The period of antiquity was marked by the invention of writing and the development of the first great civilizations. Archaic ideas about supernatural components in the treatment of diseases were replaced by a more rational approach based not only on observations, but also on empirical experience. Soon the first medical treatises appeared.
While the treatises on the treatment of diseases of the bones and joints written by the founders of Western medicine (Hippocrates, Celsus, Galen), describe in detail how to treat fractures and dislocations, as well as the treatment of combat injuries, no work is devoted to rheumatic diseases.
Hippocrates first described the picture of acute joint syndrome (Fig. 3.1). He introduced the term «arthritis», formed from the merger of the Greek word «artrion» — joint and the ending «itis», indicating the possible inflammatory nature of the changes.
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Fig. 3.1. Hippocrates (460–370 BC) ancient Greek physician and philosopher
In addition to Hippocrates’ description of rheumatoid arthritis, it is worth noting that he gave the name «gout» (Greek for «foot trap»). Distinguishing gout from other forms of arthritis, Hippocrates believed that gout is «arthritis of the rich».
«It is incredible how quickly this leprosy is spreading», Hippocrates wrote more than 2300 years ago. «The father of Western medicine» in those days described such a disease as rheumatoid arthritis (RA).
The first descriptions of gout date back to the 5th century BC. Hippocrates described the clinical symptoms of gouty arthritis due to overeating and improper diet. Gout was called in medieval medical literature by the term «gutta», the Latin equivalent of the word «drop» of poison [1], which subsequently migrated almost unchanged to most languages of the romance group, which can be found in the works of the 16th century (F. Rabelais), and in modern languages of the romance group.
In addition, Hippocrates first discovered the link between arthritis and infection of the genitourinary tract, and the term «gout» referred to all cases of acute arthritis [2].
It is quite logical to ask the question why the apparent lack of interest in osteoarthritis as such? The short life span of ancient people may explain the logical lack of interest in age-related diseases. Life expectancy at that time was at a maximum of 30 years, and the life expectancy of men was longer than that of women.
Perhaps osteoarthritis, which develops in slaves and peasants in the process of hard work, could attract the attention of doctors at that time, but there are almost no written sources mentioning the work and life of these segments of the population. In the context of the problem under consideration, the interest in the life of a simple peasant would be important from the point of view of the influence of agriculture on the musculoskeletal system. However, the life of a simple peasant was not interesting for ancient and medieval chroniclers. Their lifestyle was not considered significant to record this story in the source. The data could have been accidentally obtained from the documents of the judicial and investigative authorities, if the peasants were engaged in any illegal actions. In this regard, anthropologists studying the degenerative pathology of the ancient period focus not on written but on archaeological sources.
Robert R. Paine, Rita Vargiu, Carla Signoretti & Alfredo Coppa estimate 71 burials (44 adult skeletons and 26 child skeletons) found in the San Donato and Bivio SN necropolises in Urbino, Italy. The age of the layer is dated to the 1st–3rd centuries AD. If you add an age estimate for the 25 cremations found in San Donato, the sample increases to 96 people, while the life expectancy of the studied human skeletons was 26.6 years.
Degenerative pathology was registered in the presence of hypertrophic osteophytes along the edge of the articular surfaces and macroporous lesions of the subchondral bone of the epiphyses (Jurmain, 1980). The Frequency of OA among other pathologies in men was 47% (average age 40 years) and for women 58% (average age 34 years). Female skeletons found in Urbino show higher levels of OA compared to men. The authors attribute this to the possible physical labor of young people, or to their socio-economic status.
The most affected in men were the hip joints, and the most common joint damage for women is osteoarthritis of the right shoulder. Osteoarthritis of the spine with marginal osteophytes and macroporous surfaces of the vertebral bodies usually occurred in the elderly and those who are engaged in hard work (Mann & Murphy, 1990). In most skeletal specimens, OA begins to appear around the age of 30 and was clearly defined in most adults by the age of 60 (Goodman & Martin, 2002). Adult skeletons from Urbino also had high rates of degenerative spinal pathology [4].
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Fig. 3.2. The knee joint of a 40-year-old man whose skeleton was found in Urbino. Dystrophic rearrangement was noted on the distal surface of the femur and the articular surface of the patella
Also noteworthy is the semi-arid North of Chile, which is difficult to attribute to the ancient culture, but nevertheless it is known for its well-preserved osteological collections spanning a period of at least 3000 years. The excavations (Biskupovic, 1999), which are thoroughly documented, helped to analyze many skeletal remains from different time periods. Among these collections, a more complete reconstruction is the Diaguita culture, discovered in the 1980s in Peñuelas (sector 21 and sector 24). At the same time, a conservation Protocol and conditions for registering skeletons were developed, which are available in the database at the Museo Arqueológico de La Serena. This database is actively used by anthropologists at the present time.
Skeletal remains were studied by Biskupovic (1982-1985) and Biskupovic and Ampuero (1989) from the coastal section of Peñuelas, which forms part of the semi-arid North of Chile. Further, the study by Maria Araya Rosado, Jessica Vernacchio-Wilson examined the skeletons of 41 people, where 10 male, 16 female and 15 undetermined sex skeletons were found.