Читать книгу Unveiling Diabetes - Historical Milestones in Diabetology - Группа авторов - Страница 13

The Greeks had some knowledge of sugar, which they called “Indian salt,” suggesting some influence from the Far East in the times of Hippocrates (ca. 460–370 BC), who made reference to “watery urines” as a bad sign when passed too soon after drinking. Apollonius of Memphis and Demetrius of Apamea first used the term “diabetes” in the 3rd century BC, meaning the passing of large amounts of water through the body [1, 5].

Aulus Cornelius Celsus (25 BC to 50 AD), in his De Medicina Libri Octo, commented on polyuria, polydipsia, and weight loss and, interestingly, recommended physical exercise [6] (Fig. 2). Rufus of Ephesus (late 1st to early 2nd centuries AD) dealt with subjects often neglected by other authors, such as the treatment of slaves and the elderly. He spoke of “leiouria” (urinary diarrhea) and “dipsacos” (to die of thirst), which remained in use throughout the Middle Ages, and was probably the one who named the pancreas from its fleshy appearance, from pàn (all) and kréas (flesh), without of course connecting the symptoms to the organ [7].

Fig. 2. Frontispiece and passage from Celsus’ Medicinae Libri Octo. Verona, 1810. The Museum of Diabetes, Turin. www.museodeldiabete.it. Reprinted with kind permission.

As is well known, it was Aretaeus of Cappadocia (81–138 AD) who gave the first full clinical and empathic account of the signs, symptoms, and deep discomfort experienced by patients (Fig. 3):

Fig. 3. Frontispiece and chapter in Aretaei Cappadocis “De Diabete, sive urinae profluvio.” Padua, 1700. The Museum of Diabetes, Turin. www.museodeldiabete.it. Reprinted with kind permission.

“Diabetes is a dreadful affliction, not very frequent among men, being a melting down of the flesh and limbs into urine. The patients never stop making water and the flow is incessant, like the opening of the aqueducts. Life is short, unpleasant and painful, thirst unquenchable, drinking excessive and disproportionate to the large quantity of urine, for yet more urine is passed. If for a while they abstain from drinking, their mouths become parched and their bodies dry; the viscera seem scorched up, the patients are affected by nausea, restlessness and a burning thirst, and within a short time they expire.”

He recommended thirst-quenching remedies, such as laxatives, fruit cataplasms applied to the loins, milk, and fruit squeezes. Aretaeus lived in Rome and Alexandria but in his time was not as famous as Galenus. His works, written in the Ionic dialect, remained unknown for centuries and were rediscovered in 1552 by Junius Paulus Crassus (Giunio Paolo Grassi) of Padua, who translated them into Latin and had them printed in Venice [8].

Claudius Galenus of Pergamon (129–207 AD) said that he only encountered 2 cases of diabetes. In De Crisibus, he theorized on the inability of the body to alter the liquids ingested and the consequent weakness of the kidneys in holding them back. He defined the massive, continuous emission of urine as “urine diarrhea” (“ùderos”) and “orinae profluvium” [9].