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Diagnoses in Assyrian and Babylonian Medicine

Diagnoses in Assyrian and Babylonian Medicine: Ancient Sources, Translations, and Modern Medical Analyses

JoAnn Scurlock
Burton R. Andersen
Copyright Date: 2005
Pages: 912
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    Diagnoses in Assyrian and Babylonian Medicine
    Book Description:

    To date, the pathbreaking medical contributions of the early Mesopotamians have been only vaguely understood. Due to the combined problems of an extinct language, gaps in the archeological record, the complexities of pharmacy and medicine, and the dispersion of ancient tablets throughout the museums of the world, it has been nearly impossible to get a clear and comprehensive view of what medicine was really like in ancient Mesopotamia._x000B_The collaboration of medical expert Burton R. Andersen and cuneiformist JoAnn Scurlock makes it finally possible to survey this collected corpus and discern magic from experimental medicine in Ashur, Babylon, and Nineveh. Diagnoses in Assyrian and Babylonian Medicine is the first systematic study of all the available texts, which together reveal a level of medical knowledge not matched again until the nineteenth century A.D. Over the course of a millennium, these nations were able to develop tests, prepare drugs, and encourage public sanitation. Their careful observation and recording of data resulted in a description of symptoms so precise as to enable modern identification of numerous diseases and afflictions._x000B_

    eISBN: 978-0-252-09238-1
    Subjects: History

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Acknowledgments
    (pp. ix-x)
  4. Concordance of Sigla
    (pp. xi-xiv)
  5. Translator’s Notes
    (pp. xv-xvi)
  6. Introduction
    (pp. xvii-xxv)

    It is our objective to provide a comprehensive review and analysis of all available ancient Mesopotamian texts dealing with medical diagnosis or prognosis. Unfortunately, some of the references are so fragmented, damaged, or limited in information that nothing useful can be said about them. In these cases, we have chosen to exclude these texts from further consideration.

    Some texts are available in hand copies of the original cuneiform tablets, while others are as yet unpublished and had to be studied by J. A. Scurlock in the student’s room of the British Museum. This material represents only a fraction of the...

  7. Map
    (pp. xxvi-xxvi)
  8. CHAPTER 1 The Ancient Mesopotamian Context
    (pp. 1-12)

    Ancient Mesopotamia, the “cradle of civilization,” is one of the sources of our own Western medical tradition.² It vies with ancient Egypt for the honor of having produced the world’s earliest recorded medical texts. And yet, even the most basic questions remain unanswered. From what diseases did ancient Mesopotamians suffer? Without the benefit of modern technology, how well were they able to distinguish one illness from another? What herbs or other medicinal substances did they use to treat their patients? In view of the antiquity of this medical tradition, a surprisingly large amount of information is available to answer these...

  9. CHAPTER 2 General Health and Public Health Practices
    (pp. 13-25)

    The general level of health in a society is less influenced by the quality of its medical care than it is by the quality of its nutrition, public and personal hygiene, and the techniques used to prevent and control contagious diseases. Using these measures, ancient Mesopotamians deserve high marks.

    Although information about the quality of the diet of ancient Mesopotamians is incomplete, it was certainly better than that of the average nineteenth-century European peasant. Plants native to and first cultivated in the Near East included not only barley (from which a rich and nutritious beer was made) and bread wheat,...

  10. CHAPTER 3 Infectious Diseases
    (pp. 26-87)

    Tools of modern medicine allow us to differentiate many infectious diseases that have similar signs and symptoms. Some of these tools are the light and electron microscopes, techniques of growing infectious agents in culture media, and DNA and RNA analysis. Based purely on careful clinical observations, the physicians of ancient Mesopotamia built a body of knowledge about infectious diseases that appears to contain relatively accurate descriptions of many types of infections.

    There are, however, limitations to our interpretation of infectious diseases as described in our sources. Both microorganisms and humans are subject to evolution and selective forces of nature. It...

  11. CHAPTER 4 Sexually Transmitted Disease (STDs)
    (pp. 88-97)

    Information is available from sources outside the medical texts about sexual mores and practices in Mesopotamia. This allows for some speculation as to their influence on the incidence and spread of sexually transmitted diseases. It is known that women were expected to be virgins at first marriage, that adultery (intercourse between a married woman and a male to whom she was not married) was punishable by the death of both parties, and that homosexual relationships were not encouraged. Divorce, however, was common, and men were allowed to take slave concubines in addition to their wives.

    Prostitution was also tolerated, if...

  12. CHAPTER 5 Genitourinary Tract Diseases
    (pp. 98-115)

    Much of ancient Mesopotamia was dry and hot with little shade. These conditions placed the inhabitants at greater risk of dehydration and concentrated urine, and the potential for developing kidney stones. Another factor is the likely presence of Schistosomiasis hematobium in ancient Mesopotamia. We cannot be certain that this infection was present at the time, but it is certainly widespread in the modern Near East. This organism requires an intermediate snail host (Bulinus truncatus), which is known to have existed along the banks of the Tigris and Euphrates rivers and their irrigation canals, as was demonstrated by the discovery of...

