460-370: What remedies did Hippocrates prefer?

Hippocrates treating a child. 

Once the diagnosis and prognosis was made, then it was time to prescribe the remedy.  

Hippocrates once wrote that he wasn't sure what remedies would provide heat, cold, moist or dry properties, so he preferred to leave this to nature.  This might explain why his most common remedy was to "assist nature" in the healing process with simple remedies such as: (1, page 28)(2, page 90)(3)

• Fresh air  (1, page 28) 
• Good diet: to excite natural heat and discharge it (1, page 28) (3)
• Exercise  (1, page 28)(3)
• Massage  (1, page 28)(4, page 148)
• Cleanliness: Such as soaking in hot or cold water at a bath house (1, page 28)(1, page 90)
• Sweating (by warm bath) (3)
• Acrd drinks: to excite natural heat and discharge it (3)
• Appropriate food or drinks: to aide the humors in their discharge (3)
• Withholding of food, particularly in acute affections (4, page 147)
• Drinking lots of fluid, especially for wounds (4, page 147)
• Bodily works (like sawing wood) (4, page 148
• Reading aloud
• Singing (4, page 148)

Only when these simple remedies failed did he resort to his stash of medicinal remedies, which mainly consisted of sedatives to relax the body and purging to cleanse the body.  (1, page 28)(2, page 90)  

Examples include (in parenthesis is the expected response of the remedy):  (1, page 27)(2,page 90)

• Hemlock (sedative
• Henbane (sedative)
• The juice of poppy or opium (sedative)
• Mandragora from the family of nightshades (eases breathing, sedative) 
• Hyssop (emetic)
• Black Hellebore (emetic, universal purge)
• White Hellebore (universal emetic)
• Elaterium (laxative)
• Scammony (laxative)
• Spurge (laxative)
• Mercurialis perennis (laxative) 
• Barley water
• Wine (2, pages 90-91)(4, page 147)
• Hydrotherapy (pain) (1, page 27)(2, page 90)
• A decoction of barley for a variety of ailments (4, page 147)
• Unstrained broth
• Honey water
• Sour honey
• Broths from millet, meal and wheat (4, page 147)
• Cooling demulcent drinks (facilitate elimination of the morbid humours) (4, page 148)
• Purgatives (causes a bowel movement to facilitate elimination of morbid humours (4, page 148)
• Emetics (causes vomiting to facilitate elimination of morbid humours) (4, page 148)
• Blood letting (assisting incomplete elimination, particularly for inflammation) (4, page 148-149)
• Diruretics (causes urination to assist with incomplete elimination of humours)(4, page 148)
• Diaphoretics (causes sweating to assist with incomplete elimination of humours)(4, page 148)
• Cupping (rarely) (4, page 148)
• Cauterization (rarely) (4, page 148)
• Scarification (rarely) (4, page 148)

He rarely resorted to invasive remedies such as bleeding to treat internal diseases. Although, occasionally, blood letting (venesection) was necessary.  According to Neuburger it was...

...carried out mostly on the arm, foot, popliteal space, tongue, etc., and pushed as far as possible, even to the productoin of faintness, for, "in the treatment of advanced disease extreme remedies, employed with care, are the best."  Similar but far less efficacy was ascribed to cupping or scarification; the use of leeches was not yet known.  Blood-letting and cauterization were intended for the relief of pain as well as for the derivation of the humours.  (4, page 149)

He resorted to surgery only to treat external diseases, such as cuts, fractures, etc.  This, perhaps, was due to the effort of the Cos, and Hippocrates, to show the gentle side of medicine.

Neuburger said that "Hipocratists were far from establishing the principle of which later was enunciated, of 'Contraria contrariis.'  This meant that opposites were treated with opposites.  Hippocrates would sometimes treat opposites with opposites, and sometimes similar with similar.  An example of treating contgraries with contraries would be blood letting to decrease blood in a person with inflammation, or too much blood. 

Remedies for some common respiratory ailments: (4, page 155)

• Pneumonia and Pleurisy:  
• Remedies that could be given immediately:
• Warm lotions,
• Poultices
• Innunctions with oil
• Warm baths
• Diet
• Infusions
• Remedies that couldn't be given until the seventh day:
• Sternutatories to get rid of mucus
• Expectorants to get rid of mucus (fat and salt articles of food, sour wine)
• Injection of fluid into the windpipe to provoke cough 
• Empyema:  
• Cauterizing the back
• Thorococentesis (aspirating a needle into chest to draw out pus)
• Other respiratory ailments, of which the remedies may be same as above:
• Haemoptysis (coughing up blood)
• Hydrothorax (fluid in lungs)
• erysipelas of lung (cellulitis)
• Phthisis (tuberculosis, consumption) (4, page 155)

Neurburger also said that "disease only comes to an end through removal of its cause."  So the ultimate goal of remedies was not just to treat the symptoms, but to completely cure the malady that plagued the person.  It is for this reason that Hippocratists were concerned with cures more so than remedies.  (4, page 149)

References:

1. Meryon, Edward, "The History of Medicine," Volume I, 1861, London,  (6)
2. Garrison, Fielding Hudson, "An introduction to the history of medicine, 1922, (9)
3. Hippocrates, "The Art of Medicine," Section I, Treaties III, translated by John Redman Coxe, "The writings of Hippocrates and Galen," 1846, Philadelphia, Lindsay and Blakiston (10)
4. Neuburger, Max, writer, "History of Medicine," 1910, translated by Ernest Playfair, Volume I, London, Oxford University Press

760-370 B.C.: How did Hippocrates determine diagnosis and prognosis?

