Coughs Through The Ages

Eric Lis

Allergies and asthma have been a focus of medical attention since before the Roman Empire, and therefore make an ideal medical problem for a fantasy campaign.

Asthma and allergies are often thought of as relatively modern diseases. Prior to the 20th century, deaths due to these illnesses never attracted much attention. Before that time, we generally didn't understand the pathology of the "atopic" illnesses well enough to differentiate them from other, similar-looking deaths, and as near as anyone really noticed, some sickly kids just took ill and died, while some healthy people just fell over dead after a bee sting or eating the wrong thing. In the wake of the industrial revolution, though, as the air filled with smoke and smog, and as it became more uncommon for people to die of simple respiratory infections, it became increasingly apparent that there was something else going on there.

In retrospect, it's been increasingly clear that illnesses which match our modern understandings of allergy and asthma have long since been observed and recorded, though not always understood. Some examples are less certain. There was the Egyptian king Menes, for example, who supposedly died after being stung by a wasp. Assuming that "wasp" in this case wasn't a mistranslation of another word, such as "asp" or "poisoned dagger" or something, Menes probably died as a result of anaphylactic shock in response to a sting. If the Egyptian scholar Imhotep is sometimes regarded as history's first physician, then Sekhetnankh, who lived not too long after, may have been history's first allergist, since he's recorded as having "cured the noses of the kings." Cappadocian scholars recorded the earliest descriptions of acute asthma attacks as early as the second century BCE. Some of the best descriptions of allergies actually come to us from the early days of the Roman Empire, because some of the earliest Caesars all suffered from severe allergies. Augustus Caesar, first true Emperor of Rome, actually probably suffered from a multitude of autoimmune disorders, since writings from his time note that he experienced skin growths and rashes, a sensitivity to light, liver problems, bladder infections, and persistent itching lesions all over his body. Claudius supposedly suffered from such severe environmental allergies that he had a perpetual runny nose and red eyes throughout much of his life, while his son Britannicus apparently had a crippling allergy to horses, although his early death mean we know relatively little about him and his alleged illness. Records from medieval Europe describe many different "fevers," almost always characterized by shortness of breath or tightness in the chest and throat, associated with exposure to different allergens, including roses, feather beds, and cats. For a period of history, "rose fever" was so feared (and so poorly understood) that at least one powerful cardinal all but sealed off his estate to ensure that no roses could be brought in.

Interestingly, while ancient cultures didn't have any very good treatments for allergies, there may have been effective treatments for asthma even three or four centuries ago. Various seasonal respiratory diseases all over the world were noted to improve by wearing warm clothes and avoiding cold beverages. This is pretty much the same advice we often give to kids with asthma today, although of course, the same advice is often good for people with other breathing problems. Chinese records from the time of Emperor Shen Nong indicate that horsetail berries were used to treat a particular respiratory illness characterized by a wheezing shortness of breath and increased nasal secretions. This is interesting because horsetail berries are rich in ephedrine, so consuming them might have had much the same effect as the stimulant medications that we give kids today to relieve asthma attacks.

In some ways, allergic disorders have been seen as a positive thing. In the 1700's, the famous physician René Laennec made the observation that individuals with asthma tended to live particularly long and healthy lives, assuming their asthma didn't kill them first. This sentiment was echoed by the writings of other physicians throughout much of the 1800's, with some even suggesting that asthma somehow conferred a complete immunity to all other disease. Today, we know this to be far from true, but at the time, it might have been plausible. In modern times, there's good evidence that asthma is more common among children who are raised in relatively clean, sterile, and bacteria-free environments (the "hygiene hypothesis"), and it's very likely that even as far back as the 1700's, asthma was mostly being seen in children and adults who grew up in relative wealth and security, which certainly would have protected them from many of the deadlier infections and nutritional deficiencies of the era.

The implications for your games is that while many of the most deadly diseases of our era (heart attack, stroke, cancer) were much less common and less feared throughout much of history, some, like allergy and asthma, have always been there. These are illnesses which can very plausibly show up in a fantasy campaign and can be used to either individualize NPCs or simply annoy and distract PCs. Because such illnesses were generally poorly understood by the healers of the eras, there's ample room for storytellers to use a simple asthma attack as a story hook to send players off in search of hex-flinging witches, rare and fabled curative herbs, or any number of other MacGuffins. 

More than four years ago, Dr. Eris Lis, M.D., began writing a series of brilliant and informative posts on RPGs through the eyes of a medical professional, and this is the one that appeared here on August 3, 2014. Lis is a physician, gamer, and author of the Skirmisher Publishing LLC OGL sourcebook Insults & Injuries, which is also available for the Pathfinder RPG system