x1901-1920: Hay fever becomes allergy

Paul Portier

The term hay fever was used for the first time in medical nomenclature in 1812 by Dr. John Bostock to describe seasonal allergy symptoms associated with the hay season. The term had been used by lay people much longer than that. So, even while many physicians doubted it was an appropriate term, it stuck in medical nomenclature like gum on a little boy's shoe.
However, a series of discoveries shortly after the turn of the 20th century would introduce the world to a series of new terms, such as anaphylaxis, atopy, and allergy.

In 1901, the Prince of Morocco summoned two scientists, Paul Portier and Charles Richet, to study a sea anemones called the Portuguese man-of-war. Their job was to learn how to protect swimmers from its sting, which caused painful blisters. (1, page 608)

Charles Richot

Initially, the two believed the painful blisters were caused by toxins from the animal's tentacles once they were entered into the skin of humans.  Back then vaccination was becoming a household name, and so the two set out to create an antitoxin vaccine.  (1, page 608)

Richet started the experiment by extracting toxins from sea anemones, and gave them in small amounts to test dogs.  After the initial injection they figured the dogs would develop antibodies that would protect them from a second exposure of the toxin.  In this way they would develop a natural protection against it, or prophylaxis.

However, when they extracted the toxin of sea anemones and inserted it into test animals (dogs in this case), the reaction they got was the opposite of what they expected.  The first two doses did no harm to the animals, but subsequent doses caused many of the dogs to go into a state of shock, and most did not recover.  Richet and Portier determined the animals died due to the effects of the toxins.

Instead of prophylaxis The animals developed aniphylaxis, a new term devised by the two men.

It's time for some definitions:

• Greek pro means toward or before
• Greek phylaxis means protection
• Greek ani means opposite or away
• Prophylaxis means to add protection
• Aniphylaxis means to cause harm

So, instead of protecting the animals from developing symptoms, they caused the symptoms.  The scientists learned that a "foreign protein" was transferred from the sea anemones to the dogs making them hypersensitive to that protein. (2, page 11)

Other scientists performed similar experiments and came to similar results.

Clemons von Pirquet

In 1906, an Austrian pediatrician named Clemons Von Pirquet observed many of his patients were hypersensitive to substances that didn't bother other people.  These normally innocuous (harmless) substances were pollen, dust mites and some foods.

The purpose of the immune system is to attack foreign particles that want to harm the human body.  Yet sometimes the immune system attacks allergens that are not meant to cause harm.  Von Pirquet and Schlick observed this, and they coined the term allergy to describe when the immune system causes harm.  (5, page 53)(3)

Once again a definition is in order:

• Greek allos means other
• Greek ergon means action or enery
• Allergy means the immune system causes the opposite effect as its intention (causes harms)
• Allergen means a substance or protein that may incite the allergic response hen a hypersensitivity is present
• Hypersensitivity means over-reaction; a hyper-reaction of the immune system; as in when exposed to allergens (Dated to 1870s)(Dictionary.com)

Von Pirquet actually believed that asthma was an allergic condition, and curing this disease was only a matter of finding the right foreign proteins to inject. History would prove him right in juxtaposing asthma and allergies, yet wrong on the front of this leading to a cure.

Also in 1906, German physician Alfred Wolff-Eisner surmised that pollen is similar to the poisons of the Portuguese man-of-war in that it could trigger the immune response in some some people.  By inserting drops of pollen into the eyes of volunteers, he was able to produce the same response suffered "during the hay fever season: red, swollen, and itchy eyes." He published his findings in 1906.  (5, page 54)

Thanks to Wolffe-Eisner's discovery linking hay fever with the immune system, hay fever was no longer believed to be a nervous disease.  It as no a disease caused by a hypersensitive immune system. This was an essential transformation because it would effect the future course of treatment for the disease.  Instead of seeking to alleviate a nervous disorder, the goal of treatment as not to fix a broken immune system.  (5, page 54)

In 1910 Samuel Melzer observed the "similarity" between anaphylaxis and asthma "in which a person became sensitized to a definite substance, and an attack occurred every time the substance entered the circulation (of that patient).  Minute quantities of the substance, if inhaled, would bring on an asthma attack." (2)

We now know that about 75 percent of asthmatics have allergies.  Yet we also know that many people have allergies and not asthma.  We also know that both conditions have been linked to the immune system and can be developed at any age.  Yet in 1906 scientists were at the dawn of such allergy wisdom.