Statue of Hippocrates

After a thorough examination of his patient and surroundings, Hippocrates was able to come to a diagnosis and prognosis. It was only from this diagnosis and prognosis that he was able to come up with a remedy that would assist nature in re-establishing a balance of the qualities and humors of his body.

The assessment of the patient was very thorough, and was essential to the later diagnosis, prognosis, and treatment.  Of this, medical historian Max Neuburger said:

Eyes and ears, indeed every means, sensory and intellectual, were employed in order to arrive at the opinion based upon experience as to the general condition of the patient.  Without neglecting subjective symptomatology, the objective examination from head to foot was undertaken with the care and thoroughness which constitute so salient a feature of Hippocratism.  The painfully minute observation and examination served, however, the additional purpose of explaining, by the combined action upon a particular case of external influences and individual peculiarities, those details in the course of an illness which might diverge from the disease-type.  Hence the clinical history, as such, constitutes one of the most noteworthy characteristics of Hippocratic, in contrast with the rigid scheme of oriental medicine; the clinical history takes individuality into account. (4, page 144) 

Hippocrates wrote that there were two classes of disease: (1)

1. External
2. Internal (1)

External diseases would have been easy to see, as these were on the external surface of the body, such as inflammation (redness and swelling) of the skin.  By the time of Hippocrates the medical profession had been well acquainted with these types of diseases and how to treat them.

Neuburger said:

External localized affections were most minutely examined by sight and touch from the point of view of position, size, shape, consistence, painfulness, temperature (taken by laying a hand on the chest), colour, etc.  (4, page 144-145)

Internal diseases, on the other hand, were a bit more complicated, as the scars inside the body were less readily seen.  Although, Hippocrates did describe that some internal diseases provided scars that:

...are apparent both to sight and to the touch, by tumours, redness, &c.; and evince themselves by hardness, coldness, moisture, heat, &c.,—and thus enable us to recognise the presence or absence of such or such qualities as may or may not belong to them. There ought to be no mistake as to these,—not that they are easy to be comprehended, but because they are readily discovered, at least by those who are qualified to seek for them, by industry and natural attainments. Our art abounds in resources for visible diseases,—nor are they less abundant for those of a hidden character, or which attack the cavities or bones. (1)

Neuburger said:

internal (invisible) maladies (were examined) by a number of methods both sensory and intellectual... The following had to be noticed: -- age, temperament, mental state (memory, delirium, picking at the bed clothes), facial expression, tongue, voice, attitude in standing or in bed, condition as to nourishment or strength, power of movement, sensibility to pain, behavior during sleep, sensation of hunger or thirst, temperature, abnormal pulsation (was it abnormally strong or weak?), breathing, exhalations, condition of the skin, hair and nails, state of the sense organs, particularly of the eyes, possible abnormalities of the hypochondrium (enlargement of liver or spleen), abdominal swellings, possible tumours, abscesses, amount, color, consistence, smell, taste of blood and excretions, exceptional symptoms, such as gnashing the teeth, yawning, hiccough, sneezing, epistaxis, flatulence, itching, shivering, twitching, etc. (4, page 144-145)

There were certainly internal diseases that did not readily show their scars, such as hypochondria, hysteria, epilepsy and asthma.  Even upon the rare inspection, no scars were found on asthmatic lungs.  For this reason, Hippocrates created theories to help him understand these diseases.

After his thorough assessment he would make a diagnosis based on his education and experience.

Of diagnosing, Hippocrates wrote:

The possibility of this depends very much, nevertheless, on the accuracy of the report by the patient of his complaint, and the tact of the physician in his interrogatories. Sometimes this seems to be attained as by intuition, although more time and labour are required than in the case of external diseases. (1)

This was the basis of Hippocratic medicine. Asthma, was more likely described as a vague symptoms: shortness of breath.  Catarrh was another vague symptoms, which designated inflammation, or an accumulation of phlegm (fluid) from the brain.  Pleurisy was pain caused by inflammation of the pleura due to a swollen lung rubbing up against it.  Catarrh might have been your common cold, which may occur as inflammation of the nose or lungs. Hydropsy would have been fluid in the lungs. (5, pages 154-155)

A more specific diagnosis of lung diseases might be empyema (pus in lungs or pleura), pleuritis (inflammation on one side of lung), peripneumonia (inflammation on both sides of lung), phthsis (tuberculosis, consumption) or tumours. (5, pages 154-155)

All of these symptoms or diseases would be caused by an accumulation of phlegm from the brain to the lungs. Tumors, however, were caused by by an accumulation of blood or salt phlegm. (5, page 155)

Meryon said that upon assessing his patient, by observing his symptoms and his surroundings, he came to a prognosis, and this determined the cause and then the cure. Thus, determining the prognosis was the key to Hippocratic medicine.

