Fig. 3. Oldest
known Sumerian medical book. 2200 B.C.
The oldest medical text was written by a Sumerian
physician in the 3rd
millennium BC on a clay tablet (Fig 3). This medical text is now in the
University of Philadelphia Museum (6). Most Babylonian medicine came from
the botanical world. Their favorite mineral preparation was sodium
chloride and potassium nitrate.
Clay tablets have been found mentioning liver, eye,
respiratory diseases, fever and gonorrhea. They showed some knowledge of
night blindness, otitis media, renal calculus, stroke and scabies. (7).
The Babylonians administered drugs in every possible
way short of injections: mixtures, potions, inhalation, ointment,
liniment, enemas and suppositories. (6).
Limited physical examination was carried out by the Babylonians. The
temperature of the skin was tested in several parts of his body, the
rhythms of the pulse was apparently recognized.
The discoloration of the
skin and the color of the urine was noted. (5).
Unfortunately, the supernatural was the fundamental
feature of ancient medicine such as Babylonian medicine. They also
believed that disease was a punishment inflicted by the gods upon men for
their sins.
The Mesopotamian Disease theory can be summarized as
follows:
Numerous gods and goddesses controlled health
and disease.
Disease was punishment for sin.
When gods retract their protection, man falls
prey to disease-bearing devils
and ghosts, which swarmed around
Mesopotamia.
Illness was essentially a moral and ethical
defect, a black mark, a condemnation.
Such an ailment called for
a moral cure.
Treatment:
mostly magical and religious.
There were, in ancient Iraq, true physicians who
believed in the supernatural origin of most diseases, but who also
recognized the causative action of natural agents such as dust, dirt, food
or drink and even contagion.
The Babylonian had their own medical and philosophical
beliefs. The following are some of their enduring beliefs (6):
1. The heart is the seat of the mind.
2. The liver is the seat of emotion.
3. The stomach is the seat of courage.
4. The uterus is the seat of kindness.
These beliefs survived throughout thousands of years.
They still exist, not only in Arab culture, but also in many cultures
around the world. In Muslim and Christian Holy Scriptures, the heart was
the center of thoughts. The concept that the heart is the center of love
is almost universal. Some ancient Arab poets associated both the heart and
the liver with love. In the West, people still say, "he has
guts", when they mean courage. Most people are not aware that the
origin of such terminology goes back to the ancient Babylonians.
There was teamwork among the ancient healers of Babylon as
in modern medicine.
1.Baru-priest, or diviner, finds out the
hidden sin responsible for the divine anger.
The demons were exorcised by the Ashipu-priest
using magical rites and incantations.
The gods were appeased through prayers and
sacrifices.
2. Ashipumade the diagnosis and prognosis. It was
assumed that the patient's fate
depended largely on his findings. His task was to perform the rites
required for driving
out an evil spirit from the body and for
reconciling the patient with his god.
If the disease was obvious, it was the work of a certain
devil and no further diagnosis
was necessary!
In more complicated cases, the priest recited a long list of
possible sins to the patient,
hoping that he might be able to choose from them
the sin that had caused his disease.
If both methods failed, divination entered
the scene (7).
3. Asu was the real physician. He was neither a
priest nor a witch-doctor, but a
professional man belonging to the upper middle
class of the Assyro-Babylonian
society. He had spent years at school learning
the basic sciences of his time.
He provided rational medicine. In later periods
however, the asu was superceded
by the ashipu (5).
We have learned how an asu looked like from a humorous Babylonian story, The
a physician (asu): clean-shaven and carrying the two insignia of
his calling – a libation
(alcohol) jar and a censer(incense burner)(5).
I n other descriptions, he carried a bag of herbs.
The Babylonian priests
predicted the course of the disease using
the following methods:
1. Astronomy &
astrology: The Babylonians mastered
this science. They watched the stars and
calculated their movements with precision.
They predicted eclipses with accuracy. Eclipses
were considered bad omens. They consulted
the stars to predict the course of a battle
or the outcome of a disease. Prognosis was
linked with the constellations of the stars
and planets. The widespread practice of
astrological medicine in Medieval Europe
originated with the Babylonians.
