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A History of Allergies and Asthma, Part Two: The Middle Ages and the Renaissance

This month, we continue our historical exploration of the book Ancestors of Allergy, edited by F. Estelle R. Simons, MD, FRCPC, into the Middle Ages and the Renaissance. Progress in the field of allergy and asthma continued to be made, a little here, and a little there, regarding the causes of allergies and asthma and some effective treatments.

As human culture advanced intellectually and artistically during this time period, so did the comprehension of medical ailments, their causes, and treatments. Particularly, progress was made during the Middle Ages and the Renaissance in both Europe and the Arab world. Arabic physicians described symptoms of what we now know to be allergic rhinitis and asthma and even recorded the aggravating factors. In another part of the world, the Salerno Medical School in Italy produced a definitive book of health that described the causes of asthma.

As people began to understand cause and effect, the focus of medicine also began to shift. The focus of medicine in Europe during the Middle Ages was the direct and immediate attention to the sufferer's ailments and the offer of practical remedies to alleviate pain. The Renaissance, the rebirth of free thought and expression in Europe, modified the focus of researchers to investigate the causes of respiratory diseases, including pulmonary illness, which led to discoveries about asthma and allergies.

The Middle Ages (AD 476-1400)

The Middle Ages saw few developments in medical research in Europe, as physicians concentrated on the relief of their patients' symptoms and considered the works of Hippocrates and Galen to be definitive. Following the disintegration of the Roman Empire during the fifth and sixth centuries and the subsequent turmoil, the restoration to order and rule took center stage. Research into cause or theory of medical problems was pushed aside as European doctors focused mainly on common problems and practical solutions.

However, the Middle Ages was a time for real advancement for medicine in the Arabic culture. The Omayyad Dynasty (661-750) developed into a sophisticated society treasuring the arts and education. Baghdad was founded in 760 under the Abbāsid Caliphate, and many Greek, Syriac, Persian, and Sanskrit works were translated into Arabic. Educated Arabic young men began to explore the discipline of medicine and to progress in theories and research.

Born near Tehran, one such young man was a Persian known as Rhazes (865-932). Though Persian, he wrote in the Arabic language and understood Arabic culture. He studied music and alchemy before turning to the study of medicine. As he advanced in his profession, he was selected to build and head a new hospital in Baghdad. In an interesting note, he selected the site of the new hospital by scattering chunks of raw meat throughout the city. The location where the meat had rotted least was deemed the place most advantageous to good health, and thus the best area for the hospital.

More significantly, Rhazes was a prolific writer who authored more than 140 books on medicine. Among these writings was his piece "A Dissertation on the Cause of the Coryza which occurs in the Spring when the Roses give forth their Scent." This was the first description of seasonal allergic rhinitis or what was then known as "rose fever." He also wrote a medical encyclopedia, El Hawi, where he disavows a claim by Galen that drinking an owl's blood aided in curing asthma.

Avicenna, another young man born in Persia (980-1037), also made strides in medicine and later became hailed as the "Prince of Physicians" by his contemporaries. Beginning his medical studies at age sixteen, he was summoned two years later to care for the suffering Prince Nūh ibn Mansũr. After the Prince's rapid recovery, he rewarded Avicenna with access to his vast library of rare and precious books.

Avicenna authored more than one hundred books, including an encyclopedia of all the sciences which was written when he was only twenty-one years old. Though particularly known for his philosophy, which incorporated many Aristotelian principles, his single most famous work was al-Qānūn fi al-Tibb, or, "The Canon of Medicine." This essential medical textbook became required reading throughout the Islamic and Christian worlds for more than five hundred years after his death.

Other doctors in the same time period were heralded for their innovation and powers of observation. One of these men included Isaac Israeli ben Solomon Judaeus, a prolific writer whose Arabic texts were considered by Islamic physicians to be "more valuable than gems." Avenzoar, a well-respected and skilled physician, wrote considerably on the properties of food. Another man, Maimonides (1135-1205), was a preeminent philosopher, legislator, and physician, and wrote many theological and medical books.

Maimonides served as physician to the court of the legendary sultan Saladin in Egypt and cared for his son, who suffered from chronic asthma. He wrote a Treatise on Asthma, in which he advocated rest, good personal hygiene, environmental hygiene, equanimity, and avoidance of opium. He also made dietary suggestions recommending the exclusion of certain foods for the prevention of asthma attacks and promoting other food choices.

