Diseases and care in the ancient world: ailments that are foreign and hard to detect

24/06/2021

Diseases have existed throughout the history of mankind, and the deeper the human species goes into the treatment of them, the more strange new ailments emerge, and in many cases, difficult to diagnose. Some researchers point out that it is due to human longevity, but others blame the transgression of nature. Hence Aldous Huxley's remark that "so much progress has been made in the investigation of disease that it is increasingly difficult to find anyone completely healthy".

Photo credit: Detail: fresco mural, El puebloen demanda de salud, Diego Rivera, 1953. 112 square meters of painting and 15 square meters of mosaic. La Raza National Medical Center.
Photo credit: Detail: fresco mural, El puebloen demanda de salud, Diego Rivera, 1953. 112 square meters of painting and 15 square meters of mosaic. La Raza National Medical Center.

It is true that, throughout time, one of the human concerns has been the care of the sick, without which, in many cases, death would imminently ensue. In terms of osteological history, what the remains of the first australopithecine hominids indicate is that in these individuals there was no care for the members of the group since the skeletal remains generally present ailments related to the causes of death and not to a process of subsequent recovery.

It was not until the appearance of the hominid groups at the end of the Lower Paleolithic that generalized care for their fellows could be glimpsed, starting because the process of brain development demanded that the species had to take more care of the newborns, who also, unlike other animals, began to require a great investment of time during the first years of life because they required great dedication from the group during the learning process, so it is also thought that during this evolutionary process the family began.

The formation of more solid social groups allowed the care of each member, giving multiple changes in lifestyle, from increasing life expectancy to generating practices of prevention and cure, increasing the knowledge of the natural environment.

This beginning of the perception of disease and ailments in general also gave rise to thoughts about the supernatural, magical and religious causes that caused them, and also allowed the investigation of care, attention, and the first curative elements through observation and experimentation, identifying the qualities and power of certain plants, animals and even elements of nature such as earth, heat, humor, among others.

Thus, by 8000 B.C. the Chinese already had solid bases registered on the healing power of plants and on curative therapies, however, they were not the only ones because in each territory reached by the human being, the knowledge of the environment was given and the necessary techniques were generated to treat the different ailments that afflicted the population. An example of this in America was the creation of the Codex de la Cruz-Badiano, written in 1552, which rescued part of the ancestral knowledge of herbal medicine and Nahua medicine, through images and recipes for different ailments and the way in which the sick should be treated.

But how is it possible that we now know that the sick were cared for and looked after as far back as the Stone Age? The study of ancient disease is a relatively recent branch of science and, in a generalized way, we can learn about ailments through the traces that the ailments left in the skeletal remains and teeth.

The skull as an indicator of the state of health allows us to evaluate the biosolid itself and the teeth, in isolation from the rest of the skeleton, given the great amount of information that the section offers. Teeth give information about the quality of life of individuals and part of their habits; for example, enamel hypoplasia is a characteristic of the tooth in which malnutrition problems in early ages are observed as deficiencies in mineralization forming lines, grooves, and pits in the enamel. In ancient human groups, they usually appear with the weaning stage approximately between 3 and 4 years of age, so they are regularly observed in the incisor teeth, likewise, these traces have been recorded from Australopithecus to present humans.

Another characteristic of the state of health seen through the teeth are dental calculus or tartar and caries, which are generally related to the ingestion of proteins and carbohydrates respectively, also indicating cultural traditions with respect to food.

Another aspect of dentition is its evolutionary development since it has changed at a relatively constant rate towards the reduction of the size of the teeth, this reduction is linked to technological progress and to the increase in dietary variability over time. In Australopithecus we find strong jaws associated with large teeth, which speaks of a masticatory apparatus designed to eat hard foods, perhaps high in fiber, while in man, the dentition has been reduced and the masticatory apparatus, as well as the skull, became gracilized given the association with a softer and more varied diet, in this sense, we can point to the cooking of food as the technological innovation that totally modified human behavior and generated the adaptive changes in the digestive apparatus.

As for the care of the dental pieces, we know that the change in the diet brought with it an increase in dental pathologies, which shot up in the Neolithic period with the emergence of agriculture, this fact was accompanied by greater attention to the mouth, to the point that in Egypt a stele was found from 3000 B.C. with an inscription that speaks of Hesi-Re, a character referred to as "the greatest of the doctors of teeth."

Fragment of the stele of Hesi-Re, known as the first dentist, 3000 B.C. Saqqara, Egypt.  During the Roman period, Pliny the Elder recommended the use of wine rinses before bedtime.
Fragment of the stele of Hesi-Re, known as the first dentist, 3000 B.C. Saqqara, Egypt. During the Roman period, Pliny the Elder recommended the use of wine rinses before bedtime.

