Chapter 3: The Dawn of Homo Sapiens Sapiens and Early Medicine

Modern humans, known as Homo sapiens sapiens, first appeared in Africa around 200,000 years ago. By approximately 100,000 years ago, they began migrating out of Africa, eventually spreading across the globe. These early humans were more anatomically and behaviorally advanced than their predecessors, including Homo habilis, Homo erectus, and earlier forms of Homo sapiens . Their bodies were more suited for walking long distances, allowing them to travel to various parts of the world in search of food. As they adapted to different environments, they also developed better tools and hunting techniques .

As Patricia Netzley notes in her book World History Series: The Stone Age, these early Homo sapiens sapiens lacked the pronounced facial features of the Neanderthals and had taller, less robust bodies. In appearance, they were quite similar to modern humans. Netzley explains, "Longer legs gave them the ability to travel longer distances, which meant they came into contact with many other tribes of people. This exposure to other cultures and ideas may be the source of their greater creativity compared to their ancestors" . Additionally, these humans made a wide variety of tools, utilizing materials such as rock, bone, antlers, ivory, and wood . They fashioned weapons like saws, chisels, flint axes, spears, bows, and arrows. Thin pieces of bone were used as needles to sew hides into clothing . These advancements enabled them to hunt larger animals, like the Woolly Mammoth, and they used every part of the animals they killed—eating the meat, using the bones for tools, and creating ornaments and beads from leftover materials .

They likely developed a form of communication, possibly both verbal and artistic. Cave paintings found in several locations suggest that these early humans used art to record their activities and relay knowledge to future generations . Language, though speculative, must have existed to facilitate hunting coordination, knowledge-sharing, and the teaching of traditions, myths, and medicinal practices .

While there is little direct evidence of medical practices from this period, it’s reasonable to assume that Homo sapiens sapiens developed rudimentary forms of medicine. They likely provided care to the injured and sick, experimenting with herbs and natural substances as remedies. As they had no concept of internal diseases, their explanations of ailments likely involved the supernatural—perhaps attributing sickness to spirits or demons. Netzley hypothesizes that such beliefs led to the development of rituals, incantations, and prayers aimed at appeasing these spirits .

According to historian Fielding Hudson Garrison, primitive people often worshiped natural forces and elements, like the sun, moon, and storms, which they believed were controlled by spirits. Disease was thought to be caused by malevolent forces and could only be cured by appeasing these spirits . Garrison explains that these early humans would offer sacrifices and engage in rituals to ward off disease or misfortune. They might have believed that diseases were caused by human enemies with supernatural powers or by offended spirits of the dead .

Given the prevalence of respiratory diseases today, it's plausible that early humans experienced symptoms similar to asthma or bronchitis. While these diseases may not have existed in their current forms, infections and environmental factors could have caused airway inflammation, leading to breathing difficulties .

As empathy developed within these early communities, humans began to care for one another more attentively. Mothers would comfort their children when they were hurt, using simple remedies such as applying mud to burns or massaging sore muscles. These actions represented the earliest forms of caregiving, laying the foundation for more formalized medical practices .

By the time Homo sapiens sapiens had fully established themselves across various regions, they had created complex societies with spiritual beliefs, healing practices, and sophisticated tools. These developments mark the dawn of medicine, which would evolve as human understanding of the body and disease grew over time .

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References:

1. Netzley, Patricia D. World History Series: The Stone Age, San Diego, CA: Lucent Books, 1998.
2. Roberts, J.M. The Illustrated History of the World: Prehistory and the First Civilizations: Volume I, New York: Oxford University Press, 1999.
3. BBC Science and Nature, "Neanderthal: Their Bodies Were Well Equipped to Cope with the Ice Age," http://www.bbc.co.uk/sn/tvradio/programmes/horizon/neanderthal_prog_summary.shtml (accessed April 4, 2013).
4. Garrison, Fielding Hudson. An Introduction to the History of Medicine, 3rd ed., Philadelphia and London: W.B. Saunders Company, 1922.
5. Sigerist, Henry E. History of Medicine: Volume I: Primitive and Archaic Medicine, New York: Oxford University Press, 1951.

Understanding Different Asthma Phases: My Take on Episodes, Flare-ups, and Attacks

When it comes to asthma, we often hear terms like "episodes," "flare-ups," and "attacks" thrown around. But what do they really mean? Are they the same, or is there a difference? Let’s break it down, based on my personal experience as both a respiratory therapist and an asthmatic.