Of this, Neuburger said:

The method of arriving at a prognosis is an inductive one, taking its starting-point from the clinical history, the importance of which is to be estimated by former individual experience and external evidence, taking into consideration the age, sex, habits of life and residence of the patient, the climate and epidemic conditions. (4, page 143)

Hippocrates said that each disease had "different symptoms... through which the physician becomes enabled to estimate the treatment he ought to pursue." (1)

For instance, if the physician observed a recent change in weather from hot to cold, and the patient presented with sneezes, inflamed nasal passages, runny nose, and maybe shortness of breath, he may be diagnosed with catarrh, or a cold in the head, or asthma.  Regardless, it was caused because the patient was exposed "to the kind of humour (phlegm) coming from the brain."   (2)

Palsy and epilepsy were also caused by too much phlegm, only in this case it was contained in the head.  The cause was the same as for catarrh, a cold, and asthma, and therefore the cure for all these ailments was the same.  (2)

Since he believed nature worked to maintain, or re-establish, a balance of the qualities and humors within a patient, his cure was therefore meant to assist nature.  His most common remedies were the same for all diseases, and included a bath, sleep, diet, and exercise. Yet as the disease became stubborn to these simple remedies he resorted to more complex remedies such as purging or bleeding.

So he assessed the constitution of the patient, he assessed the surroundings of the patient, which included an assessment of the weather, of the city he lived in, and of the diseases that were prevalent for that city.  All of these would have bearing on his diagnosis. (2)

Once the diagnosis was made, the cause was known, and the cure was likewise known.

Hippocrates said:

It is then by no means surprising, that the physician should be slow in forming his judgment of diseases, before he undertakes their cure; since he has, as it were, to negotiate with them, by the agency of an interpreter. It appears, then, from all I have said, that medicine has an appropriate means of discovering the mode of cure, or at least of assuaging the sufferings of disease. (1)

Garrison said prognosis was based on one of the four categories of diseases that were created by Hippocrates: (3, page 90)

• Acute (it's happening now)
• Chronic (it's always present)
• Endemic (found among certain people)
• Epidemic (rapidly spreading) (3, page 90)

These, too, would have a bearing on the cure prescribed.

References:

1. Hippocrates, "The Art of Medicine," Section I, Treaties III, translated by John Redman Coxe, "The writings of Hippocrates and Galen," 1846, Philadelphia, Lindsay and Blakiston (10)
2. Hippocrates, On Airs, Waters, and Localities, Section III, translated by John Redman Coxe, "The writings of Hippocrates and Galen," 1846, Philadelphia, Lindsay and Blakiston (11)
3. Garrison, Fielding Hudson, "An introduction to the history of medicine, 1922, (9)
4. Neuburger, Max, writer, "History of Medicine," 1910, translated by Ernest Playfair, Volume I, London, Oxford University Press

760-370 B.C.: How did Hippocrates assess his patients

Hippocrates examining a child, a painting by Robert Thom, 1950's.

Hippocrates became the most famous physicians of ancient Greece during the Age of Pericles by his skill and gentle approach as a physician. His approach to medicine was highly regarded not just by his patients, but by his peers. By his example, and through his writings, he would almost single handily improve the image of medicine.

In order to help future physicians develop the skills and technique needed to become a respected physician, and to create a good image of the profession, he compiled all the medical wisdom from the school of Cos into a series of 60 medical treaties called The Hippocratic Corpus.  

Most historians now believe that he did not write all of the Corpus by himself, although most would agree that he was, for whatever reason, the most significant and respected physician of his era, and for this reason his name is attributed to the treaties.  It would go on to become the cornerstone of Greek medicine, and all of medicine for the next 2,000 plus years.  

In this way, Hippocrates became the most famous physicians of his era and all time.  Not only was he referred to as "The Great Physicians" during his time by the philosopher Plato, but he is referred to by most historians as "The Father of Medicine." 

By resorting to simple or natural remedies first, Hippocrates, like other physicians at the school of Cos, preferred the medical philosophy of looking out for the best interest of the patient, and to avoid risky treatment.  Such may be evident by the motto "first do no harm."

When Hippocrates was called to help a patient, he would pack his bags and travel to the patient's home.  As he was taught by his predecessors at the school of Cos, he would consider the patient as a whole.  As noted by 18th century physicians Bernardino Ramazzini, Hippocrates encouraged the following: 

'When you come to a patient's house, you should ask him what sort of pain he has, what caused them, how many days he has been ill, whether the bowels are working and what sort of food he eats.' (1, page 15)

Of the assessment of the patient, Garrison said:

Hippocrates instituted, for the first time, a careful, systemic, and thorough-going examination of the patient's condition, including the facial appearance, pulse, temperature, respiration, excreta, sputum, localized pains, and movements of the body. (2, page 89-90) 

Medical historian Max Neuburger said the following were also assessed:

Odour of the sweat, of the sputum, of the vomit, the urine, the faeces, of the discharge from wounds; the taste of skin secretions, of wax from the ear, of nasal mucus, of the tears and sputum (sweet or the contrary) and of diverse other body fluids had to be investigated, partly by the physician, partly by the patient himself.  (5, page 145)

The color, consistency, and smell of phlegm was also assessed.  The assessment was useful in helping the physician come up with a diagnosis and prognosis, which would help determine if the patient was curable.  If the patient was curable, the prognosis was used to determine the eventual remedy or cure. 

