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A History of Allergies and Asthma, Part One: The Ancients' Perspective

Increasingly, allergies and asthma have become household concerns. Often considered "the epidemic of the twenty-first century," the rise in allergies has caused allergy sufferers and physicians alike to explore options in allergy control, treatment, and possible cures. But as always when looking ahead, there's a lot to be understood by re-examining the past.

The earliest known report of an allergy was that of King Menses of Egypt, who died after a wasp sting some time between 3640 and 3300 BC. Another ancient report of allergy is that of Roman Emperor Claudius's son, Brittanicus, who was so allergic to horses that the rash he developed would prevent him from seeing where he was going.

Sir Thomas More's account of allergy is equally sordid.  He describes how King Henry III ate some strawberries before an audience with Lord William Hastings. When the king developed acute urticaria, or hives, he accused Hastings of putting a curse on him and sentenced him to beheading.

Although the Roman philosopher Lucretius observed overblown responses to common substances and noted that "what is food for some may be fierce poisons for others," the modern era of allergies didn't begin until the nineteenth century when hay fever was first described.

Before delving into the modern era which has seen an astounding increase in allergies, let's examine how our ancestors long, long ago viewed and treated respiratory illnesses such as asthma. The book Ancestors of Allergy, edited by F. Estelle R. Simons, MD, FRCPC, offers a detailed account of the history of allergies and asthma, extending from early history through the twentieth century. Join us as we trace the way ancient physicians throughout the world viewed breathing disorders and how they attempted to treat them.

China (c. 3000-250 BC) - Using Ephedra to Treat Asthma

Herbs were prolific in what is now northern China where the favorable climate and rich soil attracted large bands of settlers. Shen Nong (c. 2700 BC) is considered the Father of Chinese Herbal Medicine.  According to legend, he was the first to taste ephedra which was used to treat asthma-like symptoms five thousand years ago.

Ephedra, known to the inhabitants of China as Ma Huang, was used to relieve bronchospasms, produce vasoconstriction, reverse congestion, and inhibit mucus secretion. The Chinese brought ephedra to Greece where it spread to other civilizations.

The Nei Ching Su Wen, or the "Cannon of Internal Medicine," which is the world's oldest treatise of internal medicine, describes respiratory distress which may refer to what we now consider asthma:

"Man is afflicted when he cannot rest and when his breathing has a sound (is noisy) or when he cannot rest and his breathing is without any sound. He may rise and rest (his habits of life may be) as of old and his breathing is noisy; he may have his rest and his exercise and his breathing is troubled (wheezing, panting): or he may not get any rest and be unable to walk about and his breathing is troubled. There are those who do not get a rest and those who rest and yet have troubled breathing."

Egypt (c. 3000-1200 BC) - Ancient Inhalation Treatments for Asthma

Ancient Egyptians believed respiration was the most vital function of the human body, as delineated in the Ebers Papyrus (c. 1550 BC), which contained an impressive number of remedies for maladies including asthma, hepatitis, bubonic plague, dandruff, and more.

The document, which was unearthed in Thebes in 1862 and then translated into German in 1873, demonstrated a sophisticated approach to the practice of medicine. The Ebers Papyrus was considered a divinely inspired text that contained the worldly knowledge of Thoth, the Egyptian god of learning and the patron of physicians.

According to the Ebers Papyrus, asthma was considered to be a whdw, a "disorder or foulness," of the metu, ducts that were thought to distribute air and water to the organs, including the lungs. Physicians, therefore, attempted to heal the ducts by dispelling the "foulness." However, it is difficult to determine the effectiveness of the treatments used because the substances are unknown. We do know that some among the identifiable substances used to treat respiratory symptoms were frankincense, yellow ochre, and grapes.

The Ebers Papyrus also describes the use of a special apparatus for inhalation to ease restricted breathing:

"Thou shalt fetch seven stones and heat them by fire, thou shalt take one thereof and place a little of these remedies on it and cover it with a new vessel whose bottom is perforated, and place a stalk of reed in this hole; thou shalt put thy mouth to this stalk so that thou inhalest the smoke of it. Likewise with all stones."

Greco-Rome (c. 1000 BC-AD 200) - Asthma and the Four Humors

Hippocrates (c. 460-377 BC), the "Father of Medicine" and the most influential physician in Western history, based his teachings on objective observation and deductive reasoning. In relation to asthma, Hippocrates described "panting," and noted that "such persons as become hunch-backed from asthma or cough, before puberty die." He is also believed to be one of the earliest physicians to understand the link between respiratory ailments and the environment.

Preceding Hippocrates's time, as in ancient Egypt, Greco-Roman healing practices were a conglomeration of religion, magic, and natural cures. While the definitive medical text of the day, the Code of Hammurabi (r. 1792-1750 BC), described the use of a breathing apparatus "when the breath of man's mouth is difficult," the majority of medical texts written by successive generations considered illnesses such as asthma to be caused by sin or demon possession and magic or repentance were the predominant "cures."

Hippocrates moved medicinal practices away from the supernatural and into the realm of science. He identified four humors blood, phlegm, yellow bile, and black bile and viewed health as a proper balance between them. Hippocrates believed that asthma, which he considered to be any form of panting, occurred when phlegm, the evil humor, rose in the brain, passed through the pituitary gland, condensed in the nasal cavities, and flowed into the lungs, which would be blocked due to an excess of "catarrh."