They made accurate calendars far ahead of
their times. Much later on in history, a
Roman emperor had to send for a Babylonian
astronomer to make a calendar for the Roman
empire.
2. Hepatoscopy:
They examined the liver of sacrificed animal
to foretell the course of disease or other
future events (Fig 4).
|
Fig. 4. Babylonian
clay model of sheep’s liver used for
divination.1900-1800 B.C.
|
3. Dreams: They believed
that some dreams carried messages about the future.
Amulets are written prayers
or poems or parts of animals or plants or
statuettes carried by individuals as protection
to drive away evil spirits. The following
is a poetic amulet (7):
Seven
are they,
Seven
are they,
In
the Ocean Deep seven are they,
Evil are they, evil are they,
Seven are they,Twice seven are they!
By Heaven be ye exorcised!
By Earth be ye exorcised.
The Babylonians invented
the concept that the last day of the week
is for resting. They considered it a day
of bad omen that may bring disaster. They
stayed home as a preventive measure. The
Jews adapted the Babylonian concept of resting
the last day of the week but instead of
bad omen they considered it holy.
Nowadays, germs have replaced spirits
as causes of disease and immunization has
replaced amulets for prevention of disease.
It is not surprising that
the Babylonians perceived that some diseases
are contagious. They must have had experience
with major contagious diseases such as the
plague or minor diseases like the common
cold.
One of the Mesopotamian
kings, Zimri-Lim, King of Mari (I780 B.C.)
wrote to his wife Shibtu:
I have heard that the lady Nanname has
been taken ill... Now then, give severe
orders that no one should drink in the cup
where she drinks, no one should sit on the
seat where she sits, no one should sleep
in the bed where she sleeps. She should
no longer meet many ladies in her house.
This disease is contagious.(6).
The original Babylonian
word for contagious was sabtu, which literally
means "catching." The notion of
contagion, isolation of lepers, and regular
rest days, which came into modern culture
seem to have been of Mesopotamian origin
(7). Pouring water on hands before and after
meals was a Babylonian custom. Urination
in rivers was a sin (8). The Babylonians
had an admirable sewage system and 4000-year-old
water closets have been dug out by archeologists.
Hammurabi, in his Code
of Law (c.1695 BC), made the first declaration
of human rights in history:
To cause justice to prevail
in the land. . ., that the strong may not
oppress the weak. . .
The practice of medicine
was regulated by the state. Malpractice
was recognized and was punishable by law.
Hammurabi's Code of Law specified:
If a surgeon performs
a major operation on an 'awelum' (nobleman),
with a bronze lancet and caused the death
of this man, they shall cut off his hands
However there is no proof
that such a punishment was ever carried
out. Hammrabi also specified fees for lifesaving
operations:
Ten shekels of silver for ‘awelum’, five
shekels for ‘mushkenum’ (poor man) and two
shekels for a slave (6).
Some features of Babylonian medicine are
enumerated in table 3.
Table 2. Babylonian Scientific
achievements
|
|
1. 1. Priests
had an important role in medicine.
2.The snake was
the symbol of cure.
3.Liver was the
most important organ.
4. Prepared soap
(3000 B.C.).
5.They knew some
surgical operations (cataracts).
6.Knew leprosy,
gonorrhea, plague, night blindness
7. Abortion was
forbidden
|
Heart disease
We have no real proof that
the Babylonian physician knew how to treat
heart disease. However, there is a description
on treatment of "stricture of the lungs".The
term "stricture" was a literal
translation by a non-medical scholar. That
term might have been pressure or squeeze
sensation over the chest, which might have
been angina or myocardial infarction. The
prescribed treatment reads:
Take . . . sheep kidney;
dates, firtree, turpentine, pinetree turpentine,
laurel, opopanax, resin of galbarium, mustard,
cantharis ...Grind these in a mortar with
fat and dates. Pour the mixture on a gazelle’s
skin. Fold the skin. Put it on the painful
area and leave it in place for three days.
During that time the patient shall drink
sweet beer. He shall take his food very
hot and stay in a warm place. On the fourth
day, remove the poultice.... (6).
