Allergy through 20 Centuries Bergmann K-C, Ring J (eds): History of Allergy. Chem Immunol Allergy. Basel, Karger, 2014, vol 100, pp 15–20 DOI: 10.1159/000358469
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History of Allergy in the Middle Ages and Renaissance Johannes Ring Department of Dermatology and Allergy Biederstein, Christine Kuehne Center for Allergy Research and Education (CK-CARE), Technical University of Munich, Munich, Germany
In the Middle Ages little innovative medical literature came from Western Europe. The Greek-Roman tradition with the scriptures of Hippocrates and Galenos was preserved in Byzantium and then in the Middle East by Arabic medicine; it then returned to Europe in Latin translations mostly made in Italy and Spain. There were innovative developments in Arabic medicine also with regard to the history of allergy, especially with the first description of ‘rose fever’, which is described as very similar in symptomatology to hay fever. Under Arabic influence, the first medical university in Salerno was famous for its wellknown text Tacuinum sanitatis in which a description of asthma can be found. With the beginning of renaissance new developments were also registered in Europe, with new observations and a new way of thinking. © 2014 S. Karger AG, Basel
History of Medicine in the Middle Ages in the Middle East When the power and influence of East Rome (Byzantium, Constantinople) decreased, the art of medicine also declined in the Imperium Romanum. At the same time a new power arose, namely the empire of the Caliphate, which soon was to expand all over
North Africa, reaching Spain. In its wake a new period of active science and art developed. This period is often called ‘Arabic’ medicine; however, it should be mentioned that it was the mixture of many ethnicities which made this period so productive, most notably with influences from Persia, Syria and Egypt. The most famous Caliphs were Al-Mansur (750– 775), Harun Al Rashid (786–809) and especially Kalif Al-Mamun (813–833) [1]. The most famous personalities of ‘Arabic’ medicine in the Middle Ages were Al Rhazes, Ibn Sina [2] and Moses Maimonides [3]. Al Rhazes Born in Raj in Chorasan, Rhazes (865–932) came to Bagdad (fig. 1) where he worked in a hospital and became a famous teacher. He gave the first description of ‘rose fever’ in his treatise ‘Dissertation regarding the course of Coryza occurring in spring, when the roses emit their odor’ [4, p. 63; 5, vol. 2, p. 8; 6, 7]. Rhazes also wrote on asthma and gave practical therapeutic recommendations, for example: Two drachmae of dried and pulverized fox lung and fig extract mixed to a potion. [8]
Ibn Sina (Avicenna) The second great personality in the Middle Ages was Ibn Sina (980–1037; fig. 2) who also came from Downloaded by: National Univ. of Singapore 198.143.39.65 - 8/6/2015 7:18:05 PM
Abstract
Fig. 1. Drawing of Muhammad Zakariya Razi.
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Persia and became famous for his successful treatment of Prince Al-Mansur. Among others, Avicenna described a disease which was very similar to urticaria, namely itchy elevated lesions of the skin which in Arabic were called ‘essera’ (or ‘sora’, ‘sera’ or ‘sare’), all derived from the same root ‘As-Sarah’ (meaning ‘mountain’ or ‘elevation’) [2, 5, vol. 3, p. 66]. Avicenna compared an asthma attack with epilepsy and used a word which was translated as ‘caducus pulmonum’, which fits well with the acute character of this condition. Moses Maimonides In the Almohade Caliphate, the Jewish physician Moses Maimon (fig. 3), also called Maimonides, grew up in Cordoba. He later went to Cairo via Morocco and became the personal physician to Sultan Saladin (1135–1204). He wrote a thesis on asthma and presented a concept for treatment which comprised relaxation, personal hygiene, avoidance of noxious environmental influences, avoidance of opium and intoxicating drugs, as well as ‘equanimitas mentis’, a relaxed state of mind. He recommended asthmatic patients to avoid the following foods: poultry, milk and nuts, whilst he allowed salad, cauliflower and eggplant [3, 4, p. 66; 5, vol. 2, p. 206; 7, 9, 10]. Here is one important passage on treating asthma: From what I have heard from others, and as is known to Your Highness, I conclude that this disorder starts with a common cold, especially in the rainy season, and the patient is forced to gasp for breath day and night,
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depending on the duration of the onset, until the phlegm is expelled, the flow completed and the lung well cleared. This is all I know about the prodromal phases of this illness. You have also told me you were in the habit of taking once or twice a year certain remedies to clear the nose and the lung and often, when resorted to during an attack, these tend to weaken you. I also know that you are about forty years of age, your body build moderate (neither fat nor lean), your bodily vigor about average, that you are rather hot-blooded and your head liable to become easily inflamed. You also remarked that strong winds tend to hurt you and sharp smells offend you much. Hair weighs on you heavily and repeated shaving of the head brings you some comfort. You wear no headdress and no turban, all of which goes to show that your head suffers from excessive heat. Your Highness has already confided in me that the air of Alexandria is harmful to you and whenever you fear an attack of the illness you prefer to move to Cairo where the air is much dryer and calmer, making the attack more tolerable for you. You also told me that many physicians prescribed for you remedies of all kinds, each one of them proclaiming his cure to be the best, but that none of them cured your disorder. … In all grave disorders marked by seizures, such as lumbago, inflammation of the joints, gravel (in the kidney), asthma (also called shortness of breath), migraine, – in all of them, provided the prescribed regimen is well kept and judiciously applied, the intervals between two onsets may be lengthened, the duration of the onset shortened and its intensity mitigated. However, should the rules of management go unheeded and one’s desires and habits be followed indiscriminately, the gap between onset will grow shorter, and the duration and intensity gradually increase until a peak is reached which may well end in death. …
Ring
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Fig. 2. Ibn Sina (Avicenna).
