1985: Asthma Group Sessions

I don't remember group sessions as well as I wish I did.  Ric Donworth was my counselor, and he was also in charge of group.  Sessions were on Tuesday after school, so I imagine they were around 4 p.m.  All the adolescent patients admitted to 7-Goodman were required to attend, unless they were granted permission by a doctor for medical reasons, or if they were on a pass off the premises.  

I loved group.  I think some of the kids were like me and loved it, while probably half hated it.  I remember my room mate Eric usually sat slumped on the couch opposite wherever I sat, and he was sometimes defiant.  He was reticent to tell his story, and when he was the focus of the session Ric spent half the meetings trying to either coax Eric into talking, or allaying one of his concerns.  Yet for the most part he didn't speak much at these sessions unless it was to poke fun at someone, like me.  

I think there were a lot of purposes for the group session.  I think for the most part it was to make sure we were all getting along well, and to settle any conflicts.  I remember one of the conflicts revolved around me and, and I remember Willie gave me advice at one of the sessions.  He said, "Rick, I have good advice for you.  I think you get picked on because you are too girly.  I think you need to toughen up, and I mean that in a good way.  You can do simple things like... like the way you're sitting now."  He mocked how I was sitting.  "Your feel are aiming together, and that's how girls sit.  You need to slump back and spread your legs out.  You need to sit like a man.  Like this."  He showed me how men sit."  From that session on I always sat right.

Some of the sessions involved making rules for 7-Goodman.  I remember voting.  I don't remember what for.  I wish I did.  Yet I think most of the sessions involved conflict:  kid verse kid, kid verse nurse, kid verse doctor, kid verse parents, kid verse stress.  They also involved coping with asthma, getting to know other asthma kids, and that you're not alone.  Learning about the psychological consequences, and the fear of going to 2-may.  We talked about change.  Ric lead these sessions, and he always did so in a calm manner.  I always liked Ric.  

I remember sitting in the meetings for about two weeks before talking about myself.  I was the type of kid who needed to warm up to people before I got involved.  Finally at one session Ric told me it was time to share my story.  I told how I spent so much time in and out of emergency rooms.  Like many of the other kids in the room, I thought I was the only one.  Listening to the stories of the other kids made me realize things I experienced weren't experienced by just me.  

The two meetings I remember the most both involved Willie.  He was a black kid from Cincinnati. He was the kid who every time there was conflict said, "Later for it."  He was a break dancer, and twice the nurses held dancing competitions, and twice he won.  Once he came out of his room and stood in front of the nurses station in his long johns, and he wanted someone to take a picture.  I was the only one with a camera.  I still have the picture.  Willie was a good kid with a good heart.  

He was told he was going to go home.  He was afraid.  He told of alcoholic parents.  He said he'd have to live with his aunt, and he was afraid of her.  He said he wanted to stay here so he could be with his real friends.  He said, "I feel like I'm at home here. I really love it here.  I love all you guys." Really, before this session, Willie was always so calm and cool.  On this day he feared for his life.  

I met Willie at the tail end of his stay on 7-Goodman.  I never really had a chance to really know him.  But I did sort of during these meetings, and on 7-Goodman.  He did not want to go home.  And then he went home, and a week later Ric called me, Karl and Sean to his office so he could talk to us.  He said Willie was in the hospital again, and he wasn't doing well.  He told us about Willie, more than he probably should have.  He talked to us as though were pals and not patients.  And we were pals, because National Jewish wasn't a hospital, it was a home.  

So he called Willie and put him on the speaker phone.  We all talked to him as a group and then individually.  Then we said good-by.  It was the last time I ever talked to Willie.  I think thee was another similar session the next day, but because of a prior commitment I was unable to attend.  Willie was discharged to home, and we had a sigh of relief.  We knew his story, and we feared for his life.  Ric did too.  Yet a week later he was back in the hospital.  Ric told us that later that night we could call him.  Yet in school that day Shannon was crying.  I had no idea why she was crying. Mr. Rose tried to calm her down, but she left class.  

At about 1:00 that afternoon, or just after lunch on 7-Goodman, we returned to school only to have Mr. Rose tell us we all had to report to 7-Goodman right away.  A sudden silence stunned us all.  I remember feeling all shaky because I knew something bad had happened.  We all met on 7-Goodman in one of the back rooms on the south side of 7-Goodman.  We were all cramped in a room.  Ric was there.  He said, "There really is no good way to tell you this, so I'm just going to come out with it.  Willie passed away today."  

Yes, a cacophony of sighs and cries filled the room.  Ric told us we could have the rest of the day off.  The rest of the day was gloomy.  And at the next group session we talked about Willie.  There was a lot of speculating of why he died, and I don't think that there were any words that Ric could say to allay our minds.  Truly, there was nothing that could be said.  

So the most significant issue at these meetings was coping with life, and coping with asthma, and letting us know that we all share a common bond, and that we are not alone.  I can honestly say I am a better person today for having experienced 7-Goodman group sessions. 

639-322 B.C.: Greek medicine was key

Greek philosophy was the key to all medical knowledge through history. Later on in our history we will see that when Rome fell, all knowledge of philosophy was lost to western civilization, and therefore it became engulfed in a dark ages of medicine. This era lasted for over a thousand years, until the key was rediscovered.

So how did Greek medicine become the key to all medical knowledge? As we've learned, the Ancient Greeks were the first people to have time to sit around and think, and they basically became our first philosophers. So curious were these philosophers that they traveled the world and visited with all the sages, and upon returning to Greece they added this wisdom to the pantheon of philosophical wisdom.

Among this wisdom was all the knowledge of medicine that existed. This made Greek philosophy the key to all medical wisdom. Their medicine was basically one based on philosophy, and it evolved over a period of hundreds of years, stacking the theories of one great philosopher on to the theories of another.

This key is important to our asthma history because it would determine how your asthma was treated. Here I will list some of the key figures from Ancient Greece as far as their medicine is concerned, with a pithy explanation of that person's contribution.

