Healing and Medicine: Healing and Medicine in the Ancient near East
HEALING AND MEDICINE: HEALING AND MEDICINE IN THE ANCIENT NEAR EAST
Distinctions among religion, magic and nature, and rational thought, when referring to an ancient society that did not use those descriptive categories, are ultimately regarded as inadequate by the majority of scholars who study ancient Near East societies. Therefore, the terms "empirical" and "exorcistic" will be used throughout this entry to define the various aspects of the art of healing in the ancient Near East.
Cuneiform Script Area: Mesopotamia
Two different kinds of healers are mentioned in the earliest records: the azu (usually translated as "doctor"), found during the first half of the third millennium bce, and the ashipu (usually translated as "exorcist"), also in evidence during the same period, and more commonly after the second millennium bce. The latter term was derived from the active participle of the root wshp : "to conjure." Scholars have tried, without much success, to differentiate these two professions from each other. Texts show that the two roles overlapped, and both types of healers used the same methods, prayers, and exorcism formulas. Scurlock (1999) has recently proposed a satisfactory explanation, however: ashipu was similar to a doctor and the azu resembled a pharmacist, although the azu was also able to perform minor surgical operations. This explanation has been confirmed by P. Abrahami (2003), who has managed to place these two professions in the context of Mesopotamian cosmological thought. The exorcist (ashipu ) possessed essential knowledge which originated directly from the god Enki/Ea and was given to humans by the goddess Nininsina (literally, "Lady of [the city of] Isin"). He or she warded off evil by uttering formulas and performing rituals and treatments. The skills of the azu in contrast came directly from the goddess Nininsina alone (a lesser-ranking but important deity) and from her son Damu.
Evidence of an herbalist tradition exists in cuneiform texts from Ebla, in northern Syria dating from the twenty-fifth century bce; the skills of the azu emerged from this tradition (in fact, the profession's title is mentioned in the texts). It is reasonable to suppose, however, that the azu did not restrict his activities to the therapeutic use of plants, because the presence of small instruments may suggest that he performed surgery (D'Agostino 2003).
Collections of exorcistic texts from this period reveal the beginnings of a rich literary tradition which would continue until the end of Mesopotamian civilization. One line of exorcistic tradition runs throughout the third millennium bce; from the second millennium bce onwards, although the previous tradition continued, new trends also developed (Michalowski 1992). In this later literary tradition, the choice of particular material, drawn from an oral legacy and written down, gave rise to the distinct tradition of "academic" knowledge (typical of the schools of scribes and literary specialists), which would eventually take on a life and procedures of its own (Michalowski 1992 and Biggs 1995). Thus, the authority of academic tradition came to define the role of the healer in the second millennium bce as the preeminent opponent of evil. This role was principally centered upon the figure of the "exorcist" (ashipu ), a priest who belonged to the temple; while ancient sorcerers and witches were restricted to the negative role of agents responsible for evil, thus excluding them from any role as healers (Abusch 2002).
Ancient Mesopotamians would consider themselves to have had a "happy" life if they enjoyed the favor of the gods (and especially of their personal god), if they had a long life, raised plenty of children, and enjoyed the respect of their fellow citizens (Biggs 1995). They believed illnesses were caused by demons, ghosts, gods, witches, or warlocks. In particular, many illnesses were caused by the "hand" of a divinity or a spirit. The main reason for misfortune or illness, therefore, consisted in falling out of favor with the gods. The sick person was thought to have committed some sin, either deliberately or unintentionally, that had offended the gods. Demons, spirits, and magical spells could also cause illness, but their outbreak in the patient's life was in some way the result of a loss of divine favor, since that was considered to provide absolute protection against every misfortune. In this respect, the life of the individual corresponded to the life of the kingdom. Because loss of divine goodwill resulted in all kinds of misfortune, individual bad luck was linked to the global cosmological picture—as conceived by the Mesopotamian culture—from which were resulting every aspect of life. An example of this context is the cuneiform text "The Worm and the Toothache" (probably referring to the nerve of the pulp canal): the spell consists of only twenty-one verses—two-thirds of them describe the mythological origin and creation of the worm, and only the final seven verses give instructions on reciting the spell, the medicine, and method of treatment. (Biggs 1995).
Naturally, the ancient Mesopotamians knew contingent causes of illness in everyday living, such as wounds, overexposure to the sun or the cold, overeating, proximity to someone sick (contagion), or insect bites; still, they used spells and rituals to cure or prevent ailments.
This entry's description of the exorcist relates only those characteristics that are relevant to the modern concept of medicine. Because of their specific character, the potency incantations are the only exorcistic text to be mentioned here, for the inclusion in the ritualistic context of practical remedies (Biggs 1967).