Some foods that he believed beneficial included roe, ram, hare, and chicken soup, as well as wine in moderation. He also observed that patients' symptoms often began as a common cold during the wet months, which developed into gasping for air and coughing until phlegm was expelled. He also revealed that the dry months in Egypt seemed to be the best for those who suffered from asthma.

In this same time period, physicians in Europe also realized that plants had an effect on allergies and asthma. They recognized that certain flowers and shrubs, especially roses, caused some people to sneeze or suffer asthma attacks. In Italy, a prominent medical school was established in the coastal town of Salerno, long famous for its numerous physicians. Physicians boasted of being from Salerno as early as AD 904. By 1224, recognition and approval from the masters of Salerno were required for all physicians who wanted to practice medicine in the Holy Roman Empire.

The Salerno Medical School was taught by ten professors, or masters. Students had to be at least twenty-one years old and have completed seven years of medical study in order to graduate. They were familiar with the writings of Galen, as wells as other Greek texts translated into Latin.

In order to qualify for a degree in surgery, candidates were required to complete an additional year of anatomy. When students graduated, they entered into the Society of Physicians, and as members, were not allowed to accept fees from the poor nor partake of profits from apothecaries. The school also was known for enrolling women.

The Salerno Book of Health was translated into many languages, and discussed matters such as the causes of asthma. Known throughout the Christian and Islamic worlds, the Salerno Medical School was hailed as the greatest medical school of its time.

The Renaissance (AD 1300-1700)

The Renaissance gave birth not only to artistic and intellectual development, but also to advances in medical investigation. Progress was made in understanding respiratory diseases, along with a shift of focus from alleviation of symptoms to external causes of disease. During this time, the exploration and inquiry of cause and effect of diseases flourished resulting in original research and commentary.

Paracelsus (1493-1541) began a new way of viewing medicine, and his approach affected the entire medical world. By focusing on the causes of disease, he turned the medical field from the defensive to the offensive. He displayed his dedication to the discovery of the true nature of disease when he publicly burned the works of Avicenna and Galen.

Another physician by the name of Georgius Agricola (1494-1555) was known as the founder of the science of mineralogy. He was one of the first men to base a natural science on actual observation rather than mere speculation. He was the first to unveil that exposure to environmental pollution could lead to pulmonary symptoms. He also wrote a Treatise on Mining, in which he suggested a prototype of a protective mask for miners and wrote about dust causing occupational pulmonary diseases. His groundbreaking work impacted even the twentieth century when this book was translated into English by U.S. President Herbert Hoover.

A significant observation was made in 1552 when an environmental change was the only cause to improve a patient's condition. A renowned Italian physician, Gerolamo Cardano of Pavia was summoned to John Hamilton, the Archbishop of Saint Andrews in Edinburgh, Scotland. Hamilton believed he was suffering from tuberculosis and wanted the Italian doctor to cure him. After weeks of observation, the doctor announced that it was in fact asthma, not tuberculosis, that was the cause of his condition. He prescribed several dietary changes, exercise routines, cold baths, and rest, along with several unusual procedures, none of which helped.

Concurrent to the treatment, Cardano noticed that Hamilton slept on a feather bed and suggested that a bed of unspun silk was more appropriate for a man of the Archbishop's position. It was this environmental change that caused Hamilton to improve he was likely allergic to feathers.

Several observations by different men all contributed to the growing pool of knowledge about asthma. Jean Baptiste Van Helmont (1579-1644 AD), a physician, chemist, and physiologist from Belgium, noted that asthma originates in the pipes of the lungs. Bernardino Ramazzini (1633-1714), known to some as the father of sports medicine, also detected a link between asthma and allergies and organic dust, and recognized that asthma could be induced by exercise. An English physician, Sir John Floyer (1649-1734), another who believed in cold baths as a treatment for asthma though they did nothing to alleviate his own symptoms, wrote A Treatise of the Asthma. He described symptoms of asthma as "a laborious Respiration, with lifting up of the Shoulders, and Wheezing." He also observed two types of asthma, continuous and episodic.

Thomas Willis (1621-1675), a contemporary of Floyer, also wrote considerably on asthma in his Pharmaceutice Rationalis. He was perhaps best known for his description of the circular arrangement of arteries around the base of the brain, today known as the "circle of Willis." He also described a neural contribution to bronchoconstriction in asthma. His work is a clear demonstration of the rational inquiry into the disorder of asthma that began as early as the seventeenth century.

As human culture has progressed, so has the development of understanding the true nature of disease and its sources, as well as treatment of its symptoms. Discovering the causes of allergies and asthma and determining effective treatments for these diseases was no exception, and it's a journey we're still on to this day!