others would also cauterise the lower turbinals—an unnecessary addition. The value of proper nasal treatment cannot be gainsaid; but that it should be subsidiary and ancillary to treatment of the toxaemia I have, where mouth breathing was absent, occasionally and successfully proved by the experiment of carrying out the latter treatment and leaving the nose alone. Apart from the experimental and therapeutical evidence just mentioned, the importance of a nasal factor in asthma can be gauged from several considerations."

Some of the ailments he observed on asthmatics, were:

• Nasal polypi
• Deviated Septum
• Hypertrophied areas in nasal passages
• Pigeon chest (due to laboring for air so frequently)
• Mouth breather
• Expanded shoulders (due to years of laboring for air)
• Expanded chest (due to emphysema if chronic)

References:

1. Adam, James, "Asthma and it's radical treatment," 1913, 
2. Schmiegelow, Ernest, "Asthma, considered specially in relation to nasal disease," 

750-48 B.C.: Medicine migrates to Rome

Although they didn't know it at the time, the Latins had picked the perfect spot to build their village.  It was one of many built around the seven hills along the Tiber River in the Italian Peninsula somewhere around 750 B.C.  (1, page 112)

It was in the lowland, as compared with other Italian villages.  While close to the sea it was built on a mountain side "where there was lava flow with a dominant position over the sea and the river Sarno."  (2)

Due to its volcanic origins, the "soil is naturally rich in water springs and minerals.  The hills were made of tufa rock, "a soft hardened rocky sponge," which the Romans were later able to use to make large buildings and monuments.  (2)  The village grew into a city.

At first the Romans were peaceful farmers and herders, but around 600 B.C. the Etruscans from up north along the Tiber decided to conquer the other villages.  For the next 100 years Rome was ruled by the Etruscans.  In 509 B.C. the people of Rome rebelled and set up what became the world's first republic. (1, page 112)

The people of Rome didn't forget what had happened, and they continued to build a mighty military. Many of the people became skilled soldiers, and they decided to fight for more land.  By 270 B.C. they took over the entire Italian Peninsula, and then after 23 years of Punic wars, in 146 B.C., the Romans conquered the city of Carthage along the north coast of Africa, where the Phoenicians settled. (1, 113-114)

There were three wars with Carthage, called the Punic wars, and in the second one, Macedonia, the strongest city-state in Greece at that time, decided to help Carthage.  Romans didn't forget this, and when Carthage was defeated, the Romans conquered Greece and took many Grecians back to Rome.

Of course many of these people were philosophers and physicians, and thus Rome was introduced to Greek adaptations to these arts. (1, page 114-15) As the Roman Empire spread, so to did Grecian culture.

Greeks taken to Rome became Roman slaves, and many were better educated than their new Roman masters.  So it "became customary for the well-to-do to select for the child's nurse a Greek slave, that a child might acquire the Greek language as naturally as its own," according to historian Harold Johnston.  (7, page 71)

Johnston explains that: (7, page 78)

The Greek language came to be generally learned (§101) and Greek ideas of education were in some degree adopted. Schools were established in which the central thing was the study of the Greek poets, and these schools we may call Grammar Schools because the teacher was called grammaticus. Homer was long the universal text-book, and students were not only taught the language, but were instructed in the matters of geography, mythology, antiquities, history, and ethics suggested by the portions of the text which they read. The range of instruction and its value depended entirely upon the teacher, as does such instruction to-day, but it was at best fragmentary and disconnected. There was no systematic study of any of these subjects, not even of history, despite its interest and practical value to a world-ranging people like the Romans.

