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A Mesopotamian Tablet with Gynaecological Treatments

A Mesopotamian Tablet with Gynaecological Treatments



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The Largest Surviving Medical Treatise from Ancient Mesopotamia

Sumerian medical tablet (2400 BC), ancient city of Nippur. Lists 15 prescriptions used by a pharmacist. Library of Ashurbanipal.

Because clay tablets, especially those baked in fires, were more durable than papyrus rolls, more original source material regarding medicine survived from Mesoptomia than from ancient Greece or Rome. Even though the amount of surviving medical textual information from Mesopotamia may be greater than what survived from Egypt, comparing the quantities of the two sources of ancient medical information is complicated since, in addition to the medical papyri which survived in the hospitable climate of Egypt, Egyptian mummies represent a unique source of paleopathological information that is not textual.

The surviving Mesopotamian medical records consist of roughly 1000 cuneiform tablets, of which 660 medical tablets from the library of Ashurbanipal are preserved in the British Museum. About 420 tablets from other sites also survived, including the library excavated from the private house of a medical practitioner (an asipu) from Neo-Assyrian Assur, and some Middle Assyrian and Middle Babylonia texts.

Most of these Mesopotamian medical tablets were not discovered until the nineteenth century, and because of difficulties with translation of cuneiform script, many of these tablets were not understood by scholars until recently. Another factor that must be taken into consideration is that since these tablets survived by unintended burial rather than by manuscript copying, and they were not preserved until comparatively recently in conventional libraries or museums, the medicine they record did not necessarily play a conventional role in the Western medical tradition. What influence their contents might have had on the practice of later physicians remains unclear.

The medical texts from Ashurbanipal's library were first published in facsimile by Reginald Campbell Thompson as Assyrian Medical Texts. From the Originals in the British Museum (1923). Franz Kocher later published six volumes called Die babylonisch-assyrische Medizin in Texten und Untersuchungen (1963-1980), the first four volumes of which contain the tablets found from sites other than Assurbanipal's library.

"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' " (Nancy Demand, The Asclepion, accessed 05-30-2009).

More recently the texts of many of the Mesopotamian medical tablets were translated and analyzed from the medical point of view by Assyriologist/cuneiformist, JoAnn Scurlock and physician/medical historian Burton R. Anderson as Diagnoses in Assyrian and Babylonian Medicine (2005).

&bullThe largest surviving medical treatise from ancient Mesopotamia is known as the 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 conditions" (Nancy Demand, The Aesclepion, accessed 05-30-2009).


Like an alien in a strange old world – Reading Mesopotamian medical texts on women’s healthcare

Decoding medical cuneiform texts often makes you feel a bit like a detective who has entered a mysterious, foreign world of words and ideas. Not few of my Assyriologist colleagues would probably favour other topics, rather than studying Mesopotamian medical texts, because they are hard to understand, full of strange disease names and unknown drugs, and because these texts have a reputation of being technical, monotonous and boring.

Not surprisingly then, Mesopotamian medical texts remain a poorly known corpus, and few scholars have worked on the subject or published books for a general audience.[i] Although the majority of the texts are still unavailable in proper editions and translations, the situation is steadily improving. Beside a growing number of publications every year, cuneiform medicine is becoming an increasingly recognised topic, and a few research projects are currently investigating these texts, preserved on thousands of fragments of clay tablets and scattered in various museums.[ii] The fragmentary nature of the corpus, consisting of diagnostic and therapeutic texts as well as handbooks on materia medica, written during the 2 nd and 1 st millennium BCE, and the difficulty of decoding them connected with the cuneiform writing system and the genre (especially the use of many multivalent logograms) have contributed to the lagging behind of research in this field, compared e.g. to Egyptological research on medical papyri.

Let me describe some of the difficulties posed by the Mesopotamian medical texts, specifically those concerned with treating women, to a modern reader. These difficulties result to a considerable degree from cultural differences e.g. between ancient and modern concepts of physiology, disease and therapy.

One problem for the modern scholar is to grasp ancient disease concepts and ideas of physiology from symptom descriptions. The gynaecological texts form a small sub-corpus among the majority of medical tablets devoted to diseases which are normally not gender-specific and which use the male body as a general model. Thus, while the latter diagnostic and therapeutic texts begin with the formula “If a man (suffers from ailment X/symptoms X, Y, Z)”, the gynaecological texts begin with “If a woman …”. The gynaecological corpus, not unlike the modern medical discipline, focuses on female reproduction: (in)fertility, complications occurring during pregnancy, birth, and in childbed, but also includes treatments for abnormal vaginal bleeding and other fluxes, as well as renal, rectal and gastro-intestinal ailments in women. Yet, because the perspective of gynaecological texts was restricted to the diagnosis and treatment of abnormal phenomena, they do not contain descriptions and explanations of normal physiological functions, such as menstruation, which have to be inferred from the sparse information gleaned from the medical texts or other text genres.

A Babylonian tablet with medical prescriptions for women, ca. 7th cent. BCE. Source: Cuneiform Digital Library Initiative (http://cdli.ucla.edu/dl/photo/P238756.jpg)

For instance, Babylonian healers collected treatments “to stop a woman’s blood” in case “a woman’s blood flows and does not stop”, leaving us at loss to decide whether this refers to unusually heavy menstrual bleeding or to abnormal haemorrhage due to other causes. Beside blood, the texts also treat discharge of “fluids” (literally “water”) from the vagina, which depending on the context, refers to phenomena which modern medicine has come to differentiate, like amniotic fluid (premature rupture of the membranes) and vaginal discharge due for instance to leucorrhea. It becomes clear that the Babylonian healers do not share our differentiations of symptoms and diseases, and that progress with the texts will only be made by investigating their system of ideas about what goes wrong in the body when disease occurs.

This undertaking is somewhat hampered by another characteristic of Mesopotamian medical texts, namely that the writers (Babylonian and Assyrian healers and scholars) rarely recorded their theories (e.g. discussions which took place in the classroom and in scholarly discourse). Yet, some of their concepts of the body, health and disease emerge, often implicitly, from disease aetiologies, names, and from metaphors found especially in the incantations that accompanied medical treatments. These characteristic traits of Mesopotamian medical texts form a contrast to Greek and Roman medical writers who often speculated in writing about physiological processes such as menstruation, conception and the nature of female illnesses based on humoral theory.

