The Ancient Period

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The first ever record of diabetes appears to be the papyrus named after the Egyptologist Ebers, who found it in an ancient grave in Thebes. It is written in hieroglyphs. The exact time of its writing is unknown, but most estimates date it around 1550 bc. It contains descriptions of a number of diseases including a polyuric state resembling diabetes, which was to be treated with a decoction of bones, wheat, grain, grit, green lead, and earth (1). The term "diabetes" was first used by Aretaeus of Kappadokia in the 2nd century ad. It comes from the Greek prefix "dia" and the word "betes" meaning "to pass through" and "a water tube," respectively (2). Ancient Greeks and Romans alike saw diabetes as a disease of the kidneys. "Diabetes is a dreadful affliction, not very frequent

From: Contemporary Diabetes: Diabetic Neuropathy: Clinical Management, Second Edition Edited by: A. Veves and R. Malik © Humana Press Inc., Totowa, NJ

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 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. One cannot stop them either from drinking or making water. 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 (1)."

It was not noticed until the 5th century ad that, at that time, rare condition of polyuria was associated with sweet-tasting urine. Chen Chuan in China named it "hsiao kho ping," and made a note that the urine of the diseased is sweet and attracts dogs. He recommended abstinence from wine, salt, and sex as treatment (1,3). At about the same time Indian physician Susruta wrote in Sanskrit that the urine of patients is like "madhumeha," i.e., tastes like honey, feels sticky to the touch, and strongly attracts ants (1,4). His treatment recommendation is colorfully summarized in the following words: "A kind of gelatinous substance (silajatu) is secreted from the sides of the mountains when they have become heated by the rays of the sun in the months of Jyaishitha and Ashadha. It cures the body and enables the user to witness a hundred summers on earth" (5).

Susruta may deserve credit for what seems to be the very first record of symptoms attributable to diabetic neuropathy: "Their premonitory symptoms are—feeling of burning in the palms and soles, body (skin) becoming unctuous and slimy and feel heavy, urine is sweet, bad in smell, and white in color, and profound thirst... Complications (upadrava) include diarrhea, constipation, and fainting" (6). Susruta also made a very important observation that the disease affects two types of people: the older, heavier ones and the thin who did not survive long. All other known early records that most likely represent a description of some form of diabetic neuropathy come from the Orient. Persian philosopher and physician Ibn Sina, known as Avicenna (980-1037 ad) in the West, described diabetes in his famous "El-Kanun." He observed gangrene and the "collapse of sexual function" as complications of diabetes (4). The same manifestation of autonomic neuropathy was recorded in ancient Japanese text containing a detailed description of the "water-drinking illness" (mizu nomi yami) as suffered by nobleman Fujiwara No Michinaga from the Heian Era (7,8).

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