Asthma Attacks: The "Stop Everything" Moment

An asthma attack is what I consider the most severe phase. It’s when symptoms like shortness of breath hit you hard, forcing you to stop whatever you’re doing. It’s no longer about managing the condition quietly in the background. At this point, you need to take immediate action—whether that’s using your inhaler, moving away from a trigger, or seeking medical help.

"That asthma attack hit me like a wall—I had to rush to the ER."

In cases like this, it's all about following your asthma action plan and not delaying treatment. Waiting too long can lead to a situation that could get out of control.

Asthma Flare-ups: A Slow Burn

Flare-ups, in contrast, can feel more like a gradual build-up of symptoms. You might notice mild breathlessness that comes and goes. Sometimes, it feels like a nuisance rather than a major issue. But, if left unchecked, flare-ups can worsen and eventually lead to an asthma attack.

"I had a week of persistent wheezing before the attack—it was a warning sign I should have acted on earlier."

Think of flare-ups as your body waving a caution flag. It’s manageable, but it’s also a reminder to stay vigilant and adjust your treatment if needed.

Asthma Episodes: The Catch-all Term

“Episodes” is a more generic term often used in research or by healthcare professionals to describe any occurrence of asthma symptoms, no matter how mild or severe. This term doesn’t quite distinguish between an attack or a flare-up—it just means you’ve experienced symptoms.

"The patient had multiple asthma episodes over the course of the month, varying from mild to severe."

For most of us in day-to-day life, “episodes” isn’t a term we commonly use. But it’s helpful to know when reading medical literature or research.

Breathing Between the Storms

Ideally, between attacks or flare-ups, we should experience periods of normal breathing. For most asthmatics, lung function should stay at or above 80% of the predicted value during these calm periods. This means you should feel like yourself on most days, with little to no asthma symptoms.

"On a good day, I feel like I don’t even have asthma—my breathing is completely normal."

Remission: When Asthma Takes a Break

Sometimes, especially after childhood, asthma can seem to go into remission. This means you go long periods—months or even years—without any significant symptoms. However, asthma never truly goes away. It can always resurface, even after a long break.

"Childhood asthma can sometimes go into remission, but it’s important to remember it can return later in life."

Asthma Forgetfulness: The Sneaky Risk

When you’ve been feeling good for a while, it’s easy to forget you have asthma. This can lead to overconfidence, like skipping medication or exposing yourself to known triggers. It’s a lesson many of us have learned the hard way.

"I once thought I was free of asthma, only to have it come back full force. Lesson learned—don’t get too complacent."

What’s Your Experience?

Asthma is unique for everyone, and the terms we use can vary. What matters most is understanding your own symptoms and having a plan in place for when things go awry. How do you describe your asthma experience? Let me know in the comments below.

The flaws of those who make the rules

Jim Leyland was a good team manager for the Detroit Tigers. He laid down the law when he needed to. But he was also very good with maintaining the morale and motivating his players. 

There’s an art to making rules. It’s better to have no rule than to create a bad one. If you make a rule, ensure it serves a purpose, and most importantly, make sure it doesn’t cause harm. Rules made just for the sake of it are pointless. Put simply: it’s better to do nothing than to do something stupid.

Rules are generally created to improve a situation—or at least attempt to. Take, for instance, administrators trying to reduce infections in the emergency room. A noble goal, no doubt.

Now, consider an example involving suction equipment. For 30 years, we’ve ensured the ER trauma rooms are ready for anything. In a CODE situation, there’s no time to set up equipment, which is why we always have the suction canister ready, tubing attached, and a Yankauer nearby.

One day, I rushed into the ER for a CODE BLUE. The doctor was ready to intubate, and I had set up the endotracheal tube. But when I went to turn on the suction—nothing. No canister, no tubing, no Yankauer.

The equipment was there, but still sealed in its packaging. It took precious minutes to unwrap and set up, slowing us down at a critical moment.

During the post-CODE debrief, we learned why. The person responsible for following Joint Commission (JCAHO) guidelines had taken the suction apart, stating that JCAHO required everything to stay packaged until use. I replied, “If JCAHO has a rule preventing us from setting up vital equipment, then that rule needs to be changed. We need it ready when it matters.”