Another challenge arising from Babylonian medical texts is to understand the “logic” of ancient medical treatments and recipes even though the majority of the drugs are unidentified, and to reconstruct the cultural context in which the texts were used, e.g. how medical consultation and application of treatments actually took place. Thus, it is still debated whether Babylonian (male) healers actually examined women (and applied the prescribed remedies like tampons), or whether the symptom descriptions in the texts stem from what the patients observed themselves and told the doctor. In upcoming posts on fumigation in Mesopotamian and Hippocratic gynaecology, I will illustrate an approach to discover principles of coherence between the use of particular materia medica and specific complaints.

[i] A real primer presenting a comprehensive overview of Mesopotamian medicine is Markham J. Geller’s Ancient Babylonian Medicine. Theory and Practice. Malden / Oxford, 2010.


India

In India, at about 1000 BC, we begin to see that medical knowledge was established in the form of the Atharva veda, a type of medical text similar to those in Egypt as it had a combination of magic and belief in demons along with practical medical knowledge. For instance, there seems to have been a developed knowledge of treating leprosy using lichens, which could provide some practical results, while at the same time attributing the ailment to demons. We also know by 500 BC, surgery was well developed, including the practice of extracting teeth, fixing broken bones, and even clearing the intestine. [11]


Evidence of Oldest Gynaecological Treatment on Record, Performed in Ancient Egypt 4,000 Years Ago

Scientists from the Universities of Granada and Jaén are studying the physical evidence found in the mummified remains of a woman who suffered severe trauma to the pelvis in 1878–1797 BC, linking them to a medical treatment described in various Egyptian medical papyri of the time

During the Qubbet el-Hawa Project, led by the University of Jaén (UJA) in Aswan (Egypt), in which scientists from the University of Granada (UGR) are participating, researchers have found evidence of the oldest gynaecological treatment on record, performed on a woman who lived in Ancient Egypt some 4,000 years ago and died in 1878–1797 BC.

During the 2017 archaeological dig organised in Qubbet el-Hawa, on the western bank of the River Nile, Andalusian researchers found a vertical shaft dug into the rock in tomb QH34, leading to a burial chamber with ten intact skeletons.

Mummification techniques were not very effective at that time, at least at this site in Upper Egypt. However, the individuals buried there generally belonged to the upper classes of society meaning that they would have been given special care. These particular mummies are very well-preserved and are wrapped in thick layers of linen strips, sometimes bearing remnants of dried soft tissue.

“The mummies had grave goods (usually necklaces of different types) in some cases, their faces were covered with cartonnage masks and they were preserved inside two rectangular sarcophagi, one inside the other. These featured hieroglyphic inscriptions and were typically badly damaged due to termite infestation,” explains Miguel Botella, forensic anthropologist and Emeritus Professor at the UGR, who conducted the analyses.

The last mummy buried

One of the mummies excavated by the team of anthropologists was perhaps the last to be buried in the chamber. It belonged to a woman of high social class, whose name, Sattjeni, has been preserved in the remains of the outer coffin. That name must have been common among the upper classes of the region, perhaps explaining why she was named Sattjeni A.

Between her bandaged legs, in the lower part of the pelvis and beneath the linen wrappings, the researchers found a ceramic bowl with signs of use, containing charred organic remains. The analysis of the skeletal remains was carried out by a team of anthropologists from the UGR (coordinated by Professor Botella) and it confirmed that the woman had survived a serious fracture in her pelvis, perhaps caused by a fall, which must have caused severe pain.

It is highly likely that, to alleviate these pains, the woman was treated with fumigations, as described in medical papyri of the time describing solutions to gynaecological problems.
“The most interesting feature of the discovery made by the researchers from the University of Jaén is not only the documentation of a palliative gynaecological treatment, something that is quite unique in Egyptian archaeology, but also the fact that this type of treatment by fumigation was described in contemporary medical papyri.

But, until now, there had been no evidence found to prove that such treatment was actually carried out,” explains the UJA’s Dr. Alejandro Jimenez, an expert in Egyptology and director of the Qubbet el-Hawa Project. This work has now been published by one of the most prestigious academic journals in Egyptology, Zeitschrift für Ägyptische Spracheund Altertumskunde.

The project was funded by the Spanish Ministry of Science and Research, Fundación Gaselec, Fundación Palarq, the Calderón Group, and the Spanish Association of Egyptology.


History of Medicine: Ancient Mesopotamia and Egypt

I stumbled upon “Disease and Medicine in World History” by Sheldon Watts in the library and realized I couldn’t pass up the chance to learn about such an interesting topic. My dad also gave me another book, “the Healers: The Doctor, Then and Now” by Kurt Pollack and E. Ashworth Underwood. I also used “the Medical Book” by Clifford Pickover at some parts.

I like Watt’s stance, in which he rejects the glorification of European roots in biomedicine. He’s trying to show a global history of medicine, touching upon the influence of ancient civilizations.

He begins with describing the basic evolution of disease. How did disease even come to be? Watts states that proximity to domesticated animals led to disease. Smallpox came from its bovine form of cowpox. Measles came from fowls, like chickens (measles was absent in areas where there were few chickens, such as ancient Egypt).

The New World apparently did not have any major diseases prior to the arrival of the Europeans. He says that when people crossed into the Americas, they slaughtered animals for food. Such animals included the horse and camels, which could have been domesticated animals. So New Worlders did not live side by side with animals and were protected from disease.

ANCIENT MESOPOTAMIA

In all ancient civilizations, medicine went hand in hand with magic. Physicians acted as healers and priests. I really love this quote by Robert Adler that I found in the Pickover book

“It is in the powerful figures of shamans and sorcerers that we find the predecessors of our white-coated physicians…whom we, like our ancestors, imbue with great power.”

According to Pollak and Underwood, Mesopotamians had different kinds of healers. There was the Baru, or soothsayer, who diagnosed the spiritual cause of disease, and the Ashipu, the exorcist of evil spirits. The Asu was also a priest, but he could also use non-magical remedies, such as drugs or surgery. Note: As I’m reading about ancient physicians from different countries and their emergence from their priestly origins, it’s hard to see the divisions between who are the physicians, priests and both. No doubt there must have been overlap, but distinctions are not clear. The main idea though, is that physicians used magic and religion for the healing process.