The oldest treatises on medicine are pharmacological texts dating from the third millennium bce (Civil 1960 and Fronzaroli 1988), but scholars have been unable to identify the plants and minerals mentioned in them, thus preventing deeper study of ancient prescriptions (Biggs 1995). Three kinds of prescriptions exist: lexical texts, which list the names of plants, minerals, and ingredients; descriptive texts, which also describe therapeutic properties; and abstracts, which list the plants' names and specify the parts that should be used for treatment. In addition to these, scholars have also identified a text which provides details of how to preserve the ingredients. The city of Nippur had a central grocery store that stocked rare plants, but the most important center in terms of healing arts was the city of Isin; the temple of the city's patron goddess, Nininsina (or Gula), housed the most important school of medicine in Mesopotamia. Excavations of exorcist rooms, have unearthed collections of pharmacological texts, as well as cuneiforms texts concerning the art of healing. Even these pharmacological texts, however, emphasize the ritual element, as does the wider sphere of exorcistic literature. However, the existence of medical texts without any "magical" prescriptions has been reported from the first half of the second millennium bce (Finkel 2004).
Contrary to pharmacological texts, the remaining literature that addresses curing physical ailments was written in the second and first millennia bce. This material includes therapeutic texts and diagnostic texts. (Stol 2001).
The most well-known therapeutic manual takes its title from its opening words: "if there is fever in a person's skull"; the final version consisted of forty-five tablets. This text describes symptoms of ailments, includes prescriptions of the substances to be used in treatment, and explains how to make the required potions.
In addition to the therapeutic manual, a diagnostic manual of five chapters (contained in forty tablets) has also been preserved. This text bears the name of a scholar who lived in Babylon around 1050 bce (Finkel 1988): he not only systematically catalogued various diagnoses and prognoses, arranging them by type of divination, but he also compiled a handbook on morphoscopy in which the characteristics of healthy people were used to predict outcomes (Böck 2000).
This sort of literature is closely linked to the practice of divination. For example, the treatise on diagnosis and prognosis also contains guidelines for the doctor to interpret the signs which manifest while the patient recuperates.
Indirect evidence on healing arts comes from texts that list penalties for the negligent surgeon within the corpus of laws, and epistolographic evidence contains many descriptions of the activity of healers (either azu or ashipu ).
It is difficult, therefore, to understand Herodotus's (I § 197: Herrero 1984) claim that there were no doctors in Babylon; instead, it is reasonable to conclude that the Greek historian had misunderstood his source. In the early twenty-first century, many scholars are studying the medical history concerning Mesopotamia, as evidenced by the establishment of Le journal des médicines cunéiformes.
Cuneiform Script Area: Hittites (Hatti land)
The gap in evidence from Mesopotamia, after the Old-Babylonian period (twentieth through sixteenth centuries bce) and before the beginning of the first millennium bce, is filled by the cuneiform texts from Bogazköy (ancient Hattushash), which preserved and continued the Babylonian heritage of medical tradition. Numerous texts of Mesopotamian tradition from the city's archives often contain Hittite or Luwian terms, but the texts were written in Akkadian. Scholars have yet to fully understand the Anatolian medical practices, however, primarily because of the incomplete nature of these texts and the uncertain meaning of some Hittite terms (Burde 1974).
Texts of various kinds often provide details of Hattushash inviting doctors from elsewhere, reflecting the primitive state of health care in the region. A letter from the Hittite king Hattushilish III (r. 1275–1260 bce) to the Babylonian king Kadashman-Enlil II (r. 1263–1255 bce) mentions the arrival of two doctors in Anatolia while professional medical help was sought from Egypt, the usual source of doctors for the Hittite court (Edel 1976).
Although the Hittite term for "doctor" is unknown (the texts use both the Sumerian ideogram a-zu and the Akkadian azu ), the profession appears to have been very well organized. Various documents contain the names of several doctors; these healers participated in ritual celebrations in addition to therapeutic activities. In fact, the healer who cared for king Hattushilish III as a young man was not called "doctor"—he was the chief scribe.
As had Babylon law, Hittite legislation also regulated health provision. A notable paragraph in Old Hittite laws required those who had committed an act of violence pay the medical expenses incurred by their victims.
Scholars also have studied details of illnesses suffered by historical figures and public health epidemics. The Hittite king Murshilish II composed a dramatic prayer to the storm god and the land gods, asking them to end an epidemic which had lasted twenty years. In the text, he refers his divination attempts to discover the reason for the gods' anger: he had found out that his father, the king, had promised the gods that he would not attack the Egyptians and then broken his vow. The epidemic began when the first prisoners of war arrived in Anatolia. The admission of guilt (although his father's and not his own) is a central aspect of this prayer, seen as necessary to placate the gods.
Non-Cuneiform Script Area: Egypt
Scholars derive knowledge of ancient Egyptian medicine from a variety of sources, including artistic illustrations, treatises and medical instruments, references in literary sources and, not least, on the examination of bodies preserved by the ancient Egyptians. These sources portray a relatively accurate picture of the illnesses from which the Egyptians suffered and the theories and remedies devised to counteract them.
The oldest surviving manuscript from this period is the Kahun Papyrus, dating from the XIIth dynasty (c. 1850 bce), which contains a number of gynecological and veterinary treatments (Griffith 1898).
