10000 B.C. Opium discovered

Back in the 19th century physicians realized opium and Morphine benefited asthmatics suffering from air hunger (dypnea).  Since such opiates relax the mind, physicians back then used this as evidence asthma was a nervous disorder.

Today various opiates are used to help take the edge off when a person is suffering from air hunger caused by a variety of diseases, such as asthma, chronic bronchitis, emphysema and lung cancer.  The medicine relaxes the mind, eases pain and suffering, and is a mild bronchodilator.

Yet opiates are by no means a modern remedy.  As a matter of fact, opium was one of the first medicines ever discovered by humans, if not the first.
It was also the first cultivated medicine.  It benefited many suffering from disease, and it also brought great suffering.  It was the first recreational drug, and it was even responsible for a war.
An opiate is basically any medicine that is derived from opium, which is a medicine derived from the opium poppy, or Papaver somniferum.  

It was probably discovered by a random person in the prehistoric world, probably long before alcohol was discovered.  (11, page 15) Perhaps the person was in a frantic search for food and ingests the bulbs of the plant.  He soon forgets his hunger.  Some say it was discovered around 10,000 B.C., although some speculate it was discovered much earlier.

Perhaps a young man, in a jolly mood, during a month later known as February, in a frantic search for something jolly to show a girl, finds the pretty flower in an open, sunny field.  He breaks off a variety of bulbs or capsules and takes them home to show her. He sets them in the woods where only he would find them.   (1)(2, page 4)

The next day he walks a girl to that spot, and together they study the bulbs.  By accident, the young man pokes a stick into one of the bulbs, and a white milky juice pours out.  Several days, weeks, months or maybe even years later, further studies are performed on these interesting flowers, and in one the juice was set in a bowl over night.  By the end of the next day, which was hot and sunny, the juice turned into a dark brown mass.  This, it would be learned later, was the crude form of a drug later to be named poppy or opium.  (8)

The dark brown mass was ingested by a man who was grieving the loss of his wife. It tasted bitter, yet he forced it down. H no longer felt agony.  He credited the juice from the poppy, and told all his friends of the paradise created.  He told them the flower was a gift to him from the spirit of his grandfather.  He ingested the opium every day for a week, having no idea how much he ingested.  In was now April.  He had now become a nervous wreck, with headache and constant tremors.  He yearned for more opium.

A friend of his happened upon the flower, and he admired the plant.  He picked it and took it back to his clan.  He prepared the plant later that night, and shared it during story time around the fire the next night.  That night was especially pleasant, and a new dance emerged out of spontaneous celebration.  Those who drank of the mass seemed to make contact with parts of their mind previously un-visited.

So the benefits of ingesting the plant were quickly learned.  Soon the no more poppies were in the woods, and a young man was presented to the lady members of the clan as a physical wreck.  He was diaphoretic, anxious, restless, had a raging headache, and had horrible tremors.  He yearnedf for more of the juice.  He was taken to the medicine man who said the young man must be suffering from the curse of a mad man.  But who was the mad man?  A frantic search was on.

A few days later the medicine man found he had some of the plant in his possession, and he prepared it in a drink and gave it to the young man.  Almost immediately his symptoms dissipated.  It was here the side effects of the opium poppy were learned.  The plant allowed visitation with the white spirits, yet used too frequently resulted in possession of black spirits.

This was the first apparent overdose of opium.  The medicine man took charge.  He dissected the plant.  He found the plant contained a dark brown soft, gummy mass.  He decided the poppy must be used wisely, and so he kept the formula to himself.  He did not share it until he was on his deathbed, when he shared it with his grandson.

His grandson became the next medicine man. The new medicine man prescribed opium to an elderly man who was suffering from gout.  The formula he prepared had a strong smell, and was given in an amount just enough to take the edge off.  He put it on the sick man's tongue, who winced at it's bitter taste.  (1)

The new medicine man grew old, and became ill and on his deathbed told his grandson of the opium remedy.  The grandson prescribed it many times in his life, and before he grew too old he told of it to his son in the form of a poem to make the recipe easy to remember.  His son grew to be an old and wise member of the clan, and his grandson became among the first physicians.  He, like his great grand father, believed opium to be a gift from the gods.

Over time medicine men must have experimented with this medicine, learning of its ability to take the edge off life.  It must have become one of the first and best remedies in his repertoire. Whenever he had a patient who was ailing, be it from a broken bone or an ailment causing dyspnea, poppy seeds were prepared in a potion, and once injested would have taken the edge off the pain and suffering. It would have created an "artificial paradise" of sorts. (10, page 30)

By word of mouth the effects of the medicine made its way to ancient civilizations of Sumeria, and is written about in 5000 B.C. on stone tablets.  It was known then as Hul Gil, which meant the "joy plant."  It was also written about in the Assyrian medical tablet arat pa pa.   It was also used in Europe at this time too, including what would later become known as Italy.   (1)  This is significant, because many believe from here it made its way into ancient civilizations of Greece and Rome.