In this case, the rule that was meant to help ended up hindering care. This exemplifies the idea of letting us do our jobs without unnecessary interference.

Several years ago, a policy was introduced requiring us to rinse out nebulizers after each treatment with sterile water. This added unnecessary time spent in the room, and despite administration's insistence, no therapist complied. Eventually, the policy was forgotten. This serves as a reminder: you can make a rule, but you can’t force compliance unless you want to monitor us constantly. However, that would only decrease morale.

To conclude, I used to attend administrative meetings regularly. One time, during a discussion about an incident, an administrator said, “We have to do something.” I cautiously replied, “It’s better to do nothing than to do something stupid.” The point is to carefully consider both the benefits and consequences of any rule you make.

To illustrate this point, consider Jim Leyland, former manager of the Detroit Tigers. After a game where a third baseman made a costly error, a reporter asked Leyland what he said to the player. Leyland responded, “I didn’t say anything. He knows what he did wrong and will take the necessary actions to correct it.” He added that if the player repeatedly made the same mistake, he might intervene. This approach of allowing individuals to learn from their mistakes, rather than enforcing unnecessary rules, is a strategy hospital administrators would do well to adopt.

Asthma History: Chapter 2: The Origins of Human Empathy and Illness

The first Homo sapiens, our direct ancestors, appeared around 200,000 to 300,000 years ago in Africa. Even before that, human-like species, or hominins, walked the Earth for millions of years. These early hominins, including species like Homo habilis and Homo erectus, paved the way for modern humans with their ability to adapt, invent tools, and form social groups.

While we can never know exactly what life was like for early humans, we do know they faced many challenges. These challenges—finding food, shelter, and avoiding predators—often required cooperation and care within their small communities. Empathy, in its earliest form, likely evolved from the need to support one another for survival. Sharing food, protecting the sick or injured, and caring for offspring were vital to their existence.

The Role of Disease in Early Human Life

It’s impossible to know precisely what diseases afflicted early humans, as there are no written records or medical descriptions from that time. However, it’s safe to assume that, much like today, infections and injuries were common causes of death. Viruses and bacteria existed long before humans, so early humans likely suffered from respiratory infections, colds, and other illnesses.

But what about asthma and other chronic diseases? While it's difficult to say if asthma, as we understand it today, existed in ancient times, respiratory symptoms like wheezing, coughing, and shortness of breath could have occurred, particularly in response to infections, smoke from fires, or environmental factors. Chronic diseases often affect older populations, and most early humans did not live long enough to develop them. However, it is possible that some children developed asthma-like symptoms.

Given that asthma tends to develop in childhood, it’s conceivable that children may have suffered from it in prehistoric times. With no effective way to diagnose or treat severe asthma attacks, these children might have died without anyone fully understanding what was happening. Their symptoms may have been dismissed as the result of an illness or bad air, with no one recognizing the chronic nature of the condition.

Early Humans and Empathy

While we can't be certain whether asthma existed, we do know that early humans, including Neanderthals, demonstrated care for their fellow beings. Archaeological evidence shows that Neanderthals, who lived from about 400,000 to 40,000 years ago, cared for their sick and injured. For instance, remains of Neanderthal skeletons show signs of long-term injuries, suggesting that others helped them survive for many years after their accidents—an early form of empathy in action.

It is also believed that Neanderthals and other early humans practiced burial rituals, providing food or tools to accompany their dead in the afterlife. These behaviors suggest that they had developed emotional bonds, cared for one another, and possibly had early forms of communication and tradition.

The Birth of Early Medicine

The act of caring for the sick—whether offering food, water, or shelter—can be considered the earliest form of medicine, though not in the sense we know today. These early people likely had no concept of disease as we understand it. However, they observed the effects of illness and injury, and they learned to respond to it with empathy, offering what little comfort they could.

While the term “healthcare” would be anachronistic, early human empathy laid the groundwork for the development of communal support systems. This would have been essential for survival, as caring for the injured or sick helped ensure the tribe’s strength and longevity.

The Evolution of Human Adaptation

About 1.8 million years ago, Homo erectus emerged. These early humans were remarkable for their ability to migrate and adapt to various environments. They were the first to use fire, around 400,000 years ago, which allowed them to cook food, stay warm, and protect themselves from predators. Fire also provided them with more leisure time, which may have contributed to social bonding, storytelling, and further cognitive development.

