History Of Diabetic In Ancient Times

 Diabetes has a history that goes back to ancient times. It is one of the most studied diseases in the history of medicine. Its first mentions can be found in medical texts in Egypt as well as in ancient Indian and Chinese treatises. Intense thirst combined with copious urine production, excessive hunger, and a sweet taste of urine could not have escaped the vigilance of the eminent physicians of ancient times.

The Old Story of Diabetes

The oldest manuscript mentioning the symptoms of diabetes is a papyrus that dates back to around 1550 BCE. It was discovered in tomb excavations in Luxor. In the sarcophagus, it was found wrapped in a mummy's clothes, between her legs. The text is written in hieratic, a kind of cursive form of hieroglyphics. It consists of 877 headings, indicated in red ink, with the rest of the text written in black.

This manuscript ends with a calendar indicating that it was written during the reign of Amenhotep I, second ruler of the 18th Dynasty (New Kingdom). This papyrus measures 20.2 m long and 30 cm wide. It was discovered in a perfect state of preservation. Brought to Thebes in 1862 by the American Egyptologist Edwin Smith, the papyrus was sold in 1872 to Georg Moritz Ebers, a German professor of Egyptology. It is now kept in the library of the University of Leipzig.

This papyrus describes many diseases and more than 700 different recipes for making medicinal preparations to treat skin, eye, dental, parasitic (helminthiasis) diseases, gynecological disorders, but also mental illnesses, including one that could today be called depression. The remedies proposed were based on materials, most of them plant-based, and called upon mystical rituals (magic formulas).

The papyrus does not contain any specific mention of diabetes, but contains about fifteen prescriptions for patients emitting large quantities of urine. Infusions, pills, and enemas were recommended. The ingredients used were very varied and included gums, terebinth resin, wheat groats, fruits, roots, juniper berries, honey, grapes, sweet beer, oil, fresh milk, dates, and celery from the hills or the Delta.

Ebers (1837-1898) published a facsimile of the papyrus: two volumes of colour photographs of the entire text, accompanied by a hieroglyphic-Latin glossary written by his colleague Ludwig Stern. A German translation appeared shortly afterwards, followed by four more in English in the early 20th century.

References to diabetes appear in Indian and Chinese writings dating back to around 500 BC.

Ancient india

The Hindu medical treatises Charaka Sahmita and Sushruta Samhita from ancient India (2500–600 BCE), written in Sanskrit, mentioned the "sweet taste of urine" in about twenty diseases associated with a large volume of urine and collectively called  prameha (literally, abnormal urination). Among them, four were incurable and concerned individuals whose urine was sweet like cane sugar (iksumeha) or honey (madhumeha).

Tasting the urine of the sick was recommended by the physicians of the time, who noted whether it also had the power to attract large black ants, flies, and other insects. In this case, this variety of prameha was associated with clear urine and thirst.

There is also mention of a distinctive breath smell of rotten fruit or fermented liquid (surameha), suggesting that what is now called diabetes was known at the time. Patients with diabetic ketoacidosis are known to have a characteristic breath odor (of rotten fruit or apple). Finally, the famous physician Sushtuta observed that the disease mainly affected the wealthy castes.

Ancient China

In Chinese medicine, it was also recommended that the doctor taste the urine. In the 2nd century CE, it is mentioned that "sweet urine attracts dogs" and that this is part of the symptoms of Xioa-Ke or "thirst seeping into the urine". In fact, the Chinese term 糖尿病 (táng niào bìng) for diabetes means "sweet urine disease".

In the 7th century BC, Li Hsuan noted that these patients were predisposed to developing boils and lung infections and recommended abstinence from wine, salt and sex.

Writings from ancient India and China on diabetes do not seem to have reached the European continent. More detailed descriptions of the disease are found among physicians in ancient Greece and the Roman Empire.

Diabetes: “passing through”

Demetrius of Apamea (c. 200-250 BC) was the first to use the word "diabetes" to mean that water only passes through the body without being stored, hence the large flow of urine excreted by patients. Unfortunately, Demetrius' writings have been lost, and only quotes from later authors are available.

"Melting of flesh and limbs into urine"

The first comprehensive descriptions of the symptoms and profound discomfort experienced by patients with diabetes were given by Aretaeus of Cappadocia (81-138 AD), a physician born in eastern Asia Minor who studied medicine in Alexandria and practiced in Rome. "Diabetes is a terrible disease, not very common in men, with a melting of the flesh and limbs into urine.

The patients do not cease to produce water and the flow is incessant, like the opening of aqueducts. Life is short, unpleasant and painful, thirst unquenchable, drinking excessive and disproportionate to the large quantity of urine, because one urinates even more.

If they abstain from drinking for a certain time, their mouth becomes parched and their body dry; the viscera seem to be burned, the patients are affected by nausea, agitation and intense thirst, and in a short time they expire, the disease seems to me to have taken the name of diabetes from the Greek word διαβητης (which means siphon), because the liquid does not remain in the body,” writes Aretaeus.

According to him, fluids do not remain in the body but use the body as a "ladder", that is, a bridge, to leave it. He recommends remedies against thirst, such as laxatives (supposed to cleanse the stomach), fruit poultices on the gastric region, cereals, pressed fruits, milk, wine. Astringent wine is supposed to strengthen gastric tone because Aretaeus believes that diabetes is a disease of the stomach, responsible for intense thirst.

