The Pathology and Treatment of Tinnitus in Celsus and the Hippocratic Corpus Compared and Contrasted

DOI: 10.5935/0946-5448.20120025 ORIGINAL ARTICLE International Tinnitus Journal. 2012;17(2):140-5. Ancient voices on tinnitus: the pathology and treatment of tinnitus in Celsus and the Hippocratic Corpus compared and contrasted Maryanne Tate Maltby1 Abstract Objective: The object of the paper is to analyse the treatment of tinnitus in two ancient works, Celsus De Medicina and the Greek Hippocratic Corpus. Whilst reviews of historical references to tinnitus have identified this material, this is the first detailed treatment of the subject in these authors. Design: The paper considers the material relating to tinnitus and suggested treatments in the Roman medical writer Celsus (mid first century AD) in contrast with those found in the Greek Hippocratic Corpus (late fifth, early fourth century BC). Results and Conclusion: The lifestyle change, diet and pharmacological treatments suggested by Celsus are analysed and shown as likely to be effective. Celsus is shown to be remarkably modern in his understanding of the aetiology of the disease and his suggested dietary and pharmacological treatments appear to be soundly based. Celsus’ pharmacological approach differs from the more theoretical stance of the Hippocratic Corpus based on humoural theory. The Hippocratric Corpus is more detailed in its descriptions of otological pathology and more concerned with a humoural explanation of the disease, but offers useful advice on diet and regimen and also provides the first detailed description of what appears to be Ménière’s Syndrome. Keywords: ancient, history, materia medica, tinnitus. 1 Anglia Ruskin University. Institution: Anglia Ruskin University. Send correspondence to: Maryanne Maltby. Audiology Pathway Leader, Vision and Hearing Sciences, Anglia Ruskin University, East Road, Cambridge CB1 1PT. E-mail: [email protected] Paper submitted to the ITJ-SGP (Publishing Management System) on April 22, 2013; and accepted on May 22, 2013. cod. 118. International Tinnitus Journal, Vol. 17, No 2 (2012) www.tinnitusjournal.com 140 INTRODUCTION tinnitus. However Celsus was not averse to traditional rural remedies6, which he sometimes gives alongside Tinnitus remains a clinical and scientific enigma, the treatments of the conventional medical practitioners7. and has been considered by medical and scientific As far as his discussion of is concerned, the present authors throughout history. Such material has been paper assesses Celsus’ knowledge of audiological 1-3 summarised and reviewed by several modern authors pathology and the potential effectiveness of his proposed but in each case the perspective has been an overview treatments. rather than an in-depth and contextual analysis of particular authors which would build upon these previous Tinnitus in Celsus studies. In the first paragraph of his discussion Celsus The author at the centre of this study, Aulus speaks of three causes of tinnitus: Cornelius Celsus, was not a professional doctor, (1) The common cold causes a mild form; but rather an expert amateur. His work De medicina, (2) Diseases (unspecified) and prolonged in eight books, was originally part of a much larger headaches give rise to a more serious form; encyclopaedia, called the Artes, and was intended for an (3) The onset of serious disease, especially elite Roman audience and also contained books now lost epilepsy, causes the most serious form: on agriculture, rhetoric, philosophy and military strategy. Celsus 6.7.8a Another type of problem is His work was known to Pliny the Elder (AD 23-79) and when the ears produce a ringing sound within Columella (fl. AD 50), and the period of AD 14 to 39 best themselves; and because of this it also comes suits the sparse evidence we have for the dating of his about that they cannot receive sounds from 4 work . The central section of this work, books 5 and 6, is outside. This is least serious (1) when it comes concerned with materia medica, and the particular portion about through a cold; worse (2), when caused dealing with hearing complaints is book 6 section 7. No by diseases or prolonged head-aches; worst single source has been identified for this work, and it is of all (3) when it precedes the onset of serious clear that he had read extensively amongst earlier Greek illnesses, especially epilepsy. medical writers and made use of a wide range of earlier Modern audiologists would concur with Celsus in 5 specialist texts . seeing tinnitus as arising from a number of conditions The present study aims to analyse how Celsus and, although they would suggest more than three8, considered tinnitus and how it might be treated, for which those given by Celsus would be included among them. comparisons can be made with the treatments offered Firstly an upper respiratory tract infection can give in the Greek Hippocratic Corpus (late fifth century