For instance, as noted by Neuburger:

Yellow sputum, mixed with a little blood, occurring at the beginning of the illness in a patient suffering from inflammation of the lungs is a sign that he will recover, and is beneficial, occurring for the first time about the seventh day it is a somewhat surer sign.  (5, page 145)

Hippocrates himself wrote the following of his assessment:

Thus, it considers the voice, as to its clearness or hoarseness. It examines the discharges from certain regular channels; and drawing consequences from their odour, colour, consistence or fluidity,—he judges of the character of the disorders, and the existing state of the patient; and by the same means, medicine is even enabled, not only to ascertain the past, but likewise his future state. After having thus become acquainted with diseases, by their symptoms, if nature is unable to effect a cure, art then teaches how to excite those salutary movements, by which, without danger, the system may discharge itself of what is injurious to it. (3)

Regarding the movements of the body, Hippocrates was known to listen to a patient's heart and lung sounds by placing his ear upon his patient's chest, although if he wanted a more thorough examination of the humours inside the patient's chest, he would shake the patient, gently perhaps. This allowed him to hear secretions, if they were present, in the patient's chest.  (2, page 90)(5, page 146)

The procedure was called succussion, and was mainly used to recognize the presence of pus in the lungs to diagnose the presence of an empyema. In fact, if a physician performed the procedure and failed to diagnose empyema when it was present, this was considered a "sign of lack of surgical dexterity," said Neuburger. (5, page 157)

According to Neuburger:

This shaking was supposed to effect the outflow of pus from the parenchyma of the lung by way of the bronchi... Recognition during this process of teh splashing sound which occasionally occurred (in pyo- and hydropneumothorax, but also in bronchiectasis and cavities) resulted in the employment of succussion (known now as Hippocratic succussion) as a diagnostic method in order to determine whether and where pus were situated in the pleural cavity, also the most suitable spot for incision in thoracocentesis (a procedure involveing placing a needle into the chest and drawing up the excessive pus in the pleural space, or the cavity surrounding the lungs).  (5, page 146)

Neuburger said that succussion was also used to diagnose empyema (pus in the pleural space).  He said, "If it, and the pouring of fluid into the throat to excite coughing and expulsion of the pus, fail, then the operation of thoracocentesis is called for." (5, page 146)

Sounds other that the rare secretions heard upon succussion were also listened for by auscultation.  Some conditions caused a rattling sound in the trachea.  Diseases such as pneumothorax might cause crepitations, which is air bubbles under the surface of the skin, particularly on the upper chest area.  Pleuritic frictions, or what is now called a pleural rub, was also listened for.  This might indicate pleural a collapsed lung (pneumothorax) or other such malady.

Certain noises in the chest may indicate hydrops of the lungs, or what would now be considered pulmonary edema caused by heart failure, kidney failure, or sometimes pneumonia.  Hydrops is an old term for water in the lungs.  Of this, Neuburger wrote:

Of the diagnosis of "Hydrops of the lung" it is stated: "When the ear is held to the side and one listens for some time, it may be heard to deethe inside like vinegar."  A pleuritic friction is well described... "A grinding may be heard which sounds as if it came from two leather straps."

The Hippocratic concept also took into consideration the desires of the patient. As noted by Withington:

The wishes, and even the whims of the patient are to be indulged as far as possible, and a physician should rather lose his fee than trouble a sick person about it, for the memory of a good deed is better than a temporary advantage. He should also neglect no opportunity of serving the poor and the stranger, for "where the love of the art is, there is the love of man ". This last quotation, indeed, is from a work of very doubtful authorship, but it expresses the spirit, if not the words of Hippocrates. (4, page 51)

He paid attention to the prognosis more so than the diagnosis.  According to Neuburger, was "that the preservatoin of the organism be his goal."  He was well aware of the "limitations and of the potentialities of his art."  And he made sure he "occupied himself only with those diseases in which a cure might be anticipated and approached the sick-bed inspired by the principle: 'Do good, or at least do no harm.'" (5, page 147)
He spared no effort to ease the mind of the suffering, even when he knew there was no chance that his remedies would cure the patient's disease.

References:

1. Ramazzini, Bernardino, writer, "Disease of Workers," Wilmer Cave Wright, translator, 1964, New York, Hafner,  (8)
2. Garrison, Fielding Hudson, "An introduction to the history of medicine, 1922, (9)
3. Hippocrates, "The Art of Medicine," Section I, Treaties III, translated by John Redman Coxe, "The writings of Hippocrates and Galen," 1846, Philadelphia, Lindsay and Blakiston (10)
4. Withington, Edward Theodore, "Medical History from the Earliest Times: A Popular History of the Art of Healing," 1894, London, The Scientific Press.  (3)
5. Neuburger, Max, writer, "History of Medicine," 1910, translated by Ernest Playfair, Volume 1, London, Oxford University Press

1876: The nervous theory of hay fever x

Hay-fever sufferers, much like asthmatics, look like normal, healthy people between episodes.  So once the disease was defined by John Bostock in 1819, physicians were quick to conclude that hay-fever, like asthma, was a nervous disorder.  Yes, your hay fever is all in your head.