While in Salerno anatomy was studied in pigs, autopsies were soon being performed more and more often in human bodies. The time of just rehearsing antique texts was about to end, and own observations led to an individual and new way of thinking. In the following century, in England, we find Master John of Arderne (approximately 1306–1381), who worked as a pharmacist and surgeon and gave very detailed prescriptions for treatments, among them a ‘sirup for the asthmatic’ which contained:
The six obligatory regulations are: (1) keeping clean the air which we breathe; (2) keeping an eating and drinking diet; (3) regulation of spiritual emotions; (4) regulation of bodily exercise, and lastly rest (5) sleep and waking up, (6) excretion, eventually keeping back of superfluous outflow. The seventh group is the one the body takes according to circumstances, such as bathing and massaging. [3]
The Period from 1300 to 1700 BC One of the most colorful and famous figures from the end of the scholastic period when Arabic medical texts were translated into Latin, predominantly in Italy and Spain, is Arnaldus from Villanova (circa 1235–1311) who was active in Paris, Montpellier and Naples, and was the personal physician of several popes and kings. He wrote a remarkable number of books, among them a treatise Reginem curativum and Praeservativum contra catarrheum [1, vol. 1, p. 393]. In this period the constitution of a number of ‘universities’ was gradually improved at Bologna, Naples, Paris, Cambridge, Oxford and Coimbra, with medicine as the 4th faculty next to theology, philosophy and law.
History of Allergy in the Middle Ages and Renaissance
Root of Iris and hyssop, three handfuls of maidenhair, four seeds of the greater and lesser celandine, coriander seed, mallow seed, seed of the white poppy, cotton, fenugrek, bitter vetch, marmalade of licorice, marmalade of raisins, marmalade of pines and of almonds, and marmalade of husked barley, all which was to be boiled over a slow fire in sweet well water. Arderne claimed that it cleaned, purified, soothed nourished, healed and strenghtened, and drove out discharges. [11, p. 44]
Several books on therapy appeared in Germany in the 14th century, among them Buch von den natürlichen Dingen (‘The Book of Natural Things’) of the episcopal canonicus Konrad von Megenberg from Regensburg (1309–1378). This was like an encyclopedia and comparable to a bestseller towards the end of the Middle Ages. He described a disease called ‘asthma’ which can be treated with cress (‘Nasturtium is nütz für das atem gepresten – der asma haizt’) [12].
The 15th and 16th Centuries Another famous figure of history who was supposedly allergic is King Richard III of England (1452–1485). According to a note by Sir Thomas More (1478–1535), who was the famous law expert of the English crown, Richard knew that he did not tolerate strawberries and reacted with a skin rash. So he uses this phenomenon in the council when he orders a bowl of strawberries and soon thereafter develops wheals on his forearms which he undoubtedly sees as result of an evil spell, and immediately he accuses Lord William Hastings, who is sentenced to death [12, 13].
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Fig. 3. The purported portrait of Moses Maimonides from which all modern portraits are derived.
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A famous name at the beginning of this period is Theophrastus Bombastus von Hohenheim (called Paracelsus; 1493–1541) from Einsiedeln in Switzerland (fig. 4). He recognized that diseases were caused not only by dyscrasia or the wrong mixture of humors within the organism itself, but could also arise from outside. In a pathetic pose he burned the books of Galen and Avicenna. Once he briefly mentioned the noxious effect of rose odor, which he did not regard as a true poison, but as an ‘alteration’ of the organism [5, vol. 2, p. 12]: The roses can pass on their taste and thereby can elicit unconsciousness, while the body of the roses remains unchanged. Although the body of the venom is invisible, the evil is able to weaken the human being by causing serious sickness. [14]
For the skin disease causing wheals, which was known by the name of ‘essera’, he proposed the name ‘Leusschiepen’ [5, vol. 3, p. 73; 15]. The German physician Georg Bauer (also called ‘Agricola’; 1494–1550; fig. 5) wrote on mining and mineralogy, and also a treatise on the art of mining in which he mentioned occupational airway diseases [4, p. 70].
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Fig. 5. Georgius Agricola.
