Assyrian and Babylonian medicine
was surprisingly advanced
By William Mullen
Tribune staff reporter
October 24, 2005
In the world's first cities 4,000 years ago, people came to
doctors for help with much the same problems they do today--everything
from impotence, depression, tuberculosis and cancer to gluten
hypersensitivity, hemorrhoids, narcolepsy and migraines.
The treatment they received in ancient Mesopotamia is also
familiar in many respects, with medical specialists writing prescriptions
for pills, potions and patches that patients would take to a
pharmacist.
Studying medical texts inscribed in cuneiform, the first system
of writing, Chicago researchers JoAnn Scurlock and Burton Andersen
found the physicians of the earliest civilizations were delivering
surprisingly sophisticated, knowledgeable and effective health
care 2,000 years before Christ lived.
In fact, citizens received treatment superior to what Americans
got in George Washington's time, according to the researchers.
The first president died in 1799 after doctors bled him in an
effort to rectify the "imbalance" of his bodily "humors."
Scurlock and Andersen describe their findings in a newly published
scholarly tome titled "Diagnoses in Assyrian and Babylonian
Medicine." At 900 pages and $150 a copy, it is not a likely
bestseller.
But the book may well upend conventional wisdom about the
history of medicine, which has always given a hallowed place
to ancient Greek physicians and dismissed medicine in ancient
Mesopotamia as primitive superstition.
Mesopotamian treatments evolved through hundreds of years
of careful experimentation and observation, the authors say.
Some are still in use, such as surgically draining the pus that
sometimes develops between the lungs and chest wall of pneumonia
patients. Their precise instructions to "make an opening
in the fourth rib [with] a flint knife" to insert a lead
drainage tube pretty well match present-day procedures.
The ancient Greeks, by contrast, subscribed to the idea that
the body is composed of four "humors"--yellow bile,
black bile, water and phlegm. The Greek model of medicine persisted
in Europe and America as late as the 1850s.
"Their best known treatments were bleeding, purging with
laxatives, puking and starving," said Andersen, a retired
professor and chief of infectious diseases at the University
of Illinois at Chicago. "We now know, of course, all four
of those are injurious and very seldom helpful in any circumstance."
"The Greeks are our intellectual ancestors, but these
Mesopotamians are the true ancestors of modern medicine,"
said Scurlock, a professor of ancient history at Elmhurst College.
In fact, their medicine appears so good that the authors hope
to discover overlooked treatments that could be useful in tackling
difficult conditions today. "That is the hope," said
Andersen. "It's not likely, perhaps, but it is possible."
Scurlock and Andersen's new book, published late this summer
by the University of Illinois Press, is based on their studies
of nearly 1,000 clay tablets found in modern-day Iraq and covering
a period roughly from 2000 B.C. to 150 B.C. Key among them were
remnants of a standard diagnostic handbook used for hundreds
of years to train and inform doctors. Researchers have been able
to reconstruct about half the estimated 3,000 entries it once
contained.
If injured or ill, citizens of a city/state like Nineveh or
Uruk would seek out a doctor, called an ashipu. Often the physicians
were specialists in areas like pediatrics, obstetrics, gynecology,
neurology, infectious diseases, dentistry, vision and even veterinary
medicine.
The doctors were religious figures and worked in temples.
They and their patients usually viewed diseases as punishments
from various gods, ghosts or demons. In the handbook and other
texts, diseases are rarely named; instead they are described
and attributed to the "hand" of the god responsible.
One tablet, describing severe arthritis, states: "If
he has been sick for five, ten, fifteen [and then] twenty days
... the digits of his hands and his feet are immobilized and
so stiff that he cannot open [them] or stand [on them], `hand'
of Istar."
Without timepieces, doctors measured pulse by comparing a
patient's to their own or to an assistant's. They noted body
temperature by feel. Some of their diagnostic procedures continue
to be used today, including using metal hammers to tap just below
the knee to test reflexes.
As a cure, the doctors prescribed offerings to placate the
offending gods and spirits. The offerings, however, took the
form of medicinal treatments using plant, animal and mineral
material. Treatments were administered with nearly every delivery
system used today except for needle injections into the blood
system, a method apparently unknown to them.
There were pills and potions, rectal and vaginal suppositories,
enemas, medicinally saturated ear tampons and transdermal patches--salves
spread on bandages that were bound to the skin. They were careful
to keep surgical wounds clean with bandages treated with antiseptics
like cedar and ginger.
