CONSUMPTION (TUBERCULOSIS) IN CLASSICAL ANTIQUITY* By BRUNO MEINECKE ANN ARBOR, MICH. Preparatory Note suggestions and whom I often consulted to verify my own conclusions. Of necessity NASMUCH as this work required a such a work as this must at times have historical basis for its treatment, the recourse to probabilities, for conclusive chronological arrangement was deemed material is not in every case available. imperative. The word “tuberculosis” is several times employed from the layman’s i. Consumption in Remote Antiquity Iviewpoint, viz., as a synonym for “con­ sumption”; it carries with it no formal Ca. 3000 b.c. The remote antiquity of scientific connotation, for it would be consumption or tuberculosis does not fall manifestly impossible to demonstrate the within the immediate scope of this investi­ tubercle bacillus in a work of this kind. gation; however, it should be noted that the Many physicians use the word loosely in a Greek and the Roman phases of the disease similar manner. can be linked with older civilizations and All references to Hippocrates accord with that the predynastic mummies of the the edition of Littre only; those to Galen Egyptians furnish the earliest proof of will be found in the work of Kuhn. the existence of tuberculosis. A tuberculous The Greek and Latin texts of medical disease of the spine with positive evidence authors have been omitted at the discretion of psoas abscess has been demonstrated of the writer for obvious reasons; the cost in mummies dating as far back as the of paper and printing is too large an item dawn of Egyptian history.1 to be disregarded by the average pedagogue, Ca. 2500 b.c. Further evidence is avail­ and furthermore the original is easily acces­ able in the Vedic Hymns. In the Rig Veda sible to anyone who may be interested. the cure of Yakshma, phthisis or consump­ I wish to express a deep debt of gratitude tion is the subject of a hymn: “I drive thy to Professors Kelsey and Sanders of the affliction away from thy eyes, thy nose, thy University of Michigan, who not only by ears, thy chin, head, brain and tongue. I drive their scholarly example and attainments thy affliction from the tendons of thy neck but by their marked understanding and and neck, breast-bone and spine, shoulders appreciation of the human element in learn­ and arms. I drive thy affliction from vitals, ing have ever been of the greatest personal rectum, heart, kidneys, liver, spleen. I inspiration to me. Their kindly encourage­ drive thy affliction away from thy thighs, ment recalls the famous dictum of Goethe: knee-caps, heels and from thy feet, thy “Das eigentliche Studium der Menschheit hips, stomach, groins; I drive the malady ist der Mensch.” away from thy excretions, thy hair, thy I desire, too, to record my thanks to nails, from the whole of thee. I drive my brother, H. A. Meinecke, m.d., of away thy malady from all members, each Detroit, who gave me many valuable hair, each joint, from the whole of thee.”2 Williams3 defines the word Yakshma and *A dissertation submitted in partial fulfillment of Yakshman, translated in the above passage the requirements for the degree of Doctor of Philos­ by “affliction” and “malady,” as a“ disease, ophy in the University of Michigan. An abstract of probably of a consumptive nature, pulmo­ this work has appeared in “Epidemiology and Public Health,” by Dr. V. C. Vaughan, formerly Dean of nary consumption, consumption, decline”; the University of Michigan Medical School. while Griffith specifies that in this hymn: “the deity or subject is the cure of Yakshma in all countries where human beings have or phthisis or consumption.”4 In the Atharva congregated. Veda a reference occurs to a charm which 11. References to Consumption in Greek cures consumption, and the plant kushtha Writings is mentioned as a cure for a kind of con­ sumption.5 Scrofula is also alluded to.6 The many positive references to con­ Some commentators of the Bible have sumption found in Greek and Roman seen consumption in several passages, and, writers, both medical and non-medical, although the descriptions are in general too establish beyond a doubt their full acquain­ meager to admit of a definite demonstration, tance with this malady. They manifest a such a conclusion is not entirely fanciful. keen observation of the symptoms, causes, Atrophy of the bones and flesh is often development, and dreaded results of the referred to7; the figures of speech uttered disease, and, although we meet with no by Moses in Leviticus8 and in Deuteronomy9 scientific explanation approaching the may well have been suggested by this modern theory of tuberculosis, it is within malady; Daniel10 and Isaiah11 may have had the bounds of reason to suppose that some it in mind, and certainly the plague of the ancient physicians may have had at described in Zechariah12 has reference