Rose Fever Following its first description by Rhazes, rose fever became an entity from the Middle Ages until modern times; in its symptomatology it was very similar to allergic rhinoconjunctivitis of our day. Many authors mention this ‘condition’ [5, vol. 2]. There are famous personalities, like Cardinal Carafi (who died in 1511), who sealed off his palazzo so that no roses could be brought inside [5, vol. 4, p. 14; 16]. Martin Cromer, who wrote down the history of Poland, mentioned that the archbishop of Wroclaw, Laurentius, died around 1230 after inhaling deadly rose odor [5, vol. 2, p. 16; 17, 18]. Similar descriptions were given by Botallo [19, 20] (fig. 6): Nosco sanae homines, qui prorsus rosae odorem, tamquam capitalem inimicum, odio habent eo quod capites dolorem iis faceat, vel sternutamenta moveat, vel navibus tam molestum pruritum inducat. [19]
An interesting episode can be found in the scriptures of Veit Riedlin (1656–1724), the physician of the city of Ulm. A merchant was described who suffered from a prickling sensation in the nose each year as soon as he noticed rose odor. He then suffered from catarrhus for several days which could
Ring
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Fig. 4. Paracelsus.
I am certain no hot regimen can be proper for asthma, but the cold is very useful, viz. to drink water in the morning, to shave oft and wash the head every morning, and to cold bath in a month or fourteen days. [4, p. 71; 28]
His fellow countryman, Thomas Willis (1721– 1675), wrote in his Pharmaceuticae Rationalis in extenso on asthma, and he observed that the nerves were also involved in the acute form of asthma: Among the diseases whereby the region of the breath is wont to be infested, if you regard their tyranny and cruelty, an asthma (which is sometimes by reason of a peculiar symptome denominated likewise an Orthopnea) doth not deserve the last place; for there is scarce
History of Allergy in the Middle Ages and Renaissance
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Fig. 6. Leonardo Botallo.
anything more sharp and terrible than the fits thereof; the organs of breathing and the praecordia themselves, which are the foundations and Pillars of Life, are shaken by this disease as by an Earthquake, and so totter, that nothing less than the ruine of the whole animal Fabrick seems to be threatned; for breathing, whereby we chiefly live, is very much hindred by the assault of this disease, and is in danger, or runs the risque of being quite taken away. [4, p. 72]
Amatus Lusitanus reported a case of heavy rhinorrhea with mostly aqueous secretion [5, vol. 3, p. 13; 24]. Cornelius Stalpaart van der Wiel (1620–1687) reported a case of ‘an almost uncontrollable sneezing cramp (sternutatio) each time after the coitus with his wife’ [29]. Giovanni Battista Morgagni (1682–1771) tells us about a patient who suffered from heavy aqueous nasal secretions over months [30]. The Italian physician Matteoli describes a patient in 1570 who was suffering from severe dyspnea due to a tomcat hidden in the same room. The patient developed anxiety, sweating and pallor together with airway symptoms, and he suspected the presence of the animal to be so noxious to him: Sed quamvis nec vi disset ille nec audisset catulum, cum pauco post tempore aerem felis alitum infectum inspirasset iritate statim eam temperamenti qualitate felium inimica, emissio, sudore, pallida ad modum facie omnibus sanae admirantibus cremebundus non clamare coepidi aliquo in angula latet felis. [31]
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only be prevented when he avoided contact with roses [5, vol. 2, p. 24; 21]. Riedlin was probably one of the first controlled provocation testers in this case, hiding a pouch of rose leaves in the coat of the patient without him knowing [22]. Rose fever also occurred in pharmacists when they prepared medications containing roses, as we learn from Ramazzini [23], the founder of occupational medicine [5, vol. 2, p. 28]. Amatus Lusitanus described the case of a woman with a very serious condition following a strong reaction to pharmacy containing the blossoms of lime trees, rose water and cinnamon [24]. Another well-known allergic patient was the Archbishop of St. Andrews in Edinburgh, Sir John Hamilton (1511–1571), who was the brother of James Hamilton, regent for the young and minor Queen Mary Stuart of Scotland. He suffered from airway disease at the time when it was considered ‘catarrhus of the brain’, with an accumulation of phlegm and mucus in the lung which was treated in the classical way. When the Italian physician Gerolamo Cardano (1501–1576) came from Milan his discomfort improved. Cardano documented his advice in a consilium of 20 pages. He removed the feather bed from the bedroom of the archbishop, probably in order to avoid too much heat at the spine. He also recommended dietary restrictions, more sleep and applications of cold water [5, vol. 2, p. 208; 25, 26]. In 1698 the English physician Sir John Floyer (1649–1734) published a book entitled A Treatise of the Asthmas in which he differentiated between a continuous and an episodic form of asthma [4, p. 73; 27]:
These are clear-cut descriptions of possible allergic reactions against indoor allergens such as feathers from a bed or pets. The Belgian physician Jan Baptista van Helmont (1577–1644) reported a patient who was suffering from ‘summer asthma’ and at the same time from strongly itching whitish ‘blisters’ (probably wheals). It is interesting that van Helmont realized that not only the patient, but also his mother and sister were also suffering from the same symptoms [4]. Van Helmont saw similarities to epilepsy in the cramplike acute attack, and he also differentiated between moist and dry asthma: Est ergo duplex asthma, humidum et seccum. [5, vol. 2, p. 226; 32]
There are more detailed descriptions of symptoms and signs of allergic airway and skin disease from this time which directly lead to the first classic description of allergic rhinitis in the 19th century.