You can kind of bare with me as we proceed through this, and by the end you should see the connection with modern medicine, or I so hope Ready? Here we go*!

1. Thales of Miletus (639-544 B.C.): Garrison, in his 1922 history of medicine, said "he was taught under Egyptian priests, and taught that water is the primary element from which all else is derived." (1)

2. Anaximander of Miletus (611 B.C.): Garrison said "he mapped the heavens and made a successful prediction of an eclipse."(1) Perhaps he did this while working with Thales, because Sigerist credited Thales as accomplishing this feat. He believed the common elements were fire, air, water and earth, and their qualities were wet, dry, hot and cold. He believed they were all caused by a primary substance. From this the idea of two primary elements with opposite qualities was born. In a healthy person they were in balance. This theory would go on to become a significant part of Greek medical theory. (2, page 91) It must be assumed her that he did not create these elements and qualities, simply introduced them into Greek philosophy.

3. Pythagoras of Samos at Crotona (580-489 B.C.): Garrison said he studied in Egypt and it is probably from here that he "acquired his doctrine of the mystic power of numbers... (of which) the numbers three and four represent the worlds, the spheres, and the primordial elements" (earth, air, fire, water). He was also the first to associate the brain as the "central organ of higher activities." (1)

Sigerist said that while he believed in the elements and qualities, he believed the number was the most significant. He said:

Among the numbers, four played a significant part, for it seemed logical that two pairs of forces with opposite qualities would constitute an ideal balance, and we shall see that this view had a profound influence on medical theory, as had the Pythagorean doctrine of opposites of its dualistic form in general. These opposites were necessary to explain the harmony of the world. (2, page 97)

He believed that a balance of the internal qualities must be achieved in order to
maintain health, and this was maintained by "practicing moderation." When a person was unhealthy it was because the balance was disturbed. Health was therefore re-established physically by medicine, and mentally by music. (2, page 96-98)

Neuburger said some of the internal materials present in the body that needed to be balanced were cold, moist, warm, dry, sweet, and bitter. Empedocles would later limit these to four.   (13, page 107)

As can be assumed with some degree of accuracy, he basically compiled all the wisdom of the sages of the world, and all the wisdom of the earlier philosophers of Greece, and created a large following who listened to his lectures. He even organized his followers into a school, and in this way he made philosophy popular in Greece, and is often given credit for giving birth to the Age of Philosophers in ancient Greece.

You can read more about Thales, Anaximander, and Pythagoras in this post. (1)

4. Anaximenes of Miletus (570-500 B.C.): He lived about the same time as Pythagoras. Garrison siad he "assumed that indivisible matter (earth?), air, or fire respectively are the primordial elements."(1) Sigerist said he believed that of the elements of earth, air, fire and water, that air was the primary element. Of this, Sigerist said: (2, page 92)

He wrote a book of which one sentence has survived: "As our soul, being air, holds us together, so do breath and air surround the whole universe." (2, page 92)

He believed air was essential for sustaining life, and that it was also evident in the soul. He believed air was the primary element because he believed the others were "born from it through changes of density," said Sigerist, "through rarification and condensation." As a note here, rarification is an old term meaning that the air pressure is decreased. Condensation means the air pressure has become increased. (5, page 92)
Sigerist continued, "Rarified air became fire, and heat was generated in the process, while condensed air became water and finally earth, and produced cold. This was a logical explanation, and breath or air came to play an increasingly important part in biology." (2, page 92)

5. Heraclitus of Ephesus (556-460 B.C.): Same contribution as Anaximenes.(1) Sigerist said he believed everything changes constantly, and therefore he believed the primary element was fire because it caused things to change. He believed fire produced air, water and earth. Fire, like war, causes strife, and the polar opposite of war and fire causes peace and unity (or balance).
Sigerist quotes him as saying: (2, page 93)

That which is in opposition is in concert, and from things that differ comes the most beautiful harmony." (2, page 93)

Sigerist said that, quoting Heraclitus along the way, "It is through opposites that we become aware of things. Disease 'makes health pleasant; evil, good; hunger, plenty; weariness, rest.' And everything in the world moves according to eternal laws. These very principles, unity of the world, eternal changing of all things caused by tension, and law and order ruling the world, were principles which proved to be strong stimulants to scientific research." (5, page 93-94)

You can read more about his theory of opposites by clicking here.

6. Anaxagorus of Clazomenae (500-428 B.C.): He assumed the four elements (earth, air, fire, water) to be made up of as many parts or 'seed' as there are varieties of sensible or perceptible matter. (1)

7.  Empedocles of Agrigentuin in Sicily (504-443 B.C.): Medical historian Edward Withington said he first mentioned the four elements, which would later influence Greek medicine, in the following poem:  (7, page 45)

Listen, first, while I sing the four-fold root of creation,
Fire, and water, and earth, and the boundless height and the aether, For therefrom is begotten what is, what was, and what shall be. (7, page 45)

Withington explained that by... 

"...substituting air for aether, this is the doctrine of the four elements, which Empedocles introduced into philosophy, and which, with the co responding four qualities, heat, cold, moisture, and dryness, and the four humours, blood, phlegm, black and yellow bile, lies the basis of Greek medical theories." (7, page 45)

Fielding Hudson Garrison verifies this, adds to its significance.  He said:

"He introduced into philosophy the doctrine of the elements (earth, air, fire, water) as 'the four fold root of all things.'  The human body is supposed to be made up of these primordial substances, health resulting from their balance, disease from imbalance.  He holds that nothing can be created or destroyed, and that there is only transformation, which is the modern theory of conservation of energy.  Everything originates from the attraction of the four elements and is destroyed by their repulsion, and he applies the same idea, under the forms of love and hate, to the moral world.  Development is due to the union of dissimilar elements, decay to the return of like to like (air to air, fire to fire, earth to earth)." (1, pages 80)

The association between the four elements, four qualities, four humors, four basic organs, four seasons, and the four personalities can be seen by the following chart.