Demons were the root of illness. If someone committed a sin, he lost protection from the gods. Physician-priests would then use magical charms or religious chants, praying to the gods (like Marduk, the main god of Babylon) to free the person of demonic presence. If it was difficult to ascertain a reason for sickness, they searched for omens in things like the color of the flame, the formation of oil globules in water, or the appearance of sacrificed animals (the sheep was popular — if the liver was long, then the patient would have a long life).

“Ashakku caused fever in the head and also phthisis [pulmonary tuberculosis] Namtaru threatened to bring plague Utukku afflicted the neck, Alu the breast, Gallu the hand, Rabisu the skin.” Pollack and Underwood pg 15

The doctor-priests were not without some use of rational empiricism. Coloration played a role in allowing for one to determine the severity or cause of a disease. For instance, if the eye was yellow, the doctors knew that it was a bile disease and not an eye disease.

Assurbanipal hunting lions

Most of what historians know about medicine in Mesopotamia (Assyrian, Babylonian etc.) came from cuneiform tablets, which were discovered in the mid 1800s in Iraq, near the ruins of the ancient city of Ninevah. The Library of Assurbanipal (who was King of Assyria 668-626 BC) contained 22,000 cuneiform tablets, 800 devoted to medical information, which is where historians got most of their information on medicine in the region.

Another document that sheds some light of doctors of the time was the Code of Hammurabi (Hammurabi was Babylonian king 1728-1686 BC), one of the oldest pieces of law in history. Out of its 282 paragraphs, 9 were related to the physician’s fee charges. These were based on the status of the patient, with those of higher status having to pay more.

(whole section from Pollack and Underwood)

Code of Hammurabi’s physician fees. From The Healers

ANCIENT EGYPT

Like in Mesopotamia, religion and medicine in Egypt were one. Demons and gods caused diseases, and gods brought healing. Doctors played the role of priest as well as physician (Watts). Pollack and Underwood states “Every general statement on Egyptian medicine or on Egyptian doctors is inevitably a simplification of the many-coloured picture. All that we can say with certainty is that all the sciences, including medicine, bore a strongly religious character and the priests were the educated class.”

Physician-priests were highly regarded and very important for the ruling class. Watts says that because of this, peasants who were distant from the imperial courts could not easily access doctors. Workers just made do by praying. Thus while doctors were important figures in the high classes, low classes did not benefit as much.

Watt states that there is evidence that Egypt changed medical practice from science to magic, not magic to science as other researcher had speculated. It seems that pre-dynastic Egypt and the Old Kingdom (3100 – 2181 BCE) was based more on empirical evidence (physical symptoms), while the New Kingdom and the time of Persian rule, were on the side of magic. Physicians became well regarded not really because of their curing abilities, but because of their knowledge on the ancient religious rituals.

Imhotep was the Pharoah Zoser’s counselor during the Third Dynasty (circa 2600 BC). Imhotep (who was the inspiration for the evil guy in The Mummy) was a polymath, being a scribe, priest, teacher, architect, and physician amongst others. It’s not completely clear what exactly he did (though he’s credited with founding a medical school in Memphis). But he is seen as one of the first physicians. He was deified later as a healing god. People went to his temple for miracles and healing (Pollack and Underwood). Watts however, has another perspective, stating that Imhotep didn’t have anything to do with medicine. It wasn’t until hundreds of years later when he was raised in status by the Egyptians. Note: Need to research more on this.

The four essential organs of the Egyptians were the liver, lungs, stomach and intestines. They were placed into jars with a mummy, as they were needed for the next life. The heart was the most important organ, as it was the seat of the soul or ba. The brain was not important. It was taken out of the dead body through a tube going up the nose (Watts).

Other points: Herodotus states that Egyptian doctors were specialized, one for a particular part of the body. Egyptians also believed in cleanliness to make the gods happy. They were conscious of what they ate, thinking it was the an important route for disease. Emetics were used for vomiting. (Pollack and Underwood).

“Their remedies by which they prevent diseases are enemas, fasting and vomitting. These are at times applied daily, at others they are suspended for three or four days. They claim that of every food the main part is superfluous after digestion and that the diseases are born from this therefore they served the preservation of health best” Diodorus Siculus

It seems that before the coming of Alexander the Great, there were no epidemics of major diseases such as cholera or malaria. So what were the causes of death? Staple foods were wheat, barley and rye. When they were ground up for making bread, little stones were released from the rolling stone and got into the bread. These stones wore away the teeth enamel, exposing vessels and nerves at the center of the tooth. Infections from this led to deaths. Since Egyptians did not eat much sweets until the Persians arrived, sugar was not a string possible cause of tooth decay. Other causes of death included neck and spinal injuries from carrying heavy loads on head. If the Nile failed to rise, there was famine and starvation. There were also deadly/poisonous animals such as crocodiles and snakes (Watts).

In 1862, an American named Edwin Smith bought an ancient roll of papyrus from a local. It was around 1906, when he died, when his daughter gave it to the New York Historical Society. Egyptologist James Breasted was given the job of translating, which he did in 1922. The Edwin Smith Papyrus as it is known, is thus far, the oldest work of surgery ever. The papyrus is a copy written around 1600 BC of an original that was probably written around 3000 BC. The papyrus describes 48 surgical cases (the 48th was not finished). The authorship is unknown, though Breasted thought it could be Imhotep. The papyrus reveals that the Egyptians did not know much about the interior of the body. Wound treatment was using living animal flesh (Pollack and Underwood). Of the 48 cases, 27 deal with head trauma. Also mentioned are cranial sutures (natural fibers that attach pieces of the skull together), surface of brain, and cerebrospinal fluid (Pickover). Six cases describe suturing a wound. Physicians also noted that cases had to be labeled on realistic results: could be cured, healed, or death.

Edwin Smith had another papyrus, which he sold to German Egyptologist Georg Ebers in 1876. A couple years later, Ebers published it. It contains 876 remedies, with more than 500 substances coming from minerals, plants, animals, and “disgusting things” like feces, fat etc. There was also magical therapy, which was more prominent here than in the Edwin Smith Papyrus.

