400 B.C.: The Hippocratic Inhaler

The first inhaler was probably invented long before Hippocrates walked the earth in the 5th century B.C.  Yet the first time it was ever recorded was by Hippocrates, or at least by one of the writers of the Hippocratic Corpus.  

The inventor is unknown to history, although one might suspect that a young Greek priest learned about it on one of his journeys, and it appeared to him in a vision at the Aesclepion at Cos.  He provided it as a remedy and it worked for what he was told it would work for.  It was then recorded in the votive tablets.

Many years later, while making his own effort to record the wisdom of the ancients, Hippocrates would have learned of this inhaler.  He wrote about it in his Hippocratic Corpus.  

Of course he didn't refer to it as an inhaler, of course not, as the term wasn't coined yet.  Also, chances are pretty good the inhaler he learned about was not used for asthma, or even asthma-like symptoms, but some other unknown malady.  Yet it may have been used for asthma at some point.

So, in the Corpus Hippocrates mentions this inhaler-like device.  The model basically consisted of a jar with a hole in the lid for the insertion of a hollow reed for inhaling the contents. The mouth was saved from burns by use of a soft sponge or egg shells between the mouth and reed.  (1, page 461)

Boiling water would be inserted into the jar, perhaps a recipe of medicines, the lid placed atop the jar, the reed stick inserted through the hole.  The patient would inhale by placing his mouth on the reed stick.  It was a simple design and must have worked quite well, because it was the design used by physicians for many years.

Hippocrates also described fumigations, which probably would have been of smoke or steam.  This treatment might have been more readily available than the inhaler.  (2, page 241)

However, it should be noted that the most common use of fumigations and the inhaler was probably not for respiratory ailments.

For instance, he recommended fumigation to induce menstuation in virgins.  He
recommended fumigation, among other treatments, as a option when a female had pituitous (mucousy) menstruation, or when female hysteria results form displacement of her uterus, which might cause sterility.  It was also recommended when a female could not feel her infant moving in the uterus at four or five months. He also recommended it for severe ulcers, among other similar non-respiratory ailments.  (2, page 300, 304)

He did, however, recommend fumigations for certain types of phthisis, although mainly for spinal tuberculosis and not the pulmonary type. (2, page 281)

He also recommended inhalation for quinsy, or the various diseases that causes swelling of the throat. He also recommended inhalation for angina. (2, page 281, 260-262)

Getting back to the inhaler, many believe it was the Hippocratic Inhaler that was fine tuned during the 19th century when the first two inhalers were manufactured and placed on the market.

References: 

1. Glasgow Medical Journal, Volume 14 By Glasgow and West of Scotland Medical Association, Royal Medico-Chirurgical Society of Glasgow
2. Hippocrates, Claudius Galen, writers,  John Redman Coxe, translator, "Hippocrates, the Writings of Hippocrates and Galen," 1846, http://oll.libertyfund.org/titles/1988, accessed 7/6/14, also see the book online at Google books, Philadelphia, Lindsay and Blakiston

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History of Difficult Breathing

It's time we embark on a journey through the tunnels of time.  Yet rather than traveling along the warpath of mankind, we'll be traveling along the path of disease, particularly asthma and respiratory therapy.

Like the path of war, the path of disease takes us all the way back to the beginning.  Actually, certain diseases may go back farther than war itself, as they exist regardless of the desires of mankind.

This history begins the spring of 1981, although the tunnels will take us back to a time when the first people walked the earth.

I was dreaming I was unable to breathe. To use an overly used cliche, it felt as though an elephant was sitting on my chest.  No matter how hard I tried, and I tried vigorously, I could not get in half a breath.

Quickly I realized I was no longer suffering in a dream but real life.  I stood up on the bed and leaned against the window pane, putting my face up to the screen where a cool night breeze brushed upon my face, appearing to give me a slight hint of relief.

There was a little white Alupent inhaler clutched in my left fist, although there most of the medicine was gone except for a few drops.  I figured when I was absolutely desperate I'd run it under hot water and see if I could get one or two more puffs of relief.  But I had to wait just a little longer.

My heart was pounding from all the puffs I had already taken.  A fear within was that if I fell back asleep I might not wake up, but this fear arose from inhaler abuse more so than from difficulty breathing.  You see, I had nights like this so frequently during the first several years of my life I sort of just took it in stride.

It was this thought, of taking the inability to breathe in stride, that had me wondering about the past as I smelt the dusty screen.  I wondered how many people had suffered like this in the past, a time before medicines like Alupent existed.

What if I lived in 1881?  Worse, what if I lived in 1881 B.C.?  I decided that having asthma would have been much like this: suffering with no one to empathize with you because you didn't want to bother anyone.  Your parents and siblings were asleep, so you suffered alone.

I was introduced to the Alupent inhaler in 1980, I was ten-years-old.  I sat frogged up on the edge of the doctor's bed in Dr. Gunderson's office at the Apothecary shop on 1st Street in Manistee, Michigan. He told me to sit up high, take in a deep breath, and when I did he squirted the medicine into my mouth.  I inhaled as he instructed, holding my breath, regardless of the nasty taste, for ten seconds before I finally exhaled.

A minute later he gave me a second puff, and I took in a deep breath.  Ah, it felt so great to be able to breathe.

My mom held on to my Alupent inhaler for about a month or so, but she found that I asked for it so frequently she ended up just giving it to me.  I don't know if this was good or bad, because the medicine worked so well, and I was short of breath so often, I found I was using it without much hesitation.

Yet on this particular night as my inhaler had gone dry, the third time this had happened in the past month (Dr. Gunderson had said an inhaler should last about six months), I was hesitant to wake my parents because I had already bothered them too many times.