to an least a visual acquaintance with the small intense emaciation, consumption or atrophy. rounded nodules produced by the bacillus of The Hebrew word is from a root meaning tuberculosis, as subsequent references will to “waste away,” a condition which is suggest. That the ancients recognized the often the result of severe internal abscess. existence of the tubercle will appear as a This may very well have been “The Great reasonable inference; it will, however, appear White Plague,” and it may generally be as equally true that they did not associate assumed that the consumption of the Bible the existence of true phthisis and the was the pulmonary phthisis of the western tubercle as belonging to the same disease. world. That the disease was well known in The earliest Greek reference to consump­ the Apostolic period can be conjectured tion occurs in Homer13: “Nor did any dis­ from the careful description of Aretaeus, ease come upon me, such as usually by the Cappadocian, who, if his surname is not grievous consumption takes the soul from misleading, must have had an opportunity the body.” Hesychius defines as to associate both with Jews and Christians 7^is or <p0uns; Pollux,14 it would seem, at Tarsus and other Asiatic centers. places rriKeSuv in the same category with Tuberculosis, then, seems to be a disease <p0i<ns, and Kuhn’s15 note is instructive; which has an unbroken sequence traceable Suidas likewise gives the following citation: to a civilization as early as 3000 b.c., but Kat voael voow fxaKpa Kai rrjKeddov avrjv biedel-aro. we may safely conclude that it existed and In another passage Homer refers to a was known centuries before that time. In father “who lies in sickness ... a long view of the historical record of the contact while wasting away,”16 and he also may well of these several civilizations it would hardly have been a consumptive, though such a require a violent stretch of the imagination conclusion is not absolutely certain. Hippo­ to believe that the Greeks took consumption crates, however, uses tijkw several times in from the Egyptians and that the former in connection with consumption,17 and espe­ turn passed it on to the Romans. We are cially noteworthy in his use of Trjxovrat the unfortunate recipients of this disease with reference to consumption of the spinal from these earlier peoples, and it would seem marrow.18 Aristotle19 also has an example. that the German Volkskrankheit is an apt Fl. 468 b.c. Though the expression is too term to designate tuberculosis, for it has brief to admit of a solid interpretation, it is been found in all ages, in all climates, and at least possible that Sophocles20 had con­ sumption in mind when he said: “smitten his treatment the primary purpose seems to not by wasting sickness,” for Hippocrates have been to build up and replenish the often designates this disease by system. The milk of wolves, asses, cows with or without voaos.21 and goats is prescribed, as well as Ca. First Half of Fifth Century b.c. proper purgatives, mild exercise in the open, Euryphon, a celebrated physician of Cnidos vapor baths, hot water baths, vomiting, in Asia Minor and an older contemporary of potions prepared from various herbs, wine Hippocrates, treated consumptives with the with honey, certain kinds of meat, and milk of she-asses and mothers, and likewise above all quiet and rest. employed actual cautery.22 A scene described Fl. 443 b.c. Herodotus knew of consump­ by Plato may possibly refer to him, and in tion and mentions it clearly in the follow­ this passage he is ridiculed for treating the ing passage: “For as he was riding, a consumptive Cinesias with cautery.23 dog ran beneath the feet of the horse; and Furthermore, if he be the author of the the horse, not seeing it, was frightened, “Cnidiae Sententiae”24 in the Corpus reared up and threw Pharnuches, and, after Hippocraticum, his knowledge of consump­ he had fallen, he spit blood, and the disease tion was already well defined in the pathol­ turned into consumption.”26 ogy of the disease. In the “De Affectionibus Fl. 441 b.c. Euripides says of Alcestis: Intends” of this collection appears a “ For she fades and wastes away by disease,” lucid discussion of three divisions of phthi­ and “Cry out, Oh groan, Oh land of sis25: first, pulmonary infection caused by Pheres, for the noblest woman, wasting a flow of putrid phlegm from the head to away with sickness.”27 The poet here cer­ the lungs, causing death usually within a tainly emphasizes the gradual decline of year’s time; second, that caused by over­ the body which would happen from a slow, exertion, in which the patient suffers as in lingering disease such as tuberculosis, and the first case, except that the sputum is of there is no special obstacle in the Greek a heavier consistency, the cough more text to neutralize such an interpretation.