Aretaeus of Cappadocia took up the term diabetes, which more precisely comes from the ancient Greek verb διαβαίνω (diabaino) and literally means "to go or run across", and popularized it.

Aretaeus' medical practice was based on the principles of the Pneumatic School. Founded in the first century BCE, it believed in the role of pneuma (air) and the four elemental qualities (or humors, such as heat, cold, moisture, dryness) in the occurrence of diseases. According to Aretaeus, the cause of diabetes is the moisture and cold that reside in the body.

Aretaeus of Cappadocia's description of weight loss and thirst is precise and rigorous. The physician also takes care to describe the symptoms according to the stage of progression of the disease, which represents new information compared to medical texts written by other physicians.

Finally, he also discusses a pathology that also causes excessive thirst (dipsada). Thus, thirst due to diabetes is to be differentiated from the intolerable thirst that occurs after the bite of a species of venomous snake, the dipsada.

Aretaeus of Cappadocia was not very famous in Late Antiquity. His writings, which represent the best description of diabetes in ancient times, were written in an Ionic dialect. As a result, they remained unknown for centuries, until they were discovered in 1552 by Junius Paulus Crassus of Padua, who translated them into Latin and had them printed in Venice.

"Urinary diarrhea"

Claudius Galenus of Pergamon (129-207 AD), known as Galen, the most famous physician of the Greco-Roman era, claimed to have seen only two cases of diabetes in his entire career.

In De Crisibus, Galen theorizes that the body is unable to modify ingested fluids and that the kidneys cannot retain them. He defines the copious emission of urine as "urinary diarrhea" and compares the rapid elimination of urine in diabetes to lienteria, a diarrheal disease characterized by stools containing incompletely digested food.

For Galen, diabetes was not a disease of the stomach but a disease of the kidneys, which were unable to retain water. The theory that the kidneys were the cause of diabetes would then dominate for centuries.

In the Galenic treatise De locis affectis, Galen mentions that patients "have an inordinate thirst, and therefore drink copiously." According to him, "Some speak of chamber-pot dropsy, others of diabetes or violent thirst.

For my part, I have so far seen twice a disease in which the patients suffered from an unquenchable thirst, which obliged them to drink enormous quantities; the liquid was urinated rapidly with urine resembling water, diabetes is a true kidney disease."

In addition to the terms urinary diarrhea (Diarrhoia eis ora) or chamber pot dropsy (Hyderos eis amida) to designate diabetes, Galen uses a third to speak of pathological thirst: dipsakos. He never mentions Aretaeus of Cappadocia, his contemporary.

Between 25 and 50 BC, Aulus Cornelius Celcus (whose name was Gallicized to Celsus) summarized in De Medicina Libri Octo the knowledge of the time on diabetes. This physician, who lived at the time of the Roman emperor Tiberius, wrote in Latin. He discussed polyuria (increased volume of urine), polydipsia (intense thirst leading to drinking very abundantly) and weight loss.

Interestingly, he recommends physical exercise. "But when the urine exceeds in quantity the liquid absorbed, even if it is evacuated without pain, it gives rise to emaciation and danger of consumption, it is necessary to exercise.

The bath should be taken only rarely, and the patient should not remain in it long; the food should be astringent, the wine dry and undiluted, cold in summer, lukewarm in winter, and in minimum quantity to quench thirst. The intestines should also be stirred by an enema or by taking milk."

Rufus of Ephesus, a Greek physician born around 80 AD in Ephesus and died around 150 AD, spoke of leiouria (urinary diarrhea) and dipsakon (burning thirst). Thus, Rufus of Ephesus and Galen use, in addition to the ancient term diabetes, practically the same words to designate the rapid flow of fluid that passes through the body.

Later, Aetius of Amida (527–565 AD), a late antique Greek physician, adopted Galen's theories and brought information about the disease from Aretaeus of Cappadocia. He alternately mentions the terms diabetes, chamber-pot dropsy, extreme thirst, or dipsacus.

Alexander of Tralles (525-605 AD) was one of the most famous physicians of the Byzantine era. His 12-volume medical treatise covers a variety of topics such as internal medicine, surgery, ophthalmology, gynecology, and pharmacology. He also uses the terms diabetes, chamber pot dropsy, and dipsacus. The proposed treatment aims to refresh the body and restore hydration because it loses moisture due to abundant urination.

Let us finally quote Paul of Aegina, whose Latin name was Paulus Ægineta, a Greek physician of the 7th century (625–690 AD) who studied medicine in Alexandria. The last famous Greek physician of late antiquity, his work served as a reference in the following centuries.

Quoting Celsus, he describes diabetes as “the rapid passage of drink out of the body, and it is accompanied by immoderate thirst, hence the name dipsacus, since it is caused by the weakness of the retention faculty of the kidney, it deprives the whole body of its moisture by its immoderate heat.” Thus, after Galen, Aetius of Amida, Alexander of Tralles and Paul of Aegina in turn use the same term ( dipsakos or dipsacus ) to designate the pathological thirst associated with diabetes, probably derived from the name of a venomous snake ( dipsas), whose venom causes terrible thirst in the victim.

So much for the history of diabetes in ancient times, a history that spans centuries during which human intelligence, meticulous clinical observation and curiosity led doctors to accumulate knowledge about a disease that was rare at the time but today constitutes a scourge on a global scale.