I certainly felt alone, yet not just alone in this room but in this world.  I had never seen anyone else suffer like this, nor heard of it.  So I was alone, the only person in the world stiff and struggling to inhale with his face against a window screen.

A few years later, in 1985, Dr. Gunderson and my parents would have me flown on a United Airline jet on a three hour trip to Denver Colorado so I could spend time with the best asthma doctors in the world at National Jewish Hospital/ National Asthma Center.  I would learn that I was not alone, that there were many asthmatics just like me.

Yet for the time being, I could feel my heart palpating fast and powerful, as I looked out into the dark night air trying to see if I could make the outline of a poplar tree, smelling the lilac bush just under the window, I wondered, just for a brief moment perhaps, if this was the fate of asthmatics prior to the discovery of modern medicine, and the invention of modern inhalers.

I did end up waking my mom up that night, and she was not angry as I suspected. Mom woke dad up and dad drove me to West Shore Hospital, where, despite my fear, no one inquired as to how frequently I had been using my rescue inhaler.  In fact, just the opposite as I expected, I was treated quite well.

A respiratory therapist started a breathing treatment, but, as expected, it was useless.  A nurse poked my right arm, and as she did so I watched the clock on the wall.  More specifically, I watched that second hand, and as soon as it spun around five times, just as I had experienced before, my breath came in like new.  I could breathe.

For a splint second, my mind wandered to a young boy, from 1881 B.C. perhaps, who was leaning against a tree to breathe sometime before the advent of modern medicine like Alupent and Susphrine.  Unlike me, he had no choice but to suffer alone and wait for nature to either give him his breath back, or give him peace through death.

While I didn't know it then, couldn't know it then, this was the beginning of my history of asthma and respiratory therapy.  A journey through time would take me all the way back the the beginning of mankind to the first person who suffered from asthma.

Yet asthma back then was more than just asthma, as people had no concept of changes in the body that resulted in symptoms.  So, back then, if you suffered from trouble breathing you were just having trouble breathing; your asthma-like symptom was your disease.

Surely I knew that I had asthma as we define it today, yet the boy from 1981 B.C. might just as easily have suffered from chronic bronchitis, emphysema, heart failure, influenza, tuberculosis, pneumonia, cystic fibrosis, scoliosis, osteoporosis, allergies, dyptheria, or kidney failure.  They were all diagnosed as the symptom of shortness of breath, or dyspnea, or as the ancient Greeks would later call it, asthma.

This is how it was for 99.9 percent of history.  As I enjoyed the relief provided by the shot, I couldn't help to appreciate that I was born in 1970, as compared with 1870, or worse, 1870 B.C.

Although, as we travel through time, we'll realize life wasn't much better for the asthmatic in 1870 as it was in 1870 B.C. Truth be told, there were few advancements in asthma medicine during this time.

So while most histories follow the path of war, the history of asthma and respiratory therapy follows the path of health and healing, with an emphasis on asthma, respiratory therapy, nebulizers and inhalers.  In order to organize this history I will use the following definitions:

• Prehistory (prehistoric):  Time prior to the first written language, or recorded history, which is generally considered to be around 2700 B.C. 
• Ancient:  Time after written language, or time with recorded history.  This period lasted from around 2700 B.C. until the fall of Rome in 476 A.D. 
• Time:  After the birth of Christ people developed a need to keep track of time, and so the birth of Jesus was chosen as the date to begin time.  The date of his birth was estimated and this was chosen as 1 A.D. When a child is born we usually refer to the first year as zero.  With time the first 100 years is considered the first century, and therefore the years 100-199 were referred to as the 2nd century.  It's for this reason why the years 1900 to 1999 were referred to as the 20th century.  This is just how it is.  

This system was created to help people study history and keep track of dates and time.  Whether accurate or not, this is how history is recorded.  I will use this system to categorize this history of asthma:

• Beginning to 5000 B.C.: Prehistoric people (prehistory)
• 5000-2700 B.C.: Ancient Societies (Before History and Time)
• 2700 B.C.-1 A.D.: Ancient Societies (During History, Before Time)
• 1 A.D.-276 A.D.:  Ancient Societies (Beginning of Time)
• 276 -1600 A.D.: Middle Ages (The Dark Ages of Medicine)
• 1600-1800:  Age of Reason (The Age of Enlightenment)
• 1800-1900:  The Scientific Revolution (the Age of Progress)
• 1900-2000: The Age of Results
• 21st Century:  The present

Considering the vastness of our history, and the brief time each person lived among it, this history is but a small glimpse of the past.  Most of our history is told by the select few privileged to learn to read and write, so it is nearly impossible to impress upon what life was like among the common folk.

Despite this, from the various pieces of literature left behind by those who suffered from this disease, or those who took care of those who suffered, we can gather a pretty good picture of what life would have been like for the asthmatic during nearly every era of human existence.  

So, what was it like to live with asthma in fill in location and year?  To best answer this question, I make a gallant effort to describe the various cultures. This, I think, should allow us to gain a more complete understanding of what it would be like to be sick if you lived among them.  

However, I would like you to consider the following quote from historian Henry E. Sigerist:

"We have no evidence whatsoever of any paleolithic medicine." (1, page 107)

I use this quote because there will be times throughout this history when we must use our imaginations to gain an understanding of what it was like to live with asthma in fill in the year and place.

So what was life like for asthmatics 2.5 million years ago?  Let's go!

(For the duration of this history, a post will be published every Friday and Saturday right here at the RT Cave.)

Reference:

1. Sigerist, Henry E "History of Medicine," volume I: Primitive and Archaic Medicine, 1951, New York, Oxford University Press