Well, surely your symptoms weren't all in your head.  The itchy eyes, nose and throat, the watery eyes, the sniffling, sneezing and wheezing are real.  But the cause of your symptoms is indubitably caused by a  a nervous temperament.  Surely you can get the condition without being nervous, but this was more the exception than the rule.

It appears that the champion for the nervous theory of allergies is our good friend, the physician George Miller Beard, the standing head of the United States Hay Fever Association. He explains that: (1, page 77)

"In order to induce an attack, there is necessary first of all a predisposition, frequently hereditary, to special and excessive sensibility of the nerves supplying the affected parts.

"The debilitating influence of heat and the external irritation of a large number of vegetable and other substances are exciting causes merely, widely varying in their effects with different individuals, and of themselves are powerless to induce, or at least to sustain, an attack. As the disease depends mainly on the individual predisposition, no two cases will be precisely alike, but all will differ as individuals differ."

Now, it is important to note here that by implying that hay fever sufferers are "nervous" in no way am I implying that people who have hay fever are goofy in the head, or mad or insane.  This is farthest from the truth.  Dr. Beard explains: (1, page 85)

"Skepticism of this sort comes from an entire misconception of the meaning of the term nervous. Nervousness is assumed to signify debility—of body or of mind, or of both; and to show itself by paleness, emaciation, and incapacity for muscular or cerebral toil. Of all popular delusions, none are more baseless than this. The nervous temperament—even the nervous diathesis, and various manifestations of that diathesis—may coexist with an imposing physique, and with both the appearance and the reality of high health. Physiology and pathology may thus go hand in hand; few people are wholly sick or wholly well; in certain directions we maybe diseased or liable to disease—in all other directions we may be almost absolutely strong."

So the underlying disposition among hay fever sufferers is a nervous temperament, and this predisposes them to the effects of a variety of causes, such as dust, ozone, plants, flowers, grasses, hay, animals, and of course pollen.

Evidence?  Yes, you want evidence.  Dr. Beard provides the following:

1. It's hereditary character:  Because it runs in families makes it nervous.  "From this we justly conclude that the disorder is of a constitutional character, in the sense that a tendency to it is innate in the organization.  Since dust and pollen don't trigger hay fever in most people, they are thus deemed tetriary or secondary causes.  The primary cause must be something inert, like the nerves.  The descendents of those who suffer from it are the ones most likely to also suffer from it.  "Parents who are of the nervous diathesis, and who illustrate this diathesis by sickheadache or hysteria, may have children and grandchildren among whom prevail many nervous symptoms, of which hayfever is but one."(1, page 79-81)
2. It prevails mostly among those who have nervous diathesis:  People most likely to have it have stressful brain jobs, are educated, upper class, and have an "active emotional nature," and it seems to "develop with the progress of civilization...As would logically be expected, it is oftener met with in cities than in the country, is more marked and more frequent at the desk, the pulpit, and the counting-room than in the shop or on the farm."  It is more likely to be prevalent in those who "overwork" the brain (brain or desk job) as compared to overworking the muscles (outdoor job, farming). It is more prevalent in the nervous melancholy person (the thinker) as compared to the relaxed phlegmatic person (the relaxer).  (1, page 81-87)
3. It is peculiar to modern civilization, and most prevails in most climates and countries where other functional nervous diseases prevail:  "We have seen already that hay-fever is a disease of the nineteenth century; it has arisen side by side with neuralgia,with nervous dyspepsia, and allied disorders, of which the eighteenth century knew little or nothing.* There are physicians who can recall the time when neuralgia, now the heir-loom of all well-to:do families, was an unknown word, and when nervous dyspepsia, now so common as to excite no comment, was unheard of."  Hay fever is also seen more in the U.S. and Britain, countries that are more civilized.  Some in Europe call it the English disease, considering it's more prevalent there than in other less civilized countries of Europe. (1, 87-89)
4. The symptoms of the disease, from first to last, through all the stages, are largely of a nervous character, and are made better or worse by mental influences: Consider the following nervous symptoms prevalent in most, but not all, hay fever victims: (1, page 90)
• Lassitude
• Sleeplessness
• Poor appetite
• Depression
5. It sometimes appears to take the place of other diseases, and to be replaced by them:  Physicians have noted that patients with upset stomach, for example, noted their symptoms of that ailment went away as soon as the hay fever struck, and returned when hay fever symptoms disappeared.  Ironically, I have noted this same thing.  I once remember telling my mom I have never been nauseated and short of breath at the same time.  It's an interesting observation and I can see by my own personal experience how it might be thought of.  (1, page 92)
6. It is affected for better or for worse largely by those influences that operate through the nervous system:   The remedies of the symptoms prove the illness is "under the influence of the mind.  Symptoms come on during periods of overwork and emotion, and remedies to relax the patinet seem to make the symptoms go away.  Likewise, "the remedies that thus far have been of the highest service for the relief of the symptoms, as quinine, arsenic, electricity, stramonium, alcohol, opium, ether, are pre-eminently nerve remedies, and in all the diseases for which they are used accomplish their results directly through the nervous system. Hygienically it is found that cold, of any kind or from what ever source—cool land-breezes, cool sea-breezes, the coolness of elevations or high latitudes, or a cellar or dark room —never fails to relieve; and for a large number of nervous states cold is one of the most potent of tonics."  (1, page 92-94)
7. Three factors are needed for hay fever symptoms to be present:  Symptoms are only present when all three of the following are present (removal of any one makes the symptoms go away, or not appear): (1, page 94)
• Predisposition
• Heat
• External irritant (dust, pollen, etc.)
8. Like other functional nervous diseases, hay-fever appears to be excited more by heat following cold than by continuous heat:  Geographic regions where the weather changes around the year, as it does in the tropics, the poles, and northern U.S., have a greater incidence of hay fever sufferers.  Such changes in temperature cause exhaustion, and this stimulates the nervous system.  Geographic regions that are consistently warm have lower rates of hay fever, such as the northern parts of U.S., the tropics and the poles.  So "warm climates are the best resorts for nervous people."  (1, page 95) 