  13. CHAPTER 6 Gastrointestinal Diseases
    (pp. 116-154)

    The āšipu had an excellent understanding of the anatomy of the intestinal tract as well as a good grasp of many of the common gastrointestinal diseases. A specialized vocabulary was used to describe gastrointestinal diseases, a good indication of the sophistication and precision of the āšipu’s observations.

    The entire gastrointestinal tract was known collectively as the libbu.¹ In the recitation cited below not only are the individual portions of the tract listed (stomach [karšu], small intestine [irrû], and colon [riqῑtu]), but there is a clear description of the greater and lesser omentum and the mesenteries (“eyes” of the libbu), the...

  14. CHAPTER 7 Metabolic and Nutritional Diseases
    (pp. 155-164)

    Abnormalities in growth, development, and energy production can be caused by acquired or inherited defects in biochemical pathways and by nutritional deficiencies. Hormonal (endocrine) abnormalities may also play a role in growth and development. The signs and symptoms produced by these diseases often do not identify a specific condition, and modern laboratory techniques may be required to establish the diagnoses. There are, however, some metabolic diseases that can be identified with some degree of confidence from the signs and symptoms that they produce.

    When individuals have an adequate calorie intake, but inadequate protein intake, they develop protein malnutrition, sometimes called...

  15. CHAPTER 8 Heart, Circulatory System, and Lungs
    (pp. 165-184)

    The physicians of ancient Mesopotamia were aware that the heart has a rhythmic movement and that there are structures throughout the body that contain blood. They sometimes referred to these structures literally as “vessels with blood,” but more typically in medical texts, muscles, veins, and arteries are all referred to by a single term SA/šerʾānu, leaving the exact translation to be derived from context (see below).¹ It is unclear whether they knew that blood was circulated through the blood vessels by the heart, or that arteries carry the blood away from the heart and veins are responsible for returning it....

  16. CHAPTER 9 Eyes, Ears, and Nose
    (pp. 185-207)

    The importance of good vision to an individual’s activities and his or her functioning within society caused the āšipu to be acutely aware of the signs and symptoms of eye diseases (IGI.GIG).¹ He also devised a series of technical terms to describe various degrees and types of vision loss in his patients. It would appear that there were three similar but distinguishable types of vision loss: “clouding,” “confusion,” and “dimness,” and that these were further subdivided into patients experiencing a simple diminution versus those having serious difficulty seeing. Frequently, the minimal vision loss words appear together, which might imply that...

  17. CHAPTER 10 Skin and Hair
    (pp. 208-246)

    Modern physicians consider the skin to be the window of the body because so many diseases leave important clues on its surface. It is clear from reviewing ancient Mesopotamian medical literature that āšipus had reached the same conclusion. The number and variety of signs and symptoms relating to the skin that they described exceed those assigned to any other organ.

    The population of ancient Mesopotamia was a mixed one, including by the first millennium b.c.e. not only Sumerians and Akkadians but also Hurrians, Arameans, and a host of other population groups including some Indo-Europeans. The origin of the Sumerians is...

  18. CHAPTER 11 Bones and Joints
    (pp. 247-258)

    Modern people tend to think of broken bones (fractures) as less serious medical problems because of our facility in stabilizing the broken bone until it fully heals. Fractures in early humans must have been life-threatening problems. Without stabilizing the bone in the correct position, the fracture might never heal or could knit in a configuration that would be detrimental to function. This could markedly interfere with the individual’s ability to compete in a hostile environment. Other more immediate problems associated with fractures include secondary infections and blood clots.

    Ancient Mesopotamians recognized the potential problems associated with fractures. Legal codes specified...

  19. CHAPTER 12 Obstetrics and Gynecology
    (pp. 259-283)

    Women’s illnesses, including gynecological and obstetrical problems, received considerable attention from ancient Mesopotamian physicians. Treatments were prescribed for most of them, and the patients were followed as closely as their male counterparts. Judging from the clinical texts, there did not appear to be any reluctance on the part of the patient to be examined by the physician, including palpation of the abdomen during pregnancy to ascertain the size of the uterus (and therefore the fetus). The external genitalia also were examined and described. Although the āšipu is unlikely to have performed a regular pelvic (vaginal) exam in pregnant or nonpregnant...

  20. CHAPTER 13 Neurology
    (pp. 284-344)

    The signs and symptoms associated with diseases of the nervous system provide some of the most unique and focused findings. These abnormalities can readily be found by an observant physician, a characteristic that certainly applies to the āšipu. Another advantage to the student of neurologic illnesses is that the signs and symptoms described in the past can generally be explained in terms that are understandable today. Pain, paralysis, tremors, and seizures, both focal and generalized, are well described in ancient medical texts. This has resulted in an impressive array of diseases and symptom complexes that can be identified by modern...

