Medicine (Akkadian)

Mesopotamia has produced a rich corpus of medical and medically related texts that provide valuable insights into the nosology (the study of disease) of the area. Such texts include the lexical sources on anatomical and disease terminology, as well as Old Babylonian and Neo Babylonian diagnostic and prognostic texts. Knowledge of the disease processes at work in the region, along with an understanding of the medical tradition practiced in Mesopotamia during the period in which these texts were written and used, may help us gain familiarity with the ways in which the Mesopotamians conceptualized disease and medicine, thus providing important information regarding Mesopotamian culture.

Human skeletal remains may also provide valuable information on Mesopotamian medicine and disease. Many types of diseases leave distinct and specific markers on the skeleton. In some cases diagnoses made from skeletal material may be particularly valuable as a means of corroborating diagnoses made from textual sources.

This project intends to exploit these two types of evidence (the textual and the skeletal) in order to learn about the disease processes at work in ancient Mesopotamia and come to understand the medical field that was developed to combat such disease processes. For more details on the importance of textual and skeletal sources concerning disease and medicine see: The Sources.

There are several specific goals that this project seeks to achieve. First, it will provide researchers, when completed, with a single, comprehensive source for disease symptoms and terminology. It will organize data on anatomical and disease terminology as well as disease symptoms implied in the textual record with the goal of creating a differential diagnosis for given symptoms. A differential diagnosis is a list of potential diagnoses that may explain a given set of symptoms, from which a more secure diagnosis may be established after further examination.

Second, it will provide a database concerning the locations of skeletal collections and paleopathological studies that might be of value in corroborating textual descriptions of diseases.

Third, it will provide a comprehensive bibliography for disease and medicine in Mesopotamia. This bibliography will include published editions of the texts, books and articles on Mesopotamian medicine and paleopathological studies relevant to the region.

Finally, it is hoped that this project may contribute to the wider discipline of the History of Medicine by relating the Mesopotamian material to contemporary and later traditions of medicine in Egypt and Greece, and by making the Mesopotamian sources readily available to scholars in these areas.

There are many types of texts that may provide information on Mesopotamian disease and medicine, including letters, law codes and some literary texts as well as, most importantly, the medical texts and lexical sources.

The earliest known medical text dates from the third dynasty of Ur (2000 BCE) and is written in Sumerian. Other early (fourteenth century BCE) Sumerian texts have been found at Hattusa (Boghazkeui), but it is not known if they were originally composed in Sumerian or copied and translated from Babylonian originals. Most of the medical texts (in Akkadian) date from the Neo-Assyrian period and come primarily from Assur (Qalat sharqat) or the library at Nineveh with some originating from Nippur, Boghazkeui, and Sultantepe (Biggs 1969, 1995). However, as has been pointed out (Oppenheim 1964, Biggs 1969), these texts represent a tradition that dates from the Old Babylonian period. Unfortunately no medical texts have been discovered that date from this period.

Oppenheim (1964) separates the medical texts into two traditions, a “scientific” and a “practical”, Biggs (1969) refers to these same two traditions as “diagnostic” and “therapeutic” respectively. In the “scientific” or “diagnostic” category belong texts termed prognostic omens. This is a group of about forty texts that are titled Enuuma ana biit mars,i aaszipu illiku… meaning, “when, to the house of the patient the magician goes…” (edited by R. Labat as Traite akkadien de diagnostics et prognostics medicaux). These texts help the magician by informing him on potential diagnoses for his patient given signs he might see on the way to the patients home or the symptoms and/or behavior of the patient. They also provide a prognosis that is simply whether the patient will live or die. Rarely do they provide a treatment and when they do such treatment is exclusively magical.

The texts belonging to the “practical” or “therapeutic” category are called, “if a man is sick…” or “if a man suffers from…”. These texts describe in a formulaic manner the symptoms of the patient, and finish with a description of the treatment. In these texts the materia medica, consisting primarily of plant, animal and mineral parts, are described in detail as are the procedures for the correct application for the medicine. A prognosis is sometimes given as well (Oppenheim 1964, Biggs 1969).