While all of this information is based on the few records that have been excavated, it gives an idea of the status and function of medicine thousands of years ago. Pretty cool!

1. Why do some diseases not occur? I don’t understand how malaria was not prominent, because I’d think the Nile would have had mosquitoes.


Ancient Civilizations — Mesopotamia

The ancient region of southwest Asia known as Mesopotamia is literally “between rivers”: the Tigris and Euphrates, which have their headwaters in the mountains of Asia Minor and ultimately merge as they flow into the Persian Gulf, nearly a thousand miles to the east. This fertile land, tilled for ten thousand years, also has been called the Cradle of Civilization. Here, about five thousand years ago, man first attempted to develop a system of writing, and here the first cities in the world were built.

In the course of the fourth millennium B.C., city-states developed in southern Mesopotamia that were dominated by temples whose priests represented the cities’ patron deities. The most prominent of the city-states was Sumer, which gave its language to the area and became the first great civilization of mankind. About 2340 B.C., Sargon the Great (c. 2360-2305 B.C.) united the city-states in the south and founded the Akkadian dynasty, the world’s first empire.

The next major civilization was centered on Babylon, and the most famous ruler of the Old Babylonian dynasty was Hammurabi (r. 1728-1686 B.C.), whose code of laws is the most prominent work of the period. Many thousands of inscribed clay tablets from this era still exist and make it one of the best-known cultures of Near Eastern antiquity.

The civilizations of Mesopotamia exerted powerful influences on their neighbors not only in their own time but also in subsequent centuries. Hebrew, Greek, Christian, and Islamic cultures owe many debts to ancient Mesopotamia. Some of the most famous early Bible stories have precursors in venerable Sumerian legend. The story of the Flood and Noah’s Ark is lent credence by the discovery of ancient Nineveh beneath eleven feet of silt, and the description of the Tower of Babel in the Bible seems to fit the ziggurat temple-form of early Sumerian city-states. Perhaps Mesopotamia’s most important contribution to the world was the introduction of a writing system, attributed to the Sumerians of about 3000 B.C. Although the Sumerian language itself did not long survive, the writing, called cuneiform, was adapted to Akkadian and its Babylonian dialect and was used to preserve the records and literature of Mesopotamia on clay tablets. Found by the thousands among the ruins of Babylon, Mari, and Nineveh, many of these tablets list representative plants, animals, and implements and provide a rudimentary zoological and botanical survey of the area. Others list the dynasties of rulers and major events which have enabled historians to work out a satisfactory chronology for the era.

Many other innovations came from the region of Mesopotamia: metallurgy, the wheel, the arch, clock dials, and uniform weights and measures. The sexagesimal system from which we derive our sixty-minute hour had its origins in Babylonian mathematics. The Chaldeans, a late Babylonian people, under Nebuchadnezzar developed extensive information on astronomy as well as concepts of astrology which were used in the medicine of Greco-Roman, Arabic, and medieval times. The earliest known regulations of the practice of medicine were found in the Code of Hammurabi (c. 1700 B.C.).

Ideas about Disease

Although the various Mesopotamian cultures had their differences, there was a certain basic agreement on cosmology. As among their primitive forebears, illness was a curse, a punishment by the gods which could be visited on the family and descendants as well as on the sinner who had knowingly or inadvertently violated a moral code. However, there was probably some realization of nonspiritual causes for illness since physicians were admonished, for ethical reasons, to avoid continuing treatment for hopeless cases.

There was a pantheon of numerous deities, some of them patrons of the local region or city-state. For the most part, the chief early Sumerian gods remained supreme throughout the era, either unchanged or mingled with the Semitic gods of later times. The three principal deities of Sumer were Anu, Enlil, and Enki. Enlil had a son, Ninib, who was a healing god. An important Babylonian god was Ea, Lord of Water and the first great cosmic ancestor of physicians, whose son Marduk became the most influential god in Babylonian worship. Marduk was the father of Nabu, who ruled over all science, including medicine, and to whom a temple was erected where a medical school developed. It is worth noting that one healing god, Ningishzida, has been pictured with a double-headed snake as his emblem, an indication of how long the snake has been a medical symbol. Indeed, in the early Sumerian epic of Gilgamesh, the search for the secret of immortality was thwarted when a snake stole and ate the plant of everlasting life. The snake immediately shed its skin and appeared rejuvenated, which qualified it as a symbol of regeneration and the cure of illness.

There were also evil demons who filled the spirit world. Each brought a different disease: Nergal gave fever, Ashakku debilitating consumption, Tiu headache, Namtaru throat ailments. Especially feared were the Evil Seven who wandered about afflicting the unwary. Because of them, physicians did not treat patients’ on the days of an illness divisible by seven.

Methodology

Mesopotamian doctors depended on divination to uncover the sin committed by a sick person and to learn the expiation demanded by the gods, but they also observed a patient’s symptoms to estimate their seriousness. One method of divination particularly associated with Mesopotamian medicine was hepatoscopy (detailed examination of the liver, and other entrails, of sacrificed animals). Although the Mesopotamians seem to have had no overall idea of anatomy, they regarded the liver as the seat of life since it appeared to be the collecting point for blood. Clay models of livers have been found with markings that probably were used to instruct neophytes in the art of divination or to guide the priest himself.

Recitations, ceremonies, prayers, and sacrifices were common religious means of beseeching the gods for a cure however, along with these a veritable pharmacopoeia of drugs was used regularly in the treatment of disease. In addition to clay tablets which report illnesses with their symptoms and diagnosis, prognosis, and treatment, others were found that list drugs and their appropriate uses. Hundreds of plants, minerals, and animal substances were the therapeutic agents. They were given by mouth in compositions, applied as salves and fomentations, blown into orifices, inhaled as vapors and fumigations, and inserted as suppositories and enemas. Oil was apparently the principal balm for open wounds, probably preventing the adherence of overlying dressings. The medications were administered according to rituals, the time of the day, and the positions of constellations.