The word asthma comes from the Greek word for "wind" or "to blow." Roman encyclopedia author Aulus Aurelius Cornelius (fl. first century BC), the first medical historian, described asthma in his De Medicina as "the inability to breathe without making noise and gasping." Treatments included bleeding, purgatives, hot wet compresses, emetics, and diuretics.

Greek physician Aretaeus the Cappadocian (c. second century AD) documented the earliest known description of what is now recognized as asthma. His writings, written in the Ionic dialect and re-discovered in 1554, included On Causes and Symptoms of Acute and Chronic Diseases and On the Treatment of Acute and Chronic Diseases. About asthma, Aretaeus wrote:

"If from running, gymnastic exercises, or any other work, the breathing becomes difficult, it is called Asthma, for in the paroxysms the patients also pant for breath The lungs suffer, and the parts which assist in respiration, namely the diaphragm and thorax, sympathize with them The cause is a coldness and humidity of the spirit (pneuma); but the materialis a thick and viscid humour."

Claudius Galen (AD 129-c. 199), who is well-known for his study of anatomy and his excellence as a physician both in Pergamum and Rome, where he was Marcus Aurelius's personal physician, also contributed to the knowledge of respiratory illness. He was the first to discover that respiration was the result of muscular contractions, not the expansion caused by breath warming the heart. He substantiated his theory by observing that the respiratory rate could be controlled consciously.

The next significant respiratory-related contribution occurred when Pliny the Elder (AD 23-79) acknowledged pollen as a source of respiratory distress. He recommended ephedra (the herb also used by the Chinese) in red wine for asthma. In addition, he suggested the folkloric remedy of drinking the blood of wild horses, fox liver in red wine, or millipedes soaked in honey.

The Ancient Hebrews (c. Third Century BC-AD 700) - Laws to Prevent Illness and the Sneezing Superstition

Although Hebrew physicians were no doubt influenced by Mesopotamian and Egyptian medicine, they believed that the power to heal was with God, and they looked to God's laws, recorded in the Old Testament, as the source of dietary and sanitary practices that would prevent illness from occurring. The book of Leviticus in particular codifies rituals and regulations that each person was to abide by.

The Talmud, a text that analyzes Hebrew laws, describes much of what the Hebrews understood about sickness. In a chapter entitled, "Sickness and Their Treatments," lung diseases and the following description of breathing are described:

"The breathing of individual people differs, all according to the spirit for which God maketh a weight. Some people have a long (projecting) breath whereas others have a short breath."

The Talmud and the Bible both give medical treatment advice. Notably, the Talmud discusses the use of "hiltith," the Arabic word for asafetida, an odoriferous gum resin of oriental plants belonging to the carrot family. Asafetida was a popular folk medicine prophylactic, or disease-preventing, agent but it was specifically thought that the digestion and elimination of this oil through the lungs could both prevent and treat asthma, whooping cough, and bronchitis.

Interestingly, the way sneezing was viewed by ancient cultures, including the Jewish people, is indicative of widespread superstition about what a sneeze meant. While Talmudic scholars saw sneezing as a positive bodily function, the practice of a sneezer thanking God when he didn't die points to the ancient Jewish thought that the only time a person sneezed was when it was time to die; they believed that the sneeze released the soul through the nose.

India (c. 800 BC-AD 500) - Smoking to Treat Asthma?

Charaka, physician to King Kanishka (c. AD 78-101 or AD 120-162) wrote or dictated the oldest known Indian medical textbook, the Charaka Samhita. The information contained in the text, which was a documenting of oral tradition that had previously existed for centuries, was believed to be a record of the medical secrets revealed by Brahma, the creator god, to Atri, a mystic.

Susruta, head of a renowned Indian medical school (c. fifth century AD), also had a medical textbook, which contained both rational information and references to magic and mythology. In a section devoted to anatomy, the book describes how Indian physicians thought of "winds," which were essential to the proper function of the body. Much like the four humors, five winds were thought to be inhaled; if one wind was not functioning correctly, juices took control of the body and sickness occurred.

Regarding treatment, Indian pharmacology was quite advanced and remained the backbone of European pharmacology well into the seventeenth century. Smoking stramonium, derived from thorn-apple and noted for its relaxation properties, was recommended as a treatment for asthma and was practiced by the British army following its incursion into India.

The Americas (AD 1600) - Asthma Treatments from the New World

A combination of plants and religious or ceremonial customs was used to treat respiratory ailments in the ancient Americas. Early peoples of Mexico and South America used natural resources to compound cures and to make medical instruments. For instance, they used rubber to make an enema syringe. Rubber was also used to treat chest disorders and rheumatism.

Additional herbal remedies were discovered after Colombus arrived in the New World, including the dried root of the ipecacuanha shrub of Brazil, which is a natural expectorant, and balsam which is used in cough medicines to this day. In addition,atochietl and tzompilihuizxihuitl were pungent herbs used as inhalants to clear the head. The ancient Americans also used ephedra. Cocaine, the principal ingredient of the dried leaf Erthroxylon coca, was another Incan herbal remedy and was later used in both the United States and Europe to treat rhinitis and asthma.

Conquistadors shipped cacao, rubber, and tobacco to Europe, resulting in the experimentation of tobacco to treat asthma; physicians thought that tobacco's stimulant properties could help open constricted airways.

Having traversed the planet's ancient conceptions of and remedies for respiratory diseases such as asthma, it's fascinating to note both how far we've come in some respects, and how remarkably advanced our ancient forefathers were in others.

Join us next month for Part Two of our history of allergies and asthma series.