Diabetes Mellitus: a Complete Ancient and Modern Historical Perspective
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Article ID: WMC004831 ISSN 2046-1690 Diabetes mellitus: a complete ancient and modern historical perspective Peer review status: Yes Corresponding Author: Dr. Chukwuemeka Nwaneri, Visiting Senior Lecturer, Community & Child Health, University of Chester, Riverside Campus, CH11SL - United Kingdom Submitting Author: Dr. Chukwuemeka Nwaneri, Visiting Senior Lecturer, Community & Child Health, University of Chester, Riverside Campus, CH11SL - United Kingdom Article ID: WMC004831 Article Type: Review articles Submitted on:15-Feb-2015, 10:48:54 PM GMT Published on: 17-Feb-2015, 10:12:38 AM GMT Article URL: http://www.webmedcentral.com/article_view/4831 Subject Categories:Diabetes Keywords:type 1 diabetes, type 2 diabetes, insulin, metformin, insulin resistance, glucose tolerance How to cite the article:Nwaneri C. Diabetes mellitus: a complete ancient and modern historical perspective. WebmedCentral Diabetes 2015;6(2):WMC004831 Copyright: This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Source(s) of Funding: Nil Competing Interests: Nil WebmedCentral Peer Reviewed: Yes Webmedcentral > Review articles Page 1 of 28 WMC004831 Downloaded from http://www.webmedcentral.com on 27-Mar-2015, 10:10:37 AM Diabetes mellitus: a complete ancient and modern historical perspective Author(s): Nwaneri C Abstract diabetes medicine and health. An attempt is made in this study to produce a chronologically organised, engrossing and multi-dimensional account of diverse documented work in diabetes. An in-depth review of Diabetes mellitus is one of medical conditions that the historical timeline of diabetes shows that diabetes have been extensively investigated. Despite these has evolved over six era: era of recognition of disease, enormous developments cure for diabetes still remains description of causes, clinical diagnosis, biochemical virtual. The history is backdated to the Egyptian development and advancement and millennium antiquity. As the history became unravelled with developments. regard to the pathophysiological and biochemical bases, medical and surgical treatments and other Discussions management strategies, roadmap towards achieving success in curbing the menace of diabetes is st promising. It is only in the 21 century that diabetes Ancient time (era of recognition of disease) has been considered a chronic and heterogenous The first recognition of what came to be known as DM endocrine disorder which requires interdisciplinary and was documented in the Egyptian ancient papyrus, multidisciplinary approaches in its management, with discovered by Georg Ebers in 1862, dating back to the role of genetics looking exciting. However, there 1550 BC which highlighted the first documented cases are lots of lessons to be learnt from the past. This of DM over 3500 years ago as stated by Ebbell, in review aims to explore the timeline of diabetes journey, 1937 and Tattersall in 2010. In this chronological and and correct the inconsistencies in the historical hieroglyphically written document of compendium of perspectives of diabetes with intent to project the medical literature from 3000 BC, was noted ‘to future. regulate………excessive urine’ in 1552 BC by Introduction Hesy-Ra, an Egyptian physician. Although this may as well represent the first recognition of diabetes, medical historians believe that the first attempt at describing Diabetes mellitus (DM) has been described as a the symptoms of diabetes was made by Aulus ‘silent’ epidemic. Its presentation can either be a slow Cornelius Celsus (30 BC-50 AD) of Greece (Medvei onset and asymptomatic progression leading to 1993, Southgate 1999, Zajac et al. 2010). Celsus had secondary complications, or rapidly emerging described an ailment which presented with excessive symptoms leading to complications and/or coma. The urination in frequency and volume, and painless projection is that by year 2030, an estimated 366-438 emaciations. Apollonius Memphites, an Egyptian million (i.e., 7.8% of the world population) people will physician at around 230 BC had used the prefix have diabetes, an increase of 54% compared to that ‘diabetes’ for the first time to denote an excessive predicted in 2010 (Wild et al. 2004, Whiting et al. passage of urine and ascribed its aetiology to the 2011). After the recognition of diabetes by the kidney (Papaspyros 1964). At that time, due to lack of Egyptians, various attempts were made to understand evidence, treatment had involved dehydration and the heterogenous nature of the disease, phlebotomy (bloodletting) as a method of treatment pathophysiological mechanisms, appropriate therapies (Papaspyros 1964, Zajac et