MEDICINE IN ANCIENT MESOPOTAMIA
Historical Background
The name Mesopotamia (meaning "the land between
the rivers") refers to the geographic region which lies near the Tigris
and Euphrates Rivers and not to any particular civilization. In fact, over the
course of several millennia, many civilizations developed, collapsed, and were
replaced in this fertile region. The land of Mesopotamia is made fertile by the
irregular and often violent flooding of the Tigris and Euphrates Rivers. While
these floods aided agricultural endeavors by adding rich silt to the soil every
year, it took a tremendous amount of human labor to successfully irrigate the
land and to protect the young plants from the surging flood waters. Given the
combination of fertile soil and the need for organized human labor, perhaps it
is not surprising that the first civilization developed in Mesopotamia. The
origins of civilization can be traced to a group of people living in southern
Mesopotamia called the Sumerians. By c.3500 BCE, the Sumerians had developed
many of the features that characterized subsequent civilizations. Towns grew to
be cities, an early form of pictographic writing was used, metal working had
begun, and temples were built on a monumental scale. Generally speaking,
however, true civilization is said to have begun around 3100 BCE with the
development of cuneiform writing. Cuneiform was a system of writing established
by the Sumerians which required the use of a stylus in order to make
wedge-shaped marks on wet clay tablets, once the tablets were dry they could by
stored, transported, etc. After its development, cuneiform became the dominant
system of writing in Mesopotamia for over 2000 years. Even after Sumerian
became extinct as a spoken language, many other Near Eastern cultures continued
to write using cuneiform. As a result of its extensive use of several
centuries, many cuneiform tablets have survived. These tablets provide
historians with the opportunity to glimpse the culture of the ancient
Mesopotamian civilizations.
Mesopotamian Medicine: The Sources
Most of the information available to modern scholars
comes from cuneiform tablets. There are no useful pictorial representations
that have survived in ancient Mesopotamian art, nor has a significant amount of
skeletal material yet been analyzed. Unfortunately, while an abundance of
cuneiform tablets have survived from ancient Mesopotamia, relatively few are
concerned with medical issues. Many of the tablets that do mention medical
practices have survived from the library of Asshurbanipal, the last great king
of Assyria. The library of Asshurbanipal was housed in the king's palace at
Nineveh, and when the palace was burned by invaders, around 20,000 clay tablets
were baked (and thereby preserved) by the great fire. In the early 1920's, the
660 medical tablets from the library of Asshurbanipal were published by Cambell
Thompson. Other medical texts have been published more recently. For example,
Franz Kocher has published a series of volumes called Die
Babylonishch-Assyrische Medizin. The first four of these contain 420 tablets
found from sites other than Assurbanipal's library, including the library of a
medical practitioner (an asipu) from Neo-Assyrian Assur, as well as Middle
Assyrian and Middle Babylonian texts. The remaining two volumes of Kocher's
work augment Campbell Thompson, providing new joins of broken fragments and
much material uncovered in the British Museum. At least one more volume of
Nineveh texts has been announced. In addition, the series Spaet Babylonische
Texte aus Uruk contains some 30 medical texts not included in Kocher's work.
The vast majority of these tablets are prescriptions, but there are a few series
of tablets that contained entries that were directly related to one another,
and these have been labeled "treatises." The largest surviving such
medical treatise from ancient Mesopotamia is known as "Treatise of Medical
Diagnosis and Prognoses." The text of this treatise consists of 40 tablets
collected and studied by the French scholar R. Labat. Although the oldest
surviving copy of this treatise dates to around 1600 BCE, the information
contained in the text is an amalgamation of several centuries of Mesopotamian
medical knowledge. The diagnostic treatise is organized in head to toe order
with separate subsections covering convulsive disorders, gynecology and
pediatrics. It is unfortunate that the antiquated translations available at
present to the non-specialist make ancient Mesopotamian medical texts sound
like excerpts from a sorceror's handbook. In fact, as recent research is
showing, the descriptions of diseases contained in the diagnostic treatise
demonstrate a keen ability to observe and are usually astute. Virtually all
expected diseases can be found described in parts of the diagnostic treatise,
when those parts are fully preserved, as they are for neurology, fevers, worms
and flukes, VD and skin lesions. The medical texts are, moreover, essentially
rational, and some of the treatments, as for example those designed for
excessive bleeding (where all the plants mentioned can be easily identified),
are essentially the same as modern treatments for the same condition.