Of course we must understand that after doing battle against many Greeks during the Punic wars, a prejudice developed among the Romans regarding Greek culture.  This might explain Pliney the Elder's statement that Rome "got along for 600 years without physicians." (5, page 72)  He said that while knowing full well Rome had physicians, as he later contradicted himself by claiming the first physician came to Rome in 535 B.C.  (3, page 81)

This prejudice might also explain why the Greeks were often disparagingly referred to as "graeculus esuriens of Juvenal," which means "hungry young Greek"  (5, page 72)

We must also understand that the Romans, as might be expected, had their own gods that they believed were responsible for health and sickness.  They had incantations and prayers they'd been using for hundreds of years.  They also saw Greek remedies as harsh, and the fact Greeks kept snakes in their "private houses in pursuance of the esculpian cult, did nlittle to make medicine respectable in the eyes of the austere Romans." (5, page 97).

But medical profession of Rome had it's problems. For one thing, the medicine was primitive in nature, and based mainly on incantations and prayers.  In describing the flaws of the Roman medical system of the time, Bradford quotes medical historian Pierre-Victor Renouard:

In the midst of this overflowing of charlatanism, the health of the citizens was given over to the first imposter who called himself a doctor; for how could the cheat and usurper of the title be distinguished from the man of knowledge and probity, who had acquired it by study? No examination, no legal proof was imposed on any one who wished to practice medicine; there was no security for the sick.''

These weaknesses may have left the door open ever so slightly to the curiosities of some of those who yearned for a remedy that Roman physicians were not providing. Regardless, as Grecian physicians and teachers migrated to Rome, they did so with little encouragement from the Romans. (4, page 96)

Yet as what usually happens, time heals all wounds.  When a person is really sick, when he realizes that incantations and prayers don't heal pain and suffering, he becomes eager to accept new ideas.  And it must have been in this way the Romans were gradually exposed to Grecian medicine, and slowly grew to respect and gain confidence in Grecian physicians.  (4, page 96)

One of the best ways to change the mindset of a people is to impress the king.  Even kings are human, and even kings get sick.  And kings have the ability to change the mindset of a nation.  And it must have been in this way Caesar was exposed to the benefits of Grecian medicine, because in his travels he started taking physicians with him.(4, page 97)

Perhaps it was for this reason that Roman philosopher and orator Cicero (106-43 B.C.) "declared the duty of all men -- a duty particularly incumbant of himself -- to support the dignity of the healing art." (4, pages 96-97)

A Greek physician named Archagathus was among the first to escape the wars of Greece by emigrating to Rome.  When he was born no one knows, although what is known is he was born in Sparta and was later adapted by the Romans, becoming a Roman citizen in the year 219 B.C., around the time that Ptolomy Philopater in Egypt.  He was among the first physicians to emigrate to Rome.

Historian Thomas Lindsley Bradford, in his 1898 book "Quiz questions on the history of medicine," discussed the influence of Archagathus the Executioner upon Greek medicine.

He was the first of all the Greeks who attempted to introduce their kind of physic (medicine) into Italy. At first his coming was very agreeable to them, and many marked distinctions were paid him, but when he came to the cutting and burning part they changed their opinion, and conceived such an aversion to him that he was compelled to leave the city. He was called executioner on account of the too frequent use of the actual cautery and the knife. He was also called Vulnarius and Carnifex. He was honored by the Senate." (8, pages 27-28)

Bradford must have obtained much of his wisdom about Archagathus from the writings of Pliny the Elder, who wrote  about 150 years later:

He obtained Roman citizenship and was extraordinarily popular on his arrival, but very soon, gained the nickname of the "executioner." (9)

Greek physicians were slowly gaining the respect and confidence of the Roman people, and the man given credit for this was Asclepiades of Bithynia.  He was born in Rome at the time of Pompey in 106 B.C., and then was educated at the school of Alexandria and practiced in Athens before moving back to Rome.  (4, page 99-101)  Despite his name, Asclepiades has no ties with the Asclepiate temples that rose in Ancient Greece and Rome. (8, page 28)

His opinions and remedies were based on the Atomist philosophy of medicine devised by Democritus, and were the opposite of the Hippocratic doctrine.  Since he believed in a different hypothesis as Hippocrates, he also had different remedies which included fresh air, light diet, hydrotherapy, massage, clysters, local application of some external medicines, and sparing use of internal medicine.  (5, page 72)(8, page 28-29)