Element	Quality	Humor (Greek)	Combination	Organ	Season/ Cause	Personality Temperament
Fire	Hot	Blood/ Haima	Wet & Hot	Heart	Spring/ Energetic Hopeful	Sanguine: jovial, social
Air	Dry	Yellow Bile/ Choli	Dry & Hot	Liver	Summer/ Diseases	Choleric: fussy, irritable
Earth	Cold	Black Bile/ Melanchia	Dry & Cold	Spleen Stomach	Autumn/ Melancholy Depressed	Melancholy: depressed, gloomy
Water	Wet	Phlegm/ Phlegm	Wet & Cold	Brain Lungs	Winter/ Coughs, Colds	Phlegmatic: peaceful, laid back

You will see the significant of these played out in pretty much an history of mankind, and definitely in an history of medicine.  While some contribute these to various different authors, such as Aristotle sometimes gets credit for the four elements, and Hippocrates for the four humors, it is the great Empedocles to which they may all be traced back to.

He believed that respiration, along with occurring through the lungs, also occurred through tiny pores in the skin.  (13, page 108-109)

While Empedocles probably wasn't the first to conceive of the idea that something in the air inhaled was essential to life, he created the theory of pneuma.  Pneuma was a substance in the air that contained a vital spirit.  It flowed through the body by veins, providing life to the organs.  It was responsible for movement, consciousness and perception.

8,  Democritus of Abdera (460-370 B.C.):  He was a student of Leucippus, and believed the mind and body were composed of corpuscles or atoms that were solids and unchangeable.  In this way, he believed living things were made of these solid atoms as compared to the humours of Hippocrates.  (14)

He believed the atoms were organized and arranged within the human body by a natural mechanism. (8, page 23)  He believed that inflammation was an accumulation of phlegm.  He believed the "widespread appearance of epidemic disease was... due to the disseminated atoms of shattered heavenly bodies." (13, page 110)

9.  Hippocrates (460-370 B.C.):   Prior to Hippocrates, methods of treating diseases were relatively simple, and taught mostly by word of mouth.  However, stored in the Asclepions were votive tablets, and these contained lists of diseases and their cures.  Hippocrates was the first to take all this wisdom and publish it into a compilation of 60 treaties called the Corpus Hippocraticum.

He believed air was inhaled, and this air contained pneuma.  He actually referred to "breath" as the pneuma, and this pneuma (or breath) flowed through the veins, such as was noted by Empedocles.  In health its flow through the body was unimpeded.

He believed that within each person was a combination of the following qualities: (14)

• Acid
• Saline
• Acerb
• Bitter
• Mild
• Insipid
• Austere (14)

He said each of these was...

...possessed of different powers, in proportion to their quantity and degree of strength. All of these, when well united, and tempered by each other, are insensible to us, and do no injury; but if one should separate, and exist alone, it then becomes sensible, and ravages the system. It is the same with aliment. That which is improper for us, is either bitter, saline, acid, or too strong. (14)

Healthy food, such as bread, barley and cakes, " causes no uneasiness, or any separation of the particles of the humours of the body, and serving only to strengthen, nourish, and promote its growth. All these benefits arise from its well-attempered state, in which nothing predominates, nothing is irritating, nothing too strong. Every thing is reduced to a point, so as to be esteemed simple, homogeneous, and at the same time, of adequate strength." (14)

However, in the process of making such food, things like fire and water are employed, "each having its own peculiar powers and qualities. (The food) loses part of what it had, and what remains is a compound mixture." (14)

In this way, each type of food has its own particular qualities, such that bread has different qualities than cakes.  Likewise, depending on how it was prepared, two different loaves of bread may have unique qualities. (14)

Hippocrates believed, therefore, that eating the wrong food, or too much of the good food, or food that was not prepared correctly, or food that was not part of that person's normal diet, might upset the unity and homeostasis within the body. This, in turn, leads to changes in the four qualities and four humors of Empedocles.

Medical historian Edward Meryon said Hippocrates must have studied the works of Democritus, who believed that a natural process usually worked to maintain a balance (homeostasis, unity) of the atoms.  Hippocrates believed a natural process usually worked to maintain four qualities and four humors of Empodocles in order to maintain health.  Hippocrates taught that any imbalance of the qualities or humors within a person was the cause of disease.  (8, page 23)

Nature worked to maintain balance in health, and to re-establish balance in sickness.  He believed imbalances were generally the result of eating the wrong foods, or changes in the wind, or changes in the temperature, or changes humidity.

His remedies were generally gentle, and merely worked to assist nature in the healing process.  They included simple things such as getting plenty of sleep, taking a bath, eating healthy, and exercise.  

He believed in the maxim:

 "Merely give nature a chance, and diseases will cure themselves."  (3, pages x-xii)

His ideas would transform medicine from one of mythology and philosophy taught at the Asclepions, to a "distinct department of practical knowledge" that could be learned by anyone.  (9)

10.  Plato (427-347 B.C.):  He was a student of Socrates, and became famous for recording the wisdom of the great philosopher.  He then became a famous philosopher himself.  As was normal for the era he was born into, he was educated in all the knowledge of the day, including medicine.

Garison said that his main contribution to medicine was that "In pathology, the plastic significance of the number four was combined with the doctrine of the four elements." This can be seen here (in parenthesis is our modern correspondence): (1)

• hot + dry = fire (hydrogen)
• cold + dry = earth (oxygen)
• hot + moist = air (carbon)
• cold + moist = water (nitrogen) (1)

These could also result in the following:

• hot + moist = blood
• cold + moist = phlegm
• hot + dry = yellow bile
• cold + dry = black bile

The various combinations of these resulted in both the aspect of disease and the action of the drugs used to treat them.  Each person had a unique combination of these and maintained the equilibrium in times of health. Disease was a result of increases and decreases of any of the above.  Health was re-established by making the necessary adjustments.  (1)

Plato believed in the Pythagorean Theory of Opposites, although he also believed there was a "third element mediating between a pair of opposites." He believed the soul completed "the human trinity of body, soul and spirit."   (12, pages 2-4)

He believed the body consisted of a soul with three parts: (11, page 23)

• Rational Soul: Created by the brain 
• Animal Soul: Created in the chest and is responsible for emotions and passions
• Vegetable Soul: Created in the abdomen and controlled physiological needs (11, page 23)

While Plato didn't create any of these ideas, he helped to keep them alive by his fame.  He would also relay this wisdom to his famous pupil, Aristotle.   

