Aretaeus of Cappadocia (~2nd century ad), the celebrated Greek physician, is reputedly second only to Hippocrates in clinical observation. He is credited with the first description of coeliac disease, the naming and earliest accurate account of diabetes, the first correct depiction of asthma – among other things. Phrenitis, hysteria, melancholy and mania were identified before him but Aretaeus advanced empirical psychiatric nosology on a contemporaneous biological basis.
He was forgotten until the discovery in 1552 of two incomplete manuscripts on the causes, symptoms and treatment of acute and chronic diseases. A Latin translation appeared in Venice and 2 years later the original Greek text was published in Paris. In English, he is best known from a translation (1856) by Francis Adams (1796–1861), an overlooked medical scholar and the family doctor for 42 years in rural Banchory, Aberdeenshire.
The Cappadocian tells that phrenitis is seated in the head and senses. There is no surviving explanation of and treatment for hysterical suffocation, perhaps because missing or of spontaneous resolution. Melancholy is lowness of spirits from a single phantasy: the commencement and a part of mania. There is not one particular form of melancholy, which with treatment is entirely removed or has intervals of several years, but generally melancholy is again engendered. Mania is madness, derangement of mind: one genus and infinite in species. Those who have formerly been mad are more prone to melancholy. Dotage in old age never intermits, until death, whereas mania intermits and, with care, ceases altogether; but if patients attain some relaxation from the condition, they become torpid, dull, sorrowful; for having come to a knowledge of the disease they are saddened with their own calamity.
Against that background, Aretaeus says:
‘It is impossible, indeed, to make all the sick well, for a physician would thus be superior to a god; but the physician can produce respite from pain, intervals in diseases, and render them latent;’
yet,
‘A story is told, that a certain person, incurably affected, fell in love with a girl; and when the physicians could bring him no relief, love cured him. But I think that he was originally in love, and that he was dejected and spiritless from being unsuccessful with the girl, and appeared to the common people to be melancholic. He then did not know that it was love; but when he imparted the love to the girl, he ceased from his dejection, and dispelled his passion and sorrow; and with joy he awoke from his lowness of spirits, and he became restored to understanding, love being his physician.’
Although some advocate that Aretaeus plagiarised Archigenes of Apamea. That is another story.
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