History of Ancient Medicine in Mesopotamia & Iran
Science, including medicine, has a very long history in the Middle and Near East. Its origins go back to the ancient Mesopotamian period beginning with Sumerian civilization around 3,000 BC. There are many cuneiform tablets from cities as ancient as Uruk (2500 BC). However, the bulk of the tablets that do mention medical practices have survived from the library of Ashurbanipal at Nineveh (668BC) Assyria. So far 660 medical tablets from this library and 420 tablets from the library of a medical practitioner from Neo-Assyrian period as well as Middle Assyrian and Middle Babylonian texts have been published. The vast majority of these tablets are prescriptions, but there are a few series of tablets that have been labeled "treatises". One of the oldest and the largest collections is known as "Treatise of Medical Diagnosis and Prognoses." The text consists of 40 tablets collected and studied by the French scholar R. Labat.
Although the oldest surviving copy of this treatise dates to around 1,600 BC, 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. To the non-specialist they sound like magic and sorcery. However, the descriptions of diseases demonstrate accurate observation skills. Virtually all expected diseases exist; they are described and cover neurology, fevers, worms and flukes, venereal disease and skin lesions. The medical texts are essentially rational, and some of the treatments, (such as excessive bleeding) are essentially the same as the modern treatments for the same condition.
In these ancient texts, diseases are often blamed on pre-existing spirits: gods, ghosts, etc., and each spirit was held responsible for only one disease in any one part of the body. Ancient mythologies tell stories of diseases that were put in the world by supernatural forces. One such figure was Lamashtu the daughter of the supreme god Anu, a terrible she-demon of disease and death. It was also recognized that various organs could simply malfunction and cause illness. Medicinal remedies used as cures were specifically used to treat the symptoms of the disease, and are clearly distinguished from mixes or plants used as offerings to such spirits.
There were two distinct types of professional medical practitioners in the ancient Mesopotamian city-states. The first type of practitioner is called ashipu, who in older texts is identified as a sorcerer or the witch doctor. One of the most important roles of the ashipu was to diagnose the ailment. In the case of internal diseases or difficult cases the ashipu determined which god or demon was causing the illness. He also attempted to determine if the disease was the result of some error or sin on the part of the patient. He prescribed charms and spells that were designed to drive out the spirit causing the disease. The ashipu could also refer the patient to a different type of healer called an asu. He was a specialist in herbal remedies, and in texts is frequently called "physician" because he dealt with the empirical applications of medication. For example, in case of wounds, the asu applied washing, bandaging, and making plasters. The knowledge of the asu in making plasters is of particular interest.
Many of the ancient plasters (a mixture of medicinal ingredients applied to a wound often held on by a bandage) seem to have had some helpful benefits. For instance, some of the more complicated plasters called for the heating of plant resin or animal fat with alkali. When heated this particular mixture yields a soap-like substance, which would have helped to ward off bacterial infection. The two practitioners worked together and at times could function in both capacities.
Another textual source of evidence concerning the skills of the Mesopotamian physicians comes from the Law Code of Hammurabi (1,700 BC). There are several texts showing the liability of physicians who performed surgery.
These laws state that a doctor was to be held responsible for surgical errors and failures. Since the laws only mention liability in connection with "the use of a knife," it can be assumed that doctors were not liable for any non-surgical mistakes or failed attempts to cure an ailment. According to these laws, both the successful surgeon's compensation and the failed surgeon's liability were determined by the status of his patient. Therefore, if a surgeon operated and saved the life of a person of high status, the patient was to pay a lot more as compared to saving the life of a slave. However, if a person of high status died as a result of surgery, the surgeon risked having his hand cut off. If a slave died, the surgeon only had to pay enough to replace the slave. At least four clay tablets have survived that describe a specific surgical procedure. Three are readable and one seems to describe a procedure in which the asu cuts into the chest of the patient in order to drain pus from the pleura. The other two surgical texts belong to the collection of tablets entitled "Prescriptions for Diseases of the Head." One of these texts mentions the knife of the asu scraping the skull of the patient. The final surgical tablet mentions the postoperative care of a surgical wound. This tablet recommends the application of a dressing consisting mainly of sesame oil, which acted as an anti-bacterial agent.
It is hard to identify some of the drugs mentioned in the tablets. Often the asu used metaphorical names for common drugs, such as "lion's fat" (much as we use the terms "tiger lily" or "baby's breath"). Of the drugs that have been identified, most were plant extracts, resins, or spices. Many of the plants incorporated into the asu medicinal repertoire had antibiotic properties, while several resins and many spices have some antiseptic value, and would mask the smell of a malodorous wound. Beyond these benefits, it is important to keep in mind that both the pharmaceuticals and the actions of the ancient physicians must have carried a strong placebo effect.
Patients undoubtedly believed that the doctors were capable of healing them. Therefore, visiting the doctor psychologically could reinforce the notion of health and wellness. Temples belonging to gods and goddesses of healing were also used for health care. Gula was one of the more significant gods of healing. The excavations of such temples do not show signs that patients were housed at the temple while they were treated (as was the case with the later temples of Asclepius in Greece). However, these temples were sites for the diagnosis of illness and contained libraries that held many useful medical texts. The primary center for healthcare was the home. Most of the healing processed took place at the patient's own house, with the family acting as care givers. Outside of the home, other important sites for religious healing were nearby rivers. These people believed that the rivers had the power to care away evil substances and forces that were causing the illness. Sometimes a small hut was set up either near the home or the river to aid the patient and their families.
To be continued ...
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