Many experts estimate the Biblical beginning of time to be about 4004 B.C., so it must have been shortly thereafter that Adam and Eve walked the Garden of Eden.  The use of a "soporific medicine" was mentioned in Genesis, and it's easy to speculate the medicine might have been opium: (10, page 29)

And the Lord caused a deep sleep to fall upon Adam, and he slept; and he took one of his ribs, and closed up the flesh instead therof."

It was soon cultivated for it's ability to relieve pain, dull the senses, and induce sleep.  It may also have been cultivated for its perceived ability to cause peace and calmness and creativity, or what otherwise may have been perceived as pleasure.  It brought upon a relaxed state of mind induced by the spirits or gods.

It was prepared in wine, which was sweetened with pepper and other aromatics.  Ancient Roman texts note how the Egyptians yearned for it, and were addicted.  It was given to sooth children who were teething as early as 2000 B.C., and the recipe is mentioned in the Eber Papyrus of about 1550 B.C.  

Around 1300 B.C. cultures started cultivation of the poppy in poppy fields.  "The opium trade flourished during the reigns of Thutmose, Akhenaton and King Tutankhamen. The trade route included the Phoenicians and Minoans who move the profitable item across the Mediterranean Sea into Greece, Carthage, and Europe."  (7)

The Hebrews learned about it, perhaps when they spend time as slaves in Egypt, and it's therefore alluded to in the Hebrew Bible.  It was called rosh, which means head, perhaps alluding to the head of the poppy.  It was also referred to as me-rosh, or juice of the poppy.

Ancient Roman and Greek physicians new of it.  The Greeks referred to is as apyun.  (2, page 5) While Homer doesn't necessarily write a medical book, he alludes to ailments and wounds from time to time, although there would be little known of specific diseases when Homer walked the earth around 800 B.C. Many historians speculate Homer was a surgeon, and so from his experiences he describes battle wounds and treatments, one of which may have been opium to sway away pain and suffering. (3, page 22-23)

In his epic poem Odyssey, Homer writes that an arrow aimed at Hector missed him and hit another son of Priam.  Homer writes, "Just as a poppy in a garden hangs on one side, its head laden with fruit and with the dew of spring, so he bent on one side his head, made heavy by his helmet."  (2, page 3-4)

The Odyssey has other allusions to opium, such as described by historian Henry Sigerist: "the drug given to Helen by the Egyptian lady, Polydamna, had strong euphoric properties so that whoever took it forgot all unpleasant memories and would not shed a tear even if his closest relative died; this drug might be opium, or hashish.  But it could just as well be the kind of miracle drug found in many fairy tales." (3)

Very little is mentioned about opium by Hippocrates, the father of Medicine, who lived around 400 B.C., although he is given credit for the first mention of poppy juice. While he wrote little of it, it must certainly have been known to him, especially considering he was one of the most noteworthy and prominent physicians of his time.  (2, page 4)

It most certainly would have been used at healing temples, such as those of Apollo or his son Aesclepeons.  The sick would sleep in the Aesclepeons and, supposedly, the god would appear in a dream with a remedies.  Success stories were recorded at the temple, and some believe Hippocrates had access to the the recordings at the Temple at Cos.

Perhaps this is why Hippocrates had knowledge of the "juice of the poppy," and that it has soporific effects.  Although mentioned by him, it was barely by by physicians until the Arabs started studying Greek medicine, including the works of Hippocrates.  (6, page 280)

Pedanius Dioscorides, who lived 40-90 A.D., may have been the "first to give a detailed account of opium and its uses in medicine.  Treating of the cultivated poppy, he says, that it's juice is very congealing (solidified), incrassative (thick), and desiccative (preserved), when taken in small quantity, to the size of a vetch, is anodyne (relieves pain), soporific (induces sleep), concoctive (mixed with food or drink), and is useful in coughs, and caeliac affections.  Taken in greater quantity, it proves injurious, inducing lethargy and death. (6, page 280)

He is the first to describe the best time of year to prepare the opium, and he wrote about a technique the involved finely incising the capsules to release a white milky juice.  It was set out overnight, and by the end of the next day, after sitting in the hot sun, the contents turn into a dark brown gummy mass.  This method of preparation was basically unchanged through the 19th century.  

Dioscorides noted that it benefits:  (6, page 280)

• Headache when rubbed in with rose oil
• Earache when injected  with almond oil, saffron, and myrrh
• Inflammations of the eyes with the roasted yelk of an egg and saffron
• Erysipelas and wounds with vinegar
• Woman's milk and saffron
• Inducing sleep when applied as a suppository per anum

Dioscorides recommends the following preparation of opium: (6, page 280-81)

The best kind is that which is dense, has a heavy stupefying smell, is bitter to the taste, readily incorporating with water, smooth, white, not rough, nor grumous, nor moulding like wax in the process of straining; when laid in the sun softening, and when applied to a lamp not burning with a smoky flame, and after being extinguished preserving its powers in its smell. He then mentions several modes of adulterating it which were practised in his time, and then adds, it is roasted for ophthalmic medicines upon a recent shell until it becomes soft and of a tawny colour

Dioscorides also described the method that

Themison of Laodicea, who lived in the century before the birth of Christ, wrote of opium and other narcotics, and he used "confection of poppies, which he employed in the diseases of the respiratory organs (John Watson, page 110).  This may be the first allusion of the medicine to relieve the suffering from dyspnea, such as that caused by diseases later referred to as heart failure, kidney failure, bronchitis, emphysema, and asthma.  Although please note these diseases were not defined until much later, so to Laodicea they would have been all lumped under "diseases of the respiratory organs."