Conclusion Following the clear-cut descriptions of clinical symptoms very similar to hay fever under the name of ‘rose fever’ from Arabic medicine with Rhazes, and then over the whole period of the Middle Ages until modern times, more and more precise descriptions of similar disease entities can be found for acute seasonal rhinitis and perennial rhinitis by possible indoor allergens, as well as certain forms of asthma and urticaria.
References 1 Neuburger M: Geschichte der Medizin. Stuttgart, Enke, 1911, vol 1, 2. 2 Avicenna (Ibn Sina): Canon Medicinae (Plempius VF ed). Leuven, 1658. 3 Maimonides M: Treatise on asthma (Magali-vi-l-ra-bu). Historical document. Allergy 1956;14:382. 4 Simons E (ed): Ancestors of Allergy. New York, Global Medical Communications, 1994. 5 Schadewaldt H: Geschichte der Allergologie. Munich, Dustri, 1983, vol 1–4. 6 Elgood C: Persian science; in Arberry AJ (ed): The Legacy of Persica. Oxford, 1953, p 315. 7 Sarton G: Pollen allergy. Isis 1947;38:101. 8 Kamal H: Encyclopaedia of Islamic Medicine, with a Greco-Roman Background. Cairo, 1975. 9 Steinschneider M: Die Hebräischen Übersetzungen des Mittelalters und die Juden als Dolmetscher. Graz, 1956, p 767. 10 Muntner S: The Book on Asthma (Hebrew transl, Benveniste S). Jerusalem, 1940. 11 Avenberg KM, Harper DS, Larsson BL: Footnotes on Allergy. Uppsala, Pharmacia AB, 1980.
12 Bergmann KC, Bergman I, Schadewaldt H (eds): Bebilderte Geschichte der Allergologie. München, Dustri, 1980. 13 More T: The history of King Richard III; in Campbell WE (ed): The English Works of Sir Thomas More. London, Eyre and Spottiswoode, 1931, p 426. 14 Paracelsus von Hohenheim TB: De morbis metallicis; in Opera Omnia. Geneva, 1658, vol 1, chapt 2, p 711. 15 Paracelsus von Hohenheim TB: Von Apostemen, Geschwüren, offenen Schäden, Sironen und anderen Gewächsen, 1527; in von Sudhoff K (ed): Sämtliche Werke. Munich, vol 4, 1931, p 317. 16 Valerianus JP: Hieroglyphica, sive de sacris Aegyptiorum libris commentarii. Basel, 1556, vol 8, chapt 25, p 61. 17 Cromer M: De origine et rebus gestis Polonorum libri triginta. Basel, 1558, vol 8, p 207. 18 Sachs PJ: Gammarologia Curiosa. Frankfurt, 1665, vol 2, chapt 4, p 577. 19 Botallo L: Commentarioli due, alter de medici, alter de aegroti munere. Lyon, 1565, p 25. 20 Major RH: A History of Medicine, ed 1. Oxford, 1954, p 380.
21 Riedlin V Jr: Iter medicum sanitatis recuperandae causa non solum institutum, sed et feliciter finitum. Augsburg, 1702, p 25. 22 Riedlin V Sr: Observatorium medicarum centuriae tres (Riedlin V Jr ed). Augsburg, 1691. 23 Ramazzini B: De morbis artificum diatriba. Padua 1713 (Facsimile, Rome, 1953), Modena 1700. 24 Amatus Lusitanus (Rodriguez de Castello Branco J): Curationum medicinalium centuriae. Lyon, 1567 (first ed Venice, 1557). 25 Cardano G: De vita propria liber. Padua, 1575. 26 Cardano G: Consilia. No 52; in Opera Omnia. Leiden, 1663. 27 Floyer J: Treatise of the Asthma. London, 1698. 28 Floyer J: Essay to prove cold bathing safe and useful. 1706. 29 Stalpaart van der Weil O: Hondert seltsame aanmerkingen, so in de genees-als heelensuij-konst. Cent Post Obs 6. Amsterdam, 1682, p 45. 30 Morgagni GB: De sedibus et causis morborum per anatomen indagatis. Venice, 1761. 31 Mattioli PA: Commentarii in libris Dioscuridis; in Opera Quae Exstant Omnia. Frankfurt, 1598, vol 6, chapt 25, p 996. 32 van Helmont JB: Asthma et tussis; in Ortus Medicinae. Amsterdam, 1648, p 366.
