The Asclepion
Prof. Nancy Demand, Indiana University
- Bloomington
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).