BC). rise to poor Eustachian tube function and middle ear When comparing Celsus with the sparse Hippocratic dysfunction, leading to conductive hearing loss. In such writing in this area, it is clear that Celsus is much more circumstances tinnitus may be perceived as external concerned with the use of pharmacological cures and sounds are reduced in perceived intensity, and the less with humoural theory, which is the main focus of individual may become aware of any internal percept. Hippocratic treatments. Secondly, the association of troublesome tinnitus with The humoural theory is found for the first time in malaise induced by illness is recognised. Thirdly, whilst works of the Hippocratic Corpus and is later refined and a direct association between epilepsy and tinnitus is not standardised by Galen. In its original form as found in the commonly clinically observed, recent theories of tinnitus Hippocratic work On the Nature of Man the theory states generation have considered the ways in which patterns of that the human body contains four humours: blood, neuronal activity in the central nervous system can either phlegm, yellow bile and black bile (chapter 4). Health induce or exacerbate tinnitus. Specifically, proponents results from a harmonious mingling of these constituents, of the theory of thalamo-cortical dysrhythmia indicate whereas pain results from one of them being in excess that the normal harmonious patterns of firing between (chapter 4). Finally the four humours relate to the seasons the auditory thalamus and the cortex may be disrupted with phlegm, as cold and wet, being most frequent in in troublesome tinnitus9,10. winter; blood, being moist and warm, in spring; yellow Next Celsus goes on to suggest some treatments, bile, being warm and dry in summer; black bile, being starting with tinnitus arising from a cold: dry and cold, in autumn (chapter 7). Celsus 6.7.8b If it is due to a cold, the ear should In his treatments Celsus is more selective than be cleaned and the breath held until some liquid his contemporaries in avoiding the more outlandish froths out from it. (to modern eyes at least) folk remedies recommended One reading of this would be that the treatment by writers such as Pliny, e.g. in Pliny Natural Histories consists of cleaning the ear. No detailed information is 20.162, veal suet with wild cumin is used as a cure for given as to the cleansing agent that might be used, but International Tinnitus Journal, Vol. 17, No 2 (2012) www.tinnitusjournal.com 141 the mention of breath holding and of liquid frothing out swollen root more like a turnip is used earlier in 6.7.7c of the ears suggests perhaps the use of some substance with vinegar and laurel oil for deafness17-19. such as soda dissolved in wine, as recommended by Oil of roses was prepared from the fresh and dried Pliny11: petals of the damask rose. In ancient pharmacology it is Natural History 31.117 Soda dissolved in wine used to clear up inflammation, mainly in ear complaints, is poured into purulent ears; wax in the same and for example used as such in Celsus at 6.7.1c and organ it eats away in vinegar; noises and tinnitus 6.7.1d. It also appears in mixtures in Pliny 20.137 it stops if added dry. and 23.85 as a constituent of a tinnitus treatment. In In the case of tinnitus caused by a common cold, modern times the rose plant has been suggested as a cleaning it would not resolve middle ear dysfunction. In source of anti-depressant, antiseptic, antiviral, laxative the case of tinnitus caused by wax, on the other hand, and tonic substances20,21. The cucumber root contains cleaning the meatus in this way might be of benefit. bitter compounds known as cucurbitins, one of which Baking soda mixed with warm water is still used to has an anti-tumour effect. It is rich in antioxidants and remove wax, but this is usually seen now as a rather harsh contains a number of fatty acids which have been treatment12. Wax dissolved by the soda can be washed or considered to have cooling and diuretic effects22. In syringed out of the ear and the use of wine or vinegar as Dioscorides 2.162, it is used, as here, with rose oil to solvents, as suggested by Pliny (quoted above), would cure earache. Earlier in Celsus at 6.7.7c it is applied to act as effective antimicrobial agents. Alternatively, the the ear with castoreum and crushed rose leaves to cure combination of breath holding and an emission from deafness. In Western folk medicine in general it is used to the ear may indicate a tympanic membrane perforation. reduce heat and inflammation, particularly when applied It is difficult to see how tinnitus might be improved by to wound swellings. such a procedure. Moving on to the second mixture, castoreum is Celsus now moves on to the second cause of the name given to the strongly odiferous, oily yellowish tinnitus, this being unspecified disease and headache.

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