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Ring
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Prof. Dr. med. Dr. phil. Johannes Ring Department of Dermatology and Allergy Biederstein Biedersteinerstrasse 29 DE–80802 München (Germany) E-Mail johannes.ring @ lrz.tu-muenchen.de
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History of Allergy in the Middle Ages and Renaissance Johannes Ring Department of Dermatology and Allergy Biederstein, Christine Kuehne Center for Allergy Research and Education (CK-CARE), Technical University of Munich, Munich, Germany
In the Middle Ages little innovative medical literature came from Western Europe. The Greek-Roman tradition with the scriptures of Hippocrates and Galenos was preserved in Byzantium and then in the Middle East by Arabic medicine; it then returned to Europe in Latin translations mostly made in Italy and Spain. There were innovative developments in Arabic medicine also with regard to the history of allergy, especially with the first description of ‘rose fever’, which is described as very similar in symptomatology to hay fever. Under Arabic influence, the first medical university in Salerno was famous for its wellknown text Tacuinum sanitatis in which a description of asthma can be found. With the beginning of renaissance new developments were also registered in Europe, with new observations and a new way of thinking. © 2014 S. Karger AG, Basel
History of Medicine in the Middle Ages in the Middle East When the power and influence of East Rome (Byzantium, Constantinople) decreased, the art of medicine also declined in the Imperium Romanum. At the same time a new power arose, namely the empire of the Caliphate, which soon was to expand all over
North Africa, reaching Spain. In its wake a new period of active science and art developed. This period is often called ‘Arabic’ medicine; however, it should be mentioned that it was the mixture of many ethnicities which made this period so productive, most notably with influences from Persia, Syria and Egypt. The most famous Caliphs were Al-Mansur (750– 775), Harun Al Rashid (786–809) and especially Kalif Al-Mamun (813–833) [1]. The most famous personalities of ‘Arabic’ medicine in the Middle Ages were Al Rhazes, Ibn Sina [2] and Moses Maimonides [3]. Al Rhazes Born in Raj in Chorasan, Rhazes (865–932) came to Bagdad (fig. 1) where he worked in a hospital and became a famous teacher. He gave the first description of ‘rose fever’ in his treatise ‘Dissertation regarding the course of Coryza occurring in spring, when the roses emit their odor’ [4, p. 63; 5, vol. 2, p. 8; 6, 7]. Rhazes also wrote on asthma and gave practical therapeutic recommendations, for example: Two drachmae of dried and pulverized fox lung and fig extract mixed to a potion. [8]
Ibn Sina (Avicenna) The second great personality in the Middle Ages was Ibn Sina (980–1037; fig. 2) who also came from Downloaded by: National Univ. of Singapore 198.143.39.65 - 8/6/2015 7:18:05 PM
Abstract
Fig. 1. Drawing of Muhammad Zakariya Razi.
1
Persia and became famous for his successful treatment of Prince Al-Mansur. Among others, Avicenna described a disease which was very similar to urticaria, namely itchy elevated lesions of the skin which in Arabic were called ‘essera’ (or ‘sora’, ‘sera’ or ‘sare’), all derived from the same root ‘As-Sarah’ (meaning ‘mountain’ or ‘elevation’) [2, 5, vol. 3, p. 66]. Avicenna compared an asthma attack with epilepsy and used a word which was translated as ‘caducus pulmonum’, which fits well with the acute character of this condition. Moses Maimonides In the Almohade Caliphate, the Jewish physician Moses Maimon (fig. 3), also called Maimonides, grew up in Cordoba. He later went to Cairo via Morocco and became the personal physician to Sultan Saladin (1135–1204). He wrote a thesis on asthma and presented a concept for treatment which comprised relaxation, personal hygiene, avoidance of noxious environmental influences, avoidance of opium and intoxicating drugs, as well as ‘equanimitas mentis’, a relaxed state of mind. He recommended asthmatic patients to avoid the following foods: poultry, milk and nuts, whilst he allowed salad, cauliflower and eggplant [3, 4, p. 66; 5, vol. 2, p. 206; 7, 9, 10]. Here is one important passage on treating asthma: From what I have heard from others, and as is known to Your Highness, I conclude that this disorder starts with a common cold, especially in the rainy season, and the patient is forced to gasp for breath day and night,
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depending on the duration of the onset, until the phlegm is expelled, the flow completed and the lung well cleared. This is all I know about the prodromal phases of this illness. You have also told me you were in the habit of taking once or twice a year certain remedies to clear the nose and the lung and often, when resorted to during an attack, these tend to weaken you. I also know that you are about forty years of age, your body build moderate (neither fat nor lean), your bodily vigor about average, that you are rather hot-blooded and your head liable to become easily inflamed. You also remarked that strong winds tend to hurt you and sharp smells offend you much. Hair weighs on you heavily and repeated shaving of the head brings you some comfort. You wear no headdress and no turban, all of which goes to show that your head suffers from excessive heat. Your Highness has already confided in me that the air of Alexandria is harmful to you and whenever you fear an attack of the illness you prefer to move to Cairo where the air is much dryer and calmer, making the attack more tolerable for you. You also told me that many physicians prescribed for you remedies of all kinds, each one of them proclaiming his cure to be the best, but that none of them cured your disorder. … In all grave disorders marked by seizures, such as lumbago, inflammation of the joints, gravel (in the kidney), asthma (also called shortness of breath), migraine, – in all of them, provided the prescribed regimen is well kept and judiciously applied, the intervals between two onsets may be lengthened, the duration of the onset shortened and its intensity mitigated. However, should the rules of management go unheeded and one’s desires and habits be followed indiscriminately, the gap between onset will grow shorter, and the duration and intensity gradually increase until a peak is reached which may well end in death. …
Ring
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Fig. 2. Ibn Sina (Avicenna).