"A couple of tablets describe night blindness when a
patient can see in daylight but is blind at night," Andersen
said. "They talk about cutting off a piece of liver and
having the patient eat it. Night blindness, we now know, is caused
by Vitamin A deficiency, and liver is loaded with Vitamin A."
The doctors had a system of putting plant material to burn
on a hooded brazier, then telling the patient to stick his head
under the hood to inhale the smoke. Scurlock said she is certain
they used medical marijuana in that way.
"It seems to have been used to relieve pain, as an antidepressant
and nausea," she said. "It seems also to have been
used to treat impotence, but they recognized that it was a double-edged
sword. It could create desire, but too much could be the cause
of impotence."
What they couldn't treat, they were honest about, giving the
patient and family the sad but inevitable prognosis.
The diagnostic handbook is almost poetic in its description
of the sad hopelessness for a patient with dementia: "his
[mind] is continually altered, his words are unintelligible,
and he forgets whatever he says, a wind from behind afflicts
him; he will die alone like a stranger."
A strong ethical code prohibited doctors from prescribing
expensive treatments and magic rituals for patients who were
obviously dying, Scurlock said. Instead, doctors were bound to
do what they could to ease the patient's suffering, saving families
from false hope and unnecessary expense.
The researchers say some diseases appear to be deadlier then
than now, such as herpes, which apparently could cover people's
bodies with sores and kill them. Some of the described diseases
seem to have no modern counterparts.
"Humans since these texts were written have had thousands
of years to develop disease immunities," Andersen said.
"We may have evolved defense mechanisms that make herpes
less serious now than it was then. There may be old diseases
we have never seen because we developed immunities that long
ago rendered them extinct."
Scurlock and Andersen's book deals mostly with the diagnoses
and prognoses of disease by the early physicians, leaving treatments
and therapies as the subject for a second volume still being
researched.
The first book is so exhaustive and specialized that other
scholars have barely begun to refer to it. Gary Beckman, a University
of Michigan professor of Near Eastern studies, said his sampling
of the contents has been enough to convince him the book will
be invaluable to other cuneiform scholars--and also to question
some findings.
"Most of these texts were known before, but most have
never been available in transliteration before and gathered in
one place," Beckman said. "Now it will be easier for
others to approach these texts.
"It's difficult to know in fact if their conclusions
are correct. Certainly they show there was more to this than
mere magical belief. To say it is like scientific medicine might
be difficult for others to accept."
The authors said it will prove impossible to figure out the
contents of most Mesopotamian medicines because so many were
plant-based. Scholars have identified about 200 to 300 Mesopotamian
plant names, but that does not tell us what present-day plants
they represent.
Without pictures or written descriptions of most of the plants,
experts can only try to deduce what the plants are by deciphering
the context in which they were used. By that means, Scurlock
is fairly certain the Mesopotamians used henna, best known today
as a hair dye, in many medicines.
"They didn't get everything," she said. "But
it's amazing what they did find. ... It makes you proud to see
what human intelligence could do back then without all the machines
and computers we have now."
- - -
Mesopotamian medicines
- Ancient name: Sagkidibbu ("affliction of the temples")
Modern condition: Headache
Modern treatment: Salicylic acid (aspirin)
Ancient treatment: "[You crush] together [and sift] adaru-poplar
seed [poplar trees contain salicin], aktam, kamantu seed, amharu,
kasu, huratu seed and kirban eqli. You decoct it in drawn wine.
You scatter roasted grain [flour] and emmer flour on it. [You
massage it into leather]. You shave his [head]. If you bandage
him with it, he should recover."
- Ancient name: Nahshatu
Modern condition: Abnormal uterine bleeding
Modern treatment: Estrogen
Ancient treatment: "You char and grind date kernels [which
contain estrogens], wrap it in a tuft of wool and insert it into
her vagina."
- Ancient name: Kuraru
Modern condition: Ringworm
Modern treatment: Topical therapy with antifungal agents
Ancient treatment: "You plaster his head with cow urine.
You wash it with uhhulu qarnqanu infusion [liquid soap] and kasu
juice. You shave his head. You dry, crush and sift [these] 11
plants: shunu seed, pillu seed, qutru seed, kamantu [probably
henna, a potent fungicide experimentally proven to be effective
for ringworm], uriyanu [leaves], [...], rushrushshu, tsatsumtu,
kurkanu, tigilu, mirishmaru and kalbanu. You mix it with first
quality beer and vinegar. You bandage his head with it and do
not take it off for three days."
Source: Dr. Richard H Beal, HittiteDictionary Project, Oriental
Institute
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