Mesopotamian Concepts of Disease and Healing
Mesopotamian diseases are often blamed on pre-existing
spirits: gods, ghosts, etc. However, each spirit was held responsible for only
one of what we would call a disease in any one part of the body. So usually
"Hand of God X" of the stomach corresponds to what we call a disease
of the stomach. A number of diseases simply were identified by names,
"bennu" for example. Also, it was recognized that various organs
could simply malfunction, causing illness. Gods could also be blamed at a
higher level for causing named diseases or malfunctioning of organs, although
in some cases this was a way of saying that symptom X was not independent as
usual, but was caused in this case by disease Y. It can also be shown that the
plants used in treatment were generally used to treat the symptoms of the
disease, and were not the sorts of things generally given for magical purposes
to such a spirit. Presumably specific offerings were made to a particular god
or ghost when it was considered to be a causative factor, but these offerings
are not indicated in the medical texts, and must have been found in other
texts.
Mesopotamian Medical Practitioners
By examining the surviving medical tablets it is clear
that there were two distinct types of professional medical practitioners in
ancient Mesopotamia. The first type of practitioner was the ashipu, in older
accounts of Mesopotamian medicine often called a "sorcerer." One of
the most important roles of the ashipu was to diagnose the ailment. In the case
of internal diseases, this most often meant that the ashipu determined which
god or demon was causing the illness. The ashipu also attempted to determine if
the disease was the result of some error or sin on the part of the patient. The
phrase, "the Hand of..." was used to indicate the divine entity
responsible for the ailment in question, who could then be propitiated by the
patient. The ashipu could also attempt to cure the patient by means of charms
and spells that were designed to entice away or drive out the spirit causing
the disease. The ashipu could also refer the patient to a different type of
healer called an asu. He was a specialist in herbal remedies, and in older
treatments of Mesopotamian medicine was frequently called "physician"
because he dealt in what were often classifiable as empirical applications of
medication. For example, when treating wounds the asu generally relied on three
fundamental techniques: washing, bandaging, and making plasters. All three of
these techniques of the asu appear in the world's oldest known medical document
(c. 2100 BCE).
The knowledge of the asu in making plasters is of
particular interest. Many of the ancient plasters (a mixture of medicinal
ingredients applied to a wound often held on by a bandage) seem to have had
some helpful benefits. For instance, some of the more complicated plasters
called for the heating of plant resin or animal fat with alkali. This
particular mixture when heated yields soap which would have helped to ward off
bacterial infection. While the relationship between the ashipu and the asu is
not entirely clear, the two kinds of healers seemed to have worked together in
order to obtain cures. The wealthiest patients probably sought medical
attention from both an ashipu and an asu in order to cure an illness. It seems
that the ashipu and the asu often worked in cooperation with each other in
order to treat certain ailments. Beyond sharing patients, there seems to have
been some overlap between the skills of the two types of healers: an asu might
occasionally cast a spell and an ashipu might prescribe drugs. Evidence for
this crossing of supposed occupational lines has been found in the library of
an ashipu that contained pharmaceutical recipes. Another textual source of
evidence concerning the skills of Mesopotamian physicians comes from the Law
Code of Hammurabi. This collection was not found written on a tablet, but was
discovered on a large block of polished diorite. It was not a code of law in
the modern sense, but probably a collection of legal decisions made by
Hammurabi (c. 1700 BCE) in the course of his activities as a judge and
published to advertise his justice. Several similar collections are known from
other areas and periods, and Hammurabi's cannot be taken as representative of
all Mesopotamian justice -- in fact, it is outstanding for its application of
the principle of an eye for an eye and a tooth for a tooth, while other
"codes" allow monetary penalties. Among Hammurabi's laws were several
that pertained to the liability of physicians who performed surgery. These laws
state that a doctor was to be held responsible for surgical errors and
failures. Since the laws only mention liability in connection with "the
use of a knife," it can be assumed that doctors in Hammurabi's kingdom
were not liable for any non-surgical mistakes or failed attempts to cure an
ailment. It is also interesting to note that according to these laws, both the
successful surgeon's compensation and the failed surgeon's liability were
determined by the status of his patient. Therefore, if a surgeon operated and
saved the life of a person of high status, the patient was to pay ten shekels
of silver. If the surgeon saved the life of a slave, he only received two
shekels. However, if a person of high status died as a result of surgery, the
surgeon risked having his hand cut off. While if a slave died from receiving
surgical treatment, the surgeon only had to pay to replace the slave. This use
of status to evaluate misdeeds does not seem to appear in other, similar
"codes" however.