Usually, attacks of hay fever only come about when you are exposed to these causes, animals or vegetable.  In most regards, this therefore makes hay fever more or less a seasonal disease, as most of the predisposed matter are only present at specific seasons of the year, such as the summer or fall, hence the terms "summer catarrh" or "fall catarrh."

Therefore, "as the disease is not due to any single specific cause, animal or vegetable, as has been supposed, no specific will ever be found for it," states Dr. Beard.  "As with ordinary asthma, sick-headache, and other neuroses, to which it is in some respects analogous, the attacks may be prevented and relieved, and some remedies will act specifically for individuals; but no one remedy will ever be found to relieve all cases." (1, page 78)

Considering there is no proven cure, the following have been tried with some success (1, page 78):

• Avoidance of exciting causes (heat, light, dust, worry, animal irritants)
• Fortifying the system by tonics before and during the attack, and relieving the symptoms by those sedatives and anodyne, locally or generally administered, which are found by eperience to be bet adapted for each individual cae
• Spending the season of the attack:
• At sea; preferably in high altitudes, here the air is always cool, invigorating, and entirely free from vegetable and animal irritants
• In elevated mountainous regions, where in all latitudes the air is cooler and more invigorating than at low elevations, and some at least of the vegetable irritants are less abundant.
• In high latitudes, at any elevation where the air is sufficiently cool.
• At the sea-shore, or on islands near the coast.
• For those who can not leave their home, keeping quiet in cool, closed, darkened rooms.

When the above remedies don't work, or for those who cannot afford to take such a vacation, the following are remedies that can be tried before and during the attack: (1, page 78)

• Local applications:
• Quinine 
• Arsenic
• Iron
• Electricity
• Atomization:  
• Quinine
• Camphor 
• Palliatives (Remedies that experiment shows to be most useful for each individual.

One may also use just about any remedy that proves to have palliative effects on the symptoms of the disease, notes Beard.

Beard also makes a bold prediction about the future of hay fever:

These facts relating to the transmissibility of hay-fever are the more astonishing when taken in connection with the fact that the disease is so recent. There has scarcely been time as yet for the malady, so to speak, to get intrenched in families, for our grandfathers never heard of this trouble, except, perhaps, as a distant and doubtful wonder, while at the present time it is increasing with such rapidity that in twenty-five years, it is safe to say, there will be thousands of families who have more than one representative in the hayfever army. (1, page 80)

It's interesting anyway.  While Beard and other experts of his era were wrong about hay fever being nervous, Beard was correct when he predicted a steady rise of hay fever sufferers in the future. 

Yet, it is true, writes Beard, that "hay fever is, then, a disease of the fashionable and the thoughtful -- the price of wealth and culture, a part of the penalty of a fine organization and an in-door life." (1, page 87)

References:

1. Beard, George Miller, "Hay-fever; or catarrh: it's nature and treatment," 1876, New York, Harper and Brothers

1820-1900: Hay Fever Holiday

Dr. John Bostock, the same man who first defined hay-fever, may also have been one of the first to leave his home and participate in what later became known as a Hay Fever Holiday.  (1, page 26-27)

He often "retired to the sea-side, in order to obtain some alleviation to his sufferings," writes William Abbotts Smith, a 19th century physician.  "And numerous instances have come to my knowledge in which the patients, including persons in all classes of society, had been prevented, annually, for years, during more or less of the summer months, from attending to their usual avocations."

It probably happened at first by chance, that hay fever sufferers realized their symptoms only occurred at certain times of the year, or when they were exposed to certain things, such as hay.  It was probably also by chance hay fever sufferers observed their symptoms did not occur when they were on vacation.

By the 1970s it was common for a physician to recommend to his hay-fever suffering patients to leave during the hay fever season to an area of the United States that offered air that was free from irritants.  And physicians had this down to such a science that they knew precisely in what regions hay fever was more prevalent.

They also had it down to a science the idea places to get away from hay fever triggers.  One such region was at high altitudes, like mountainous regions such as Denver, or the prairies of Nebraska, or the White Mountains of new Hampshire.

