International Journal of Dermatology Volume 14 Issue 5 1975 [Doi 10.1111%2fj.1365-4362.1975.Tb00127.x] Samuel x. Radbill -- Pediatric Dermatology in Antiquity- Part 1

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Reminiscenc

PEDIATRIC DERMATOLOGY IN ANTIQUITY

PART

M od er n derti-iatology becam e a spe-

cialty in relatively recent times, as did

pediatr ics. No w pediatr ics is being fur-

derm atolog y. Evidence of

know of no ref-

diseases exc lusively . O n rare occa-

inci -

dom ain of the m idw ife. Af f l ic t ions

The oldest medical text known today is

sop otam ia. It is a cuneifort-n phar-

ny salves and lo tion s are lis ted , as

e ll as oth er kinds of top ica l ret-nedies

The instruct ions g iven for compound-

der wi th kush urnm a wine and to

SAMUEL X. RADBILL, M.D

Honorary Librarian. The College o

Physicians of Philadelphi

Philadelphia. Pennsylvani

t ions the powder was to be kneaded in

water and honey, one of the earliest ref

erences to the use of honey in an oint

ment. A soap for external application is

also among the medicaments described

Unfortunately, the text does not desig

nate any disease for which these reme

dies are to be used,' but it seems likely

that if the remedies were used for adults

they were also used for chi ldren.

There are other Mesopotamian med

ical tablets which mention skin-related

condit ions such as i tching, leprosy, im-

petigo, erysipelas and jaundice, or a

least what has been interpreted to mean

these. Among words with special cu-

taneous significance are skin, nails, per-

spirat ion, hair, beard, and even melan-

otic nevus (pigmented moles), all of

which could well relate to chi ldren as

well as to adults.

Specifically in the newborn are re-

corded the vernix caseosa and some

congenital skin anomalies. These were

mentioned in the many birth omina2 by

which the soothsayers predicted the fu-

ture.

Discolorations and eruptions in the

newborn were used by the prognostica-

tors to for ete ll events. Every ne w bo rn

child was examined by these wizards.

They not only forecast the fate of the

child but also the future of the world



364

INTERNATIONAL JOURNAL OF DERMATOLOCY June 1975

Vol.

people th ink th is spo t ted ev i l i nd i -

cated congenital syphil is, but all rashes

were evi l to the ancients. To them

rashes were manifestations of inner cor-

rupt ion breaking for th f rom wi th in the

body through the

skin,

and th is corrup-

tion or evil was equated with sin against

the gods. Corrupt ion, evi l or sin could

affect not only the individual in whom

they originate but also those about him

they could spread abroad. From such

reasoning, perhaps, proceeded the dread

of ca lamity spreading throughout the

co m m un ity. Uncleanness and sin, evi l

and death were all associated with ideas

of contagion and heredity.

gypt

The most prol i f ic source of dermato-

logical Information to come out of

ancient Egypt is the Ebers Papyrus, a

medical encyclopedia about 3000 years

old compi led f rom the accumulated

knowledge of many previous centuries.

Civi l izat ion was wel l advanced by that

t ime and physicians were growing quite

sophist icated.

External manifestations of disease,

being visible to the naked eye, attracted

a large part of their attent ion; skin dis-

eases were very prevalent among the

ancients. Therefore, it is not surprising

that they recorded in the Ebers Papyrus

condit ions such as swel l ings, tumors,

alopecia and eruptions on the scalp. Pre-

scr ipt ions were provided for growing

hair, for de pilatories and hair dyes. Also

described on the face were freckles,

wr ink les, b lotches; on the body were

moles, pustules, ulcers, swell ings, fetid

suppurations, eczema, scabies, boils, car-

buncles; the ancients also described

burns, sweating feet and fall ing nails.

so great that he was called to Greec

consultation.-^ But even tho ug h s pe

references occur in the Ebers Papyru

various pediatr ic problems such as c

and bedwett ing, there is no age d

entiation in regard to cutaneous disea

India

Some authori t ies bel ieve that the

das,

the sacred books of the Hindus

back in t im e at least 6000 years. D i

ent kinds of healers are mentioned e

in the oldest of the books, and chi l

receive a fair share of atte ntio n in t

all .