While in Salerno anatomy was studied in pigs, autopsies were soon being performed more and more often in human bodies. The time of just rehearsing antique texts was about to end, and own observations led to an individual and new way of thinking. In the following century, in England, we find Master John of Arderne (approximately 1306–1381), who worked as a pharmacist and surgeon and gave very detailed prescriptions for treatments, among them a ‘sirup for the asthmatic’ which contained:
The six obligatory regulations are: (1) keeping clean the air which we breathe; (2) keeping an eating and drinking diet; (3) regulation of spiritual emotions; (4) regulation of bodily exercise, and lastly rest (5) sleep and waking up, (6) excretion, eventually keeping back of superfluous outflow. The seventh group is the one the body takes according to circumstances, such as bathing and massaging. [3]
The Period from 1300 to 1700 BC One of the most colorful and famous figures from the end of the scholastic period when Arabic medical texts were translated into Latin, predominantly in Italy and Spain, is Arnaldus from Villanova (circa 1235–1311) who was active in Paris, Montpellier and Naples, and was the personal physician of several popes and kings. He wrote a remarkable number of books, among them a treatise Reginem curativum and Praeservativum contra catarrheum [1, vol. 1, p. 393]. In this period the constitution of a number of ‘universities’ was gradually improved at Bologna, Naples, Paris, Cambridge, Oxford and Coimbra, with medicine as the 4th faculty next to theology, philosophy and law.
History of Allergy in the Middle Ages and Renaissance
Root of Iris and hyssop, three handfuls of maidenhair, four seeds of the greater and lesser celandine, coriander seed, mallow seed, seed of the white poppy, cotton, fenugrek, bitter vetch, marmalade of licorice, marmalade of raisins, marmalade of pines and of almonds, and marmalade of husked barley, all which was to be boiled over a slow fire in sweet well water. Arderne claimed that it cleaned, purified, soothed nourished, healed and strenghtened, and drove out discharges. [11, p. 44]
Several books on therapy appeared in Germany in the 14th century, among them Buch von den natürlichen Dingen (‘The Book of Natural Things’) of the episcopal canonicus Konrad von Megenberg from Regensburg (1309–1378). This was like an encyclopedia and comparable to a bestseller towards the end of the Middle Ages. He described a disease called ‘asthma’ which can be treated with cress (‘Nasturtium is nütz für das atem gepresten – der asma haizt’) [12].
The 15th and 16th Centuries Another famous figure of history who was supposedly allergic is King Richard III of England (1452–1485). According to a note by Sir Thomas More (1478–1535), who was the famous law expert of the English crown, Richard knew that he did not tolerate strawberries and reacted with a skin rash. So he uses this phenomenon in the council when he orders a bowl of strawberries and soon thereafter develops wheals on his forearms which he undoubtedly sees as result of an evil spell, and immediately he accuses Lord William Hastings, who is sentenced to death [12, 13].
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Fig. 3. The purported portrait of Moses Maimonides from which all modern portraits are derived.
1
A famous name at the beginning of this period is Theophrastus Bombastus von Hohenheim (called Paracelsus; 1493–1541) from Einsiedeln in Switzerland (fig. 4). He recognized that diseases were caused not only by dyscrasia or the wrong mixture of humors within the organism itself, but could also arise from outside. In a pathetic pose he burned the books of Galen and Avicenna. Once he briefly mentioned the noxious effect of rose odor, which he did not regard as a true poison, but as an ‘alteration’ of the organism [5, vol. 2, p. 12]: The roses can pass on their taste and thereby can elicit unconsciousness, while the body of the roses remains unchanged. Although the body of the venom is invisible, the evil is able to weaken the human being by causing serious sickness. [14]
For the skin disease causing wheals, which was known by the name of ‘essera’, he proposed the name ‘Leusschiepen’ [5, vol. 3, p. 73; 15]. The German physician Georg Bauer (also called ‘Agricola’; 1494–1550; fig. 5) wrote on mining and mineralogy, and also a treatise on the art of mining in which he mentioned occupational airway diseases [4, p. 70].
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Fig. 5. Georgius Agricola.