The prescription instructions indicate
that there may have been chest pain since
the patient was instructed to apply the
preparation "on the painful area",
which must be the chest area. The patient
who was tied to gazelle skin might not be
free to be active and that may have kept
him resting in bed for 3 days; the beer
most likely relieved his pain. It appears
that the Babylonians knew that three days
was adequate bed rest for acute myocardial
infarction, whereas we modern cardiologists
practiced it only in the last decade! The
patient was also advised to stay warm. Perhaps
they also knew that cold weather aggravates
angina!
Urinary Retention was treated
as follows:
Crush poppy seeds in beer, make the patient
drink it. Grind some myrrh, mix it with
oil and blow it into his urethra with tube
of bronze(6).
The treatment was effective.
The opium (poppy) and the beer relieved
the pain while the tube drained the urine.
The insertion of a tube into the urethra
indicates that they practiced invasive therapeutic
interventions.
If a man has taken strong
wine and his head is affected and he forgets
his words and his speech becomes confused,
his mind wanders and his eyes have a set
expression.
To cure him, take licorice . . beans, oleander.
. to be compounded with oil and wine before
the approach of the goddess Gula ..and in
the morning beforesunrise and before anyone
has kissed him let him take it, and he will
recover(9).
The above quotation is described as Treatment
of Alcoholic Intoxication but it sounds
like treatment of withdrawal. It is logical
to add wine in the treatment of withdrawal
but not in the treatment of intoxication.
The Babylonians were very skilled in treating
tooth abscess. Historians mention that an
Egyptian king sent for a Babylonian dentist
to treat his tooth abscess when his Egyptian
dentist failed. They described their methods
of treatment using herbs and oil to massage
the gum so vigorously
|
Fig. 4. Ceremonial
beaker with double-headed snake dedicated
to Ningishzida, god of healing.
c. 2000 B.C
|
until blood comes
out
They must have learned from experience
that the best treatment for abscess is to
drain it, as we do today.
The Epic of Gilgamesh is the most famous
of the Babylonian myths and is considered
the father of epic literature. Gilgamesh
sought immortality that was granted only
to the gods. The snake ate the plant of
immortality and shed its skin. The shedding
of the skin was a sign that the snake possessed
the power of regeneration and rejuvenation,
hence the snake in the epic of Gilgamesh
may have been the origin of its association
in medicine. Ninazu, "Lord of Physicians",
was an important healing deity and the
emblem of his son, Ningishzida, was a double-headed
snake (9). A double-headed snake ceremonial
beaker (Fig 5) is another proof that the
link between the snake and medicine is of
the Babylonian origin before the Greeks
adapted the concept.
The Assyrian king Esarhaddon was an interesting character: He
Killed his father for the throne; he occupied Egypt; he had
psychiatric
disturbance and suffered from
rheumatism. He had a substitute king 4 times. The substitute king
was installed when a fortuneteller warned the king that he would be
killed on a certain day. On that day the poor substitute was killed
and Esarhaddon retuned to the throne.
An Asu (physician) sent a letter to the Assyrian king Esarhaddon:
Replying to what the king my lord wrote me,
‘send me your true diagnosis":
I have given my diagnosis to the king my lord in one word:
‘Inflammation.’ He whose head, hands and feet are. . . inflamed,
owes his state to his teeth: his teeth should be extracted. On this
account his insides are inflamed. The pain will subside, the condition
will be most satisfactory (9).
King
Esarhaddon was impatient. He repeatedly said to his
physician:
Why
do you not recognize the nature of this illness of mine, Why
do you not bring about its cure? (9
If it is agreeable in the sight of the king my lord,
let a magician perform an exorcism. Let
the king take this bath: immediately his
fever will leave the king my lord. That
anointing with oils should be done two or
three times for the king my lord.
That disease is in the pus. They should
bring licorice to the king. Exactly as they
have done twice already, they should massage
(him) vigorously. I intend to come and give
instructions. At once the perspiration of
the king will come. I am sending to the
king my lord a concoction (?) of those things;
let him apply it to the flesh of his neck.
May the king anoint himself on the appointed
day with the liniment which I am sending.