No cuneiform tablets devoted exclusively to surgery have survived, but since virtually all of the medical rules in the Code of Hammurabi concerned the outcome of operations, we can be certain that surgical practices were common. Wounds, abscesses (especially of the eye), broken bones, sprained tendons, and brand marks of slaves were all clearly in the province of surgery. Furthermore, references to bronze lancets in the Code and elsewhere indicate the use of instruments in surgical operations, and there have been a few isolated archaeological recoveries of knives. A possible trephine has also been unearthed, but no examples of trepanned skulls have yet been found in the land “between rivers.” However, they have been uncovered in nearby Judea, which got its medical knowledge from Mesopotamia.

Practitioners

Medical practice appears to have been in the hands of three types of priests, only one of which was concerned exclusively with sick people. The baru as a diviner dealt with diagnosis and prognosis, but not only of illness. He also had to discover the causes and probable outcome of many other kinds of catastrophe. The ashipu, as an exorcist who drove out evil demons, was called on to rid a house, a farm, an area, and also sick people of occupying spirits. The asu apparently acted principally as a physician, employing charms and divination but also drugs and operations. The name of Biblical king Asa (Asa-El), “healer of God,” may have derived from the Babylonian asu.

The healing priests received their education in schools that were associated with the temples. The source of their learning, in addition to practical instruction, was the large number of texts available in the form of clay tablets. By the seventh century B.C., for instance, the library of Ashurbanipal contained over twenty thousand tablets, which were only discovered about a hundred and fifty years ago at the site of ancient Nineveh. They are still the most extensive source of knowledge about Mesopotamian society, including medicine, but recently tablets have been unearthed that date back to Sumerian times.

The priest-physician ministered mainly to the court, nobility, and upper classes but apparently there were also barbers who performed some surgical procedures and did the branding of slaves. They also treated tooth disorders and did extractions. Veterinary practice may have been handled by either the low-class barber or the upper-class asu, but whether there were exclusive healers for animals, “doctors of oxen or asses,” is not known.

Medical practice, as well as other professional activity, was evidently regulated by well-defined laws. The Code of Hammurabi devotes ten short statements out of the 282 provisions to the fees due medical practitioners and their punishments for failure.

If a doctor has treated a freeman with a metal knife for a severe wound, and has cured the freeman, or has opened a freeman’s tumor with a metal knife, and cured a freeman’s eye, then he shall receive ten shekels of silver.

If the son of a plebeian, he shall receive five shekels of silver.

If a man’s slave, the owner of the slave shall give two shekels of silver to the doctor.

If a doctor has treated a man with a metal knife for a severe wound, and has caused the man to die, or has opened a man’s tumor with a metal knife and destroyed the man’s eye, his hands shall be cut off.

If a doctor has treated the slave of a plebeian with a metal knife for a severe wound and caused him to die, he shall render slave for slave.

If he has opened his tumor with a metal knife and destroyed his eye, he shall pay half his price in silver.

If a doctor has healed a freeman’s broken bone or has restored diseased flesh, the patient shall give the doctor five shekels of silver.

If he be the son of a plebeian, he shall give three shekels of silver.

If a man’s slave, the owner of the slave shall give two shekels of silver to the doctor.

If a doctor of oxen or asses has treated either ox or ass for a severe wound, and cured it, the owner of the ox or ass shall give to the doctor one sixth of a shekel of silver as his fee.

Although estimating relative monetary values in modern terms is difficult, one should compare the fees in the Code with the five shekels of silver yearly rent for a middle-class dwelling or the one-fiftieth of a silver shekel daily pay for an ordinary craftsman, which indicates a generally high schedule of medical fees. The severe punishments for a physician’s failures listed in the Code (such as cutting off the hands) should be matched against the punishments (which could include execution) meted out for the failures of other professionals and the transgressions of any person against another.

If a man has destroyed the eye of a patrician, his own eye shall be destroyed.

If a man has knocked out the teeth of a man of the same rank, his own teeth shall be knocked out.

If he has knocked out the teeth of a plebeian, he shall pay one-third of a mina of silver.

One may wonder whether under risk of such stringent penalties any practitioner could have had the nerve to perform an operation, but it may well be that the Code was not enforced to the letter. Indeed, earlier Sumerian writings recently discovered indicate that punishments were less severe than called for by the later Code.

One fact seems clear. Whatever may have been the restrictions and regulations, a goodly number of healers—whether priests or barbers—practiced medicine and surgery throughout the history of Mesopotamia. It is therefore difficult to account for the statement of the Greek historian Herodotus (fifth century B.C.) that: “They have no physicians, but when a man is ill they lay him in the public square, and the passersby come up to him, and if they have ever had his disease themselves or have known any one who has suffered from it, they give him advice, recommending him to do whatever they found good in their own case, or in the case known to them. And no one is allowed to pass the sick man in silence without asking him what his ailment is.”

Public Health and Hygiene

From the numerous instructions on clay tablets recommending religious and empiric methods of treatment, one can infer that the physician was called upon to treat a large number of ailments. They were not grouped together as disease entities, as they are today, but were listed and classified according to the location of the symptoms. For instance, in the head there were aches, eye and ear pains and swellings, and tooth abscesses. Chest problems were cough, pain, and the spitting of blood. Cramps, vomiting, and diarrhea were illnesses of the abdomen.

Epidemics must have occurred often the many wars and invasions were likely events to foster pestilence. Certainly plagues of some kind were reported in the cuneiform tablets of the eighth century B.C., and fevers, probably of varying causes, were mentioned frequently in the medical texts. The shaking chills which Alexander the Great suffered in his last illness while campaigning in Mesopotamia in the fourth century B.C. may have been due to malaria.

A sick person of any rank was in a special category and was excused from work and even from service to the king. On the other hand, since disease was caused by spirits having possessed the body, the afflicted person was shunned as much as possible to avoid transference of the offending demon. This relative isolation was hygienically beneficial to the community although its purpose was based on religio-magical reasoning. The taboo against touching the sick was carried, over into Hebrew culture, where it became a key factor in a system of public hygiene—just one further example of Mesopotamia’s long-lasting influence on contemporary and later cultures.