Pirquot believed it was the body's response, not the foreign particles, that resulted in the allergic reaction. He listed as things that might cause this "hypersensitivity" as bee stings, mosquito bites, hay fever caused by pollen, and substances in certain foods such as crabs.

Soon thereafter Arthur C. Coca, founder of the Journal of Immunology, and Robert Anderson Cook, were attempting to understand studies regarding allergic conditions, used the term Atopy which literally means "strange disease."  They thought atopy should be used to describe hereditary hypersensitivities such as asthma, hay fever and eczema, and hypersensitivities that could afflict anyone should be referred to as anaphylaxis.

By 1919 two allergists, Cooke and Albert Vander veer, published the results of a study of 500 patients with asthma, hay fever, and other allergic diseases that confirmed that age old theory that these conditions were inherited and perhaps linked to other conditions.

Initially all prophylactic and anaphylactic reactions were referred to as allergies, as this as the recommendation of Van Pirquot.  He believed the two reactions should have a common name.  (3)

Yet ultimately it was learned that there were three conditions associated with hypersensitivities that didn't fit into this classification:  asthma, hay fever and eczema.  In asthma the hypersensitive response lead to constricted air passages, in hay fever it lead to a runny and stuffy nose, and in eczema it lead to red and itchy skin.

These three conditions -- asthma, hay fever and eczema -- are now often referred to as the atopic triad because in many individuals they come as a package.  One major difference between the atopic triad and anaphylactic reactions is that anaphylaxis can be induced in almost anyone, while the others occur in only a small percent (about 10 percent) of individuals and are quite often hereditary.  (4, page 608)

In subsequent years allergy was used to denote an immunal hypersensitivity or hyperresponsiveness to a foreign substance and atopy was used to denote the inherited conditions of asthma, hay fever and eczema.  Although, quite often the terms allergy, atopy and anyphylaxis are used interchangeably.

References:

1. Klein, Jan and Vaclav Horejsi, "Immunology," 1997, page 608
2. Brenner, Barry E, "Emergency Asthma," (ed. Barry E. Brenner), 1998, New York
3. Ehrlich, Paul M., Elizabeth Shimer Bowers, "Living with Allergies," 2008
4. Klein, Jan, Vaclav Horejsi, "Immunology," 1997, page 608
5. Mittman, Gregg, "Breathing Space," 2007, New Haven, London, Yale University Press

1820-1870: An ailment called Hay Fever

By the 19th century there were enough people suffering from seasonal sniffling and sneezing that certain physicians started taking a closer look at these symptoms, often referred to as hay-fever or rose-fever, especially if the physician himself was a sufferer.

This is exactly what happened on March 16,  1819 when Dr. John Bostock described his own "condition of catarrhal inflammation of the eyes and chest that appeared regularly each year during the early summer season," according to Gregg Mittman in his book "Breathing Space." (1, page 12) (also see 8, page 3)

Catarrh (catarrhal) is a 19th century term that refers to inflammation of the respiratory passages, particularly the nose, that results in a runny nose.

Bostock described his condition to the Medico-Chirgical Society, along with twenty-eight cases where patients suffered from a similar condition.  By 1828 he came up with a name for this ailment: "'Catarrhus Aestivus,' or 'Summer Catarrh.'" (1, page 12)(5, page 11)(8, page 3)

Yet despite Bostock's definition, hay-fever "still was not recognized as a distinct disease by the profession," writes William Clarence Hollopeter in his 1898 book "Hay-fever and it's successful treatment." And Bostock rejected to the term hay fever because he believed "hay-fever" not caused by hay but(10, page 19):

• Moist heat
• Dust
• Sunshine
• Fatigue 

Regardless, Hollopeter notes that he finds it "remarkable that the profession in England were unfamiliar with hay-fever when their king, George IV, was a sufferer from it." (10, page 19)

Dr. George Beard, in his 1876 book "Hay-Fever; or Summer Catarrh: It's Nature and Treatment," said that in 1828 Dr. MacCulloch wrote an essay called "An Essay on the Remittent and Intermittent Diseases," where MacCulloch described hay fever as being caused by "hot houses and green houses," and that it was "caused by hay-fields."  (5, page 11)(also see 8, page 4)  Although Hollopeter notes MacCulloch advocated nothing new of the disease. (10, page 19)