In the century after the birth of Christ, Galen was one of the many who warned that while opium has benefits, it should be used sparingly as it can do more harm than good.  For this reason Galen more often recommended simple things like good eating, cleansing and exercise as opposed to drugs, and many other physicians did the same.   (4, page 61)

In the second century Celsus describes a drug called "pavaverus lacryma" and many historians seem to think this was opium, or the juice of the poppy. He described various remedies, both internal and external, where it was used as part of the formula.  One formula used it in an emollient plaster to rub on arthritic joints, and in another it was part of an injection for ear ache, or salve for the eyes.(6, page 28)

Paulus Aegineta, who lived from 625-690 A.D., did not specifically write of the analgesic effects of opium, although he does allude to "counteracting it's toxicity:"

When one has drunk from the juice of the poppy, drowsiness comes on, with coldness and intense itching, so that often when the medicine takes effect such an itching comes on that the person is roused by sleep thereby.  The smell of the medicine too is emited from the whole body.  The remedies in such cases after rejecting the substance taken by vomiting with oil and evacuating downward by a stimulant clyster and oxymel drunk with salts, or honey with warm rose-oil and much undiluted wine with wormwood and cinnamon, and warm vinegar by itself, and natron with water, and marjoram with wine.  We must also arouse by aromatics, put the person into a hot bath, and foment on account of the pruritus which supervenes; and after the bath we may use fat broths with wine and must.  Marrow also drunk with oil is useful." (5, page 75)

During his quest to conquer the world, Alexander the Great introduced the Persians and Indians to Opium.  (6)  By the founding of Baghdad in 763 A.D. the Arabs were studying the medical texts as written by the ancient Greeks and were applying opium for their own medical purposes, and writing about it in their own texts.  The medicine was referred to as afyun, mainly because the Semitics had a habit of mispronouncing p's with f's.  The Persians referred to it as apyun or abyun, although it is from the former that the term opium is derived.  (2, page 5)

They Arabs and Persians started trading with the Chinese, and one of the products of trade was opium and other drugs, as well as precious stones, brocades, and rose water.  So it's believed opium was introduced to China during the Tang dynasty (618-907) by the Arabs. They used the Arabic formulas for the poppy seed in treatment of ailments.  (2, page 5)

It was written about in the first half of the 8th century during the reign of Tang Ming Huang by Chen Tsang Chi in a work called "Supplement to the Pentsao."  His quotes on opium were from a earlier Chinese author named Sung Yang-tzu, who wrote that "the poppy has four petals.  It is white and red.  Above them is a pale red rim.  The seeds are in a bag, which is like one of those arrow heads which have air-holes to make a sound as the arrow cuts through the air. Within these are seeds like those of millet." (2, page 7)

So the Chinese now had opium, and the ability to make it themselves, and so they did.  They made it and used it as did people of the rest of the civilized world.  In 973 the Emperor Sung Tai-tsu instructed nine men to write a book in which is written: "It's seeds have healing powers.  When men have been taking the stone that confers immortality, feel it powerfully operating, and cannot eat with appetite, they must be benefiting by mixing these seeds with bamboo juice boiled into gruel and taking this." (2, page 8)

Opium is also mentioned in a poem by Su Tung Po (1036-1101): "The Taoist advises yon strongly to partake of the drink chi-su-shui.  The boy may prepare for you the broth of the ying-su." Ying-su is the name given to opium during the Tang Dynasty, and it means "jar millet," because the poppy head resembles a jar (ying). (2, page 8-9)

Avicenna (980 A.D.) was among the most prolific Arabic medical writers during the dark ages of medicine, and he wrote that opium should be treated as a poison, and if given in doses higher than two drachmas can prove deadly, with the "proper dose the size of a tare.  Around 1020 he calls it narcotic and sedative of all pains, whether taken internally or rubbed in." (6, page 282)

Narcotic is your prototypical term that gives reference to the effects of drugs like opium, reducing pain, inducing sleep, and dulling the senses.  To ancient physicians it must have been a very nice drug for physicians to know about, as life can bring about great pains and sufferings.  Physicians wanting to alleviate such sufferings may have prescribed opium.  Although, as Avicenna notes, it must be used carefully because it is a poison.

He said it was useful for (6, page 282):

• Apostemes (Abcess):  It dries up the ulcers
• Gout:  It must be mixed with the yelk of an egg to form a linemint (lotion)
• Anxiety/ suffering:  Soak a cloth smeared with it below the head
• Ear pain:  Inject it into the ear, along with myrrh and saffron
• Chronic head pain:  Soak a cloth in it can relieve suffering, and may cure it
• Opthalmy:  Eye pain can be remedied (mix with the milk of a woman)

Warning:  placing opium in the eyes may induce blindness.  Yes, Avicenna warns, if your eye pain is bad enough you cannot bare it any more, you may try this remedy.  Yet you must do so knowing the risks of this poison.  All of you who use it must know it is a poison, as well as a possible remedy and cure.  It must be used with caution.

