Osteoarthritis in ancient times
The invention and use of writing, the birth of the first great civilizations: we have moved from prehistory to Antiquity.
The first medical treatises were soon to appear. The archaic conceptions involving gods and demons in the sickness and healing process were gradually replaced by a more rational approach based on observation but also on empiricism.
To find out what the concepts of the ancients for osteoarthritis and its treatment were, let's review the works of classical authors, examine the Egyptian mummies and finish this stage of our journey in China.
- The strange silence of Greek physicians
- Egypt at the time of the Pharaohs: osteoarthritis of the hip for the scribes, vertebral osteoarthritis for the peasants!
- And our ancestors the Gauls?
- Rome, osteoarthritis and herbal medicine: Dioscorides attributed therapeutic virtues to ivy.
- And acupuncture, since the earliest times.
The strange silence of Greek physicians
While texts on diseases of the bones and joints written by the founding fathers of Western medicine (Hippocrates, Celsus, Galen) thoroughly describe how to reduce the number of fractures and dislocations and how to treat war wounds (stabbings), no chapter is devoted specifically to rheumatic diseases.
Taking the example of Hippocrates and his 412 famous Aphorisms, only six of them, of which here is a rough translation, refer to rheumatism:
- In the elderly, dyspnoea, catarrh and coughing, dysuria, joint pain, kidney inflammation, vertigo, etc.
- Swelling and joint pain, ulcers, those of a gouty nature and muscle strain are usually improved by cold water, which reduces swelling and eliminates the pain, as a moderate degree of numbness eliminates pain.
- In gouty disorders, inflammation disappears within 40 days.
- Typically, gouty disorders are exacerbated in the spring and autumn.
- In chronic diseases of the hip joint, where the bone comes out of its socket and then returns, indicates mucosities in this region.
- In people with a chronic disease of the hip joint, if the bone comes out of its socket,
the limb atrophies and is lost unless the site is cauterised.
The only rheumatic disease clearly identified in these lines is gout. It is difficult, however, to recognise hip osteoarthritis in the last two of these aphorisms which are otherwise very unsavoury: Hippocrates seems rather to refer to an evolved form of infectious arthritis. Osteoarthritis appears only implicitly among the joint pain affecting older people, but we know that such pain can be of various origins.
Why the apparent lack of interest in osteoarthritis as such?
Could the short life expectancy of the Ancients account for a logical disinterest in age-related diseases? Would mechanical factors leading to osteoarthritis have made this disease a disease of slaves, doing the toughest jobs, but regarded as mere instruments unworthy of interest?
In reality, we are with Hippocrates at the very beginning of the rational approach to medicine. Everything remains to be invented, beginning with the identification and accurate description of the disease (or nosography).
However, osteoarthritis has existed since ancient times. Demonstrated by the techniques of spinal manipulation (very unwise!) recommended by Hippocrates and more accurate data that has survived from ancient Egypt. Egypt at the time of the Pharaohs: osteoarthritis of the hip for the scribes, vertebral osteoarthritis for the peasants!
Some perfectly preserved skeletons dating from the Pharaonic era indeed provide valuable information on the existence of several rheumatic diseases! We thus know that ankylosing spondylitis, an inflammatory disease mainly affecting the joints of the lumbar region, has existed at least since the third millennium BC.
Osteoarthritis is not lagging far behind and osteoarthritic joint damage, common in Pharaonic Egypt, even gives some indication of the occupational activities of the sufferers.
The "office" work of that time did not confer any protection against osteoarthritis. Scribes and viziers sat cross-legged which predisposed them to osteoarthritis of the hip. Moreover, we find the predisposing factor at the present time in regions of the world where sitting cross-legged is one of the favourite resting positions. Egyptian peasants, constantly bending down and straightening up were more likely predestined to develop early bone spurs (osteophytes) characteristic of osteoarthritis of the spine. At the present time, these osteophytes appear in most people only from around the age of 50 years onwards and affect virtually all people of 90 years and over.
Egyptian documents reveal that the joint pain was treated with ointments containing fat, oil, honey or bone marrow, to which could be added the most diverse ingredients: flour, baking soda, onion, cumin, incense and so on. According to some sources the Egyptian peasants still use it today in the form of ointments with animal fat from snakes and lizards in an attempt to relieve rheumatic pain.
And our ancestors the Gauls?
The little known story of the Celts or Gauls (the two terms being synonymous before Julius Caesar reserved the second term for the Celts of what are now France and Belgium) extends over more than a millennium over the whole of Europe. In the sixth and fifth centuries BC, the first Celtic "Princes" appeared in Central Europe. A princely tomb was discovered intact in Hochdorf, near Stuttgart (Germany).
The Prince of Hochdorf delivered valuable information to archaeologists because he was surrounded by everything you need to travel conveniently in the other world (weapons, jewellery, dishes). A man measuring 1.87 metres. However, he suffered from osteoarthritis of the joints and his teeth were half worn down. He was also suffering from periodontal disease.
Rome, osteoarthritis and herbal medicine: Dioscorides attributed therapeutic virtues to ivy.
Dioscorides was a Greek physician, but he worked in Rome in the 1st century AD at the time of Nero. Author of the book De Materia Medica, translated and plagiarised many times over, and ancestor of phytotherapy or herbal medicine (his descriptions of plants, however, contain many errors), he recommends using ivy against what seems to be osteoarthritis of the hips. A remedy from which we could probably expect a good placebo 1 effect, as with the Egyptian potions.
1: Patients who volunteer to participate in studies measuring the effectiveness of current drugs are often randomly divided into two groups. In one of these groups, patients receive the active drug being studied. In the other group, patients receive a completely inactive "placebo" but whose appearance is strictly identical to that of the active drug.
During the study, neither the physician nor the patient knows which of the two products was used. It is known that up to 30% of people "treated" with a placebo administered with sufficient conviction by the doctor can feel an improvement in subjective symptoms such as pain. This suggests that Dioscorides obtained some "improvements" in his patients, even if he ignored that to be considered truly active, a drug must be significantly more effective than the corresponding placebo.
And acupuncture, since the earliest times.
Let's leave the countries bordering the Mediterranean and push on to the East. The oldest book devoted to Chinese medicine is "Neiching", also known as the "The Yellow Emperor's Classic of Internal Medicine." The book is written in the form of a dialogue between the Emperor "Huang Ti" and the doctor "Chi Po." The Yellow Emperor, supposed to have lived around 2700; BC, is in fact a legendary figure.
In fact, the "Neiching" seems to be a compilation written by several authors between 2500 and 1000; BC. This is, in particular, the first reference book on acupuncture. The techniques described have remained virtually unchanged until today, where acupuncture is sometimes used in the symptomatic treatment of pain caused by osteoarthritis.