One important medical text, dating from the New Kingdom but containing material originating from the Old Kingdom, is the Edwin Smith Papyrus (Braested 1930 and Bardinet 1992), which is kept at the New York Academy of Sciences. The text describes in some detail vertebral contusions, dislocations of the jaw, and various fractures (of the shoulder blade, humerus, ribs, nose, and skull); in the forty-eight cases examined a rigorous diagnostic method is applied. Each case begins with the phrase "If you examine someone who has…" and then lists symptoms in detail. After examining the sick person, the doctor is advised to state his diagnosis and prognosis, or whether the patient will survive "an ailment which I will treat." In less fortunate cases, for example, a patient suffering from a severe dislocation of a vertebra with a lesion of the spinal cord, the doctor must recognize that this is beyond his capabilities: "an ailment for which nothing can be done."
While the Edwin Smith Papyrus concentrates on external traumas, the contemporary Ebers Papyrus describes the vascular system and the causes and development of internal ailments (Wreszinski 1913 and Bardinet 1992). This treatise demonstrates a rudimentary understanding of the circulatory system, considering it as a network of veins originating at the heart, extending to the organs, and passing through every part of the body.
This system circulated not only blood, but also air, water, sperm, and a bodily substance called ukhedu. The concept of ukhedu characterizes one of the oldest historical theories for illnesses; it attempts to explain in rational terms the causes of illnesses, old age, and death. In practice, the doctor checked that the circulation was working properly by feeling various parts of the patient's body. Excess ukhedu, would eventually manifest in a patient as pus and blisters, and produce internal disease. Furthermore, the natural buildup of ukhedu during the course of life resulted in aging tissues and ultimately in death. In addition, embalmers attempted to preserve corpses by dehydrating the body and draining off bodily fluids; these efforts were necessary to eliminate the ukhedu.
For healing preparations, Egyptian doctors used animals, vegetables, and minerals. Acacia, date, juniper, fig, garlic, onion, lotus, honey, milk, wax, arsenic, and other products were often used in their recipes, along with more extravagant substances, such as pelican, hippopotamus, and fly excrement. Such preparations could be delivered in various forms: decoctions, infusions, potions, pills, inhalations, fumigations, suppositories, lotions, and eyebaths.
The ancient Egyptians believed that illnesses—especially infectious diseases, fevers, or other ailments that did not appear to be caused by a cut or a wound—were due to a "blow" inflicted by a god, evil spirits, or the restless dead (Ritner 1993). Hence, Egyptian medicine frequently resorted to magic. This civilization viewed magic and rational methods as complementary rather than contradictory, as is expressed in the opening lines of the Ebers Papyrus: "Magical formulas which act in concert with medication are useful, as likewise is medication that acts in concert with magical formulas."
The link between medicine, magic and religion is clear, in that the Egyptian term for "magic potion," pekhet, is also used indiscriminately to mean "medical prescription" (Ritner 1993). Religion, magic, and medicine continually intermingled. Through a kind of ritual magical transference, the Egyptians thought particular animals possessed therapeutic values linked to their characteristics; the skin of deer, for example, could cure gout if tied to a person's foot; a fried fish head could draw out a headache and a pig's eye prevented blindness. Other substances owed their reputation to mythology, such as the milk of a mother who bore a male child, recalling the goddess Isis and her son Horus. Disgusting substances, especially excrement, also were believed to ward off evil spirits, a frequent suspected cause of illnesses.
The gods could not only send an illness, but they could also cure it. Medicine, therefore, was controlled from the world of the gods, and various gods were considered healers, including Amon, "the doctor (swnw ) who heals without any remedy" (Zandee 1948); Isis; the deified Imenhotep, architect of the Step Pyramid at Djoser (IIIrd dynasty); and Amenhotep, the son of Hapu (Wildung 1977). Patients often appealed to "Horus-swnw-nfr," or "Horus the good doctor," whose "word" "repels death," whose "speech cures the sting of the scorpion" and whose "magic soothes inflammation" (Ritner 1993). The priests of all these benevolent divinities were considered to be the best healers, even if the most important priest-doctors were those connected to two potentially dangerous goddesses, the lioness Sekhmet and the scorpion Serqet (von Känel 1984). A priest of Sekhmet, a goddess who could send plague, is mentioned in the Ebers papyrus alongside ordinary doctors (swnw ) and "amulet sellers" (saw ) (von Känel 1984). The latter could be employed by the state; and we know of a "seller of amulets of the king of Upper and Lower Egypt." The "officials of Serqet" were particularly sought after to heal scorpion stings and snake bites (von Känel 1984). Most of these priest-doctors practiced magic, and they were often enlisted for trips into the desert, where these deadly animals represented a constant danger.
Although Egyptian medicine seems to have been contaminated by magic and many of its treatments do not seem to have been particularly effective, its doctors were good observers and at times their healing approaches worked. Moreover, Egyptian medical knowledge earned an excellent reputation in Asia Minor and Greece; both Hippocrates and Galen attributed much of their knowledge to works they had consulted in the temple of Imenhotep at Memphis.
Dumuzi; Egyptian Religion, overview article; Hittite Religion; Kingship, article on Kingship in the Ancient Mediterranean World; Mesopotamian Religions, overview article; Soul, article on Ancient Near Eastern Concepts.
Mesopotamia and Hittites
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Pietro Mander (2005)