 It also known to allay or improve: (6, page 282)

• Incessant coughs, and often cures that kind which is noisy
• Stomach peculiarities
• Diarrhoea
• Dysentery (diarrhoea with mucous and blood)
• Ulcerations of intestines

However, one must be careful, because excessive use can "impairs digestion."  Although by observing this side effect, it became among the first effective treatments to stop diarrhoea. 

Again, however, as did other physicians, he observed that "it proves fatal, he says, by congealing the vital powers and extinguishing the innate heat; and its antidote is castor. He concludes by saying, that three times the amount of the seed of hyoscyamus, or double of the seed of mandragora may be given as a substitute for it." (6, page 282)

The Arabs were also among the first to perform surgeries, and opium must have proven a useful anaesthetic.  So it's uses were varied.  Yet a plant that was once found to be a beautiful flower, and randomly used for by primitive people, was eventually cultivated and used as a potent option for physicians.

The Chinese became addicted to the medicine, and it became very valuable to them.  However, they were unable to cultivate as much of it as was needed or desired.  So the resulted in a trade route between England, India and China.  It also resulted in a war, as we'll learn in my next post.

References:

1. Aggrawal, Anil, Dr., "The story of opium," from "Narcotic Drugs," 1995, National Book Trust of India
2. Edkins, Joseph, "Opium: historical note: or the poppy in china," 1898, American Presbyterian Mission Press
3. Sigerest, Henry, E., "History of Medicine," Volume II, "Early Greek, Hindu, and Persian Medicine," 1961, Oxford University Press, page 23
4. Prioreschi, Plinio," A History of Medicine: Byrzantine and islamic medicine," 2004, Horatius Press, page 
5. Prioreschi, page 61, quoted by Prioreschi from "The Seven Books of Paulus Aegineta," V, xlii, translated by Francis Adams, London, The Sydenham Society, 3 volumes,  1844-1847, 2, page 213
6. Paulus Aegineta, translated by Francis Adams, "The Seven Books of Paulus Aegineta," V, xlii, 1847, The Sydenham Society, 3 volumes, (1844-1847), volume 2, page 279-283; here we find a good discussion of opium use by the ancients as recommended by Plinio Prioreschi (see reference 5 above)
7. "Opium Timeline", http://www.opioids.com/timeline/, accessed 12/20/12
8. Allan, Nathan, "The Opium Trade," 1853, 2nd edition, Lowell
9. Kane, Harry Hubbell, "Opium-smoking in America and China," 1882, New York, G.P. Putnam's Sons
10. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1922,
11. Booth, Martin, editor, "Opium: a history," 1996, Great Britain, Simon and Schuster Ltd.

1950-2003: Discovering better allergy medicines

By the 1950s physicians finally had some viable options to help their allergy suffering patients, and patients had some over the counter options too.  So things were looking promising.  Still, the available treatments didn't get rid of allergies, and most just provided temporary relief. So the hunt to learn more about allergies, and find a better remdey, continued. 

I suppose I should add here that while antihystamines were a great option for poeple who suffered from allergies, the medicine made you tired.  It's a great medicine for when you're feeling sick and really need it, but it can be tricky if you have the medicine in your system and you're trying to get through the day.  How do you work when you're tired?  How do you take care of kids?  It's possible, but not any fun. 

An important development came in 1953 with the discovery of the mast cell.  This is a cell involved in the immune response that carries histamine, later referred to as a mediator of inflammation because it causes the inflammation that results in the allergy symptoms.

In 1967 Immunoglobulin E antibodies (IgE) were discovered.  It was later learned IgE have a significant role in the allergic response.  The first time an allergic person is exposed to an allergen, say dust mites, his immune system develops dust mite IgE antibodies that attach to mast cells that line the epithelial layer of the skin or respiratory tract.

The second time that person is exposed to that allergen (dust mites in this case), a mast cell that
has a dust mite IgE antibody attached to it explodes and releases its contents, the mediators of inflammation.  Other mediators eventually discovered include histamine, cytokines and leukotrienes. 

It's actually these mediators that cause the inflammation around the eyes, inside the nose, throat, bronchioles, and/or on the skin. The result then would by your typical hay fever or allergy symptoms, asthma, hives, or excema. 

By the late 1970s it was learned that leukotrienes were the main culprits in causing inflammation of the bronchioles.  By 1980 leukotriene antagonists were discovered and proven to block the effects of leukotrienes.  By the early 2000s leukotriene antagonists such as Singulair were on the market and available for the treatment of allergic asthma.

In 2003 the FDA approved Xolair to treat allergy related asthma.  It was the first medicine approved that inhibited the effects of IgE.  It's still a new drug on the market and opinions continue to vary on its efficacy.  The fact this medicine costs thousands of dollars per dose might have something to do with this opinion.