Regardless of the risks associated with performing
surgery, at least four clay tablets have survived that describe a specific
surgical procedure. Unfortunately, one of the four tablets is too fragmentary
to be deciphered. Of the remaining three, one seems to describe a procedure in
which the asu cuts into the chest of the patient in order to drain pus from the
pleura. The other two surgical texts belong to the collection of tablets
entitled "Prescriptions for Diseases of the Head." One of these texts
mentions the knife of the asu scraping the skull of the patient. The final
surgical tablet mentions the postoperative care of a surgical wound. This
tablet recommends the application of a dressing consisting mainly of sesame
oil, which acted as an anti-bacterial agent.
Another important consideration for the study of
ancient Mesopotamian medicine is the identification of the various drugs
mentioned in the tablets. Unfortunately, many of these drugs are difficult or
impossible to identify with any degree of certainty. Often the asu used
metaphorical names for common drugs, such as "lion's fat" (much as we
use the terms "tiger lilly" or "baby's breath"). Of the
drugs that have been identified, most were plant extracts, resins, or spices. Many
of the plants incorporated into the asu medicinal repertoire had antibiotic
properties, while several resins and many spices have some antiseptic value,
and would mask the smell of a malodorous wound. Beyond these benefits, it is
important to keep in mind that both the pharmaceuticals and the actions of the
ancient physicians must have carried a strong placebo effect. Patients
undoubtedly believed that the doctors were capable of healing them. Therefore,
at the very least, visiting the doctor psychologically reinforced the notion of
health and wellness.
Other Sources of Health Care
Beyond the role of the ashipu and the asu, there were
other means of procuring health care in ancient Mesopotamia. One of these
alternative sources was the Temple of Gula. Gula, often envisioned in canine
form, was one of the more significant gods of healing. While excavations of
temples dedicated to Gula have not revealed signs that patients were housed at
the temple while they were treated (as was the case with the later temples of
Asclepius in Greece), these temples may have been sites for the diagnosis of
illness. In his book Illness and Health Care in the Ancient Near East: the Role
of the Temple in Greece, Mesopotamia, and Israel, Hector Avalos states that not
only were the temples of Gula sites for the diagnosis of illness (Gula was
consulted as to which god was responsible for a given illness), but that these
temples were also libraries that held many useful medical texts.
The primary center for health care was the home, as it
was when the ashipu or asu were employed. The majority of health care was
provided at the patient's own house, with the family acting as care givers in
whatever capacity their lay knowledge afforded them. Outside of the home, other
important sites for religious healing were nearby rivers. The Mesopotamian
believed that the rivers had the power to care away evil substances and forces
that were causing the illness. Sometimes a small hut was set up for the
afflicted person either near the home or the river to aid in the families centralization
of home health care.
Concluding Thoughts
Whether or not ancient Mesopotamian medicine passed on
a legacy that ultimately influenced the doctors of subsequent civilizations is
a question that will never be complete answered. While many of the basic
tenants of medicine, such as bandaging and the collection of medical texts,
began in Mesopotamia, other cultures may have developed these practices
independently. Even in Mesopotamia itself, many of the ancient techniques
became extinct after surviving for thousands of years. It was Egyptian medicine
that seems to have had the most influence on the later development of medicine,
through the medium of the Greeks.
Some Bibliographical References for Mesopotamian Medicine
Hector Avalos, Illness and Health Care in the Ancient
Near East: the Role of the Temple in Greece, Mesopotamia, and Israel
M.Stol, Epilepsy in Babylonia (1993) JoAnn Scurlock,
"Witchcraft and Magic in the Ancient Nar East and the Bible," in
Encyclopedia of Women and World Religion
JoAnn Scurlock, "Physician, Exorcist, Conjurer,
Magician: A Tale of Two Healing Professionals," Papers of the 1995
Mesopotamian Magic Conference (forthcoming)
Mary Coleman and JoAnn Scurlock, "Viral
Hemorrhagic Fevers in Ancient Mesopotamia," Journal of Tropical Medicine
(forthcoming)
Journal des Médecines Cunéiformes http://www.oriental.cam.ac.uk/jmc