11.  Aristotle (384-322):  He was born in Stagira to a wealthy family. His father, Nicomachus, was personal physician to Amyntas, king of Macedon.  He probably learned quite a bit about medicine from his father before, starting when he was 17, spending 20 years being tutored by the great philosopher Plato at his academy in Athens.   (6, page 3)

He would spend about 20 years in Athens as a student, and then as a teacher. Some speculate he left after not being chosen as Plato's successor upon Plato's death in 347 B.C.  Some speculate the reason Aristotle was not chosen, and why he left Athens, was because Aristotle was known to debate and disagree with Plato.  He moved from Athens and continued his work elsewhere. (6, pages 3-5)

Regardless, he basically supported the same ideas regarding medicine as Plato.  He believed in the four elements, qualities, and humors.  He believed that a balance or imbalance of these determined health and sickness.  (1)

While he believed in the elements of Empedocles, he attempted to add a fifth element that he called aether, a substance that made up what was seen in the sky at night, such as the stars, sun, planets, comets, etc.  He was not the first to write about the elements and their qualities, although by the fame he acquired by being the instructor of Alexander the Great he was able to increase public awareness of them.

While he was not a physician, and is known mainly for his contributions to philosophy, he did make some significant contributions to medicine.  Considering he was unable to dissect human beings, he spent most of his time at the dissecting table studying plants and animals.  He was known for his faith in nature, claiming that "Nature does nothing uselessly."  (5)

He stayed in A

12. Erasistratus (304-250 B.C.)  He was among the first Greek anatomists.  He was the beneficiary of the new city, Alexandria, created by Alexander the Great.  After Alexander died before he was 32 years old, Ptolomy decided to make Alexandria the leading place of wisdom and science in the world, so he gave the physicians at Alexandria permission to dissect human beings.  Among these physicians was Erasistratus, who discovered and learned much about the inner workings of the human body.  Some say he even went as far as to dissect living human beings, but all in the name of advancing science and wisdom.

He disregarded the idea the the four humors caused disease, and believed that diseases like pneumonia were caused by changes in the body, such as inflammation of the lungs.  This is the type of wisdom that might have been expounded upon if it wasn't considered sacrosanct to dissect the human body in the ancient world.

13. Herophilus (335-280 B.C.): He was the other leading physician at the school of Alexandria, and he likewise participated in dissection of the human body in a quest to improve wisdom and science. Unlike Erasistratus, he supported Hippocrates and his humoral ideas.

14.  Galen:  He was born during the Roman Civilization, although he still lived in Greece.  He lived in Pergamum, a city that was ruled by the Romans, but they still lived under Greek culture.  Galen learned from all the above physicians, and he basically combined the works of all these great men, particularly combining the theories of Hippocrates with the anatomical discoveries of Erasistratus and Herophilus.

He believed in the humoral theories of health and sickness of Hippocrates. However, while Hippocrates was not concerned with anatomy of the body, Galen came up with theories of how each organ participated in the organisms life giving process.

Galen also believed in the Aristotelian idea that nature makes no flaws, and perhaps from him Galen obtained his belief that God created only perfect human beings, and therefore each part of the body had a perfect function.

Through his writings he described the faculties of nature, whereby each part of the body (veins, arteries, organs, etc.) performed a distinct function in order to maintain life, health and longevity.

He absorbed the idea of Plato of the power of three parts of the soul, although he referred to them as spirit.

• Natural Spirit: Formed in the liver and flowed through the body by veins to the various organs. 
• Animal Spirit: Formed in the brain and responsible for sensation and intelligence
• Vital Spirit: Formed in the heart when air mixed with blood, and flowed through the arteries to the various organs.  It consisted of passions. 

He believed the person ingested food, the food was cooked in the stomach, turned into chyle, sent to the liver by veins, and turned into blood in the liver.  The liver added natural spirit and nutrients to the blood, and sent it to the right ventricle of the  heart to be purified.  The blood was turned into a light, frothy substance so it could enter the lungs, and returned to the right ventricle of the heart as purified blood that ebbed and flowed through the entire system to provide natural spirit and nutrients to the body through the veins.

Some blood from the right ventricle was transferred to the left ventricle by invisible pores.  This blood was mixed with air that was inhaled by the lungs.  Since the heart was hot and controlled the temperature of the body, the cool air was needed to cool the heart.  Air also contained pneuma, and so when the air and pneuma mixed with blood in the left ventricle, it formed vital spirit.  This substance was responsible for the passions of the person, and was transferred through the body by the arterial system.

Some arterial blood went to the brain by vessels from the heart to the brain.  Here this blood was mixed with animal spirit and sensations and intelligence.  These were transported through the body by the various nerves.

His ideas of health and healing were similar to Hippocrates, although he believed changes that occur within one organ can effect the body as a whole.  For example, asthma was caused by increased phlegm in the lungs, epilepsy was caused by increased phlegm in the brain, fever was caused by increased blood, etc.

His remedy was to treat contraries with contraries, or to treat whatever was the suspected cause with the opposite.  If someone has too much phlegm, for example, Galen may with so have the patient drink an purgative or emetic to expectorate the excess phlegm.

Since Galen was the very last of the Greek and Roman physicians when Rome collapsed, and because he wrote so much about it, his works continued to be worshiped for greater than the next 1,500 years.  Basically, Greek medicine survived the dark ages through the works of Galen.