Like asthma, allergies continue to perplex the scientific and medical community.  Despite modern wisdom, the best treatment continues to be avoidance of allergens, a task that's much easier said than done.

Further reading:

1. Klein, Jan and Vaclav Horejsi, "Immunology," 1997, page 608
2. Brenner, Barry E, "Emergency Asthma," (ed. Barry E. Brenner), 1998, New York
3. Ehrlich, Paul M., Elizabeth Shimer Bowers, "Living with Allergies," 2008
4. Klein, Jan, Vaclav Horejsi, "Immunology," 1997, page 608

x1910-1950: Antihystamines to treat allergies

While some scientists and physicians studied the effects of decensitization for the treatment of hay fever (er, allergy) sufferers, others were working on other angles.  This was a good thing, because one of the best selling medicines of all time was the result. 

In 1910 British scientists discovered a chemical called histamine that was released during an allergic reaction, and they determined it was this substance that was responsible for causing tissues to become inflamed.  A year later Henry Dale proved that injecting histamine into guinea pigs and dogs would instigate the allergic response.

This discovery gave scientists a lot of hope.  Originally they beleived histamine was the only cause of allergies and that finding a treatment for histamine would mean allergies would be eliminated.  Yet later scientists learned this was not true, that allergies were a series of complex reactions.

In 2007 Gregg A. Minton explains how "in 1921 Carl Pransnitz attempted to further understand allergies by injecting into his abdomen the serum from his colleague Heinz Kustner, who had a severe allergy to fish.  Prausnitz had no such allergy, but when he sat down to a fish dinner, he found that a case of the hives appeared on his body at the injection site. The experiment demonstrated that a specific immune body -- later known as an antibody -- was present in the serum of allergic patients.  The substance could be passively transferred to nonallergic individuals, and it played a crucial role in the allergic reaction." (1, page 215)

This experiment lead researchers to think that if they could figure out what this "antibody" was they could unlock the mystery of allergies and eliminate this annoying malady from existence. (1, page 215) So the hunt was on. 

In the meantime, Daniel Bovet introduced a medicine that blocked the effects of histamine in 1937, and he called this new medicine an antihistamine.  It was the first truly effective medicine to treat the symptoms of allergies.  By blocking the effects of histamine it therefore prevented an allergen from causing a stuffy and runny nose, itchy eyes, nose and throat, and sneezing.

The next discovery was Benadryl.  Minton explains it was discovered by 21 year old professor at Cincinnati University named George Rieveschi.  He was trying to create an antispasmotic drug when he inadvertently discovered the "new compound in his laboratory." (1, page 216)

In 1946 the first two antihistamines hit the market:  Benadryl and Pryibenzamine. Minton describes how "antihistamines became, next to antibiotics and barbituates, the third most commonly prescribed class of drugs in America." (1, page 213)

Minton explains that other antihistamines hit the market in 1947, but Benadryl and Prybenzamine made up the bulk of the sales.  In 1947 Hydrillin hit the market, which was a product that had both an antihistamine and a bronchodilator called theophylline. This relieved allergy symptoms and made breathing easier, an ideal remedy for people suffering from allergic asthma (which, as it turns out, includes about 75 percent of all asthmatics)

Theophylline is a medicine that was first introduced to the world in 1930 as another antispasmotic medicine for asthma.  It was a medicine that relaxed the smooth muscles that lined the air passages of the lungs and made breathing easier.  This new medicine provided another over the counter option for allergy and asthma sufferers. (I wrote about theophylline here.)

In 1949 Neohetramine was the first antihistamine approved by the Food and Drug Administration (FDA) as an over the counter medicine.  Other antihistamines soon followed.  Minton notes that "by 1950, more than 21 antihistamine compounds packaged under one hundred different trade names in tablets, nasal sprays, eye drops, and creams on the market in the United States." (1, page 216-217)

References:

1. Mittman, Gregg, "Breathing Space," 2007, New Haven and London, Yale University Press

x1904: The first remedy for hay fever is Pollantin

There must have been a lot of excitement in the early part of the 20th century as scientists were finally honing in on the cause of the strange malady most often referred to as hay fever.  In 1901 Portier and Richet cointed the term Aniphylaxis, and by 1904 Dr. William Dunbar was working on a serum he probably suspected would be a cure for hay fever. 

The serum was written about in an editorial in the Journal of the American Mecial Association in October of 1904.  The authors noted that there were a lot of theories as to the cause of hay fever: the heat theory, the light theory, the nervous theory, the pollen theory and the bacteria theory were just a few.  Yet all that was known for sure about the disease was (1):

• You had to have a have a predisposition to suffer from it
• There had to be an exciting cause to trigger it. 

