Nephrol Dial Transplant (1996) 11: 969-975 Special Feature Nephrology Dialysis Transplantation The history of salt—aspects of interest to the nephrologist E. Ritz Department of Internal Medicine, Ruperto Carola University, Heidelberg, Germany neophyte as a symbol that wisdom is acquired. This habit goes back to a pre-Christian Roman custom. The stimulating flavour of salt was metaphorically When one reads current literature on salt, one is amazed by the emotional energies released by this applied to a tale or discourse. To be without 'salt' was issue. Why is this so? Undoubtedly much of the meant to indicate that something was insipid—based controversy is simply due to the fact that there is much on the concept that salt was an essential element, so poor science in this field. Some of it may also be that to be insipid and without salt indicated that explained, however, by the fact that in the past salt something essential was lacking. It was claimed, not without some justification, that profoundly influenced human thinking and life style in a way which is no longer properly appreciated today, salt promoted libido and potency. According to the now that salt has become an easily available commod- legend Venus was born in the salty sea (Venus saligena) ity. Even today, perhaps subconsciously, salt has not as depicted in the painting of Sandro Boticelli yet become an emotionally 'neutral' substance—no (Figure 1). There may be an even more amusing doubt a remnant of the profound symbolic significance explanation, however, for this specific custom of attached to salt for millenia. depicting Venus riding on a clam in the sea: the female vulva was considered to be impure and consequently called 'porcella', derived from 'porcus', the Latin word for pig. For obvious reasons, clams were called porThe symbolic value of salt cella. This usage explains also the origin of the word Salt had both positive and negative symbolic connota- porcelain. When Chinese porcelain was introduced into tions from time immemorial. Salt is white, immaculate, Northern Italy, a parallel was drawn between the uncorruptible and imperishable, according to an iridescent hue of porcelain vessels and that of clams. Arabian proverb 'salt is not worm-eaten'. As a con- This led to their designation as porcellano. sequence it was a symbol of immutability. It played a Nevertheless, for folklore salt is strongly linked to role in the rites of ratifying compacts and sealing sexuality. This is illustrated for instance by a custom covenants (e.g. Num. 18 19; 2 Chr. 13, 5). Its durability of Bavarians (who are never too subtle) to put salt and its immunity to decay made it an emblem of into the bride's bed. And in Shakespeare's The Merry immortality. Salt was also a symbol of immutable Wives of Windsor we read 'We have some salt of our loyalty, as illustrated by the ancient custom, particu- youth in us'. larly in Slavic countries, to share bread and salt with Salt was said to promote health. The Latin words the guest. for health and healthy, salus and salubris, are actually As a reflection of its bacteriostatic properties related derived from sal (salt). Today few Frenchmen will to osmolality and ionic strength, salt was considered think of salt when greeting each other—but the word to have healing properties. The prophet Elisha made 'salut' is derived from salt as well. Although salt was felt to be indispensible for health, the foul water of Jericho potable by using salt (2 Kings 2, 19-22). Salt was felt to be indispensible for life: the wise ancient Chinese remained sceptical. The according to the East Gothic king Theoderich (6th famous Yellow Emperor wrote approximately 3000 BC century) 'one can do without gold, but not without 'If too much salt is used in food, the pulse hardens, salt'. Salt was therefore added to the sacrificial offerings tears make their appearance and the complexion as repeatedly alluded to in the Old Testament (Lev. 2, changes'. 13; Ex. 30, 35; Ezek. 43, 24). In the New Testament, Salt was a precious commodity. In many cultures it Christ when referring to his apostles stated (Mt 5, 13, was the equivalent of money. In ancient Rome, soldiers 14) 'Ye are the salt of the earth: but if the salt has lost and officials were reimbursed in the form of a 'salarium' his savour, wherewith shall it be salted?. Salt was, and i.e. salt money—from which our word salary is derived. still is, used by the Catholic church during the cere- Salt was a symbol for exquisite value; St Jerome mony of baptism: salt is put upon the tongue of the referred to Christ as the 'true salt'. Introduction © 1996 European Dialysis and Transplant Association-European Renal Association 970 E. Ritz Fig. 2. The last supper (Cenacolo) by Leonardo da Vinci (1452-1519). Detail reproduced from a copy (Norbertijenenabdij, Tongerlo/Antwerpen), which shows the knocked-over salt shaker as a symbol of imminent disaster. After B. Loffler, in ref [5]. (By permission, Da Vinci Museum, Norbertijnenabdij, Tongerlo, Belgium.) Fig. 1. Primavera by Sandro Boticelli (1445-1510). The painting is an example of the motif of 'Venus Saligena' (see text). The symbolism of salt had also negative connotations. In biblical times salt was sown over the territory of defeated and destroyed cities. Salt was felt 'to belong to the realm of the evil, the deadly desert, the land of sin, i.e. Sodom and Gomorrah'—one of the justifications for the custom of the church to subject salt to exorcism, i.e. expelling the devil prior to its liturgical use. Even in this century Bavarian farmers still put salt into the hat brim to ward off evil. On the other hand, spilling salt at the table was considered a bad omen. In the famous 'Cenacolo' by Leonardo da Vinci (1496/97) in Santa Maria della Grazia (Milano) the knocked-over salt shaker symbolizes the imminent treason of Judas and the suffering of Jesus Christ (Figure 2). Ambivalence towards salt is also reflected by the statement 'take it with a grain of salt', indicating that something is to be taken with a healthy dose of scepticism. How did societies cope with lack of salt? Salt hunger is well known in the animal kingdom. As early as 1884, Manley wrote: The 'universal existence of an appetite for salt surely indicates that the sub- stance serves more important functions than that of merely gratifying the palate'. With very good arguments it has been assumed that one of the reasons why some species could be bred as domestic animals was that their ancestors living in the wild were attracted to human settlements by the salt content of human urine. This notion is also supported by some amusing observations, e.g. from British Columbia, where porcupines gnawed at the veranda posts of cottages which had been soaked with urine after they had been misused as substitutes for urinals; or reports from Australia where rabbits and kangaroos chewed away pales impregnated with salt. Every mountaineer knows that mountain goats are attracted by sweat soaked, i.e. saltimpregnated, pullovers which they will lick. Monkeys groom not to hunt for fleas, but rather to search for skin secretions containing salt. Grooming becomes more intense when salt is put on the fur. It is also of note that in the past many mineral springs were discovered by animals. In Germany, examples include the famous stag of the 'Teinacher Hirschquelle' or the pig (Salzsau) which discovered the salt water fountain of Liineburg upon which the immense wealth of this city was based. Salt deposits in Hall/Tirol were discovered when hunters noted that saline rock was used as salt licks by chamois. Is there evidence of salt deficiency in animals? Salt deficiency occurs usually in regions remote from the sea. It is not noted in carnivorous animals (which have a supply of sodium from the extracellular fluid of their prey), but occurs in herbivores. Lack of additional salt is not a physical handicap under normal conditions; nevertheless it can lead to a severe sodium deficit, The history of salt when additional stress such as diarrhoea, vomiting, or profuse sweating supervenes. Salt deficiency imposes a handicap in selection: speed and endurance are diminished when animals are hunted by predators; thermoregulation is disturbed and fertility is reduced. The relation between salt intake and fertility in herbivorous animals was well known to our ancestors. Compared to 5-7 g/day of salt intake that is recommended for the human diet, the recommended diet for a heifer is 25 g and that for a lactating cow no less than 90 g. This fact explains the very high salt demand in alpine countries, e.g. Switzerland, in the middle ages—a problem which had important implications for trade and politics. Do salt deficiency and salt appetite also occur in humans? It is very illuminating to note the desperate efforts humans made to acquire salt when they hade to live under conditions conducive to salt deficiency. The Venetian Ca de Mosto explored the West African coast in 1455/56 and wrote: 'At certain times in the year heat is there so oppressive that blood decomposes and starts to rot, so that (the natives) would die without salt' and a little later Valentin Fernandez, who explored the Senegal in 1506, wrote 'The chiefs trade more gold for salt than for anything else. They need salt for their cattle and for themselves. They state that without salt neither they nor their cattle will survive and prosper'. In Africa salt was traded for gold on the basis of 1:1. Lack of salt was also one element contributing to the development of the slave trade. In the interior of the continent children were sold into slavery for salt; in