al. 2010). In about 500 BC, and prevention strategies. As part of seeking for two Hindu-Indian physicians (Chakrat & Sushrut) answers to intriguing questions in diabetes, some recognised that DM was not a single disorder, and authors were more descriptive, analytic or pessimistic they made observations of the sweetness of urine rather than scientific in their search. Developmental from observing ants congregating around the urine of milestones in diabetes reflect improvements in the patients (Tattersall 2010). Although relatively understanding and management of the condition. The uncommon, as time went on, the recognition and overview of the history of diabetes, starting from the identification of diabetes became apparent. The ancient time to the present millennium helps to concept of nature showed varying and intriguing showcase the advances that have been made in debates and revisions. Webmedcentral > Review articles Page 2 of 28 WMC004831 Downloaded from http://www.webmedcentral.com on 27-Mar-2015, 10:10:37 AM 1st century (era of description of causes) Avicenna 1991). He had suggested that diabetes was Diabetes, a Greek word was the term used to denote ‘ a disorder of the nervous system in concert with run through or siphon’ in the description of incessant interplay of liver dysfunction. In a quest for treatment, urination (Adams 1856), a word originally ascribed to Avicenna prescribed the use of emetics and exercises Demetrios of Apamaia in the 200-250 BC. However, at to alleviate the symptoms, and discouraged the use of a time, medical historians believed that Aretaeus of diuretics (Savona-Ventura 2002). The first Cappadocia (81-138 AD), a Greek physician documented evidence of diabetes in English literature re-introduced the prefix ‘diabetes’ to describe the was the use of the word ‘diabete’, purported to be wasting disease from excessive urination (Leopold, written around 1425. Following these early records no 1930). In his manuscript, Aretaeus narrated what his further progress was seen until the sixteenth century. knowledge of origin of diabetes was: 16th-18th century (era of clinical diagnosis) "The disease appears to me to have got the name of As different researchers in Egypt, Persia, China, India, diabetes, as if from the Greek word διαβητης (which Greece, Japan and Korea searched for appropriate signifies a wine-pourer or siphon) because the fluid treatments of the strange and poorly understood does not remain in the body, but uses the man’s body disease, European medical literature showed no as a ladder (διαβαθρη) whereby to leave it” (Adams evidence of any documentation of the disease. In the 1856). middle part of the 16th century, Paracelsus Aretaeus went further to describe the features of (1493-1541), a Swiss German physician, was diabetes as pragmatic in his experimental search for the pathogenesis of diabetes. He was the first to depart “a dreadful affliction being a melting down of the flesh from the Galenic approach to medical conditions. and limbs into urine. The patients never stop making Paracelsus had evaporated urine samples from people water but the flow is incessant as if from the opening with diabetes with resultant production of solutes of adequeducts….and patient is short lived” (Tattersall, (Schadewaldt 1977). However, he did not taste it but 2010, p.3 citing Papaspyros, 1952). called it ‘salts’. In his conclusion, he stated that This describes the clinical picture of type 1 DM diabetes was as a result of the deposition of salts in (T1DM). Aretaeus also distinguished polyuria of DM the kidneys. The findings made him and other from diabetes inspidus, a disease in which the kidneys researchers believed that salts were the cause of are unable to conserve water. A Greek physician, excessive urination and thirst seen in these people. Claudius Galenus, referred to as Galen (129-200 AD) During the period of recognition of sweetiness of urine supported the work of Apollonius of Memphis, by from people with diabetes, Thomas Sydenham attributing the pathology to the kidneys because of the (1624-1689) proposed that ‘chyle’ from food was not diuretic effect (Eknoyan & Nagy 2005) and called it ‘ completely digested with excretion of the diarrhoea of urine’ [diarrhoea urinosa] (Zajac et al. non-absorbable residue. He concluded that this 2010). From China in 200 AD, Tchang Tchong-King diabetes was a systemic disease as a consequence of described the excessive eating symptoms seen in this process (Farmer 1952). In 1674, Thomas Willis, these people with diabetes. The triad of polydipsia, an Oxford-trained British physician (1621-1675), polyphagia and polyuria was noted in the literature as re-echoed the presence of sweet substance in the the characteristic features