During the Middle Ages the Catholic Church accepted the medical writings of Galen, perhaps because he believed that God created only perfect human beings.  This fit into the Christian belief that god made no flaws.  During this time, anyone who spoke out against the writings of Galen was greatly ridiculed, and sometimes severely punished, sometimes with death.  (4, page 113)

So during the dark ages of medicine Galen became a god, of sorts, of medicine.  His works were like the Bible to physicians.  In this way, Greek medicine was the key, or the foundation of all medical knowledge.  It would only be from using this key that any future advancements in medicine would be made.

References:

1. *The above characters and descriptions are taken from Fielding Hudson Garrison's book, "An introduction to the history of medicine," pages 80-83.  The same information can be obtained in many medical history books, with Garrison's, in my opinion, being the most pithy for our purposes.  
2. Sigerist, Henry E, "A History of Medicine: Early Greek, Hindu and Persian Medicine," Volume II ", 1961, Oxford University Press, pages 88-99
3. Brock, John, "Galen on the natural faculties," 1916, London, New York, William Heinemann, G.P. Putnam's Sons
4. Bendick, Jeanne, Galen and the gateway to medicine," 2002, San Fransisco, Ignatius Press
5. Dunn, P.M., "Aristotle (284-322 B.C.): philosopher and scientist of ancient Greece," Arch Dis Child Fetal Neonatal Ed., January, 2006, 91(1): F75–F77.
6. Lloyd, G.E.R., "Aristotle: The growth and structure of his thought," 1999, UK, Cambridge University Press

   Aristotle (384–322 bc

   Aristotle (384–322 bc

   Aristotle (384–322 bc

7. Withington, Edward Theodore, "Medical History from the earliest times: A popular history of the art of medicine," 1894, London, The Scientific Press
8. Meryon, Edward, "The History of Medicine," Volume I, 1861, London, 
9. Watson, John, "The Medical Profession from the Earliest Times: an anniversary discourse delivered before the New York Academy of Medicine November 7, 1855," 1856, New York, Baker & Godwin 
10. Hippocrates, "The art of medicine in former times," epitomised from the Original Latin translations, by John Redman Coxe, "The writings of Hippocrates and Galen," 1846, Philadelphia,  Lindsay and Blakiston
11. Weckowicz, T.E., H.P. Liebel-Weckowicz, "A history of great ideas in abnormal psychology," 1990, North-Holland, Elsevier Science Publishing Company, Inc. 
12. Nash, John, "Plato: A Forerunner," The Beacon, July/August, 2004, pages 18-24
13. Neuburger, Max, writer, "History of Medicine," 1910, translated by Ernest Playfair, Volume I, London, Oxford University Press
14. Berryman, Sylvia, "Democritus," from the book "The Stanford Encyclopedia of Philosophy," http://plato.stanford.edu/entries/democritus/, 2010, accessed 12/22/13
Hippocrates, "The Art of Medicine," "The writings of Hippocrates and Galen," Epitomized from teh original Latin translations by John Redman Coxe, 1846, Philadelphia, Lindsay and Blakiston

1949-1969: The National Foundation for Asthmatic Children

One of the main reasons National Jewish Health was able to stay afloat through the years is that it recognized the changing health needs in America. While both National Jewish Hospital for Consumptives and Denver Sheltering Home for Jewish Children opened to provide opportunities for children and adults inflicted or affected by tuberculosis.

Between the 1940s and 1960s the number of tuberculosis patients declined, and the number of asthma patients increased. Plus there as a need for taking care of patients with other diseases, including emphysema, chronic bronchitis, cystic fibrosis, bronchiectasis, silicosis, sarcoidosis, and fungal infections (1)

Yet there was also an increased emphasis on research, hence the name change of the Sheltering home to Jewish National Home for Asthmatic Children at Denver in 1953, and in 1957 to Children's Asthma Research Institute & Hospital (CARIH). The hospital also performed research into immunity, and this was a major reason for the 1985 name change of National Jewish Hospital/ National Asthma Center to National Jewish Center for Immunology & Respiratory Medicine.

There was another institution in Tuscon, Ariona, that was similar to National Jewish. People with lung ailments flocked to Arizona due to its dry climate, which was perceived to better for adults and children with breathing difficulties. The National Foundation for Asthmatic Children (NFAC) was opened in Arizona in 1949. It was actually the first "diseased based organization to launch a national campaign on behalf of the asthmatic child. (2, page 115) During the 1950s National Jewish Home for Asthmatic Children started a similar educational campaign. (2, page 116)

Back then asthma was a little known disease, yet a massive advertising and public relations campaign by both National Jewish and NFAC increased awareness of the 2.5 million children in America with asthma. The campaigns increased awareness of the hospitals and research centers in both Denver and Tuscon. And the number of patients being referred to these hospitals increased. (2, page 116)

In 1973 CARIH changed its name to National Asthma Center, and admitted financial trouble by 1978, so it merged with National Jewish to create National Jewish Hospital/ National Asthma Center. This created the largest asthma hospital and research center in the world. Although there was an emphasis on patient care, the hospital continued to emphasize research.

While the school at NFAC closed in 1969, the hospital persisted. It was another option for children with hardluck asthma or other respiratory diseases. There was another such hospital in New York called Asthmatic Children's Foundation. In 1981 there were 15 similar residential treatment centers for asthmatics. (3)


In August of 2009 several former patients at NFAC met in Tuscon, Arizona to reminisce about their stay at the institution. The major emphasis back then about asthma was that medicine was used to treat acute symptoms, with included bronchospasm. Asthma was also a disease caused by a nervous disorder, or a suppressed cry for the mother. (4)

These kids were treated with a good course of education, exercise, and a good, healthy diet. They were also allowed to live a relatively normal life outside of that, by going on trips to town like normal kids, shopping, tours, amusement parks, parks, etc. They were also allowed to participate in games and other fun things kids do.