Also in Roman times, dental care was widespread, mainly the extraction of diseased teeth, but there are records of procedures such as rinsing with wine to counteract halitosis, the use of belladonna for pain, and other more extravagant treatments such as biting the head of a live mouse for toothache.

In pre-Hispanic times, techniques were developed by means of which dental pieces were modified mainly for esthetic reasons, which leads us to think that prophylactic and medical techniques were already known, mainly the extraction of diseased dental pieces. Three important cases, in Hidalgo, Morelos, and Michoacán, could exemplify pieces with caries, in which the drilling of the piece was performed in order not to lose the dental piece and free the diseased part of the tooth by way of endodontics, which speaks of the great knowledge that was had about the human body in the Mesoamerican cultures.

The most frequently observed pathologies in the skull are those related to metabolic processes such as chronic anemia and malnutrition; it is also possible to establish cases of characteristic diseases such as those caused by treponema, which are so old that one of them was found in a skeleton of Homo erectus 1.6 million years old from Kenya, in its variant treponema pallidum pertenue (yaws).

Also, contrary to what was believed, in the ancient populations of Mexico there already existed the disease of syphilis produced by the spirochete Treponema pallidum, this disease occurred in 4 different levels of affectation, since the bacteria appeared in the individual producing sores mainly in the genitals, followed by a rash all over the body, and entering a subsequent state of latency, to reappear in a generalized manner throughout the body, invading organs and skeleton.

Apart from the presence of diseases among the ancient hominids, we know that there was attention and care for the sick. Already among the Neanderthals there are enough examples that demonstrate that the groups of this species had very solid social structures, in which food, housing and perhaps clothing were acquired for the community, giving greater security to young individuals, the elderly and the sick or people who required additional care such as pregnant women or those suffering from a lifelong illness.

In the archaeological site of Shanidar, for example, lived an individual with an approximate age of 40 years, he had dystrophy of the scapula, clavicle, and right humerus, perhaps associated with an amputation of the forearm on the same side, performed above the elbow. He also presented consolidated injuries in his right leg, the blindness of the left eye due to orbital trauma, and two injuries that healed, one in the facial region and the other in the right side of the skull. As if that were not enough, he also suffered from a degenerative disease (arthritis) and bone growths that caused hearing loss. All these ailments point to the fact that it was the social group that facilitated the subject's life, from surviving the amputation, to being able to heal and reach such longevity.

Another example seen in Neanderthals comes from the region of Chapelle aux Saints, France, where the remains of an elderly individual were discovered whose pathologies would not have allowed him to reach old age without the help of the group with which he lived. He suffered from deforming arthritis, which had already caused particular development in the extremities and left coxal bone, he also had a crushed toe, a broken rib, the absence of all his teeth, and an injured knee.

Cases on early sapiens remains showing care of the sick, we have them among the first European settlers of the Neolithic with traces of trepanation. Trepanation is presented as an exceptional case of attention and care after surgery, due to its dangerousness regardless of its function. This practice consisted of deliberately making a hole or orifice in a specific area of the skull while the individual was alive, usually in one of the parietal bones or in the frontal bone, although there are also individuals who underwent multiple perforations. The male sex presented the highest frequency of perforations, and they were performed almost exclusively in adults.

The oldest skull recorded with this practice belongs to the region of Cocherel, France, while the youngest was found in Jutland, Denmark, both temporally located between 4000 and 2500 BC. In the French skull, the perforation is considered as part of medical treatment because of the position already on the upper region of the occipital bone, which is very rare, while in the infant the cut was made because he suffered from hydrocephalus. It is believed that these operations relieved the internal pressure of the skull, so they could have been performed for therapeutic purposes.

Some researchers point out discrepancies in the medical intentionality of trepanation and attribute magical-religious explanations given its high frequency in remains from multiple localities throughout the world, a particular case is found in European collections where the custom was widely spread and in the Andean zone of Peru, whose frequency is also extremely high. Evidence of this practice has also been found in Mesoamerica, North America, and Africa.

Finally, it should be noted that the main health problems were associated with blows, fractures, and contusions. Among the main diseases that afflicted man since his appearance on earth are digestive and respiratory diseases, by extension to what is observed in current communities without a medical system, and to a lesser extent, arthritic and infectious diseases. Animal domestication and sedentary lifestyle would bring to human beings the presence of many more parasites, viral diseases, and problems with fungi mainly, although undoubtedly, this era would be accompanied by multiple advances in herbalism, therapeutics, and rituals.

By Pablo Neptali Monterroso Rivas and Isabel Bertha Garza Gómez. Source: INAH Morelos. This work is licensed under a Creative Commons Attribution 2.5 Mexico License.