Bostock tended to agree that heat had something to do with hay fever, but he doubted that hay had anything to do with it.  Beard said that Bostock "cited a number of facts from his own experience which went to show that, in his case at least, heat and direct rays of the sun had more to do with the disease than any other traceable exciting cause. He states that one season he walked out frequently among acres of hay-grass, and suffered less than usual, except when it was very hot. Dr. Bostock, however, admits that in some persons the disease was apparently brought on by hay; but he was sufficiently skeptical on the subject to suggest that possibly they might be exposed to hay and heat at the same time, and confound the effects." (5, page 12)

In 1829 Dr. W. Gordon wrote a paper where he "took the view that hay-fever was caused by the aroma of the flowers of grass, and especially of the Anthoxanthum odoratum. This writer had observed that the disease usually comes on as soon as this plant flowers, and disappeared about the time that this plant disappeared; and he stated that after the death of this plant patients could go through meadows without suffering. He believed that grass, and not hay, was the cause, and that the disease should be called grass-asthma.
 (6)

In 1831 Dr. Elliotson of England described hay-fever, and two years later and agreed with Dr. Bostock that the disease was not caused by hay, but opposed Dr. Bostock's claim the disease was caused by heat.  He believed grass was the main cause, according to Hollopeter. In 1841 Dr. Ramadge believed it was caused from "effluvia from flowers," Hollopeter adds.  (10, page 19)

Other physicians described patients with this ailment.  Many physicians reported this as being associated with wheezing and asthma.  Some physicians noted that asthma was worse during the dog days of summer.  (1, page 12) (5, page 11)

In 1837, any patient seeing Dr. J.J. Cazenave of Bordeaux, and who complained of hay-fever symptoms, were encouraged to wear goggles to protect their eyes from irritating matter.  As far as Morell Mackenzie is concerned, this was probably the first time a physician recommended protection to prevent hay fever. (11, page 15)

Mackenzie explains that Cazenave also "attempted to prepare the nasal mucous membrane for the enemy's attack by hardening it with nitrate of silver.  Cazenave attributed the complaint to the effect of light, and does not seem to have known that it had been described before." (11, page 15, 16)

In 1850 Dr. Gream "observed the symptoms of asthma were releaved after a fall of rain, and he argues that the laying of dust was the explanation; and, further, he maintained that the malady was peculiar to the summer, because at this season there was more dusts of various kinds in the air," writes Beard.  Gream believed indoor dust was just as much as an exciting factor as outdoor dust, and may have been the first to postulate this theory, notes Beard.(7)

The first to notice the difference between summer and fall hay fever was Dr. Swell from New York in 1852.  (11, page 15)

In 1859 Dr. Henry Hyde Salter, the formost asthma expert of the 19th century, refers to hay asthma as periodic asthma, in that it comes and goes with the hay season, which usually lasts 4-6 weeks.  Like other experts, he believed the exciting factor was "bright, hot, dusty sunshine."  He also blamed laughter, eating too much and hay. (5, page 14)

Also in 1859 Laforque of Tououse defined two cases of hay fever, and he described the condition as neurotic, a conclusion many of his contemporaries would also come to.  He described it as "neurotic in its origin and as being directly excited by heat."   In 1860 Dechambere was convinced "'an occult atmospheric influence' was the cause of the disease." (11, page 15)

So there were various physicians with varying oppinons on what caused hay fever.  It was heat.  It was hay. It was flowers.  It was grass. It was dust.  Some studies were perfomed, but mostly these physicians used their own experiences and observations with their own asthma, or that of their patients.  Still, the wisdom shared was mostly based on the best data available at the time. 

By the 1860s, Mittman writes, Hay Fever or Hay Asthma became a common terms used by the medical community,  (1, page 12) although some continued to use hay asthma.  In 1862, Mackenzie writes, Dr. Phoebus of Giessen, who formed opinions on hay fever from witnessing only one case, sent out flyers to various patients and obtained organized statistics about hay fever and came up with "a complete theory about the disease. I write further about phoebus here.  (11, page 17)

Another thing to note about Dr. Phoebus is that he was probably the first person to write about the link between air pollution and hay-asthma.  He referred to the substance in the air that is naturally occurring (and also a pollutant) as ozone.  Although Charles Blackley breathed the substance in his office for six hours with no effect on his hay fever. He was also among the first to note that dust might cause hay fever. (11, page 35)(8, page 79-90, 91))(I will write about this experiment in another post: See What causes Hay Fever)

Dr. Smith Abbots, Pirrie, and Moore also pulished pamphlets describing various theories about hay fever, "all, more or less, showing a disposition to limit the cause of its development to emanations from plants," Mackenzie writes.  (11, page 17)

Beard explains there's no way to know where the term "Hay Fever" originated from, although "probably it first became known among the people, who observed that the symptoms were brought on or made worse during the hay-making season." (5, page 12)

Other names used to describe related symptoms were: June cold, July cold, and rose cold.  (5, page ii)  Generally the symptoms were the same, and the diagnosis was based on the season.  Yet the most common term associated with them all, regardless of the season, was Hay Fever.