The kids "attend a boarding school for asthmatic children. These children can play out of doors year round and they become confident and competitive because they are competing with children on their own level," according A.B. Sieh, executive director for NFAC, in an article published in the Rotarian in August 1965. (5, page 51)

Boys and girls afflicted with bronchial asthma generally are admitted to the hospital for a one or two year stay, and this is at no charge, similar to the two asthma hospitals in Denver. The school the kids attend has a capacity of 72, and it's usually full (5, page 51)

Sieh notes that the "they come here pigeon chested with hollow eyes and sad faces... we have had children, who upon arrival, who could not walk up a single step without bringing on an asthma attack... the Arizona sun takes over and we have healthy looking children who can go home -- not cured, but rehabilitated to the point that they can cope with their asthma and live a normal life, attend public schools, and not be 'different.'

So while the main goal was to improve asthma, it wasn't like you were living in a hospital, at least not all the time. It allowed kids to get better, so they could go on to live normal lives.

References:

1. "Clinical History," NationalJewishHealth.org, http://www.nationaljewish.org/about/whynjh/history/clinical/clinical-history3/, accessed 11/7/12
2. Mitman, Gregg, "Breathing Space," 2007
3. Melvin, Tessa, "For 36 Children, Hope on Asthma," New York Times, September 26, 1982
4. Beal, Tom, "Tuscon asthmatic kids of reunite, view latest research," Arizona Daily Star, August 3, 2009
5. "These Rotarians: ABCs School," The Rotarian: An International Magazine, August, 1965

1714-1775: Hill's asthma panacea is honey

Sir John Hill was a physician/ actor who lived from 1714-1775.  He raised bees and wrote a book called "The Virtues of Honey," in which he described honey as the great panacea for an assortment of diseases, including most cases of asthma, and by this he disagreed with many other physicians of his time.  (1, page 223)

His book was published in England in 1759 and was the first book written about honey, and particulary of honey as a panacea for diseases.  Chapters four through eight of the book are devoted specifically to the effects of honey on phlegm, coughs, and hoarseness.  He also believed honey was a cure for consumption (tuberculosis). (2, page 511) 

Hill describes two types of asthma: (3, page 25)

1. Real Asthma:  It's very frequent, and no disease is more troublesome.  Honey is a cure. 
2. Convulsive or Nervous Asthma: It's only called asthma because the symptoms are the same.  It's a less common disorder.  Honey will do nothing

He described asthma as "usually a disease of elderly people: and those who are subject to it have frequent returns, for all the methods in common use are calculated only for relief of the present fit, not for a lasting cure.  Tis fit the old man know his case and danger, especially especially as this sure remedy is at hand; and as his life depends upon avoiding the other."  

Hill's description of asthma as either real or nervous differed from many of his contemporaries who were increasingly supporting the idea that asthma was a nervous disorder.  (4, page 71)  And he also questioned the need to use remedies for diseases that made the patient feel worse in order to give you your breath back, such as bleeding or medicines that made the patient vomit or develop diarrhea. 

He wrote:

"In the extremity of a fit, the surgeon is called in to bleed the person, and this flattering practice is universal, because it gives immediate relief; but fits return often, and if bleeding is so frequently repeated, the constitution is destroyed." 

He wrote:

"We seek from the remotest parts of the world, medicines of harsh and violent operations, for our relief in several disorders, under which we should never suffer, if we would use what the bee collects for us at our doors; and in as many others which tho' no care could make us escape, the same innocent and pleasant juice would cure... Africa is ransacked for its nauseous Ammoniacum to give breath in Asthmas, and in extreme cases the body must be bled by blisters for relief; when this pleasant and safe medicine answer all the purposes of the first, and save all the torments of the later application."(3, page 3-4)

He explains that there was a time in the past when honey was more often  used.  It was during this time that "disorders of the lungs and breast were unknown: consumptions never heard of, no obstruction of the vicera are seen; and of the long list of chronic diseases scarce one or two known." (3, pages 4-5)

He explains that some asthma is continuous and some only occur in fits, and honey will help with both.  He explains that "In both cases the difficulty of breathing goes off, when the person has spit up a tough phlegm; and this will always be promoted by the use of honey one of the most immeidate and certain effects of which is, making a person cough loose and spit easy whatsoever matter it be that oppresses the lungs."

He recommends that those who have "continual asthma should take Honey always night and morning; and everything should be sweetined with it, wherin others use sugar." 

For continuous asthma he also recommends for the asthmatic to...

• Choose proper air (where he breathes easiest let him properly reside
• Lie with his head high, and not be too much covered with cloaths
• Avoid any posture of stooping or leaning forward; write upon a high desk, and read sitting upright
• Use some exercise; but never too much, or too violent
• (Enjoy) a temperate diet, early rising, and light suppers
• Constant use of honey

The fits of occasional asthma tend to occur "usually about three in a month; they are more violent and last longer in summer than winter; and the more irregularly the person lives, always the worse they are.  In all these cases, the sooner the person begins to spit the lighter and easier will be that fit.  Therefore Honey should be continually taken to promote a natural tendency to this; and the approaches of the fit should be watched carefully, that it may be got down in larger doses as that comes on.  If the person feels a tightness about the mouth of the stomach two hours after dinner, this is a first sign of its coming on, and he should immediately take a large spoonful of Honey: he should sit still, but upright; and in half an hour take a spoonful more.  If the stomach feels swell'd and the person belches frequently, it is a continued sign of the fit gaining strength, and a straightness of the breast and lungs will soon follow.  Once in two hours half a spoonful of honey is to be taken; for three times more.  Then the person should go to bed and lie with his head high.  Generally an hour or two the fit comes on with violence.  He should then get up and continually be sucking down a little honey.  

After reading this one gets the general feeling he's simply describing an asthma attack, and is trying to sell a product he produced.  He continues:  "If the honey does not take effect, the fit will continue two, three, or four days; the difficulty of breathing all the time continuing, and at the end of the time the person will spit up a foul matter, and grow well.  In this case, the use of honey must be continued; several times a day taking a little: the person should eat no meat, nor drink any strong liquor, and by the use of honey it will thus go off."