There are also a number of medical texts that focus primarily on a particular type of ailment. These include gynecological texts, fever texts, and texts dealing with skin and eye diseases – all very important medical considerations in ancient Mesopotamia (Biggs 1969).

Generally each group of texts is arranged by subject according to body parts and run in sequence from head to foot. As is typical in Mesopotamian scribal practice each entry consists of two parts, a protasis and an apodosis. The protasis states the nature of the case; with medical texts this is usually the symptoms observed. The Apodosis states the outcome or the treatment, depending upon the type of text in question (Oppenheim 1964).

Also of importance are the lexical sources for anatomical and disease terminology. These “vocabularies” were often bilingual (Sumerian with an Akkadian translation) beginning from the Middle Babylonian period (Oppenheim 1964,247). As with the medical texts, the anatomical lists are organized from head to foot. These lists help us understand the taxonomic systems used by the Mesopotamians.

Other texts of value to the study of medicine (especially concerning the Old Babylonian period) are letters, a few literary sources, and the law codes. In letters, particularly those from Mari in the Old Babylonian period, we see references to individual physicians and their medical prowess. The Mari letters also give us information about epidemic diseases and the measures taken to prevent the spread of such diseases. Also from letters we learn that Kings would exchange information about diseases and would also exchange their court physicians, whether for training purposes or to aid in the curing of disease. A couple of humorous tales tell us something about the training of physicians (see MESOPOTAMIAN MEDICINE) and the Code of Hammurabi discusses penalties for medical malpractice (Biggs 1995).

References for published editions of the medical texts and the lexical sources, as well as the miscellaneous texts mentioned, are included here (see Bibliography).

The human skeleton is a plastic organ. It molds itself, during the life of an individual, depending upon the stresses placed upon it (or not placed upon it), and the health of the individual. There are many health issues that may cause bone to react in various ways. These bony reactions, when observed on the skeleton, may be used to diagnose health problems that affected an individual during life.

For example, the skeleton of an individual suffering from malnutrition may react to loss of iron by taking it from the blood producing regions of the body, namely bones. When this occurs there is loss of bone tissue in order to allow for the production of more blood. This loss of bone due to malnutrition often results in a porous or pitted appearance in the cortical bone of the cranial vault or in the upper margins of the orbits. The term for such lesions is porotic hyperostosis or cribra orbitalia. These lesions may also appear when iron is lost due to infectious disease, significant blood loss, or hereditary disorders such as thalassemia or sickle cell anemia (White 2000).

The location and appearance of various skeletal lesions may allow for the diagnosis of specific diseases. Tuberculosis, brucellosis, and leprosy are all diseases that may produce such specific skeletal lesions as to allow for a diagnosis of that disease.

Paleopathological studies of human skeletal remains may reveal which diseases were present in a given population of people, how significant those diseases were to the health of the population, the general health status of the population, the level of traumatic injury present and, in some cases, what means were taken to heal an injury or a disease.

The potential importance of paleopathological studies has been, to a great extent, overlooked by those studying medicine and disease in Mesopotamia. This is due, in large part, to the relative paucity of skeletal remains discovered (or saved) during archaeological excavations in the region. Bone preservation is notoriously poor in this region, adding to the problems with collection of material (Biggs, 1969). Finally, of those collections that do exist, many have not been examined for paleopathological evidence (Biggs, 1995; 1,922). Included here is a list of published skeletal reports from Mesopotamian sites, as well as a note as to whether any paleopathological analysis was performed on the sample (see Bibliography).