Sierra Leone and in Central Africa it has been documented that the natives even gave their wives and children away for salt. Enormous efforts were made to transport salt across thousands of kilometers by caravans into the interior of the continent. Some investigators ascribed cannibalism, at least in part, to the drive to satisfy the salt appetite. When did the need arise to add salt to food? Addition of salt to food was unknown to huntergatherers and this notion is well supported by more recent anthropological studies in New Guinea. The need to add salt arose when agriculture was introduced in the fertile crescent and Anatolia, leading to a largely vegetarian diet. In agreement with this idea linguistic studies provide further evidence that the use of salt was unknown to hunter-gatherers prior to the introduction of agriculture; for example ancient Asian languages do not have a word for salt. Sources of salt throughout history How was the needfor salt met? Some populations satisfied their need for salt by cannibalism (see above), others by drinking milk (e.g. the Kirgises and Numidians), others by drinking from 971 saline sources (e.g. Arabian Bedouins) or by drinking animal blood and animal urine (e.g. the Massai in East Africa). Such unaesthetic and uneconomical procedures illustrate the lengths to which humans may be prepared to go in order to gain access to salt. The intensity of salt hunger in some primitive societies is also illustrated by several laborious low-yield techniques of salt production, e.g. burning of saliferous herbs (in Neolithic England, contemporaneously documented in New Guinea and the Amazon basin), and drying and burning of seaweed (Faroe Islands) etc. The poorer classes burned plants or wood in 'pots' in order to obtain plant ash, i.e. potash (Potasche in German) as an alternative to the expensive salt. The word 'potassium' for the element K is derived from potash. Apart from such minor techniques of salt production, the three main sources of salt were: (i) sea salt obtained through evaporation of salt water in salt pans (ii) mining of rock salt, and (in) heating of the brine of salterns (this procedure gave rise to the German word 'Kochsalz'). The important role of salt production and salt trade is well illustrated by linguistic studies. In Indogermanic languages two roots for the word salt exist: one is equivalent to the Latin 'sal', sel in French, sale in Italian, sal in Spanish, Salz in German, salt in English and in the Scandinavian languages, soli in old Slavic. This word was also adopted in the nonIndo-European languages of Hungarian and Finnish. The other is represented by Greek 'hal' (ok)—which is of course going back to the same root—hall in Protokeltic, halen, haloin and holen in the Gaelic languages, al in Iranian, alt in Armenien and halicz in Ukrainian. The extreme value of salt is illustrated by the fact that many city names are derived from the radical 'sal': Salzburg in Austria (whose founder, Sant Rupert, is depicted with the salt vat), Salzkotten in Prussia, Salzuflen in Westfalia, Langensalza in Thuringia, Saltcotes in Scotland, Sulz/Neckar, Sulzbach, Sulzbrunn, Sulztal (from sulze, the Germanic word for brine). The name of the city Hall (today Schwabisch Hall) is derived from Celtic hal. Hall, an independent imperial city (Freie Reichsstadt) was so prosperous that it had the privilege of minting its own coinage, the so-called 'Heller', which was accepted throughout the German empire and is still well known in folklore. Further examples include Friedrichshall/Kocher, Hall/Tirol, Halle/Saale (a University town also called 'Salt-Athens'), Hallstatt/Salzburg (after which an entire prehistoric period is called: 'the Hallstatt period'), Hallein/Salzburg, Reichenhall/Bavaria. The distinction between Hallein (the diminutive) in Salzburg and Reichenhall (the rich Hall) in Bavaria, is evidence of medieval marketing techniques: one tried to create the impression that the salt of Hallein was of inferior quality compared to the rich salt of Reichenhall. The river Halys (famous through the prophecy of the Pythia to Croesus) also derives its name from hal. 972 English towns linked to salterns can be recognized by the suffix 'wich', e.g. Sandwich, Ipswich, etc. Similarly Soden Germany and Solnice in Czechoslovakia derive their the names from 'sot', to 'boil'. Tuzla in Bosnia (of dubious fame in recent years) also derives its name from tuz, the Turkish word for salt. The high commercial value of salt is reflected by the fact that enormous efforts were made to transport it to the customer. Ancient Rome had special salt streets (via salaria) which were taken care of by salt officials (salarii). The city of Munich owes its origin to salt trading: the bishop of Freising was collecting duty on salt transports in