As they migrated out of Africa, Homo erectus and later species like Homo neanderthalensis adapted to new environments by inventing tools, developing hunting strategies, and learning to cope with colder climates. These adaptations were crucial as the climate fluctuated and food sources became scarce. Empathy and cooperation continued to play a central role in survival, especially during times of crisis.

The Neanderthals and Their Legacy

Neanderthals, though not direct ancestors of modern humans, were close relatives. They lived in small groups, mainly in caves, and relied on hunting and gathering. Archaeological evidence suggests that Neanderthals cared for their sick and disabled, providing food and shelter for those unable to hunt. For example, one burial site revealed the remains of a man who had lived for many years without the use of one arm, indicating that others must have helped him survive.

Around 45,000 years ago, the climate in Europe began to change rapidly, transforming the forests on which the Neanderthals depended into open plains. This sudden shift in their environment, combined with the arrival of modern humans, may have contributed to their extinction. Homo sapiens, with more advanced tools and social structures, were better able to adapt to the changing landscape.

Empathy and Early Medicine in Context

In a world where survival depended on cooperation, early humans and their ancestors had to care for one another. They shared food, provided warmth, and nursed the sick—basic acts of empathy that can be seen as the foundations of medicine. However, these early forms of care were not guided by medical knowledge but rather by necessity and emotional bonds.

While there is no evidence that diseases like asthma were prevalent, respiratory symptoms likely existed due to infections or environmental factors. What we do know is that early humans, including Neanderthals, demonstrated care for their fellow beings, offering what could be seen as the earliest forms of healthcare.

Today, we continue to build on the legacy of empathy and caregiving that has been part of human evolution for millions of years.

References:

1. Netzley, Patricia D, "World History Series: The Stone Age," 1998, San Diego, CA, Lucent Books
2. Roberts, J.M., "The illustrated History of the World: Prehistory and the first civilizations: volume I," 1999, New York, Oxford University Press
3. "Neanderthal: Their bodies were well equopped to cope with the ice age, so why did the Neanderthals die out when it ended," bbc.co.uk, Science and Nature, http://www.bbc.co.uk/sn/tvradio/programmes/horizon/neanderthal_prog_summary.shtml, accessed 4/4/13
4. Garrison, Fielding Hudson, "An Introduction to the history of medicine," 1921, 3rd edition, Philadelphia and London, W.B. Saunders and Company

Problem With Nocturnal Oxygen Qualifications

Generally speaking, we consider an SpO2 of 90% as acceptable. This is because an SpO2 of 90% typically correlates with a PaO2 of around 60 mmHg, and anything below a PaO2 of 60 mmHg is considered hypoxia that requires treatment with supplemental oxygen.

Medicare, in setting guidelines for oxygen qualification, aims to ensure that people truly need oxygen. So, they set the qualification threshold at 88%. If your oxygen saturation is 88% or less while resting or with exertion, you qualify for home oxygen therapy.

In this case, I have no issue with the guideline—it makes sense. However, qualifying for nighttime or sleep oxygen is a different story. During the day, a saturation of 88% means you qualify for oxygen. But at night, you not only need to drop below 88%, it also has to remain that low for a minimum of five minutes.

For example, in a study we did last night, a patient's SpO2 dipped to 83%, which is considered low. But because of Medicare’s nighttime oxygen requirements, this person doesn’t qualify for oxygen. Even if their SpO2 dropped to 70%, they wouldn’t qualify unless it stayed below 88% for at least five minutes.

I believe this is a flaw in the system. Granted, lower oxygen levels during sleep are often considered normal, but setting a time-based threshold seems unnecessarily rigid. Perhaps Medicare could instead adopt a threshold like 85%—and if anyone’s SpO2 falls below that, even briefly, they should qualify for nighttime oxygen therapy. This would account for those whose saturation dips significantly, even if the drop doesn’t last the full five minutes.

Truly, Medicare does not always have the patient’s best interests in mind when setting qualification policies. What seems to guide their decision-making more is how they can save money. While the guidelines ensure that only those who really need oxygen get it, the rigid thresholds—especially for nighttime oxygen—can leave some patients without necessary support. It seems less about patient care and more about cutting costs.

Top 7 Benefts Of Working In A Hospital

Many people avoid working in a hospital, and the reasons are obvious—long shifts and exposure to illness. However, working in a hospital has its advantages. Here are the top ten benefits of hospital work:

1. The joy of helping others: This is the obvious #1. It feels great to use your years of experience and expertise to help people in the community feel better.