Dunham was a supporter of both the pollen theory and the bacteria theory.  When his initial experiments found no bacteria, he ruled out the bacteria theory.  His new focus was on the pollen thoery, and it was by his experiments with pollen that he would hit pay dirt. (1)

He learned that when a pollen was inserted into the eyes of hay fever sufferers it caused inflammation and redness of the mucous layers around the eyes.  He later discovered that it was not the pollen itself that caused this reaction, but a protein (toxalbumin) produced by pollen.  When exposed to that protein, the symptoms of hay fever were present.  (1)

His studies were interesting in that he discovered that "as little as 1/40,000 of a milligram of the rye-pollen toxin placed in the conjunctival sac (around the eyes) will call forth in certain individuals a paroxysm of hay fever lasting several hours." (1) 

The serum only caused hay fever symptoms in those people with a susceptibility (or predisposition), and had no effect on any one else.  His research basically confirmed the theories of Blackley, that pollen was a cause of hay fever.  He, thus, proved the pollen theory of hay fever.  (1)

Yet Dunbar didn't stop there.  By further experiments:

"Dunbar found on mixing the toxalbumin with the serum of animals which had been previously treated with pollen or the extracted poison that the former was rendered innocuous. Unlike diphtheria antitoxin, the hay-fever serum is not to be used subcutaneously, for subcutaneous injections give rise to unpleasant symptoms—itching, swelling and erythema. Experiments have shown that the local application of the serum to the irritated mucous membrane is more effective than its introduction hypodermically.

The technique he used was called passive immunization.  He "injected young thoroughgbred horses with pollen toxin in increasingly large doses, (and) produced what he believed to be an antitoxin in the horse's blood that neutralized the pollen's effects," writes historian Gregg Mittman in 2007. (2, page 56)

In one study 222 hay fever sufferers were treated with the serum, and 127 found it to be effective.  The medicine was believed to be most effective if given every morning during the hay fever season, and it lasted for several hours to an entire day, even when the patient spends the day "in the open air." (1)

Dunbar patented his serum in Germany, England and the United States as Pollantin.  To treat hay fever patients the serum, a liquid or powder, must be administered frequently, such as every morning, to the mucus layers of the nasal passages and around the eyes.  

It was soon realized that Pollantin wasn't what it was cracked up to be.  Not only did it not really work, it caused aniphylactic shock in some patients exposed to it.  (2, page 56) So the quest was on to find a better remedy.  This research would ultimately lead to the discovery of desensitization and antihistamines. 

 References:

1. "The situation in regards the serum treatment of hay fever," The Journal of the American Medical Association, Editorial, Saturday, October 15, 1904, page
2. Mittman, Gregg, "Breathing Space," 2007, New Haven and London, Yale University Press

460-370 B.C.: Why was Hippocrates dubbed 'the father of medicine?'

A depiction of Hippocrates writing. 

Hippocrates might possibly be the most important figure in the history of medicine, and our history of asthma. His Hippocratic Corpus became the most essential medical document of all time.  But, did he work alone, and did he deserve such an honor?

Who wrote the Hippocratic Corpus?

First off, in ancient Babylonia and Egypt, only a select few had the ability to write, and, even then, only a select few scribes, as they were called back then, were accorded with the privilege of credit.  In most cases, no matter who did the writing, only some very famous and well respected person's name was inscribed on the document.

The reason for this was to increase the credibility of the document.  The gods were considered all knowing, and only the ruling class had the ability to communicate with the gods.  So usually, regardless who wrote it, the book was written by the king, or a famous scribe of the king.  Or, in this case, a famous Greek physicians.

Whether or not this was the case with the Hippocratic writings we may never know, although most modern experts on the subject would attest to the fact that most of the writings do not appear to be written by one person.  In fact, some experts suspect some were written prior to his birth, some during his lifetime, and some after.  So, chances are, he did not write the whole thing.

Max Neuburger, in his 1910 history of medicine, said: 

The wide range of opinion is shown by the fact that the number of "authentic writings (of which the commentator Erotianus at the time of Nero's time recognized thirty one and Galen thirteen) has sunk to two or even to nil, whilst modern criticism admits no more than six." (8, page 122)

So now we must ask: if Hippocrates did not write the whole thing, then who helped him out?  Considering most of what we know about Hippocrates was written after his lifetime, we have no choice but to refer to speculation from the various experts on the subject.

In the ancient world there were a variety of diseases that plagued mankind, or that made their way through the cities killing hundreds, if not thousands, of people along its path.  Ancient physicians did not have knowledge of germs, so they simply referred to such epidemics as plagues.

Supposedly sometime during the life of Hippocrates word got out that there was a plague in nearby city-states, and the people were, perhaps, in an all out panic. The leaders of the city-state must have approached the physician to see if he was privy to wisdom that might stop the plague from reaching the city.

Perhaps based on what he learned from his father, or from his teachings at the school of Cos, or by his travels to the school of Alexandria, that strong winds can bring about disease.  So Hippocrates came up with an ingenious idea.

Of this, Meryon said:  (1, page 25-26)

Thucydides informs us that he kindled fires to neutralize the infection of a pestilence which broke out on two successive occasions in Attica, when the skill of the physicians could do nothing else to mitigate it."  (1, page 25-26)

Bradford said:

He rendered a great service in stopping a plague which broke out in Athens in the time of Pericles, for which he was given a golden crown and the privilege of Athenian citizenship. (2, page 23)

So maybe such an act of heroism made him worthy of such fame.  