Fohringen; Henry the Lion (Heinrich der Lowe), then Duke of Bavaria, destroyed the Fohringen bridge and founded Munich a few miles upstream in order to collect duty from salt for his treasury. Another example is the 'golden staircase' (Goldene Steig), a path along which large quantities of salt were laboriously transported by mule tracks from Passau/Bavaria across the mountains of the Bohmer Wald to Prachatice/Bohemia. The first tunnel in the Alps, Monte Viso, was built in 1480 to transport salt from Provence into Savoy. Even earlier, in 1298, the Elbe-Trave canal with 17 locks and covering a distance of 94 km was built to ship salt from Liineburg to Liibeck in order to meet the high demand for salt in Liibeck and the Hanseatic League to produce pickled herring. The Latin word for herring, alecium, is said to be derived from hal. Let us return to the issue of salt production. In more southern countries, Mediterranean and Southern Atlantic, salt was produced by evaporation of sea water in salt pans: sea water was run into basins, the salt concentration increased by evaporation and finally salt would precipitate in crystalline form. In Northern countries, heat from the sun was not sufficient for this process. Salt production required heating brine or seawater, e.g. sel de briquetage in Normandy or brenna-salt in Scandinavia. An alternative was the burning of peat soaked in sea water. The 'peaty' taste of Dutch herrings was a sales-promoting gimmick similar to the 'peaty' taste of some whiskies from West Scotland. Until the 17th century, in central Europe salt was almost exclusively produced in salterns e.g. in Luneburg, Hall/Kocher, Reichenhall etc. Brine, with a salt content of 10-25% (compared to 3.5% in sea water) was heated in pans until salt precipitated and could be collected. This process required enormous quantities of wood. Mining of rock salt was known in the early Iron Age. In 1846 graves with rich gifts ranging from Baltic amber to Egyptian fayence, were discovered in Hallstatt close to Salzburg—an impressive documentation of the high market value of salt in those days. The mining shafts extended over a length of several kilometres and penetrated to a depth of 300 m into the mountain. In Roman times mining of rock salt was abandoned because the salt pans in the E. Ritz Mediterranean supplied sufficient salt for the entire Roman empire. Salt from Palestine was one of the sources of wealth of King Herod. It was only after the collapse of the Roman empire that salt became a scarce item again, and the market value of salt increased dramatically. In ancient Rome salt had been a necessary but not exorbitantly expensive item: a lazy slave was referred to as 'bought with salt', i.e. for next to nothing. It was not until the 16th century that mining of salt was resumed, when exploitation of the rich salt deposits in Wieliczka (close to Cracow in Poland) began. Massive expansion of mining occurred under August the Strong (August der Starke) of Saxony, then also king of Poland, with the help of Saxon miners. The regions of salt production and of high salt demand did not coincide. As a consequence salt trading became important. Salt, the 'white gold' was an object of high politics, comparable to oil in present times. In the early Middle Ages, Venice monopolized salt trading for a long time. Large amounts of salt were produced in the salt pans of Chioggia and Cervia in the Adriatic sea, but it was also imported from Alexandria, Cyprus, and the Balearic islands. Salt trade with Alexandria is illustrated by the legend of St Mark, today the local Saint of Venice, who gave his name to the Duomo San Marco (St Marc Cathedral) and Piazza San Marco (St Marc Square). In the 4th century his bones had been stolen from Alexandria and smuggled through customs, according to the legend 'hidden under salt and salt meat'. Pisa and Genoa imported their salt from Sardinia and Provence and delivered it across the Alpine passes into Switzerland. With the beginning of the 14th century salt was also produced South of the Bretagne on the Atlantic coast. This so-called bay salt was of inferior quality. Nevertheless, enormous quantities, up to 100000 tons per year, were bought by Dutch herring fishers. Until the 14th century the German Hanseatic League had monopolized trade in herrings, which were cured with salt from Luneburg. After the treaty of Straalsund (1372) Denmark opened the Sund and the cheaper though qualitatively inferior bay salt of Dutch merchants penetrated into the Baltic, and contributed to the decline of the Hanseatic League. Bay salt was first used for preservation of herring, but from the 16th century onward large quantities were also needed for the curing of cod caught in the rich Newfoundland fishing grounds. It is ironic that production of herring