Rose Fever Following its first description by Rhazes, rose fever became an entity from the Middle Ages until modern times; in its symptomatology it was very similar to allergic rhinoconjunctivitis of our day. Many authors mention this ‘condition’ [5, vol. 2]. There are famous personalities, like Cardinal Carafi (who died in 1511), who sealed off his palazzo so that no roses could be brought inside [5, vol. 4, p. 14; 16]. Martin Cromer, who wrote down the history of Poland, mentioned that the archbishop of Wroclaw, Laurentius, died around 1230 after inhaling deadly rose odor [5, vol. 2, p. 16; 17, 18]. Similar descriptions were given by Botallo [19, 20] (fig. 6): Nosco sanae homines, qui prorsus rosae odorem, tamquam capitalem inimicum, odio habent eo quod capites dolorem iis faceat, vel sternutamenta moveat, vel navibus tam molestum pruritum inducat. [19]
An interesting episode can be found in the scriptures of Veit Riedlin (1656–1724), the physician of the city of Ulm. A merchant was described who suffered from a prickling sensation in the nose each year as soon as he noticed rose odor. He then suffered from catarrhus for several days which could
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Fig. 4. Paracelsus.
I am certain no hot regimen can be proper for asthma, but the cold is very useful, viz. to drink water in the morning, to shave oft and wash the head every morning, and to cold bath in a month or fourteen days. [4, p. 71; 28]
His fellow countryman, Thomas Willis (1721– 1675), wrote in his Pharmaceuticae Rationalis in extenso on asthma, and he observed that the nerves were also involved in the acute form of asthma: Among the diseases whereby the region of the breath is wont to be infested, if you regard their tyranny and cruelty, an asthma (which is sometimes by reason of a peculiar symptome denominated likewise an Orthopnea) doth not deserve the last place; for there is scarce
History of Allergy in the Middle Ages and Renaissance
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Fig. 6. Leonardo Botallo.
anything more sharp and terrible than the fits thereof; the organs of breathing and the praecordia themselves, which are the foundations and Pillars of Life, are shaken by this disease as by an Earthquake, and so totter, that nothing less than the ruine of the whole animal Fabrick seems to be threatned; for breathing, whereby we chiefly live, is very much hindred by the assault of this disease, and is in danger, or runs the risque of being quite taken away. [4, p. 72]
Amatus Lusitanus reported a case of heavy rhinorrhea with mostly aqueous secretion [5, vol. 3, p. 13; 24]. Cornelius Stalpaart van der Wiel (1620–1687) reported a case of ‘an almost uncontrollable sneezing cramp (sternutatio) each time after the coitus with his wife’ [29]. Giovanni Battista Morgagni (1682–1771) tells us about a patient who suffered from heavy aqueous nasal secretions over months [30]. The Italian physician Matteoli describes a patient in 1570 who was suffering from severe dyspnea due to a tomcat hidden in the same room. The patient developed anxiety, sweating and pallor together with airway symptoms, and he suspected the presence of the animal to be so noxious to him: Sed quamvis nec vi disset ille nec audisset catulum, cum pauco post tempore aerem felis alitum infectum inspirasset iritate statim eam temperamenti qualitate felium inimica, emissio, sudore, pallida ad modum facie omnibus sanae admirantibus cremebundus non clamare coepidi aliquo in angula latet felis. [31]
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only be prevented when he avoided contact with roses [5, vol. 2, p. 24; 21]. Riedlin was probably one of the first controlled provocation testers in this case, hiding a pouch of rose leaves in the coat of the patient without him knowing [22]. Rose fever also occurred in pharmacists when they prepared medications containing roses, as we learn from Ramazzini [23], the founder of occupational medicine [5, vol. 2, p. 28]. Amatus Lusitanus described the case of a woman with a very serious condition following a strong reaction to pharmacy containing the blossoms of lime trees, rose water and cinnamon [24]. Another well-known allergic patient was the Archbishop of St. Andrews in Edinburgh, Sir John Hamilton (1511–1571), who was the brother of James Hamilton, regent for the young and minor Queen Mary Stuart of Scotland. He suffered from airway disease at the time when it was considered ‘catarrhus of the brain’, with an accumulation of phlegm and mucus in the lung which was treated in the classical way. When the Italian physician Gerolamo Cardano (1501–1576) came from Milan his discomfort improved. Cardano documented his advice in a consilium of 20 pages. He removed the feather bed from the bedroom of the archbishop, probably in order to avoid too much heat at the spine. He also recommended dietary restrictions, more sleep and applications of cold water [5, vol. 2, p. 208; 25, 26]. In 1698 the English physician Sir John Floyer (1649–1734) published a book entitled A Treatise of the Asthmas in which he differentiated between a continuous and an episodic form of asthma [4, p. 73; 27]:
These are clear-cut descriptions of possible allergic reactions against indoor allergens such as feathers from a bed or pets. The Belgian physician Jan Baptista van Helmont (1577–1644) reported a patient who was suffering from ‘summer asthma’ and at the same time from strongly itching whitish ‘blisters’ (probably wheals). It is interesting that van Helmont realized that not only the patient, but also his mother and sister were also suffering from the same symptoms [4]. Van Helmont saw similarities to epilepsy in the cramplike acute attack, and he also differentiated between moist and dry asthma: Est ergo duplex asthma, humidum et seccum. [5, vol. 2, p. 226; 32]
There are more detailed descriptions of symptoms and signs of allergic airway and skin disease from this time which directly lead to the first classic description of allergic rhinitis in the 19th century.