(9)
Esarhaddon, however,
consulted not only his asu, but also his ashipu, his exorcist. He
complained:
My arms (and)
legs are limp, and I cannot open my eyes. I am smeared (with
liniments) and abed with fever, it burns my very bones. (9)
The priest answered:
At (the root)
of this there is no sin. Ashur, Shamash, Bel, (and) Nabu will bring
about the recovery. His illness will leave, (his condition) is truly
most satisfactory.(9)
It was common in those
days to try the drugs on slaves before giving them to the royals.
Adad-shum-usur, crown prince's asu wrote:
Concerning the
medicine about which the king my lord wrote (me), it is perfectly
safe. As the king my lord has commanded, we shall give it to those
slaves to drink. Afterwards the crown prince may drink. . . The
king’s commands shall be fulfilled as are those of a god.(9)
It was normal for Mesopotamian
kings to send their physicians for consultations
when the Egyptian king was sick and vice
versa. It was a friendly gesture with political
motive to strengthen their relations. So,
at foreign courts Babylonian and Egyptians
physicians competed.
In 1300 B.C. the Egyptian
physician Pareamakhu was in Anatolian courts
and a Babylonian Raba-sha-Marduk was at
the Hittite court and in 1280 B.C. the king
of Babylon sent a physician to the Hittite
monarch Hattusil (9).
Both the Mesopotamian and
Egyptian lands witnessed fruitful exchange
of medicine with Europe over thousands of
years. First, Mesopotamian medicine was
transmitted in part to the Greeks, and together
with Egyptian medicine, it paved the way
for the great Hippocratic reform of the
fifth century B.C. Then, during the rise
of the Arab Empire (8th
-10th
century), Greek medicine was translated
to Arabic. The Arabs preserved Greek medicine
when most of the original works was lost
from Europe. The Arabs improved on Greek
medicine as well as made new discoveries
over several centuries. In the 13th
and 14th
century Greco-Arab medicine was transferred
to Europe again from Arab capitals such
as Cordoba in Andalusia, Spain and Baghdad
in Iraq.
It is true that not only medicine but human
civilization started north of the Arabian
Gulf, but neither medicine nor civilization
belongs to one nation on earth. Nations
as well as civilizations borrowed from each
other medicine, science, arts, and technology
over centuries of human development. Fortunately
for us, in the field of medicine, the same
trend is continuing in the medical sciences.
No country has monopoly on medical science
today. With the present vast publications
and fast communications via the internet,
medicine is becoming a global science. In
fact the whole world is becoming a village
in a small planet in our universe.
Medical history shows us the evolution of
medicine, how medical therapies come and
go, and how useful procedures become not
so useful. Some of us may laugh at the diagnostic
and therapeutic methods used by the ancient
Babylonians. But to be fair we should credit
the Babylonians and ancient Egyptians for
starting the foundations of medicine with
their trial and error. Through such trial
and error, they laid down the foundations
of medicine upon which this field progressed.
They deserve our admiration.
Modern medicine with its scientific theories
has its roots in the "old" theories
of the past. Many of today's medical facts
and theories sprang out from yesterday's
myths and errors. Today's truth might also
become tomorrow's myth.
1. Michael R. Cultural Atlas of Mesopotamia and The
Ancient Near East.
Equinox (Oxford) Ltd. 1990:20.
2. Kramer SN. History begins at Sumer. University
of Pennsylvania press 1956.
3. Trinkaus E, Shipman P. The Neandertals. Pimlico.
1993.
4. Am. J Cardio. Packer M. Hormone-Electrolyte
interactions in congestive
heart failue. Lessons from a 4000-year-old
Sumerian tablet. 1990;65:(Suppl): 1E-3E.
5. Joan Oates. Babylon. Thames and Hudson Ltd.
London 1979.
6. G Roux: Ancient Iraq. George Allen & Unwin
Ltd 1964.
7. Ackerknecht E H. A short History of Medicine.The
John Hopkins University Press. 1982.
8. Al Badri A. Min’ Al Tib Al Ashuri. Iraq
Science Society Press 1979.
9. Sigerist HE. A Story of Medicine, vol.1. Oxford University Press
1951.
|
Sumerian Lyre c.
2500 BC. From the Royal Cemetery at Ur, Babylonia (Modern Iraq).
|
|
EDITOR'S PAGE