Mixing Magic and Medicine: New Study Shows Mesopotamian Doctors Had to Battle Demons

Analysis of a collection of clay tablets confirms that a Mesopotamian doctor had to deal with more than just physical ailments. The ancient healer was expected to exorcise demons, ward off witchcraft, and appease the gods – all while staying up to date on the latest medical-magical healing strategies!

The recent study demonstrates that doctors living in Mesopotamia in the 7th century BC were expected to combine what we commonly call magical rituals with “harder science” and medicine if they wished their patients to recover.

Fragment of talisman used to exorcise the sick, Assyrian era. (Rama/ CC BY SA 2.0 )

Science Nordic reports the research came about through the work of Dr. Troels Pank Arbøll from the Department of Cross-Cultural and Regional Studies at the University of Copenhagen in Denmark. Although the clay tablets written by an Assyrian doctor named Kisir-Ashur have been known about for decades, Arbøll completed the first known analysis on the complete collection of writings.

As Phys.org mentions, the term “doctor” has been applied to Kisir-Ashur based on his level of education and the information he provides on his work. Kisir-Ashur documented his training and healing techniques – thus his work provides unique insight into the education and practice of medicine at the time. Arbøll says ,

“The sources give a unique insight into how an Assyrian doctor was trained in the art of diagnosing and treating illnesses, and their causes. It’s an insight into some of the earliest examples of what we can describe as science.”

While in training, Kisir-Ashur began with treating animals and then babies. The doctor was not allowed to heal adults until his studies were complete. According to Arbøll , “This shows a relatively clear chronology in his training, where he takes on more and more responsibility.”

Assyrians believed that gods, demons, and ghosts were at the root of human illness, social and economic problems – doctors such as Kisir-Ashur were expected to heal all these issues. Disease was seen as the result of punishment for sins or inappropriate behavior, or witchcraft. This means that ancient Mesopotamian healers had to be ready with a variety of tools and rituals, even to perform exorcisms, in their treatments.

Assyrian Cylinder depicting an exorcism. (Wellcome Images/ CC BY 4.0 )

Ancient Origins has described some of the practices Mesopotamian doctors used to treat disease. Caleb Strom writes that a doctor would perform exorcisms to rid patients of their problems. The first step was to ask patients to be sincere about any wrongdoings they may have committed against ghosts or the gods. After that,

“Assyrian exorcisms involved magical rituals, incantations, and invocation of deities such as the god Shamash. Shamash was the Mesopotamian sun god as well as the god of justice. He was believed to visit the underworld every night after sunset to judge the dead. Because of being the god of justice and a god associated with the dead, those suffering from haunting or possession would often invoke him in prayers or magical rituals hoping that he could resolve the matter by pacifying or restraining the ghost.”

The king with a mace, who stands on a rectangular checked board dais, follows the suppliant goddess (with necklace counterweight), and the robed king with an animal offering. They stand before the ascending Sun god, Shamash, who holds a saw-toothed blade and rests his foot on a couchant human-headed bull. ( CC BY SA 3.0 )

But exorcisms were not the only tool for doctors such as Kisir-Ashur. Arbøll explains, “He does not work simply with religious rituals, but also with plant-based medical treatments […] Kisir-Ashur observed patients with bites or stings. Perhaps he did this to find out what the toxins had done to the body and from that, try to understand the venom’s function.”

Some of the beliefs Kisir-Ashur and his contemporaries held seem to have similarities with ancient Greek medicine. For example, they may have believed some diseases were linked to liquids. Arbøll’s study suggests that Assyrian doctors apparently viewed bile as a toxin. “This idea is reminiscent of the important Greek physician, [ Hippocrates’] theory of humors, where the imbalance of four fluids in the body can be the cause of illness,” Arbøll says .

Hippocrates, engraving by Peter Paul Rubens, 1638. Courtesy of the National Library of Medicine. ( Public Domain )

Nonetheless, there is some difference between the concepts and a large amount of time and space between the lives of Kisir-Ashur and Hippocrates, so this idea, however appealing it may seem, is only a tentative one.

Arbøll acknowledges this and also states that his study of Kisir-Ashur’s training and medical practice may not have followed all trends during his lifetime, “It's a snapshot of history that is difficult to generalise and it is possible that Kisir-Ashur worked with the material in a slightly different way than other practising healers,” yet “Kisir-Ashur copied and recorded mostly pre-existing treatments and you can see that he catalogues knowledge and collects it with a specific goal.”