Conclusion Following the clear-cut descriptions of clinical symptoms very similar to hay fever under the name of ‘rose fever’ from Arabic medicine with Rhazes, and then over the whole period of the Middle Ages until modern times, more and more precise descriptions of similar disease entities can be found for acute seasonal rhinitis and perennial rhinitis by possible indoor allergens, as well as certain forms of asthma and urticaria.
References 1 Neuburger M: Geschichte der Medizin. Stuttgart, Enke, 1911, vol 1, 2. 2 Avicenna (Ibn Sina): Canon Medicinae (Plempius VF ed). Leuven, 1658. 3 Maimonides M: Treatise on asthma (Magali-vi-l-ra-bu). Historical document. Allergy 1956;14:382. 4 Simons E (ed): Ancestors of Allergy. New York, Global Medical Communications, 1994. 5 Schadewaldt H: Geschichte der Allergologie. Munich, Dustri, 1983, vol 1–4. 6 Elgood C: Persian science; in Arberry AJ (ed): The Legacy of Persica. Oxford, 1953, p 315. 7 Sarton G: Pollen allergy. Isis 1947;38:101. 8 Kamal H: Encyclopaedia of Islamic Medicine, with a Greco-Roman Background. Cairo, 1975. 9 Steinschneider M: Die Hebräischen Übersetzungen des Mittelalters und die Juden als Dolmetscher. Graz, 1956, p 767. 10 Muntner S: The Book on Asthma (Hebrew transl, Benveniste S). Jerusalem, 1940. 11 Avenberg KM, Harper DS, Larsson BL: Footnotes on Allergy. Uppsala, Pharmacia AB, 1980.
12 Bergmann KC, Bergman I, Schadewaldt H (eds): Bebilderte Geschichte der Allergologie. München, Dustri, 1980. 13 More T: The history of King Richard III; in Campbell WE (ed): The English Works of Sir Thomas More. London, Eyre and Spottiswoode, 1931, p 426. 14 Paracelsus von Hohenheim TB: De morbis metallicis; in Opera Omnia. Geneva, 1658, vol 1, chapt 2, p 711. 15 Paracelsus von Hohenheim TB: Von Apostemen, Geschwüren, offenen Schäden, Sironen und anderen Gewächsen, 1527; in von Sudhoff K (ed): Sämtliche Werke. Munich, vol 4, 1931, p 317. 16 Valerianus JP: Hieroglyphica, sive de sacris Aegyptiorum libris commentarii. Basel, 1556, vol 8, chapt 25, p 61. 17 Cromer M: De origine et rebus gestis Polonorum libri triginta. Basel, 1558, vol 8, p 207. 18 Sachs PJ: Gammarologia Curiosa. Frankfurt, 1665, vol 2, chapt 4, p 577. 19 Botallo L: Commentarioli due, alter de medici, alter de aegroti munere. Lyon, 1565, p 25. 20 Major RH: A History of Medicine, ed 1. Oxford, 1954, p 380.
21 Riedlin V Jr: Iter medicum sanitatis recuperandae causa non solum institutum, sed et feliciter finitum. Augsburg, 1702, p 25. 22 Riedlin V Sr: Observatorium medicarum centuriae tres (Riedlin V Jr ed). Augsburg, 1691. 23 Ramazzini B: De morbis artificum diatriba. Padua 1713 (Facsimile, Rome, 1953), Modena 1700. 24 Amatus Lusitanus (Rodriguez de Castello Branco J): Curationum medicinalium centuriae. Lyon, 1567 (first ed Venice, 1557). 25 Cardano G: De vita propria liber. Padua, 1575. 26 Cardano G: Consilia. No 52; in Opera Omnia. Leiden, 1663. 27 Floyer J: Treatise of the Asthma. London, 1698. 28 Floyer J: Essay to prove cold bathing safe and useful. 1706. 29 Stalpaart van der Weil O: Hondert seltsame aanmerkingen, so in de genees-als heelensuij-konst. Cent Post Obs 6. Amsterdam, 1682, p 45. 30 Morgagni GB: De sedibus et causis morborum per anatomen indagatis. Venice, 1761. 31 Mattioli PA: Commentarii in libris Dioscuridis; in Opera Quae Exstant Omnia. Frankfurt, 1598, vol 6, chapt 25, p 996. 32 van Helmont JB: Asthma et tussis; in Ortus Medicinae. Amsterdam, 1648, p 366.
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Ring
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Prof. Dr. med. Dr. phil. Johannes Ring Department of Dermatology and Allergy Biederstein Biedersteinerstrasse 29 DE–80802 München (Germany) E-Mail johannes.ring @ lrz.tu-muenchen.de