and cod was mainly restricted to the protestant countries of the North, while salted fish was predominantly consumed in the catholic countries of the South, where the catholic church insisted on abstinence from animal meat on Friday. In 1350 horsemen still had to transport fish on ice at a gallop from the Mediterranean to Avignon to allow the Pope to have his Friday fish meal. From the 16th century onward, even lesser catholics had ready access to (salted) fish, which unfortunately had to be supplied by the hostile protestants— according to Bergier 'trade between fools and dimwits'. The history of salt 973 /*/£/W Fig. 3. a Plans of a graduation house, and b view of a graduation house still in existence (after ref [7]). Brine was put on top of brushwoodcovered beams and gradually trickled downward. Water evaporated and the salt concentration was increased. 174 E. Ritz A great demand for salt resulted not only from fishing, predominantly in Holland and Scandinavia, but also from cattle breeding in the Alpine countries. Salt was needed for maximal yield of milk (which is sodium-containing extracellular fluid, if you wish), for the preservation of butter and cheese, for curing meat and for tanning hides. It is important to remember that in those days it was not possible to feed animals during winter. Animals had to be slaughtered in late autumn and their meat salted. Very early on the Swiss developed the art of doing business peacefully, while others bloodied their noses in wars. Food supplies for European armies, and from the 16th century onward of fleets as well, were dependent on the supply of salted meat and cheese from Switzerland. Switzerland imported salt from Venice, Salzburg, Bavaria, and Franche Comte. It was thus able to play off one supplier against the other and to achieve optimal prices—undoubtedly one important element in the origin of the dreaded Swiss business acumen. Production of salt—its role in the beginnings of modern industry and capitalism Salterns were forerunners of industrial production and capitalistic organization. They are therefore of great interest with respect to the history of economics and social sciences. At the end of the 16th century, salterns were confronted with an economic and an ecological crisis. Wood firing became uneconomical (i) because wood had to be transported over increasingly long distances, and (ii) because wages became prohibitive. An ecological crisis arose because gradually the forests in the vicinity of salterns had been cleared. This is not surprising since the production of one ton of salt required 1.5 tons of wood. The heath around Liineburg (Liineburger Heide), for romantic German poets the incarnation of untouched nature, is mainly the result of wood cutting to satisfy the voracious needs of the Ltineburg salterns. What measures led to a solution? Admirable technological efforts were made to rationalize salt production. The brine was transported to the wood instead of vice versa. After the forests around Reichenhall had been cut down, a pipeline was built to bring brine from Reichenhall to Traunstein which was then still surrounded by dense forests. The pipeline (Figure 4a) covered a distance of 33 km and with the use of sophisticated pumps (Figure 4b) elevations of more than 300 m were overcome. Fig. 4. a Part of a pipeline, built by Reiffenstuel and operating in 1619, that delivered brine from Reichenhall to the factory in Traunstein, 33 km distant, b Sophisticated water pump used on the pipeline. (After Ref [5].) 975 The history of salt The second technological advance concerned concentration of brine by evaporation in graduation houses. The ecologically compatible cost-free energies of sun and wind were harnessed to increase the salt concentration of brine from 20 to 60%, thus lowering wood consumption by 80%. Figure 4 shows a typical construction, 6-10 m in height and 100 m in length. The third technological advance concerned substitution of cheap coal for wood. This was introduced in Liverpool in 1770-71 after the saline sources of Cheshire had been discovered. This was one of the triggers of the industrial revolution in the Midlands. , Salt as a source of revenue and its role in the French revolution For peasants salt was indispensible because they were forced to use it for curing food and raising cattle. This state of affairs was a golden opportunity for taxation. It is little known that the salt tax, the so-called gabelle, was one of the factors that led to the French revolution in 1789. In India late as 1929-31, this tax still gave rise to a civil disobedience campaign under Mahatma Ghandi against the British. The word gabelle is related to Arabian quabala, hebraic gab, and Latin gabellum, the term for tax— equally unpleasant in all languages. Saracens in Sicily 'invented' the