Mesopotamian medicine has been generally overlooked in the greater discipline of the history of medicine. Perhaps we have Herodotus to thank, in part, for this as he makes very clear his disdain for Babylonian medical practices, claiming they brought their sick to the marketplace to ask passersby what might be done (Histories, I, 197). More significantly however, Mesopotamian medicine has been relatively inaccessible to historians of medicine as there are so few editions of the medical texts (Biggs 1969). As a result there are some misunderstandings about the nature of Mesopotamian medicine, and it has not received the attention that ancient Egyptian or Greek medicine have.

One old misconception was that the Mesopotamians saw all causes of disease as supernatural. It is true that the perceived origin of most illnesses was supernatural, the result of an outside force intruding upon the body whether as the result of divine displeasure, a curse, a demon or witch. However, the Mesopotamians probably did recognize the natural origin of some illnesses such as those caused by food poisoning, drinking too much alcohol, or trauma. They also seem to have understood that some diseases were communicable and even observed the pulse (although did not seem to be an understanding of circulation) (Oppenheim 1962, Biggs 1995). This dichotomy between the supernatural and the natural does not seem to have been a problem for the Mesopotamians, and in fact they would often combine the two in affecting a cure. This can be seen in how the practitioners of medicine worked.

There were two different types of medical practitioners in Mesopotamia, the aszipu and the asuu, who are traditionally seen as having distinct functions in the healing of illness. The asuu (physician) was the therapeutic practitioner, he or she (female practitioners were known) dealt with the physical aspects of curing disease, concocting potions, salves, and tinctures and applying them (or instructing the patient in their application). The aszipu (magician) was always male and dealt with illness from a magical standpoint through the use of omens and incantations. They functioned as exorcists and were members of the clergy (Biggs 1995). It is well known, however, that although maintaining distinct primary functions, the two practitioners probably worked together to a certain extent (Biggs 1995). Hector Avalos (1995) gives a great deal of evidence to show that the two did often work together. For example, an asuu, after examining a patient, might suggest he see the aszipu for further help, or if the physician’s cure was not successful, the magical one was often recommended. Also, the physician would sometimes use incantations or other rituals as part of the application procedure for a medication. Likewise the magician was recorded as having sent patients to the physician for supplemental treatment.

Given the fact that the practitioners of medicine seem to have worked together to a certain extent, how did the medical texts themselves fit into the daily practice of a physician or a magician? The earliest medical text dates to 2000 BCE (see The Sources), but it is in the same form as the therapeutic texts a thousand years later. Does this mean that the practice of medicine remained the same for a millennia without change? It is unclear whether the practitioners were all literate, and thus we are not certain to what degree the texts were used as handbooks for medical practice. It is clear that not all the functions of the physician or magician are addressed in the texts. Letters often refer to broken bones and traumatic wounds, but the texts never mention these problems. What the primary purpose of the medical texts was and what developments may have taken place in the field of medicine after the official form of the texts was set is not yet clear (Biggs 1969).

What little information we have specifically regarding the training and education of the physicians comes from two humorous tales, “The Poor Man from Nippur” and “Why Do You Cuss Me?” (Reiner 1964). In the first tale we see the poor man disguise himself as a physician, he is shaved and carries a bag and censer. He claims to be a physician from Isin, which we know to have been the center of Gula the goddess of healing. It was likely that Isin was, therefore, a center for medical training and by claiming to be from Isin the poor man is announcing his expert qualifications (Biggs 1995). In the other tale, however, we see a physician that could not understand spoken Sumerian, suggesting that at least this particular physician’s training was lacking (Reiner 1964). Biggs (1995) states that the title “chief physician” is attested, suggesting that there may have been some sort of professional guild for physicians.

There is even less known about the training of magicians than of physicians. As they probably had to consult the diagnostic texts they may have had extensive scribal training. Several colophons name the magician as the scribe and /or owner of certain medical texts. But whether all magicians were literate it is not known for certain (Biggs 1995).

J. Rashidi

*[http://www.ames.cam.ac.uk/jmc/ Le Journal des Médecines Cunéiformes]

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