2. Free food: We get plenty of opportunities for free meals. During COVID, for example, we had free food nearly every day from places like Hungry Howie’s, Mancino’s, and Jimmy John’s. Local owners supported us frontline workers, even when we weren’t always busy. Occasionally, admins organize meals for special occasions—summer picnics, holidays, etc. One doctor brings in bagels every Saturday I work with him—an excellent way to make friends! Sometimes, when we’re overwhelmed, someone (often a doctor) will order pizza for everyone. There are also random days when admins hand out candy or ice cream (Snickers, Klondike, Twix, etc.).

3. Healthy air: One of the reasons I went into healthcare was because hospital air is always clean and fresh. In the heat of summer, hospitals offer cool, dry, air-conditioned air—a welcome relief.

4. Free health supplies: While this may not be officially part of the deal, many healthcare workers 'borrow' supplies and never quite return them! In my 30 years as a respiratory therapist, I’ve never bought a nebulizer—I just grab one from work when needed. The same goes for band-aids, antibiotic ointments, knee wraps, and other small items.

5. Empathy and care: Working in a hospital is a good fit for me since I have asthma. If I’m having trouble breathing, my coworkers will encourage me to take a break, use my inhaler, or take a breathing treatment—whatever I need to feel better.

6. Free health advice: Everyone has health concerns at times. Maybe you cut yourself and wonder if you need stitches, so you ask a nurse or doctor friend. Or you're feeling short of breath—well, you’re surrounded by experts who can help immediately.

7. Learning what not to do: In healthcare, we see people at their worst. It serves as a daily reminder to take care of ourselves. That’s why many healthcare workers try to eat healthy, stay active, and exercise. We know what happens when you don’t.

These are some of the benefits I can think of. I am sure there are more. Please help me add to this list. 

Asthma History: Chapter One: The First Asthmatic—Speculation and Mystery

When did the first person with asthma live? Since written language didn’t exist until around 2700 B.C., we have no direct records to answer that question. But that doesn’t mean we can’t explore the possibilities. Using what we know about early humans, their environments, and later documentation of asthma-like symptoms, we can imagine how respiratory issues might have existed long before history was written down.

Asthma in Prehistory: A Possibility

Let’s travel back 2.5 million years to the Stone Age, a time when early humans were adapting to their environments, creating stone tools, and beginning to hunt for food. This period is referred to as the Stone Age because of the widespread use of stone tools, and it’s divided into three phases: the Paleolithic, Mesolithic, and Neolithic.

We have no concrete evidence to suggest that asthma existed during this time, but it's plausible. Early humans were exposed to environmental factors that are known to trigger asthma today: smoke from fires, pollen from plants, and close contact with animals. Could these early humans have experienced shortness of breath or respiratory distress, much like people with asthma today? While we can’t be certain, it’s intriguing to think about how such challenges might have impacted their lives and survival.

Later Evidence: Clues from Ancient Civilizations

Even though there is no direct evidence of asthma in the Stone Age, historical records from later periods give us a glimpse of what early respiratory issues might have looked like. The Ebers Papyrus, dating back to 1550 B.C. in ancient Egypt, contains remedies for breathing problems, suggesting that respiratory conditions were known and treated at that time. Similarly, the Greek physician Hippocrates (around 450 B.C.) described conditions resembling asthma, highlighting how long humanity has grappled with respiratory ailments.

Given that asthma was documented in ancient civilizations, it’s reasonable to speculate that similar conditions existed much earlier. People in the Stone Age might not have had a name for these conditions, but they likely experienced the symptoms—perhaps leading to natural remedies, adaptations, or simple survival techniques.

The Mystery of Early Asthma

We may never know if people during the Stone Age suffered from asthma, but what we do know about their environment makes it plausible. It’s easy to imagine a Stone Age individual struggling to breathe after inhaling smoke from a fire or coming into contact with pollen-rich plants. What treatments, if any, existed? Did their peers help them, or did they suffer in silence? These questions remain unanswered, but they open up fascinating possibilities about life before written history.

As we explore the evolution of asthma and its treatments in later sections, we’ll see how our understanding of the condition has grown. But for now, we can only wonder about the earliest days of this mysterious illness.