25 BC-50 AD: Celcus spearheads quest to define asthma

So what would life be like for us asthmatics when Jesus and Caesar walked the earth?  From my investigations into this era I'd imagine the best remedy might simply be to tough it out, as many of the recommended remedies seem like they'd be worse than the disease.  Of course this was true of most medicine prior to the 20th century.

Aurelius Cornelius Celsus

The second century A.D. was a very "fruitful era of literature and philosophy."  (1)  It is for this reason we have resources available to help us learn what was known about asthma at that time and the remedies to treat it.  Among those influential to medicine in this era are Pliney the Elder, Seneca the Younger and Aurelius Cornelius Celsus.

Pliney and Seneca are written about in another post.  Celsus, who was born of respectable parents, was well learned, and shared with us his wisdom through his many writings.  He was a philosopher, physician, surgeon and a pharmacist.  One author noted him to be so skilled at his crafts that he was "second to none." (2)

His writings are also known to be "diligent" and "attentive," yet many future biographers and historians have debated as to whether he really practiced what he preached.  Some speculate that he never was a surgeon, let alone a physician.  (3)

Perhaps it was due to this that he was "ignored by Roman practitioners of his day, and his name is mentioned only four times by the medieval commentators, but with the revival of learning (at the closing of the middle ages), he has his revenge. In that his work (De Re Medicina) was one of the first medical books to be printed (1478), afterword, passing through more separate editions than almost any other scientific treaties." (7, page 74)

Celsus was born in Greece in 25 B.C.  He was a stoic, which meant he did not believe in an after life.  As an arch opponent of Christianity he wrote "The True Word," which was a well read attack on Christianity, a new philosophy in that era.

He wrote several other books as well, such as "A Treaties on Agriculture" and "A Treaties on Military Tactics."  Yet what history most remembers him for is his "Treaties on Medicine."  It is thanks to this work that we gain our first look at asthma during the time of Jesus.

As a medical writer Celsus emulated Hippocrates, and parts of his books are word per word transcriptions from the "Hippocratic Corpus."  In fact, Celsus did this so often that one later author, Nicholas Mondaris, referred to him as the "Ape of Hippocrates." (4)

Treaties on Medicine

Yet he incorporated into his book the latest wisdom of his day, plus some of his own ideas.  This is clearly evident in his writings on asthma.

When asthma was first defined by Hippocrates in 400 B.C., it was often difficult to distinguish between the causes of dyspnea, and therefore they were grouped under the umbrella term asthma. Thus, all that caused dyspnea were referred to as asthma.

Celsus, on the other hand, believed asthma was more than just dyspnea, and for this reason he provided us with our first description of asthma as more than simply a blanket term. 

Celsus wrote the following:

"Est etiam circa fauces malum, quod apud Gracos aliud aliudque nomen habet. Orane in difflcultate spirandi consistit; sed haec dum modica est, neque ex toto strangulat, Suazvom appellator. Cuta vehementior est, ut spirare asger sine sono et anhelatione non possit iaO/ia; cum accessit id quoque, ne nisi recta cervice spiritus trahatur SpOoxvota."(8, page 10)

By the above, which is taken from John Charles Thorowgood version of asthma history (from 1890), we learn that Celsus believed there were three thoracic disorders that resulted in difficulty of breathing, and they varied by their "degree of violence":

1. Dyspnea:  Moderate, unsuffocative breathing without a wheeze; it's chronic
2. Asthma:  Vehement breathing that is sonorous and wheezing; it's acute
3. Orthopnea:  Breathing only takes place in an erect position; it's acute (5) (8, page 10)

By the order above, Celsus implies that asthma is the "mean" level of difficulty of breathing, with dyspnea being less severe than asthma, and orthopnea being more severe than asthma.  (8, page 10)

He was also the first to describe asthma as a specific condition involving constriction of the air passages in the lungs, and he was likewise the first to describe a wheeze.  He described an attack of asthma this way:

(Asthma is caused by)  the narrow passage by which the breath escapes, it comes out with a whistle; there is pain in the chest and praecordia, at times even in the shoulder blades, sometimes subsiding, then returning; to these there is added a slight cough."

His remedies were barbaric, and may have included any of the following:

1. Blood letting (common remedy for just about any ailment)
2. Milk (to relax the bowels)
3. Purging of the bowels with enemas (clysters) or injections if necessary
4. Hydromel (honey diluted in water
5. Head must be kept high in bed
6. Thorax relieved by fomentations (warm, moist medicincal compress)
7. Thorax relieved by hot cataplasms (a heated medical dressing, either dry or moist)
8. Malagma (lotion or salve) or iris ointment after fomentations and cataplasms (these act as emollients to soften skin to make chest movements easier)
9. Hydromel as a drink (mixture of water and honey)
10. Bruised root of capers has been boiled
11. Nitre or white cresses fried, bruised, then mixed up with honey and given as electuary (oral, by mouth)
12. Honey, galbanum, and turpentine resin boiled together and, when they are coalesced to the size of a bean, dissolved under the tongue daily
13. Impure sulfur or southernwood triturated together in a glass of wine and sipped warm
14. Fox's liver dried, hardened and pounded into a powder and sprinkled on a drink (such as wine)
15. Eating the fresh, roasted lungs of a fox (but you can't cook it with iron utensils)
16. Gruels (watery porridge) and mild food
17. Light austere wine
18. Sometimes a vomit (Emetics)
19. Anything that promotes urine (diuretics make you pee, but they probably believed they were full of poisons that caused the humors to be imbalanced)
20. Gentle walking (nothing more)
21. Massage (he referred to it as friction; it's done to move poisons around the body to balance the humors and to make breathing easier) (6)

While some of Celsus's remedies were later proven to have medical significance, most were simply palliative, and some were downright barbaric.  Still, Celsus's ideas were studied and followed for many years after his death.

We asthmatics should be thankful to Celsus for spearheading -- although he didn't know it at the time -- a 3,000 year effort to define asthma as a disease of its own. You can decide for yourself if you'd have been satisfied with his remedies for your asthma...

... or if you'd have rather just stayed home and suffered.  Let me know what you think.

References:

1. Celsus, Aurelius Cornelius, "De Medicina," translated by L. Targa, London, pages xiiv-xxiii, "The Life of Cornelius Aurelius Celsus," by J. Rhodius and translated from Almeloveen's Lugduni Batavorum, page xxi, xxii
2. Celsus, ibid, page xvii
3. Parr, Bartholomew Par, M.D., "The London Medical Dictionary," 1809, London, Vol. 1, pagegs 425-5 
4. Celsis, op cit, page
5. Celsis, op cit, pages 259-61
6. Celsis, op cit, pages 259-61
7. Garrison, Fielding Hudson, "An introduction to the history of medicine: with medical chronology, Bibliographic data and test questions," 1913, Philadelphia and London, W.B. Saunders company
8. Thorowgood, John C., "Asthma and Chronic Bronchitis: A New Edition of Notes on Asthma and Bronchial Asthma," 1894, London, Bailliere, Tyndall, & Cox