Yet high altitudes weren't the only places for a hay fever vacation.  Places such as towns along the shores of Lake Michigan, such as Mackinac island and Petoski, were places where hay fever vacations became an important source of income for local merchants.  Resorts were set up specifically for hay fever sufferers, resorts that may have been barren in the off season.

Unfortunately for the lay hay fever sufferer, hay fever vacations were expensive.  So this meant that getting away from hay fever triggers was left only to the wealthy. Fortunately, however, it was observed that most who suffered from the disease were wealthy citizens, such as physicians.

This resulted in many theories about hay fever.  One was that it was a modern disease that only occurred in persons who grew up away from hay fields and farms associated with urban life.  People who grow up in cities and towns are not exposed to such things as hay and grass, and develop sensitivities to them.

Another theory is that hay fever is a disease of the educated.  Another theory is that hay fever is a nervous disease caused by stress of city life.  It was caused by the stress of obtaining an education, the stress of making tough decisions, and stress of making money.  It was a disease of the aristocracy.

According to historian Gregg Mitman, 'hay fever holidays enjoyed by America's well-to-do were part of an expanding nineteenth-century tourist trade.  Leisure had become both a popular pastime and a marketable commodity after the Civil War.  And... hay fever began as an illness that only the wealthy could afford to treat." (2, page 12)

Hay fever holidays became a major tourist trade, and this was significant for the economies of these areas.  Petoski was amid the towns in Michigan, like my home town of Manistee, where lumberjacks migrated to because of all the white pines in the area.

Manistee was so prosperous due to the lumbering era that it was one of a few places to become a city before being designated a village.  It grew that fast.  It was such a prosperous region that by the turn of the 20th century Manistee had the third most millionaires per capita than any other place in the United States.

Yet the lumbering boom ended in the 1920s because all the trees had been cut down and none replaced.  Manistee's economy was stalled, while the economy of Petoski continued to boom mainly because of the new market created there for hay fever vacations.

There was really never any evidence that hay fever vacations did any good, although there were many physicians, many wealthy businessmen, many famous authors and poets who continued to do it throughout most of their adult lives.

It was such a popular idea that even up until the 1990s relocation was still prescribed by physicians of asthma and hay fever sufferers.  I'm sure that even to this day there are people who relocate specifically to ward off the evil allergies.

If you really want to get a good picture of the hay fever holiday, I highly recommend you purchase Gregg Mitman's book.  And just for the record, I will in no way benefit from this endorsement other than knowing that I've recommended to my fellow asthma and allergy sufferers a great book about the history of our ailment.

References:

1. Smith, William, Abbots, ""On Hay-Fever, Hay-Asthma, or Summer Catarrh," 1867, London, Henry Renshaw, pages 17-24.  The quotations are from Smith's descriptions of Phoebus's ideas. 
2. Mitman, Gregg, "Breathing Space: how Allergies Shape our lives and landscapes," 2007, New Haven and London, Yale University Press

wymann

holopeter

120-200 A.D. Galen wonders what causes asthma

Galen saw that some of his patients presented with a symptom described by Hippocrates as asthma, and he saw this malady in his own patients.  By placing his ear to their chests he heard their wheezes.  He thus set off on a relentless quest to find the natural cause of asthma and remedies to cure it.

He relentlessly questioned and assessed his asthmatic patients. He would have loved to have dissected those who died of the malady, but such an act was forbidden under sentence of death and punishment by the gods.

So he cut into apes, pigs and monkeys instead.  He cut open their chests and observed their lungs.  He cut into the lungs and traced the air passages.  He concluded this was where the vital force of life, the pneuma, enters the body.

He traced vessels from the lungs to the brain.  Perhaps this confirmed his assumption, one Hippocrates had alluded to, that asthma was similar to epilepsy. Both asthma also displayed no symptoms between attacks (sporadic), and left no observable traces of disease.

He believed epilepsy was caused by an increased abundance of phlegm in the brain, and this caused seizures. So he concluded asthma was caused by an increased abundance of phlegm in the lungs, and this caused difficulty breathing by blocked air passages.

He also noted a second cause of asthma, and this was tubercles in the lungs.  (13, page 1)

In one experiment he severed the medulla spinalis and artificially produced asthma.  He used this experiment to prove to his pupils that asthma could be produced artificially.  Perhaps later physicians used this experiment as proof that asthma was nervous in origin.  (13, page 1)

Asthma historian Mark Jackson said that on Galen's experience he wrote that "if the breathing is rough and noisy it indicates that a large amount of thick and sticky humors in the bronchial tubes of the lungs has accumulated and become annoying because it is difficult to expectorate." (4, page 24)

In this way he is credited by history as being the first to link asthma to the air passages of the lungs, and the first to describe asthma as a disease of obstructed air passages.

As noted, remedies by Galen were meant to restore the balance of the elements and humors. If you sought him out to cure your asthma, he'd probably first recommend a bath, a good diet, and exercise.  Once these simple remedies were attempted and failed, only then would he dip into his stock of medicine.