The Modern Era

With the exception of J. Krecher’s useful but brief entry on “Kommentare” in RlA 6 (Krecher, 1980/1983 J. Krecher , “ Kommentare ”, Reallexikon der Assyriologie , vol. 6, pp. 188-191, 1980.
Like Labat, Krecher pays comparatively little attention to the vast body of mukallimtu-commentaries on astrological and extispicy texts. ), there have been no comprehensive treatments of Mesopotamian commentaries since Labat’s book, but several important studies of individual commentaries and commentary groups have appeared. The number of commentaries available in form of autographs or editions has radically increased over the past decades, with the series Spätbabylonische Texte aus Uruk, authored by H. Hunger H. Hunger , Spätbabylonische Texte aus Uruk. Teil I . Gebr. Mann Verlag, 1976. and E. von Weiher E. von Weiher , Spätbabylonische Texte aus Uruk. Teil II . Gebr. Mann Verlag, 1983.
E. von Weiher , Spätbabylonische Texte aus Uruk. Teil III . Gebr. Mann Verlag, 1988.
E. von Weiher , Spätbabylonische Texte aus dem Planquadrat U 18 . Gebr. Mann Verlag, 1993.
E. von Weiher , Spätbabylonische Texte aus dem Planquadrat U 18 . Verlag Philipp von Zabern, 1998. and a number of publications by U. Koch(-Westenholz) (1999 U. Koch-Westenholz , “ The Astrological Commentary Šumma Sîn ina tāmartīšu Tablet 1 ”, Res Orientales , vol. 12, pp. 149-165, 1999. , 2000b U. Koch-Westenholz , Babylonian Liver Omens. The Chapters Manzāzu, Padānu and Pān Tākalti of the Babylonian Extispicy Series mainly from Aššurbanipal's Library . Museum Tusculanum, 2000. , 2005 U. S. Koch , Secrets of Extispicy. The Chapter Multābiltu of the Babylonian Extispicy Series and Niṣirti bārûti Texts mainly from Aššurbanipal's Library . Ugarit-Verlag, 2005. ) providing the bulk of the new material In addition, many astrological commentaries have been published in the BPO volumes authored by E. Reiner and D. Pingree:
E. Reiner and Pingree, D. , Babylonian Planetary Omens. Part Two. Enūma Anu Enlil Tablets 50-51 . Undena Publications, 1985.
E. Reiner and Pingree, D. , Babylonian Planetary Omens. Part Three . Styx, 1998.
E. Reiner and Pingree, D. , Babylonian Planetary Omens. Part Four . Brill, Styx, 2005. . Particular attention has been paid to the hermeneutical techniques used in the commentaries (Civil, 1974a M. Civil , “ Medical Commentaries from Nippur ”, Journal of Near Eastern Studies , vol. 33, pp. 329-338, 1974. , Cavigneaux, 1976 A. Cavigneaux , Die sumerisch-akkadischen Zeichenlisten. Überlieferungsprobleme . PhD thesis, 1976. : 151-160, Bottéro, 1977 J. Bottéro , “ Les noms de Marduk, l'écriture et la 'logique' en Mésopotamie Ancienne ”, in Essays on the Ancient Near East in memory of Jacob Joel Finkelstein , deJ. M. Ellis, Ed. Archon Books, 1977, pp. 5-28. , Cavigneaux, 1987 A. Cavigneaux , “ Aux sources du Midrash: L'herméneutique babylonienne ”, Aula Orientalis , vol. 5, pp. 243-255, 1987. , Limet, 1982 H. Limet , “ De la philologie à la mystique en Babylonie ”, in Studia Paulo Naster oblata II: Orientalia Antiqua , J. Quaergebeur, Ed. Peeters, 1982. , George, 1991 A. R. George , “ Babylonian Texts from the folios of Sidney Smith. Part Two: Prognostic and Diagnostic Omens, Tablet I ”, Revue d'Assyriologie , vol. 85, pp. 137-167, 1991. , Hunger, 1995 H. Hunger , “ Ein Kommentar zu Mond-Omina ”, in Vom Alten Orient zum Alten Testament. Festschrift für Wolfram Freiherrn von Soden zum 85. Geburtstag am 19. Juni 1993 , W. Dietrich and Loretz, O. , Eds. Butzon & Kevelaer, 1995, pp. 105-118. , Seminara, 2001 S. Seminara , La versione accadica del Lugal-e. La tecnica babilonese della traduzione dal sumerico e le sue "regole" . Dipartimento di Studi Orientali, 2001. : 546-48), and some authors have compared these techniques to those employed in rabbinical exegesis (Lambert, 1954/1956 W. G. Lambert , “ An Address of Marduk to the Demons ”, Archiv für Orientforschung , vol. 17, pp. 310-321, 1954. : 311, Cavigneaux, 1987 A. Cavigneaux , “ Aux sources du Midrash: L'herméneutique babylonienne ”, Aula Orientalis , vol. 5, pp. 243-255, 1987. , Lieberman, 1987 S. J. Lieberman , “ A Mesopotamian Background for the So-Called Aggadic 'Measures' of Biblical Hermeneutics? ”, Hebrew Union College Annual , vol. 58, pp. 157-225, 1987. ). Less work has been done to illuminate the socio-cultural context of the commentaries (Meier, 1937/1939b G. Meier , “ Kommentare aus dem Archiv der Tempelschule in Assur ”, Archiv für Orientforschung , vol. 12, pp. 237-246, 1937. and 1942 G. Meier , “ Ein Kommentar zu einer Selbstprädikation des Marduk aus Assur ”, Zeitschrift für Assyriologie , vol. 47, pp. 241-246, 1942. , George, 1991 A. R. George , “ Babylonian Texts from the folios of Sidney Smith. Part Two: Prognostic and Diagnostic Omens, Tablet I ”, Revue d'Assyriologie , vol. 85, pp. 137-167, 1991. , Frahm, 2004 E. Frahm , “ Royal Hermeneutics: Observations on the Commentaries from Ashurbanipal's Libraries at Nineveh ”, Iraq , vol. 66, pp. 45-50, 2004. ), but a number of studies of the milieu in which first millennium Babylonian and Assyrian scribes operated have paved the ground to tackle this issue in greater depth (Parpola, 1983b S. Parpola , Letters from Assyrian Scholars to the Kings Esarhaddon and Assurbanipal, Part II: Commentary and Appendices . Butzon & Bercker, 1983. , Pongratz-Leisten, 1999 B. Pongratz-Leisten , Herrschaftwissen in Mesopotamien. Formen der Kommunikation zwischen Gott und König im 2. und 1. Jahrtausend v. Chr. The Neo-Assyrian Text Corpus Project, 1999. , Brown, 2000 D. Brown , Mesopotamian Planetary Astronomy-Astrology . Styx, 2000. , Frahm, 2002 E. Frahm , “ Zwischen Tradition und Neuerung: Babylonische Priestergelehrte im achämenidenzeitlichen Uruk ”, in Religion und Religionskontakte im Zeitalter der Achämeniden , R. G. Kratz, Ed. Gütersloher Verlagshaus, 2002, pp. 74-108. , Clancier, 2009 P. Clancier , Les bibliothèques en Babylonie dans le deuxième moitié du 1er millénaire av. J.-C. Ugarit-Verlag, 2009. ). Our understanding of the emergence of canonical texts in Mesopotamia, a phenomenon intimately linked to the birth of the commentary, has also received considerable attention in the past years (Rochberg-Halton, 1984 F. Rochberg , “ Canonicity in Cuneiform Texts ”, Journal of Cuneiform Studies , vol. 36, pp. 127-144, 1984. , Finkel, 1988 I. L. Finkel , “ Adad-apla-iddina, Esagil-kin-apli, and the series SA.GIG ”, in A scientific humanist: studies in memory of Abraham Sachs , E. Liechty, Ellis, MdeJ. , Gerardi, P. , and Gingerich, O. , Eds. University Museum, 1988, pp. 143-159. , Veldhuis 2003 N. Veldhuis , “ Mesopotamian Canons ”, in Homer, the Bible, and Beyond. Literary and Religious Canons in the Ancient World , M. Finkelberg and Stroumsa, G. G. , Eds. Brill, 2003. , Heeßel, 2010a N. P. Heeßel , “ Neues von Esagil-kīn-apli. Die ältere Version der physiognomischen Omenserie alamdimmû ”, in Assur-Forschungen. Arbeiten aus der Forschungsstelle »Edition literarischer Keilschrifttexte aus Assur« der Heidelberger Akademie der Wissenschaften , S. M. Maul and Heeßel, N. P. , Eds. Harrassowitz, 2010, pp. 139-187. ).