Much like asthma, hay fever left no scars inside the body, other than inflammation (catarrh) that went away in time.  So the condition, like asthma, was soon theorized to be a nervous affection. (5, page iii)

References:

1. Mittman, Gregg, "Breathing Space," 2007, New Haven and London, Yale University Press
2. Taylor, C.F., editor, "The Medical World," volume 16, 1898, Philadelphia, 
3. Fry, John, "The Natural History of Hay Fever," J. Coll. Gen. Practi1, 1963, 6, page 260
4. Ehrlich, Paul M., Elizabeth Shimer Bowers, "Living with Allergies," 2008
5. Beard, George, "Hay-Fever; or Summer Catarrh: It's Nature And Treatment," 1876, New York, Harper & Brothers
6. Beard, ibid, pages 12 and 13, referenced by Beard from Dr. Mr. W. Gordon's paper "Observations on the Nature, Cause, and Treatment of Hay-Asthma," London Medical Gazette, 1829, vol. iv, page p. 266
7. Beard, ibid, pages 13 and 14, referenced from "On the use of Nux Vomica as a Remedy in Hay Fever, Lancet, 1850, vol. 1, page 692
8. Blackely, Charles Harrison, "Hay-fever: its causes, treatment, and effective prevention," 1873, 1880 2nd edition, London, Bailliere
9. Smith, William Abbotts, "On Hay-Fever, Hay-Asthma, or Summer Catarrh," 1867, London, Henry Renshaw
10. Hollopeter, William Clarence, "Hay-fever and it's successful treatment," 1898, Philadelphia, Blakiston's Sons & Co.
11. Mackenzie, Morel, "Hay fever and paroxysmal sneezing," 5th ed., 1889, London, J&A Churchill

1930-1950: The rise of the asthmatic institution x

Figure 1 -- NJH patients receiving sunlight exposure treatment

Thanks to better care, improved diets and good hygiene, the number of tuberculosis patients declined significantly during the 1930s. National Jewish Hospital at Denver and National Home for Jewish Children in Denver continued to stay open mainly because the doors to these hospitals were open to people with other diseases besides just tuberculosis, particularly asthmatics having trouble managing their asthma at home.   (1, page 115)

In the 1940s the number of tuberculosis patients was generally higher than those with other diseases, like asthma.  However, the number of asthma patients at the institution was on the rise.  And, for the most part, the goal for people with chronic lung diseases was to seek the cool, dry climate of Colorado for improved breathing.  So both asthmatics and TB patients received open air treatment (see figure 1).

Figure 2 --Children playing on swings at the National Home
 for Jewish Children, 1936 (6)

Likewise, patients who got better were provided the "added bonus of rehabilitation, social and education programs.  The education programs were intended to equip patients, who often came from lives of poverty, to function more effectively, in the world outside of the hospital."

Now, before I get into the rise of asthma patients at these hospitals, you have to understand the common thinking about asthma in this era.  First of all, asthma was a much rarer disease at this time, so it didn't get even close to the type of limelight that a deadly disease like tuberculosis got.

During most of the 19th century the two most prominent theories about asthma were that it was a neurotic disorder that resulted in airway constriction and shortness of breath.  This theory continued to be prevalent until it was disproved in the 1940s, and even then it held sway. So for the most part, if you had asthma, it was because you were a nervous person. This wasn't the only theory, but it was among the more prominent.

Another theory that became prominent around the turn of the 20th century was that asthma was also caused by allergies.  So while asthma was a nervous disorder, it was believed many cases were associated with allergies.  Many asthmatics got allergy testing to show they had allergies, and it was determined that some unknown substance in allergens -- like dust mites -- was causing asthma.  What it was no one knew, but some asthma experts believed this might lead to a cure for asthma.

In the meantime, many parents of severe asthmatics failed to understand the need to remove their children from asthma triggers, and so their asthma never got better.  They also failed to remove their children from their neurotic triggers, so, again, their asthma never got better.  Since asthma was much more rare back then than it is today, there was no push to better educate asthmatics, parents of asthmatic children, nor their doctors.

