HISTORY OF NEUROLOGY
An Early Description of Painful Neuropathy
in Hittite Tablets
Èerefnur Öztürk, MD
S
N
europathic pain occurs with many illnesses but is particularly typical of diabetic neu-
ropathy. Neuropathy affects approximately one third of diabetic patients, and 11%
to 20% of diabetic neuropathies are painful.1
A very early report, likely the first, of pos-
sible painful diabetic neuropathy is found
in a Hittite tablet dating from approxi-
mately 1250 BC. The text recounts a de-
scription by Queen Putuhepa of her hus-
band, Hattushili III, who ascended to the
throne in 1275 BC. Queen Putuhepa made
frequent offerings to the gods and god-
desses to restore her husband, who had
chronically poor health, and in one rec-
ord she said, “If my Sun is cured from the
fire that burns his feet, I will give a golden
cup with a handle of lapis lazuli to God-
dess Ningal.”2(p145) The tablets also state
that the king could not attend his daugh-
ter’s wedding because of his burning feet.2
Peripheral nerves were described by
Pythagoras (570-500 BC),3 and the con-
cept of nerve diseases appeared in Greek
and Roman texts between 1000 and 100 BC.4
However, the medical heritage of the Sum-
ers of Mesopotamia, who occupied the
heartland between the Tigris and Eu-
phrates rivers as early as 3600 BC, is far less
known. Most important of the few remain-
ing medical documents from this period are
a series of cuneiform clay tablets contain-
ing stories of the royal family and also thera-
peutic admonitions and remedies.5,6 These
Hittite and Sumer documents have been
found mainly in Anatolia and record the
medical concepts of the Hittite kings. The
Turkish archaeologist Muazzez Ilmiye Cig
was the primary translator2 of these tab-
lets, including the story cited previously.
Hattushili III’s chronic illness dating from
Author Affiliations: Department of Neurology, Ankara Numune Research and
Teaching Hospital, Ankara, Turkey.
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childhood and the prominent burning dys-
esthesias evoke the clinical picture of dia-
betes mellitus with neuropathic complica-
tions. Although no other information is
available from these fragmentary medical
references, the impact of the patient’s medi-
cal problem is captured with modernity.
The extravagant offering of gold and the
most valuable jewels blanches beside the
heartrending detail that the pain was suf-
ficiently disabling to prevent the king from
witnessing his own daughter’s wedding.
Accepted for Publication: February 9,
2005.
Correspondence: ÈSerefnur Öztürk, MD,
Ankara Numune Eğitim ve Araştirma
Hastanesi 1, Nörologi Kliniği, Sıhhiye-
Ankara, Turkey (serefnur.ozturk@noroloji
.org.tr).
REFERENCES
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Istanbul, Turkey: Analiz Basım Yayın Tasarım Uygulama LTD
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ÈTİ; 2000:143-151.
3. Brean A. The brothers of Jumiege: the peripheral nervous
system in early French mythology [in Norwegian]. Tidsskr
Nor Laegeforen. 2002;122:789-791.
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1998;5:23A.
5. Bryce T. The Kingdom of the Hittites. Oxford, England: Ox-
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