Prioreschi said there were many medical schools when Hippocrates walked the earth, the two most relevant to our history being the school of Cos and the school of Cnidian, which were near each other (about 20 miles apart) and were competing "in knowledge and effectiveness in curing disease." (3, page 28) 

Prioreschi mentions one theory where each school was stuck in it's own paradigm about diseases and its treatment. The Corpus Hippocraticum was the result of a koinon, or an association between the two schools.  It is thus a Treaties whereby the two schools compromised on how to treat medical conditions.  (3, page 208-209)

Watson wrote of Mercuriali, who suggested:

"Not more than fourteen treaties out of the whole collection were published by Hippocrates himself.  Five others... may have been left by him unfinished to be completed either by his son in law and successor, Polybius, by his sons Thessalus and Draco, by his grandson Hippocrates, or by other members of his family." (4, page 49)

Watson also notes the following:

"A third portion, including about 22 treaties, though perhaps not even begun by Hippocrates, is in strict accordance with his doctrines, and is believed by Mercuriali to have emanated from the immediate descendants of Hippocrates or other disciples of the school of Cos.  The remaining portion of the collection, according to the same authority, consists of spurious writings, and as such as contains opinions not in accordance with the doctrines of Hippocrates, though published as his."
(4, page 49)

Another theory is that as many as seven Hippocrates worked on the documents. We know that his  grandfather was Hippocrates. In addition, Neuburger said:

In addition to his two sons Thessalos and Dracos, who also undertook journeys, his son in law Polybos, with Apollonios and Dexipos of Cos, probably also Praxagoras of Cos, ranked as his most famous pupils. It has been shown that Polybos took part in the formation of the Collection and acted as deputy in the school. Amongst the successors, there were five who bore the name of Hippocrates and represented themselves as medical authors. (8, page 125)

Prioreschi said that some parts of the Corpus may even have been written by physicians from the school of Cnidron. He said this may be evident in some of the passages that do not use theory to describe medicine, as the physicians of Cnidron tended to be more rational in their approach to medicine, compared to the speculative approach by the Con. (3, page 209-210, 214)

Whether or not parts of the corpus were written by Cnidron physicians may never be known. What is known is that, according to Neuburger:

"the Hippocratic collection was brought together and edited in the beginning of the third century B.C. by a commission of Alexandrian scholars under order from the book loving Ptolomy. Even at that time doubt existed as to which of the writings could with certainty be ascribed to the great Hippocrates, and hardly one of the books had remained free from alterations and additions." (8, page 121)

So while they had the documents, they had no proof Hippocrates wrote them all. Some simply speculated that Hippocrates was simply a common name among the family of physicians at the school of Cos, and it is for this reason this name, if not inscribed on, was ascribed to it.

Henry E. Sigerist  suggests the entire treaties may be credited to Hippocrates because of his hard work, method of teaching, and skillful medical technique. It may have had nothing to do with Hippocrates being the superior physician at all, and mainly because later historians sought to credit someone for such important documents. (2, page 266)

Some historians speculate that Greek medicine had reached a point where a significant figure was needed to lift medicine to the next level, and the man born into, or raised into, this job was Hippocrates II.

It was, thus, his job to free medicine from the "fetters of oriental dogmatism... the leading-strings of the priestly caste... to rational science and moral dignity... (to) transition from the guild of the Asclepiads into the free profession of medicine." (8, pages 128-129)

Sigerist said one theory postulates that Hippocrates was not superior to, but respected equally among his fellow physicians, with Hippocrates being the most senior.  With later Alexandrian physicians viewing these anonymously written medical texts as extremely important, they sought to give someone credit, and Hippocrates seemed the most logical choice.  (5, page 266)

Meryon goes as far to suggest that perhaps Hippocrates himself stole the best ideas of Cnidron. Meryon wrote:

It has been stated, that having extracted all the information which the records contained in the temple of Cnidros could yield him, he set fire to it, in order that he alone might enjoy a monopoly of knowledge. (1, page 25)

Regarding this, Meryon stated in his notes:

The above calumy is attributed to Andreas, but Tzetstates said that it was the library of Cos, and not that of Cnidos, that was burnt. (1, page 25)

So was Hippocrates so selfish to earn credit for the documents that he was willing to destroy the information used in creating it?  Once again, there is no evidence to support this claim.

Meryon suggests Hippocrates was simply the benefactor of the era he was born into.  He was, after all, the son of a family of physicians who were all taught at the school of Cos.  Meryon explains:

Much of the information contained in his writings, and which has been transmitted to us, appears to have been the accumulated knowledge of his immediate ancestors; and it is supposed by competent judges in the matter, that many, if not most, of the numerous treaties which are commonly attributed to him, were simply collected and written by him; for he had the great advantage, which can scarcely be appreciated, since the introduction of printing, of acquiring a thorough knowledge of the observations of his predecessors; and having, moreover, access to all the records and votive tablets in the temple of Cos, he had peculiar facilities to achieve the honour which is universally accorded to him. (1, page 22)

Watson, likewise, credits the era he was born into for his fame. 

