In the late first century and early second century AD,
Dr. Aretaeus knew about diphtheria, as well as pleurisy, tetanus, pneumonia,
asthma, epilepsy, psychiatric disorders, diabetes, and other diseases. Aretaeus
(aka Aristaeus) from Cappadocia, Turkey, was a Greek Physician who practiced in
Rome and Alexandria. It is thought that he moved from Cappadocia, Turkey, to
Alexandria, Egypt, about the time Nero died. Little is known about his personal
life, but historians agree that he is one of the most brilliant ancient
physicians.
He didn’t know what caused diphtheria, which he called
Syriac or Egyptian ulcers (because it was widespread in Syria and Egypt), but
he made a practice of describing what he observed. Diphtheria, he noticed,
occurred most often, but not always, in children. He described the false
membranes in victims and stated that surgical interference was “secure.” (One wonders if he performed tracheotomies
and laryngectomies with success.)
Aretaeus classified diphtheria in a group of ailments
called “Uvula’s Diseases.’ He compared false membranes to batwings. If the
covering was deep, he called it eschara, meaning a dry scab.
Here’s a quotation of his description:
“Around it, the area is inflammatory, red, and painful.
The presence of smaller scattered reddish rashes at the beginning causes wide
ulcers after their merging. In case of the disease spreading towards the
opening of the mouth cavity, it reaches the uvula and cuts it out. The disease
continues its spread to the tongue, gums, and towards mouth corners, and even
the teeth get blackish, sensitive and tremble. The inflammation reaches the
neck and then the sufferer has only a few days before he dies by inflammation,
fever, bad breath, and anorexia.”
The disease caused diphtheritic
laryngitis, which he described as follows: “The sufferers breathe heavily and
deeply as they need cool air to sustain fever, while expiration is light, and
hoarseness or voice absence is present. The symptoms worsen, and the patients
suffer until they fall down and die.”
This acute disease was a
medical emergency. His treatments included
“enemas, phlebotomy, compresses, poultices, re-heating, suction cups and
surgery.” He subscribed to the theory of the humors. Phlebotomy from a wide
opening at the elbow and relentless enemas would, in his opinion, save victims
of diphtheria from drowning. He had bandages applied on the feet, ankles, knees,
wrists, elbows and arms. As death approached, he required more incisions and
more suction cups.
Medicines were sumac, Acacia
arabica, parasites from the roots of rockrose, earth from exotic locations, unripe
grapes, myrrh, pomegranate, dates, wild figs, alum, honey, oak bark,
copper, zinc, and rhubarb. Using reeds, feathers, or tubes, he poured
concoctions on the uvula.
To soften the diphtheritic membrane, he instructed his
assistants to apply a caustic formula, which corroded the uvula and inflamed
the throat until swallowing was impossible. The patients would die of hunger.
The use of alum proved to be valuable. Alum gargles dissolved
the false membrane. This method was used for centuries. His writings provide sophisticated knowledge
about diphtheria. Even in the present day, doctors refer to his findings and
reflections.
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Sources:
Gregory Tsoucalas, "Aretaeus
of Cappodocia. Views on Diphtheria"
Marcos Sampaolo, "Aretaeus of Cappadocia, Greek
Physician" https://www.britannica.com/biography/Aretaeus-of-Cappadocia
Roswell Park, An
Epitome of the History of Medicine, 1897. Kindle Version. Project Gutenberg.
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