  21. CHAPTER 14 Trauma and Shock
    (pp. 345-353)

    Āšipus were provided with ample opportunities to observe trauma victims. The armies of Assyrian kings contemporary with the bulk of the surviving medical texts were protected by shields, helmets, and flexible suits of armor made from iron scales sewn onto a cloth backing. Wars were unavoidably frequent, at times virtually annual events, as during the reign of Sargon II. Swords were made of iron hardened by heating and quenching in cold water and coated with bronze to maintain a consistently sharp edge. Attacking soldiers were greeted with showers of sling-stones and iron-tipped arrows, shot from composite bows. Below are some...

  22. CHAPTER 15 Poisons
    (pp. 354-366)

    A poison is any substance which, when relatively small amounts are ingested, inhaled, or absorbed, will cause illness or death. Ancient cultures must have first learned of such harmful substances in their efforts to find edible plants. Poisonous plants would have been quickly identified and knowledge of them entered into the shared information of the culture.¹ Knowledge of poisonous animals and minerals would also have been important.

    Poisons can have medicinal and social uses. Some substances that may cause illness and death in larger doses may have therapeutic roles in lower doses. Poisons may be used for revenge, to gain...

  23. CHAPTER 16 Mental Illness
    (pp. 367-385)

    There is a sufficient record in many cultures, regions of the world, and times for us to conclude that mental illness is a problem common to human society. The peoples of ancient Mesopotamia must have shared this problem, and the medical texts discussed in this chapter show that the āšipu had a clear idea of what was normal and what was “sick” behavior. However, since virtually all of the signs and symptoms of psychiatric disease can be produced by organic brain disease or metabolic abnormalities, it is difficult to read a single text and know with certainty whether it is...

  24. CHAPTER 17 Pediatrics
    (pp. 386-417)

    The birth process and the early years of life are subject to many risks of morbidity and mortality in the current era, and those risks were even greater in ancient Mesopotamia. Inherited diseases often become evident early in life, and the immature immune system of children places them at greater risk for infectious diseases. The āšipu reserved a tablet of the diagnostic/prognostic series exclusively for diseases of infants and small children (TUR/šerru). A section of the omen series Šumma Izbu also discussed malformations in newborns and their ominous significance. This chapter will cover only those conditions that are unique to...

  25. CHAPTER 18 Dental and Oral Diseases
    (pp. 418-428)

    Many of the conditions that manifest oral signs or symptoms are complex and often systemic diseases. In these cases, the references and associated discussions are included in other chapters, but are cross-referenced here. Toothache, however, is a focal problem which can reach a level of intensity that totally absorbs the patient’s mind and demands attention. The quotes below make it clear that ancient Mesopotamians had their share of toothaches.

    In ancient Mesopotamia there were no dentists or health care workers devoted exclusively to dental care. Certainly drilling and filling teeth would not have been possible. It is probable that, as...

  26. CHAPTER 19 Ancient Etiologies: The Naming of Disease Patterns
    (pp. 429-528)

    This chapter will explore the approaches used by ancient Mesopotamian physicians to identify and name syndromes or patterns of disease (ancient etiologies). Although ancient Mesopotamian medicine was remarkable for its foundation in prior observations, the āšipu was still an intellectual. He was expected to be well versed in the scribal arts, Sumerian, classics of literature, and a wide variety of “magical” rituals in addition to the forty tablets of the diagnostic/prognostic handbook and innumerable therapeutic texts. Moreover, like intellectuals everywhere, it was not possible for him to approach a medical problem without bringing to it a bit of preconceived theory....

  27. CHAPTER 20 Prognostics
    (pp. 529-548)

    The importance of correct diagnosis looms large in both ancient and modern medicine. It guides therapy and patient management, and can be the foundation for approaches to preventive measures. Prognosis is an allied skill that can require as much medical knowledge and intuition. The art of prognosis in the modern era, however, gets less recognition and attention, even though it can be important to the mental and emotional well-being of the patient and his or her family.

    In ancient Mesopotamia, prognosis had a significant impact on therapy. When the case was considered to be hopeless,¹ the āšipu did not continue...

  28. Conclusion
    (pp. 549-552)

    In many of the previous books and articles on the subject of ancient Mesopotamian medicine, little credit has been given to the medical knowledge and skills of these early physicians. Although the roles of viruses and bacteria were played by gods/goddesses, ghosts, and demons, it does not follow that diagnosis was “irrational” and treatment “pure magic.”

    The problem presented by the divine language of what we still call medical signs and symptoms was to determine which combinations of animal products, minerals, and plants and which recitations were effective for which medical problems. To answer this question, the ancestor of the...

  29. Unsolved Puzzles Appendix
    (pp. 553-574)
  30. Chart Showing the Arrangement of Entries in the Diagnostic/Prognostic Series
    (pp. 575-678)
  31. Notes
    (pp. 679-764)
  32. Bibliography
    (pp. 765-778)
  33. Photographs
    (pp. None)
  34. Indexes
    (pp. 779-880)
  35. Back Matter
    (pp. 881-882)