salt tax and in 1320 Philip le Bel was quick to introduce the gabelle as an indirect tax for the salt produced in the salt pans of Peccais, which were run as a royal monopoly. In this respect France was certainly not unique. Salt production for instance was also a royal monopoly in Bavaria, and in 1596 income from the salt tax amounted to two-fifths of the royal revenue and two-thirds of the revenue from customs. Before the French revolution, the salt price to the customer was 20 times higher than the production cost. Because of the gabelle no less than oneeighth of the yearly income of a peasant's family was spent on salt. Some regions in France were forced not only to pay the tax, but also to consume 9 kg of salt per head from the Royal salt stores (sel de devoir). The gabelle was particularly oppressive because it was so arbitrary: the gabelle was levied only in some regions of France, and not in others, for instance when Brittany joined France in 1550 it insisted on remaining exempt from the gabelle forever. This situation was bound to give rise to salt smuggling, which became so much of a problem that a special police force, the hated gabelous, was created to stop it. The force was entitled to enter and search private property for hidden salt and even undertook military action against the smugglers. The degree of oppression is illustrated by the fact that in the last year before the French revolution, 3500 citizens were sentenced to death or the galleys for salt smuggling. The French government had the wisdom to use not only police and military action, but also to summon the spiritual assistance of the church. In 1674, Collet in his treatise on moral theology wrote that 'for all Christians, smuggling of salt is a mortal sin'. He stated that 'flagrant injustice is done to the Faith by the licentiousness of salt smuggling, an accursed trade, which leads to neglect of the church and disregard of the holy sacraments'. Today the internal revenue office has less painful, but more efficient means of indirect taxation to extract money from citizens—undoubtedly an admirable testimony to continuous human progress. What salt intake is optimal? This historical survey shows that salt deficiency may undoubtedly exist in humans. The potential dangers of salt excess that have been recognized more recently must be balanced against it. In this contextfigureson salt consumption in historical times are of definite interest. What evidence is available? According to Pliny the Elder and Columella among ancient Romans 25 g salt per day were used in the cuisine of the patricians (in whose houses salt was kept in a salt box, the so called patella). Not all of the salt was consumed, however, since part of it was discarded with the cooking water. In France where salt was heavily taxed very detailed records are available from revenue offices. For instance in 1725 daily salt consumption in different districts subjected to the gabelle varied between 13 and 15 g. In regions with less taxation, consumption was presumably higher, but the evidence is somewhat conflicting. For instance, according to J. Waser, daily salt consumption in Baden (Switzerland), a region without cattle raising, was approximately 15.5 g. Similarly, in Zurich (Switzerland) 8.5 kg of salt per capita were consumed annually. In contrast, considerably higher salt consumption is documented in Scandinavian countries. According to Astrup as much as 50 g per person per day was consumed in Denmark, and Nils Alwall even estimated that in the 16th century daily consumption of salt in Sweden approached 100 g, mainly from salted fish and cured meat. What all these considerations show is that there is little room for fanaticism when making recommendations concerning optimal salt intake in healthy individuals. Furthermore, for the nephrologist, who is often forced to recommend reduced dietary intake of salt, it may be useful to consider that a long history has charged salt with emotional and symbolic connotations beyond what is supported by scientific evidence. References 1. Denton D. The Hunger for Salt. An anthropological, physiological and medical analysis. Springer-Verlag, Berlin, 1984 2. Hocquet 3C. Le Sel el le Pouvoir. De Van mil a la Revolution francaise. Editions Albin Michel S.A., Paris, 1985 3. Astrup P, Bie P, Engell HCH. Salt and Water in Culture and Medicine. Munksgaard, Copenhagen, 1993 4. Bergier JF. Die Geschichte vom Salz. Campus Verlag, Frankfurt, 1989 5. Trend, M, Jahn W, Brockhoff E. Salzmacht Geschichte. Aufsatze Haus der Bayerischen Geschichte. Verlag Dietrich Pustet, Regensburg, 1995 6. Adshead SAM. Salt and Civilisation. MacMillan, London, 1992 7. Mager J. Johann Gottfried Borlach. Technisches Halloren- und Salinemuseum, Heft 1, 1990
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