Regardless, the main theory regarding asthma in the 1940s was that it was a nervous disorder, or, as some called it, a psychosomatic disorder. It was all in your head.  Physicians heard stories by concerned mothers that when their asthmatic child went with the guys to do guy things the wheezing started.  So the logical conclusion made by these doctors was that these children were suffering from separation anxiety.  They were having asthma because they longed for their mothers.  For this reason they needed psychological help to be cured of their asthma.

As an asthmatic myself I can kind of understand this theory.  I remember not being able to do normal things with my brothers and dad, and when I did them I was a major burden on them more so than anything else. I remember my dad driving over an hour from hunting camp just to take me back home to mom because I couldn't breathe.  So ultimately I learned it was better for me just to stay home with my mom, where I became close to her.  So now it looks to others as though I'm overly attached to my mother, and when I go hang out with the guys I have separation anxiety, and this results in asthma.

Of course I really wasn't having separation anxiety, nor were any of these other kids back in the 1940s.  The truth is when they hung out with their dads and brothers they, like me thirty or forty years later, were doing things that made them get close up with their allergens.  Dad would take us deep into the woods to cut down trees, and he'd have us kids haul and stack the wood.  He'd come home and burn the wood, creating chimney smoke.  He'd take us to hunting camp, where allergens were galore.  And then when I was back at home my asthma would miraculously get better.

There were also many experts who believed the birth of a new brother could also result in worsening asthma, and this is exactly what happened to me on January 26, 1971 when my brother David was born.  So I suppose these experts might assume my asthma was a suppressed cry for my mother, who was providing all her attention to my little brother.  My physicians may not have thought this when I was suffering from asthma, yet this was the kind of thinking that persisted in the  1940s and 1950s and 1960s, and I'm sure  -- I'm positive -residue from these theories radiated into the 1970s and 1980s. I'm certain some of it affected me when I was a patient at NJH/NAC in 1985.

At first there weren't many asthmatics at these hospitals, mainly because, as noted, asthma was pretty rare in the 1940s. However, it was around this time Dr. M. Murray Peshkin, medical director for the National home for Jewish Children, observed a trend among asthmatic children at the hospital, and he postulated a theory based on his observation that would cause a spike in asthmatic children admitted to asthma hospitals around the nation.

What he observed was there were about 10 percent of asthmatic children who never got better at home, even when he personally visited their homes to make sure they were perfectly clean and antiseptic with no trace of any known allergen.  (2) He observed that as soon as being admitted to his hospital many of these children became immediately better. He observed that 99 percent of the chidlren treated this way had 'substantial or complete relief' of symptoms, according to his own reports. (3, page 145)

He concluded the reason for this was that once admitted to the hospital those children were away from both the stress of home life and away from the allergens at their homes.  So he proposed the idea of the "Parentectomy."  This basically means that children with severe asthma non-responsive to home treatment are removed from their homes, removed from their parents, and admitted to one of the many asthma hospitals around the nation.

So plucking the asthmatic and placing them in hospitals like National Jewish for one or two years was a growing trend throughout the 1940s and 50s, according to George Travis in his 1976 book, "Chronic Illness in Children."  He described that these hospitals worked on the "assumption that severe, intractable asthma stems from the family environment, and thereby removes the child from the parents from one to two years." (4, page 170)

Travis notes that there were some "interesting studies," and I might add, very credible studies, at very credible institution like National Jewish performed that proved the psychosomatic theory of asthma.  (4, page 170)  So it was only fitting that this theory, that began almost two thousand years earlier on some accounts, continued to reign prominent in the medical community. 

So this began the rise of the asthma institution.  It also resulted in some name changes:  In 1953 National Home for Jewish Children was changed to Jewish National Home for Asthmatic Children at Denver.  In 1957 the name was changed again to Children's Asthma Research Institute & Hospital (CARIH), and in 1973 to National Asthma Center.

References:

1. Minton, Gregg, "Breathing Space,"
2. Wamboldt, Fredrick S. "Asthma Theory and Practice: It's Not Too Simple," April 2, 2008,
3. Jackson, Mark, "Asthma: A Biography,"
4. Travis, George, "Chronic Illness in Children," 1976, California, Stanford University Press
5. "Clinical History: The Early Years," NationalJewishHealth.org, http://www.nationaljewish.org/about/whynjh/history/clinical/, accessed 11/7/12
6. Photo from Penrose Library, http://lib-anubis.cair.du.edu/About/collections/SpecialCollections/NAC/index.cfm, accessed 11/8/12

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.