 "He lived in an age of progress, and while other arts and sciences were thus springing into life, and rising at once to maturity, it is not surprising that some man of genius should appear in the ranks of medicine, to give to it's principles from the utterance.  This man was Hippocrates." (4, page 47)

So it appears that Hippocrates probably didn't work alone in creating the Hippocratic Corpus.  What will never be known with any certainty is who helped him.  

Does Hippocrates deserve credit for the Corpus?

Considering that the document attributed to Hippocrates became the most significant document in Greek medicine, and that Greek medicine was the key to all medical wisdom, then I think we're fine with giving Hippocrates credit for the whole thing.

Considering how dogmatic people can be when considering new ideas, it must have been many years in the workings to transform medicine from the primitive mindset to the ancient mindset.  The fact that it eventually happened at all can be considered a revolution of sorts.

What matters most is that Hippocrates, or the Hippocratic writers, helped transform medicine away from the primitive world to the ancient world. Or, as Meryon put it, Hippocrates helped transform medicine from a profession of superstition to one of speculation by 'vague hypothesis.'  (6, page 21)

Of this, Watson said: 

"According to Celsus (a physician of the 2nd century), his (Hippocrates) principle credit is removing the teaching of medicine from the schools of philosophy, where it had always received some attention, and treating it as a distinct department of practical knowledge.  Pliny the elder supposes he was the first to institute clinical instruction."  (4, page 46, also see 3 page 42)

Withington said: 

It has been well said that great men illuminate the world by gathering into a focus the rays emanating from itself, and this is well seen in Hippocrates' third great service to medicine -- his rejection of supernatural heroes of disease.  The age was one of transition, and the simple faith in the old mythology was giving way in all direction."  (6, page 50)

Garison said:

Instead of attributing disease to the gods or other fantastic imaginations, like his predecessors, Hippocrates virtually founded that bedside method which was afterword employed with such signal ability by (later physicians).  (7, page 87)

Bradford said:

So great was his influence on medicine that it was no longer called the art of Aesculapius, but the science of Hippocrates." (2, page 23)

Chances are, however, that he did not work alone.  If it were possible to jump into a time machine and travel back to the age of Hippocrates, we'd probably find him, along with many other physicians, writing the passages that would end up in the Corpus.

Regardless, Hippocrates was referred by his contemporaries, including Plato, as "The Great." (6, page 48) He was also referred to as "the Great" when Aristotle walked the earth.  The great second century Greco-Roman physician Galen referred to him as "the divine."  The rest of history knows him as the father of medicine, and medicine as the "Hippocratic art." (8, page 125)

Max Neurburger, in his 1910 history of medicine, said:

The achievements of Hippocrates' family, of the Coan (Con) school, of many of his predecessors and immediate successors, all these were placed to the credit of the one man, whilst the historic personality was more and more veiled by the nimbus of homage. (8, page 126)

Yet through most accounts of the historians he earned this honor by his hard work and gentle approach. While he may not have written the Corpus, his name made it famous.  Perhaps for that reason alone he is deserving of honor as the father of medicine.

Over time, said Neurburger:

The mysticism of the Asclepiads diminished on the one hand in proportion to the admission of strangers into their fraternity, whereby the preservation of professional secrets were relaxed, on the other through intercourse with physicians (particularly Pythagorean), who had derived a more extended outlook from the schools of philosophy or who by empirical capacity had earned the confidence of the people." (8, page 100)

Neuburger also said that physicians like...

...Pythagoras, Empedocles, and their pupils, who were not without medical knowledge and dexterity, proved that healing was to be found even remote from the Asclepion shrines. Philosophically educated physicians aroused by their speculative and theoretical writings -- and considerable medical literature was in existence long before Hippocrates -- general scientific interest. (8, pages 100-101)

Hippocrates expounded upon this literature, setting up a system of medicine that made medical wisdom available to all who wished to become physicians.

This was all made possible by the physician of Cos, and, more particularly, by the writings of the Hippocratic writers.  Although, through it all, it was made possible by the greatest physicians of all time: Hippocrates.

Legend has it he died in Thesally at the ripe old age of 80 or 85 or 90 or 105, depending on the source of reference.  Perhaps the longevity of his life was due to his mythical legacy; the fact he was essentially deified by later physicians.

Click here for more asthma history.

References:

1. Meryon, Edward, "The History of Medicine," Volume I, 1861, London, (6)
2. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey (7)
3. Prioreschi, Plinio, "A history of medicine: Primitive and ancient medicine," volume 1, 1995, NE, Horatius Press, (1)
4. 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 (4)
5. Sigerist, Henry, "A History of Medicine," volume 2, 1961, Oxford University Press  (2)
6. Withington, Edward Theodore, "Medical History from the Earliest Times: A Popular History of the Art of Healing," 1894, London, The Scientific Press. (3)
7. Garrison, Fielding Hudson, "An introduction to the history of medicine, 1922, (9)
8. Neuburger, Max, writer, "History of Medicine," 1910, translated by Ernest Playfair, Volume I, London, Oxford University Press

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