In 1815, Thomas Young said that general remedies prescribed by Galen were copied from the likes of Asclepiades, Musa, Andromachus, Heron, Crito, Menecrates, Archigenes, and Phillipus.  Galen mentioned a treatment borrowed from Asclepiades for orthopnia, a common symptoms of asthma, that contained mellepedes, which were supposed to have a diuretic effect (makes you pee).  (5, page 145)

Arabic historian Paulus Aegineta said that for asthma Galen prescribed the following (in parenthesis is what modern experts believe would be the effect of the remedy): (6, page 407)

1. Squill (alleviates coughing)
2. Pepper (stimulates digestive system)
3. Wormwood (stimulates digestive system)
4. Opoponax (antispasmotic, respiratory decongestant)
5. Storax (expectorant)
6. Oxymel (expectorant)
7. Sulfer (eases allergy symptoms such as sore throat and cough)
8. Millepedes (diuretic)(6, page 407)

Jackson said he made about 70 references to asthma, sometimes as the symptom of rapid breathing described by Homer and Hippocrates, and sometimes as a disease that caused breathing difficulties.  (4, page 24)

In 1851, Joseph Bergson said that Galen may even have been among the first to suspect that asthma was nervous in origin.  He wrote:

Galen, who made sections of the spinal marrow in different places in living animals, in order to demonstrate to his pupils the influence of it on motions of respiration. (12, page 374)

The theories he postulated about asthma, as with all his medical theories, influenced the world for the next 1,800 year. Slowly, through the course of time, a few brave physicians would expound upon his ideas about asthma, and by this means the definition would mature.

References:  see the post "120-200 A.D.: Galen becomes world's first physician"

1898: Interesting remedy for hay fever x

One of the first doctors to recommend nasal rinses, or nasal washes, was Dr. William Hollopeter in his 1898 book "Hay-fever and its successful treatment." He believed that by washing the nasal passages you'd also be washing out the exciting factors that might contribute to hay fever or other diseases.

Hollopeter said he conducted a study of the sputum of children waiting treatment for hay fever, and he found the bacteria of: (1, page 103)

• Diphtheria
• Scarlet fever
• Measles 
• Whooping Cough
• Tuberculosis

So he concluded that while these children showed "no constitutional indication of the disease whatever," the following bacteria, or some other substance (such as dust or pollen) may be in the sputum to cause hay fever. So a rational treatment here was washing the nasal passages. (1, page 103)

He said that in order for a disease to occur, some weakness has to occur within the body, such as a decrease in vitality or resistance. So, an "overwhelming exposure" to an "unhygienic environment" would result in hay fever or some other disease.

Hollopeter said:(1, page 104):

Conceded that an external irritant is necessary to cause the disease, to prevent or cure it we must either prevent the irritant from reaching the points of exposure, fortify these vulnerable spots, or remove or render inert the irritant when already lodged. In hay-fever the vulnerable spot is undoubtedly somewhere within the nasopharynx (nose and throat). It is now conceded that the nose and throat are entrances for the bacteria of many infectious diseases; and I feel sure that as I have limited the extension of house-epidemics of scarlet fever, diphtheria, whooping-cough, and measles by a carefully conducted antiseptic toilet of the nose and throat, in the same manner I have prevented the dreaded paroxysms in cases of hay-fever.

So it is for this reason the he tried a daily sterilization of his hay fever patients, and, lo and behold, it was successful. The idea behind daily sterilization is this: (1, page 103)

By a daily sterilization of the nares and postnasal spaces the victims of hay-fever may remain in the city attending to their usual duties, surrounded by dust, or in the country amid blooming flowers, without any fear of the distressing symptoms—a consummation devoutly to be wished for by the great army of hay-fever sufferers.

Therefore, he recommended the following daily treatment:

1. Cleansing the nasopharynx with a hand ball atomizer containing a warm solution of boric acid (10 grains to an ounce of water) or Dorbell's solution. Afterwords, wipe the mucous membrane and apply menthol and liquid cosmolin freely to the parts (this would have to be done by the doctor) (1, page 107)
2. Removal of hypertrophy or polypi he no longer recommended because it causes pain and increased inflammation. He therefore recommended Debell's solution applied first with a hand ball atomizer and then with a curved aluminum applicator or Harrison Allen's cotton carrier. Very carefully swab the whole nasopharynx . Dry membranes with clean cotton, followed by free use of blandine comp. (a solution of menthol in albolene). 
3. Surgery only when absolutely necessary, and always followed by 1 and 2 above

When I first stumbled upon this remedy in this book, I thought it sounded very interesting and odd. However, upon further review, it was't far removed from the nasal washes I was forced to endure daily when I was a kid, and what is still recommended to this day for many sufferers of nasal rhinitis.  

So, he said:  "I believe that acute infective disease, particularly in children, may be prevented by most thorough and repeated sterilization of the nasopharynx, and just as house epidemics are never excusable evils so I claim the same to be true of hay fever." (1, page 106)

Here is a recipe for making a nasal rinse.

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Dobell's Solution:

•   R. Sodii bicarb
•   Sodii boratis
•   Acidi carbolici
•   Glycerini
•   Aqua? rosae, 25 per cent
•   SlG.—Teaspoonful to one ounce of warm water.

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If you are so inclined, try it and let us know if it works.
References:  

1. Hollopeter, William Clarence, "Hay-fever and its successful treatment," 1898, Philadelphia, P. Blakiston's Son and Co.