In the Atharva-Ve da the prayers

chi ldren include one for heal ing

j

d ice,

and another used to prevent

lucky marks, probably bir thmarks.

The Puranas dictate that a man sh

marry a maid only one third of his

This work st ipu lates, dermatologic

that she be not too hairy, not have b

or yel low complexion, nor have a b

or other masculine characteristic, nor

covered w ith hair. Ch i ld marr iages w

the rule . It was the du ty of a fathe

brothers to f ind a husband for a

before she attained the age of pub

Important medical works were wr

in ancient India, but there is much

agreement about how old they are.

most outstanding are the works of

authori t ies, the Charaka Samhita and

Susruta Samhita. The latter, cit ing

gers to an unexpected

ch i ld ,

warns

gravid woman not to anoint her b

lest her child be a leper, not to pare

nails lest the c hild have bad nails. A

it was born, the infant was cleansed

linen pad soaked in clarif ied butter

a special sesame oil preparation was

pl ied to i ts head; or else an emol

preparat ion was rubbed on the ba



No 5

HISTORY Radbill

3

as the infusion of the bark of Kshin trees,

or a deco ction of a fragrant m edic am ent

called sarv aga nd ha, or with water in

which red-hot gold or silver had been

immersed; or simply a decoction of

some herbs.

Obviously the economic and social

status of the father had some bearing on

xactly what was used, and so would the

egion in which the child lived, the sea-

f the child and oth er factors. M ustard

to fumigate the child's body . Many

In choosing a wet nurse, Susruta stip-

led yau van a-pid aka has been inter-

Children were subject to erysipelas,

In som e cases it ap pe are d at the

In othe rs it com m enc ed on the

Diaper rash was called ah ipu tan a.

purulent discharge because of the c

stant scratching. This eczema (vra

soon spread and could prove obstin

In treatment, the milk of the mot

or nurse had to be purified by diet

other means, because the nursing wo

an's blood was full of impurities ac

mulated after nine months or more wi

out the purification of menstruation, a

milk was believed to be merely alte

blo od . Treating the sick child by w

of the child's nurse, therefore, was sta

ard practice throughout the ages.

Local treatment was also practic

universally in India. Salves with but

as a base and lotions were reco

mended by Susruta in conjunction w

the triph ala gro up of drugs that po

sessed particular virtues in healing sk

diseases. Plasters and dusting powde

were likewise Included in the medic

armamentarium, the latter especial

for intertrigo of the groin and scrotu

(vrishana) so common in the torrid c

mate of the low regions of India.

The Hindus were firm believers in h

redity. Susruta said that the black an

wh ite ku sh tha (skin diseases du e

heredity), we re impossible to cure. H

also stated that offspring born to me

and women with severe kushtha wou

also have kushtha. Then there we re

diseases that came from unlucky sta

(graha), one of which caused the chil

to be covered with ulcerations or

burning eruption with vesicles that bur

and suppurated. Treatment of disease

caused by the malignant influence of un

lucky stars included use of incense, fum

gations, libations, amulets and prayers.

Charaka covered much of the sam

groun d that Susruta did. He is sup po se

to have lived before Susruta. There i



366

INTERNATIONAL lOURNAL OF DERMATOLOGY June 1975

Vol.

Another medical treatise from about

200 A.D., entitled Nav anitaka was dis-

cov ered by Bower in 1890. Thereafter

designated the Bower Manuscript, i t

deals with child ren. It m entio ns ring-

worm, leukoderma, eczema and diseases

of the skin in general, with directions for

treatm ent. Thu s: In the case of ring-

worm, skin diseases, leukoderma, ec-

zema, psoriasis, and in short, in all dis-

eases which have their seat in the skin,

the physician should give a pill made

with the powders of kampilya

{malleotus

Phillippinensis),

and afterwards smear

the patient with powders of gudika

{arbus precatorius)

rubbed into a paste

with mustard oil , and douche with cow's

urine in a tepid state, or with the juice of

Khadira

{acacia catechu),

or with a de-

coc tion of num. * Else wh ere: If disc ol-

ored round spots appear on the body of

a child, the physician should apply plas-

ters made of pastes of the set of 10 roots,

mixed with clarified butter, or of pastes

of Punarnava

{Boerhaavia diffusa),

or of

liquorice; he should also give to the

child frequent douches of tepid water.' '