Of course his prevention is the same as his remedy:  honey.  He writes:  "It will be first used when the disease is established in the constitution, it will by degrees produce the effect, shortening the fits, and gradually preventing them entirely."

Another remedy he thought was neglected since the introduction of chemical medicines was erysimum.  It's a herb that can benefit asthma when mixed with honey.  And thus it was his mission to make popular once again the remedy of honey.

References:

1. Rousseau, George S, "The Notorious Sir John Hill:  The Man Destroyed by Ambition in Era of Celebrity," 2012, U.S., Lehigh University Press
2. Crane, Eva, "The World History of Beekeeping and Honey Hunting," 1999, Great Britain, Gerald Duckworth and Company
3. Hill, John, "The Virtues of Honey," 3rd edition, 1760, :London,
4. Jackson, Mark, "Asthma: The Biography," 2009, New York, Oxford University Press

(Notes:  Other physicians during this time were Philip Stern and John Mudge.  They were busy inventing and patenting inhalers.  A post about them will be coming soon)

Further reading:

1. Buchan, William, "Domestic Medicine: or, a Treaties on the Prevention and Cure of Disease by Regimen and Simple Medicines," 5th edition, 1776, London, Introduction and page 441-5

1892: Dr. Osler's recommends asthma remedies x

Dr. Osler's book "The Principles and Practice
of Medicine" was first published in 1892, and
was continually updated until 2001. 

Dr. William Henry Osler's recommended treatment for asthma didn't sway much from what other physicians of his day prescribed.  Since there really was no one medicine to resolve an asthma attack, which medicine to recommend was mainly based on personal preference.

However, Osler was among the first to note the urgency of treating asthma as he wrote "immediate and prompt relief is demanded."  Remedies include any of the following:

• A few whiffs of chloroform will produce prompt but temporary relief
• Perles of nitrite of amyl may be broken on the handkerchief or 2-5 drops on cotton-wool and inhaled
• Strong stimulants given hot or a dose of spirits of chloroform in hot whiskey will sometimes induce relaxation
• Morphia or morphia with cocaine will produce more permanent relief (requires hypodermic injection). Good for obstinate attacks.
• Antispasmotics, such as belladonna, stramonium, and lobelia in solution or cigarettes
• Solanacae with nitrate or chlorate of potosh (common in most remedies)
• Any form of asthma cigarettes (one form benefits one pt while another benefits another)
• Nitre paper made with strong solution of potash.  "Filling a room with the fumes of this paper may sometimes ward off a nocturnal attack."
• Tobacco smoke:  sometimes as potent as the prepared cigarette
• Large meals early in the day as opposed to later
• Coffee is better than tea
• City is better than country
• High and dry altitudes are more beneficial than sea shore
• Oxygen may also be tried
• City living was better than country living

Osler was among the first to recommend oxygen for the treatment of asthma, yet while epinephrine (adrenaline) was discovered in 1901, updated editions of his book prior to his death did not mention this quick acting medicine.

Many historians have  noted that Osler was unique in that he mentioned that "death from the attack is unknown."  However, many asthma experts during the 19th century, including Henry Hyde Salter, made similar observations.

References: 

1. Osler, William, "The Principles and Practice of Medicine," 1892, New York, pages 497-501

Click here for more asthma history.

References:

1. "Sir William Osler At Seventy -- A Retrospect," The Journal of the American medical Association," 1919, Saturday, July 12, pages 106-108
2. Osler, William, "The Principles and Practice of Medicine," 1892, New York, pages 497-501
3. Bliss, Micheal, "William Osler:  A Life in Medicine," 1999, New York

Further readings:

1. Jackson, Mark, "Asthma: The Biography," 2009, New York, pages 211-12
2. Brenner, Barry E, ed., "Emergency Asthma," 1998, New York, pages 212-14

1849: The dawn of modern medicine (the height of the scientific revolution)

Oliver Wendell Holmes was among the first to realize that
fevers can be spread by unclean hands. (4, page 457)

William Henry Osler was born in Canada on July 12, 1849.  This was an era where age old habits, methods and ideals used by physicians were being reconsidered.This was an era where physicians were just starting to adapt the use of the stethoscope, laryngoscope, thermometer and microscope into their daily practice.  It was from these devices that physicians were leaning that what went on inside the body effected what went on outside the body.  Through scientific method, many ancient ideas about medicine were being reviewed, and some were even cast away in favor of better wisdom.

Consider the following wisdom that was plastered throughout the medical community:

1843:  Oliver Wendell Holmes (1809-1894) announced to the medical community that women in child bed should not be attended by physicians who had studying the victims of perpetual fever.  He was concerned the causative agent might be spread to the mothers and their babies.  He recommended that physicians and medical caregivers wash their hands and change their clothing after leaving patients infected with perpetual fever. He received harsh criticism from his fellow physicians who were in harsh opposition to change. (4, page 457)

Ignaz Semmelweis proved washing hands and changing
dirty attire between patients reduces the spread of sickness.
Despite his evidence, he was mocked and ignored. (4, page 458)

1846:    Ignaz Philipp Semmelweis (1818-1865) became an assistant in an obstetric ward in Vienna where there was such a high death rate from child bed fever that women feared to go there.  Semmelweis observed the death rate was higher in the 1st ward where he and his fellow male physicians worked compared to the 2nd ward where female mid wives worked.  Upon investigation he learned the women were much cleaner in appearance than the physicians, who often walked proudly around with blood stained hands and aprons.  The physicians also were more likely to perform postmortem investigations just prior to checking the vagina.  The women, on the other hand, did not have blood stained clothes and washed their hands in calcium chloride solution between patients.  When he insisted his physicians likewise wash their hands and put on clean clothes prior to checking women in child bed, the death rate fell from 9.92% to 3.8%.  The following year it was down to 1.27%.  The proud physicians were unhappy, and eventually rejected Semmelweis.   After they went back to their old poor habits, the death rare once again duly rose.  (4, pages 457-8)

1859:  Charles Darwin  (1809-1882) published his "Origin of Species" in which he published his theory of evolution.  This may have been one of the key publications that helped to spark the scientific revolution. The medical profession was one of the main beneficiaries of this revolution.  However, many proud and stubborn medical professors and physicians refused to let go of old theories.  Continued investigations, and scientific evidence, would ultimately force change.  