This new medical philosophy, coupled by his "good bedside manner," made Asclepiades a very popular physician in Rome.  He was so well accepted that after his death other physicians took on his name hoping to take advantage of his fame.  (6, page 83)

Asclepiades basically believed Romans had a negative view of Greek medicine because their dogmatic remedies appeared to make a patient worse before he got better.  He believed it was perceived as a "crude and unfeeling practice."  He took advantage of this and smoothed out the edges by not using medicine that "offended the stomach" and using hygienic remedies instead.  His techniques were so well accepted he became famous and wealthy.  He wrote a book on General Remedies, and started the first school of medicine in Rome. (4, page 99)

Bradford said that:

He does not seem to have followed any course of medical study, but owing to his fashion of catering to the patient and avoiding everything that was painful and disagreeable, he soon gained a large practice.  He eschewed emetic and purgatives, though he practiced blood-letting.  He also relinquished the religious ceremonies which had held so large a place in medical practice...  His treatment was mainly dietetic and hygienic.  He advocated exercise, bathing, music, and even declamation as a means of curing disease." (8, pages 28-29)

He was revered by some as the greatest physician ever, aside from Hippocrates.  Others claimed he was no more than a philosopher and charlatan.  Even Galen "charged him with many absurdities, and with having but little knowledge of the great fathers of the profession, whom he affected to ridicule." (4, page 98)

Yet Caesar liked him and approve of his work, and that may have been all that was needed.  Asclepiades died in 48 B.C. "and is said to have been killed by a fall from a ladder in his extreme old age." (4, page 101)

So perhaps more so than the physicians themselves, it was a combination of both the politics, philosophy and public relations of the physicians, coupled with the approval of various emperors, who improved respect and confidence in Grecian medicine.  It is because of them Grecian medicine survived the test of time.

As John Watson said: (4, pages 97-98)

Caesar, after reaching the summit of his power, in order to attract men of science to the capital, and to improve the condition of those already there, decreed that all who practiced physic at Rome, and all the masters of the liberal arts therin residing, should enjoy the privilege of citizenship.  And Augustus, after having been relieved of a dangerous illness by his freedman, Antonius Musa, loaded this physician with wealth; raised him, by consent of the Senate, to the equestian rank; erected a bronze statue to his honor near that of Aeslepius; and, at his instigation, conferred important privileges on the whole body of the profession then residing in the city... These privileges afterwords confirmed by... later emperors." (4, pages 97-98)

Of Roman medicine, Bradford said:

Before the consolidation of the Roman empire in 31 B.C. there were no established medical laws.  The Greek system of training seems to have been in vogue.  Everyone who was liberally educated was instructed in philosophy of medicine. which explains why all the philosophers of the old days were also to some extent teachers of medicine. But the physician was expected, in common with his medical knowledge, to be familiar with the grammar of his own language, with rhetoric, arithmetic, geometry, dialectics, moral philosophy, astronomy, and even architecture. (8, page 53)

The benefactors of all this education were, of course, all those who became sick or injured.

References:

1. Suter, Joanne, "Fearon's World History," 1994
2. "Ancient Rome Geography,"  mariamilani.com, http://www.mariamilani.com/ancient_rome/Ancient%20Rome%20Geography_.htm
3. Watson, John, "The Medical Profession in Anciet Times: an anniversary discourse delivered before the New York Accademy of Medicine November 7, 1855, New York, Baker and Godwin
4. Watson, ibid, pages 97-98, in reference to Seutonius, Octav, August, cap. lix.
5. Garrison, Fielding Hudson, "An introduction to the history of medicine: with medical chronology, Bibliographic data and test questions," 1913, Philadelphia and London, W.B. Saunders company
6. Withington, Edward, "Medical history from the earliest times: a popular history of the healing art," 1994, London
7. Johnston, Harold, "The Private Life of the Romans," 1908
8. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey
9. Pliney the Elder, "Natural History,