If boils appear on a child's body and

a sensation of burning, it should be

treated with cold decoctions made of

butter and sweet drugs. Further, powder

of parpataka

{oldenlandia corymb osa),

usiva

{andropogon muricatus)

and red

ochreequal parts taken of all these and

rubbed into a paste make a beneficial

ointment. Saugandhika

{andropogon

muricatus), sugar and filaments of white

lotus,

also sandal and madder make an

ointm ent for children. Sugar water, bi-

valve shells, conch shell, sadvala {cyno-

don dactylon)

and vetasa

calamus ro-

tang)

a p laster m ad e up of the se is a

remedy against boils. ^

of the patients probably had lepr

Excessive hairiness in children was

work of a de m on . O ne of the evil sp

mentioned in Avesta was described a

bird covered with spots. This imag

has been interpreted as an allusion

the evils of eruptive diseases.'

Israel

From the story of Jacob and

spotted cattle in the Bible it is evid

that the Hebrews, like their neighb

were strong believers in maternal in

enc es on the un bo rn child. So, fr

time immemorial, birthmarks were

tributed to prenatal influences, usu

with some blame on the mother.

As soon as the baby was born it

washed. The name of one of the m

wives wh o at tende d the newborn M o

was Shiphrah, a Hebrew name deri

from the wo rd m ean ing to clean. It w

the midwife's duty to wash and clea

the newborn infant of the impuri

clinging to it after birth in the form

the vernix, blood and amniotic remna

Ezekiel describes an exposed infant,

washed, unsalted and polluted in its o

bloo d. He indirectly informed us t

the newborn had to be washed in wa

to make its skin supple, then salted

swaddled.

The salting, part of the cleansing pr

ess,

was also intended to toughen

skin. Nitre, m en tion ed allegorically

Jeremiah, was the salt used, and so

soap. Nitre denoted native soda, an

pure form of sodium sesquicarbon

and a fairly goo d d ete rg en t. Salt, wh

was emblematic of durability, perm

nence and vitality, was also used

healing.

Subs equen tly, wh en it was bathed ,

child was well oiled to give skin and h



No. 5

HISTORY Radbill

367

nificance. Being indicative of joy and

gladness, anointing was not used as a

sign of sorrow or hu m il iat io n. Oils we re

used to make ointm ents. They form ed

so im po rtan t a part of me dical practice

that the apothecary mentioned in the

Bible, as w el l as the phy sician, w h o made

up these remedies, were recognized

practit ioners of healing in ancient Israel.

The curious bel ief, common to al-

most al l pr imit ives, that the menstruat ing

woman was dangerous to those around

her led to the prohibit ion of intercourse

w ith her at the t im e of her pe riod . The

effect of cohabit ing with a menstruat ing

woman was that the infant born of this

un ion wo uld deve lop zaraath , a re-

pulsive aff l ict ion character ized by cu-

leprosy. If the coitus took place on the

In the Hippocratic writ ings, at least 6

h throa t disease. It also

In A ph or ism 111:26 ch ild re n be yo nd

not to be regarded as an apo stas is,

but as a disease; but when they set in

rank and suddenly, then they are an

apostasis.

While there is some uncertainty abou

this word apostasis, Hippocrates called a

distemper an apostasis by excretion in

which the distempered humors passed

off by way of some body outlet, presum-

ably by the pores of the skin. In his

Book on Epidemics we can see the im-

portance he attached to apostasis of the

skin in children when he states that

cough, intest inal disorders and continu-

ous fever could lead to the outbreak of

small ulcers on the lower part of the

body. Wh en roun d and deep, these ul -

cers were associated with serious danger

in small infants.^

Leuke, he said, also arises from the

most fatal diseases, such as the one

called phthisis. But leprosy and lichen

are associated with black bile. These dis-

orders are more easily cured, the more

recent they are and the younger the

patients and the more soft and fleshy

the parts of the body in which they

occur . '

It is not clear what Hippocrates had in-

mind here when he mentions leprosy,

l ichen and leuke . Lepra referred to any

scaly rash; leuke, or alphos as the Greeks

also said, was considered by many schol-

ars to be a for m of leprosy or it may

have been some form of vi t i l ig o. As for

l ichen,

it has been variously translated as

a tet ter or r ingworm.

