Aretaeus of Cappadocia

Aretaeus was a native of Cappadocia, now in southern Turkey. He is believed to have lived in the first century AD, but he was never referred to by other medical writers of the time, and no biographical details are available. He wrote in the Ionian Greek dialect, and his medical practice followed the teachings of Hippocrates. Manuscript copies of his major work on acute and chronic disease survived the dark ages and were first printed in Latin translation in 1552 AD. His writing is memorable for vivid descriptions of medical conditions including diabetes, asthma and coeliac disease. He is sometimes (wrongly) credited with introducing the name diabetes, since this was evidently in use before his time, and he did not know that the urine tasted sweet. He did however produce the first clear written description of diabetes, and his works are still a pleasure to read.

Background

Aretaeus of Cappadocia is a mysterious character. His descriptions of a range of diseases are clearly described and beautifully expressed, indeed still worth reading today. Nonetheless, he is scarcely mentioned by any medical writer of antiquity, the only exceptions being Aëtius (?5th century) and Paulus Aegineta (?7th century). At least one major work survived reasonably intact, however, and first came to notice in a Latin translation published in Venice in AD 1552. Aretaeus' manuscript consists of eight books describing the causes, features and treatment of acute and chronic disease.

Cappadocia is an area in south eastern Anatolia, and Aretaeus wrote in the Ionian Greek dialect, otherwise known as old Attic, descended from the Greek of Hippocrates or Herodotus. Various dates have been assigned to him, but from internal evidence he most probably lived between 100-200 AD, most likely in the reigns of Nero or Vespasian.

Who was he?

We have no autobiographical details, but we may suspect that he was describing himself when he pictured the person most likely to suffer from an obscure stomach complaint:

It is familiar to ... those who, for the sake of education, are laborious and persevering; whose portion is the love of divine science, along with scanty food, want of sleep, and the meditation on wise sayings and doings ... to whom in place of a soft couch, is a hammock on the ground without bedclothes ... whose wealth consists in the abundant possession and use of divine thought ... if they take any food, it is of the most frugal description, and not to gratify the palate, but solely to preserve life; no quaffing of wine to intoxication; no recreation; no roving or jaunting about; no bodily exercise or plumpness of the flesh; for what is there from which the love of learning will not allure one? - from country, parents, brothers, oneself, even unto death.

His writings are most accessible to English readers through the 1856 translation of Francis Adam, reprinted for members of the Classics of Medicine Library[1].

Of chronic disease he wrote:

“Hence, indeed, is developed the talent of the medical man, his perseverance, his skill in diversifying the treatment, and conceding such pleasant things as will do no harm, and in giving encouragement. But the patient also ought to be courageous and co-operate with the physician against the disease”

Of diabetes he wrote:

“Diabetes is … not very frequent ... being a melting down of the flesh and limbs into urine … for the patients never stop making water, but the flow is incessant, as if from the opening of aqueducts. It consists in the flesh and bones running together into the urine … the illness develops very slowly. The nature of the disease is chronic, and it takes a long period to form; but the patient does not live long once the disease is fully established; for the melting is rapid, the death speedy. Moreover life is disgusting and painful; thirst, unquenchable … and one cannot stop them either from drinking or making water".

The origin of the name is explained as follows:

"The disease appears to me to have got the name of diabetes, as if from the Greek word διαβητης (which signifies a siphon) because the fluid does not remain in the body, but uses the man’s body as a ladder (διαβαθρη) whereby to leave it”. It can be noted that Aretaeus offers two possible etymologies for the word diabetes, and seems uncertain about both.

He further speculates that the disease occurs as a delayed consequence of a previous acute illness which “may have left some malignity lurking” in the system, a hypothesis still favoured by many who study the disease, and goes on to draw an analogy with the bite of dipsas, the thirst-adder, which also (or so he claims) induces an unquenchable thirst. Although Dipsas (the name means thirst, as in dipsomaniac) is the modern name of a harmless family of snakes, classical writers used the name very loosely and there seems little hope of identifying the snake Aretaeus had in mind, even if it existed. Aretaeus loses credibility when he reports that those bitten by the snake drink insatiably to the point at which they "suddenly burst"!

Both Aretaeus and the Roman physician Galen attribute the incessant loss of urine to disease of the kidneys, and this view of diabetes remained in vogue for centuries to come.

Although elements of his description of diabetes mellitus are immediately recognisable, Aretaeus did not know that the urine tasted sweet and his description may thus have included patients with other forms of polyuria.

Aretaeus' treatment of diabetes

He believed that the thirst should be reduced by strengthening the stomach, “which is the fountain of thirst”. “When therefore you have purged with the hiera”, he continues, “use as epithemes the nard, mastic, dates and raw quinces...” and so forth. Drinking water should be boiled with autumn fruit, and the food is to be milk with cereals, starch, groats and gruel; dry wines are recommended.

From which it may be seen that polypharmacy coupled with unreasonable demands upon the patient are of great antiquity in the management of diabetes.

References

  1. ^ The extant works of Aretaeus the Cappadocian. Edited and translated by Francis Adams. Printed for the Sydenham Society, London, 1856. Reprinted for the Classics of Medicine Library

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