From 296 B.C till date... the path we travelled!

This topic might not excite many... When everybody is trying to talk about future modalities of treatment why did i choose to travel back in time... well the answer is simple. we were the first ppl to introduce diabetes to the world. current situation is that we leadin Diabetes in tems of numbers. Diabetes has become a noncommunicable epidemic in our country. To retrace the path our ancestors followed and to understand how our present day understanding of modern medicine has evolved in truly fascinating!!!!!!!

Diabetes is a disease of worldwide distribution. Initially it was thought that diabetes is a disease of the affluent. But recent studies have shown that prevalence of diabetes is same among the rich and poor. It affects the urban and rural population alike. The earliest mention of Diabetes is seen during the vedic period. Among the Vedas, Atharva veda deals with medicine. During this period Diabetes was referred by two terms

1)Asrava means to flow. From here a new term “Mutratisara” evolved which meant excessive urination
2)Premeha

During 321-296B.C Kautilya who was considered as a Father of diplomacy has mentioned a method to produce Diabetes in his book Arthesastra. According to him burnt chameleon and lizard combined with intestines of frog & honey if administered can cause diabetes.

After the vedic period more accounts of Diabetes are recorded in chararka samhita. These accounts are supposed to have been written in about 600B.C. This explains more about the etiology including heredity, pathogenesis, symptoms, complications and methods of treatment in detail. Here in these accounts the etiology of diabetes is mentioned as

· Overnutrition

· Lack of exercise

· Undernourishment with excessive labour

In this account the inherited diabetes was considered incurable.

Pathogenesis was considered to be derangement of “meda”, “mamsa” & “kleda”. The main point is that in this account it is a point of historical importance that the book mentions the loss of sweet substance in urine.

One more book to document diabetes is bhela samhita. This book documents two types of diabetes

Prakrti prabhava (congenital)

Svarakta (Acquired)

Susrutha followed the same classification and he concluded that the congenital variety of diabetes was caused by defect in” bija” (reproductive units – sperm & ovum) and the acquired variety is due to heavy diets and luxurious lifestyle.

Susrutha contributed a separate chapter for treatment of Diabetes and he also described management of carbuncles.

After susrutha Bhagbatta was a great contributor to the field of Medicine. He explained two types of Diabetes based on the pathogenesis.one is “dhatuksaya (thin diabetes) and other is avarana janya (obese diabetes)

The medieval period was only collections of previous works. No great information was added to the already known facts

In the 16^th century Bhavamisra contributed to history of Diabetes by adding some new vegetable and metallic preparations for management of Diabetes. After this time our country fell into the hands of foreign rulers and Indian culture and Aryan civilization was affected by foreign rulers and their policies to abolish the Aryan civilization. During the British rule the schools of Indian medicine were replaced by the western system. The whole events resulted into a big stagnation and gap in the evolution of this system.

The moderm Medicine evolved with Chinese medicine and explained the syndrome of 3P’s (polyphagia, polyuria & polydipsia) the study of chemistry of urine was initiated by Paracelsus in the 16^th century. It took nearly hundred years to identify the sweet material as glucose. This discovery led to rational dietary approach.

Morton in 1686 noted the hereditary nature of diabetes

Paul langerhans working in Berlin reported in 1868 a type of cells in the pancreas which lie together in considerable number and these were later named islets of langerhans and are still known by his name
The work of great clinicians like Bouchardt, Naunyn, Von Noorden, Allen and Joslin led to significant therapeutic success with diet.

Von mering & Minkowski ‘s studies in 1889 demonstrated that dogs can be made diabetic by pancreatectomy. After 30 years of tiring work Banting & best were able to produce extract from dog pancreas which was capable of reducing elevated blood glucose level.

1939 à Hagedorn introduced the first long acting insulin.

1953 à structure of OX insulin established by Sanger

1955à experimental work lead to accidental discovery of hypoglycaemic action of Carbutamide

1960 à Nicol and Smith described the structure of Human insulin

1964à Katsoyannis and Zahn synthesised both A and B chains of insulin

1967 à Steiner described large proinsulin molecule which is not biologically active but is converted to biologically active substance by enzymatic action.

Note - i would like to place on record my heartfelt gratitude to Upadhayay and Mrs D.Upadhyay for their article "A few facts of historical interest relating to Diabetes Mellitus" published in Indian journal of history of science published in 1987.