Plato, a conte mp orary of Hippoc rates,

in one of his dialogues discussed skin,

hair and nails. In a passage on disease

he expressed the general view of his

time that leuca, alpha and associated dis-

eases arise from bubbles of phlegm,

phlegm being one of the four humors.



368

INTERNATIONAL JOURNAL OF DERMATOLOGY June 1975

Vol .

specific dermatosis. As for he rpes, the

cree ping disease, a w or d used in m ed i-

cine for at least 25 centuries, its meaning

original ly was entirely di f ferent from

wha t it is now . In ancient t imes the term

was applied to spreading cutaneous, usu-

al ly ulcerat ive, lesions.' W hile the H ip-

pocrat ic terminology has been changed

in meaning, it has endured. Through it

the background was established for the

vast tapestry of all descriptive dermato-

logical nosography up to now.

Aristotle, a pupil of Plato, in his His-

tory of Animals mentioned akari (mean-

ing small or tiny) as a kind of tiny

animal , but today we apply this term

acarus to the m ite of scabies. A risto tle

also described lice, fleas and bedbugs

as well as nits, all of which were and

st i l l are common problems of ch i ldhood.

Samuel Taylor Coleridge (1772-1834) re-

called that while he was a friendless,

half-starved poor orphan at Christ 's Hos-

pital he was overtreated with sulfur oint-

men t for the itch by one of the da m es

at the school, an experience he never

forgot .

Returning to Hippocrates, in the Book

of Epidemics there is the suggestion of

urticaria in his statement about diseases

in the form of dysenteries, tenesmus,

lienteries a nd flux. He says tha t small

rashes occurred in severe disease and

quickly disappeared. I tching was not

mentioned; he may have been referr ing

to the rose spots seen in typhoid fever.

Hippocrates went on to say these dis-

eases were especially fatal to infants just

weaned and to older chi ldren unti l 8 or

10 years.

While on the topic of swell ings in his

Book of Epidemics, Hippocrates related

the case of the son of Timonax who,

when about 2 months old, had an erup-

died.**

Without modern d iagnost ic a

it is impossible to make a definit ive

d

nosis but cl inically one would have

think of some fatal form of septicem

possibly meningococcic.

While Hippocrates certainly called

tent ion to cutaneous condit ions in

c

dren,

it is diff icult to pin down

precise diagnosis. In antiquity der

tology was restricted largely to clin

observat ion. Morphological and pat

logical labels were applied to transmit

image; condit ions were described

analogy and m eta ph or. Scales were le

and so we re psora w he n they itch ed

swell ing was tumor or phyma; in the

ter case the swell ing was small and m

or might not suppurate. The thicken

wrinkled skin of the leper, which look

to them l ike that of a pachyderm, w

called elephantiasis.

While the Greeks appl ied the te

exanthemata to efflorescences or er

tions of various sorts, we apply this te

mainly to the eruptive diseases of ch

hood .

Herpes, lepra, psora, l ichen a

the l ike are far more l imited in th

application today than they were in

t ime of Hippocrates.

References

1. Kram er, S. N., From the Tablets of Su

Indian Hil ls, Colorado, Falcon Wings Pr

1956, p. 57.

2.

De nne fel, L., Babylonisch-Assyrische Ge bu

Om ina. Leipzig, 1914.

3. Fox, H., De rma tology of the ancients. JA

65:470, 1915.

4. Richter, P., Geschichte der Dermatolo

1928,

p. 16.

5. Bh ishagralna , K. K., An English Tra nslation

Ihe Sushruta Samhita. Varanesi, 1963, p. 1

6. H oe rnle , A. F. R., The Bower M anu scrip t.

Archeological Survey of India, New Impe

Series. Calcutta, 1909. Vol. XXII.

7. Rosenthal, R., P ersonal co m m un ica t

1970.

8. G hin op ou lo, S., Paediatre in Hellas

International Journal of Dermatology Volume 14 Issue 5 1975 [Doi 10.1111%2fj.1365-4362.1975.Tb00127.x] Samuel x. Radbill -- Pediatric Dermatology in Antiquity- Part 1

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