Because no synthesis of the information gathered in these studies is available at present, recent works that analyze the history and typology of the commentary from a multi-disciplinary perspective have paid little attention to commentaries from Babylonia and Assyria. Assmann & Gladigow, 1995 J. Assmann and Gladigow, B. , Text und Kommentar . Fink, 1995. , the broadest and intellectually most stimulating recent treatment of the commentary tradition, with discussions of exegetical texts from Egypt, the classical world, Jewish, Christian, and Islamic tradition, India, China, and the West, ignores them altogether. Most, 1999 G. W. Most , Commentaries - Kommentare . 1999. includes an important article on cuneiform “etymography” by Maul S. M. Maul , “ Das Wort im Worte, Orthographie und Etymologie als hermeneutische Verfahren babylonischer Gelehrter ”, in Commentaries/Kommentare , G. W. Most, Ed. Göttingen: , 1999, pp. 1-18. , but it, too, fails to discuss the cuneiform commentaries.


A Mesopotamian Tablet with Gynaecological Treatments - History

The people of Mesopotamia made advancements in medicine to improve their health and make their lives longer.

Medical knowledge was developed over many centuries by advanced civilizations. Mesopotamia added onto the discoveries and research of ancient Egypt. Through their own findings, they made many new advancements in the field of medicine and developed means of surgical practices.

How Did It Impact Later Civilizations?

Civilizations like the Hebrews based their medical treatments on Mesopotamia's. They shared the idea that illness was a sign of the gods' displeasure. Their priests, like those of Mesopotamia, were considered healers. Their treatment of injuries was derived from Mesopotamia as well, using bandages.

Medicine advancements created a hierarchy in Mesopotamia's society. Mesopotamia's doctors, asus and ashipus, were at the top. Since medical attention was very expensive, only the very rich could afford it. Those who didn't have money would be less likely to live as long as those who could, making them less important in the eyes of their society. It also affirmed their religious beliefs because sickness was blamed on spirits or was interpreted as a sign of the gods' displeasure.

Mesopotamia's advancement served as a model for people centuries later. Many of our modern day medical procedures are based off of Mesopotamia's contributions to the medical field. The medical texts were some of the largest and most extensive that have been found. Mesopotamians were the first to successfully perform surgery on the sick. This lead to advancements in surgery and modern day medicine.


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kindle unlimited but one of my owned ones, 7 different books, all of which have read, but do rather like the sets because less grief with my tablet reader.

Mesopotamia: A Captivating Guide to Ancient Mesopotamian History and Civilizations, Including the Sumerians and Sumerian Mythology, Gilgamesh, Ur, Assyrians, Babylon, Hammurabi and the Persian Empire -- If you want to discover the remarkable history of Mesopotamia, then keep reading. Free History BONUS Inside!

Seven captivating manuscripts in one book:
Sumerians: A Captivating Guide to Ancient Sumerian History, Sumerian Mythology
Mesopotamian Empire of the Sumer Civilization
Gilgamesh: A Captivating Guide to Gilgamesh the King and the Epic of Gilgamesh
Ur: A Captivating Guide to One of the Most Important Sumerian City-States in Ancient Mesopotamia
Assyrian History: A Captivating Guide to the Assyrians and Their Powerful Empire in Ancient Mesopotamia
Babylon: A Captivating Guide to the Kingdom in Ancient Mesopotamia, Starting from the Akkadian Empire to the Battle of Opis Against Persia, Including Babylonian Mythology and the Legacy of Babylonia
Hammurabi: A Captivating Guide to the Sixth King of the First Babylonian Dynasty, Including the Code of Hammurabi
The Persian Empire: A Captivating Guide to the History of Persia, Starting from the Ancient Achaemenid, Parthian, and Sassanian Empires to the Safavid, Afsharid, and Qajar Dynasties

Some of the topics covered in part 1 of this book include:
The Ancient Sumerians In a Nutshell The Social Structure of Ancient Sumerians The Religion and Mythology of Ancient Sumerians The Sumerian Kingdoms Chronology The Everyday Life of Ancient Sumerians and more!

Some of the topics covered in part 2 of this book include:
The History of the Epic All Eleven Tablets Sumerian Poems About Gilgamesh And much, much more!

In part 3 of this book, you will:
Get a sense of how Ur came to existence, how it grew, reached its zenith, fell, re-rose, and ultimately perished until it reemerged a little over a century and a half ago Learn of its history, laden with wars, trade, divine worship, political corruption, and entertainment and more!

Some of the topics covered in part 4 of this book include:
The Assyrians Arrive in Mesopotamia: The Early Assyrian Period The Birth of a Civilization: The Old Assyrian Empire to the Middle Assyrian Empire The Beginning of the Neo-Assyrian Empire Imperial Expansion and the Golden Age of the Neo-Assyrian Empire The Fall of the Empire Assyrian Government and more!

Some of the topics covered in part 5 of this book include:
The Land of the Babylonians Life, Culture, and Gender Roles Throughout the Years Where Superstition Met Science Babylonia Before the Babylonians The Amorite Dynasty or the First Babylonians The First Fall of Babylon and the Rise of the Kassites Assyrian Domination and Rule, 911-619 BCE And much, much more!

Some of the topics covered in part 6 of this book include:
Babylon Before Hammurabi: Position of the City in Mesopotamia, Early Rulers Rise of Hammurabi: Wars and Achievements Chronology of Hammurabi Hammurabi’s Character: Physical Appearance, Relations with Other Rulers, Glimpses of His Personality The Code of Hammurabi and Early Mesopotamian

Each of these books in this collection are also available as standalone books.