Louis Pasteur forever changed medicine with his
Germ Theory of Medicine. 

1865:  Louis Pasteur (1822-1895) discovered that microbes were the cause of diseases, and he saved the silk worm industry by his discovery that "microbes were  went on" to extend his germ theory to develop causes and vaccinations for diseases such as anthrax, cholera, TB and smallpox." (3)

1870s:  Joseph Lister (1827-1912) discovered that antiseptic use reduced post surgical infections.  He was a British scientist and physician who observed that about 50 percent of amputation patients survived the surgery but died later of septic fevers, or what was known as "ward fevers."   With knowledge of the works of men like Pasteur and Semmelweiz, Lister surmised microbes in the air were infecting wounds, and so he used phenol as an antimicrobial to reduce the death rate by 15 percent. (4)  He recommended the antimicrobial carbolic acid to be placed on bandages to keep the wounds clean, and he invented a machine to pump carbolic acid into the air in the rooms where surgeries were being performed, and mortality rates from infections after surgeries plummeted. (5)

1879:  While working with Jordan Wheat Lambert (1851-1889), Lister invented an antiseptic to use during surgeries.  In honor of Lister's discovery, Lambert insisted the product be named "Listerine," introducing it to surgeons in 1879.  The product was so successful that it was ultimately marketed to dentists as an oral rinse in 1895, and to the public as a mouthwash in 1914.  The product is still available on the market to this day (although the taste has been improved).

Joesph Lister proved that antiseptic use during surgery
greatly reduced the post surgery morbidity and mortality.

A young William Osler must have been inspired by all this wisdom.  He became so rapt in it that he cast aside his father;s wish that he go into the ministry to study medicine.  However, while a young, impressionable Osler was keen about the new ideas regarding medicine, other physicians were pent on grasping onto the old theories holding on for dear life.  

For example, there were many medical professors who learned about Robert Bree's theory that asthma was caused by some peccant matter in the lungs, and an ideal sign this peccant matter was present was increased sputum.  Sputum, in essence, was the bodies attempt to rid of this peccant matter from the body.  These seasoned physicians worshiped this theory so long it was hard for them to let go.

This does not mean these were bad physicians.  They did the best they could with the wisdom that they had, although instead of doing better when the evidence was presented to them, they rejected it.  This is not in any way abnormal to humans.  It's normal to reject new ideas prior to accepting them.  Stated another way: the truth hurts before it makes you better.

By the various experts performing autopsies and dissections, these types of theories were cast aside for better ones, such as the spasmotic and nervous theories of asthma, as so duly noted by Henry Osler in his review of asthma in his 1892 book "The Principles and Practice of Medicine." (2, page 497)

In his review of heart failure he must have been among the first to describe it as a separate disease entity, as opposed to looping it under the asthma umbrella as so many physicians before him.  Through his writings on heart failure we can see how new ideas were still commingled with old theories.

Listerine bottle from the 1920s

Consider the following regarding heart failure from "The Principles and Practice of Medicine":

Osler explailned that as the flow of blood through the heart and lungs becomes blocked, perhaps from a stenosis (narrowing) of blood vessels or emphysema in the lungs, the heart becomes overworked.  This causes the heart to become hypertrophied (enlarged).  The heart becomes weak, and may cause blood flow to become "embarrassed" (slowed down, backed up, congested).  This in turn will cause acute (it's happening now) symptoms of heart failure (cardiac asthma).  (2, page 624)

Treatment for this would be:

1. Rest: Allows heart time to catch up and breath can be restored
2. Relief of embarrassed (impaired) circulation:  Dyspnea from blood pooling in the lungs may be severe, even fatal.  The vessels of the body become engorged with blood, thus dilating (enlarged). When this can be seen upon assessment, and when there is orthopnea and cyanosis, the following are the recommended treatment options:
1. Venesection (bleeding): The abstraction of 20-30 ounces of blood. He notes that "this is the This is the occasion in which timely venesection may save the patient's life. It is a condition in which I have had most satisfactory results from venesection. It is done much better early than late. I have on several occasions regretted its postponement., particularly in instances of acute dilatation and cyanosis in connection with emphysema.'' (2, page 624)
2. Depletion through the bowels:  This is particularly valuable when dropsy is present. Of the various purges the salines are to be preferred,and may be given by Matthew Hay's method. Half an hour to an hour before breakfast from half an ounce to an ounce and a half of Epsom salts may be given in a concentrated form. This usually produces  (2, pages 624-625)

So you can see that science had impacted his description of heart failure, although old theories regarding its treatment were still held on to.  It must have been well known to him that he couldn't cure disease, yet he did have the ability to alleviate pain and dyspnea with medicines like opiates, morphine and strammonium (or, in some cases, bleeding).  .

Through it all, and regardless of scientific advancements, even Osler must have known the limits of medicine. He must have known that the gentle touch of his hand, or the soft ring of his assuring voice, was all that was needed to alleviate suffering. Providing hope may have been the main job men like Osler, even during this era of improved medical wisdom. (3, pages 50-60)

Click here for more asthma history.

References:

1. "Sir William Osler At Seventy -- A Retrospect," The Journal of the American medical Association," 1919, Saturday, July 12, pages 106-108
2. Osler, William, "The Principles and Practice of Medicine," 1892, New York, pages 497-501
3. Bliss, Micheal, "William Osler:  A Life in Medicine," 1999, New York
4. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1921, London and Philadelphia, 

Further readings:

1. Jackson, Mark, "Asthma: The Biography," 2009, New York, pages 211-12
2. Brenner, Barry E, ed., "Emergency Asthma," 1998, New York, pages 212-14