Markham J, Geller
Ancient
Babylonian
Medicine
Theory and Practice
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Markham J. Geller
Ancient
Babylonian
Medicine
Theory and Practice
®WILEY-BLACKWELL
A John Wiley & Sons, Ltd., Publication
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Ancient
Babylonian
Medicine
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Ancient Cultures
These enjoyable, straightforward surveys of key themes in ancient culture are ideal for anyone new to the study of the ancient world. Each book reveals the excitement of discovering the diverse lifestyles, ideals, and beliefs of ancient peoples.
Published
Ancient Babylonian Medicine Markham J. Geller
The Spartans Nigel Kennell
Sport and Spectacle in the Ancient World Donald G. Kyle
Food in the Ancient World John M. Wilkins and Shaun Hill
Greek Political Thought Ryan K. Balot
Sexuality in Greek and Roman Culture Marilyn B. Skinner
® Theories of Mythology ®
Eric Csapo
In preparation
Science in the Ancient World Daryn Lehoux
Ethnicity and Identity in the Ancient World Kathryn Lomas
Roman Law and Society Thomas McGinn
Economies of the Greek and Roman World Jeremy Pater son
Economies of the Greco-Roman World Gary Reger
The City of Rome John Patterson
Family in Greek and Roman Culture Emma Griffiths and Tim Parkin
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^
Markham J. Geller
Ancient
Babylonian
Medicine
Theory and Practice
®WILEY-BLACKWELL
A John Wiley & Sons, Ltd., Publication
9781405126526_1_pretoc.indd iii {©} 1/29/2010 9:07:31 PM
#
This edition first published 2010 © 2010 Markham J. Geller
Blackwell Publishing was acquired by John Wiley & Sons in February 2007. BlackwelFs publishing program has been merged with Wiley's global Scientific, Technical, and Medical business to formWiley-Blackwell.
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Library of Congress Cataloging-in-Publication Data
Geller, Markham J.
Ancient Babylonian medicine : theory and practice / Markham J. Geller. v. cm. - (Ancient cultures)
Includes bibliographical references and index.
Contents: Introduction to Babylonian medicine and magic - Medicine as science -Who did what to whom? -The politics of medicine - Medicine as literature - Medicine and philosophy - Medical training : MD or PhD? - Uruk medical commentaries - Medicine and magic as independent approaches to healing -Appendix: An edition of a medical commentary.
ISBN 978-1-4051-2652-6 (hardcover : alk. paper) 1. Medicine, Assyro-Babylonian. 2. Medicine, Assyro-Babylonian-Philosophy. 3. Medicine, Assyro-Babylonian- Methodology. 4. Magic, Assy ro-Babylonian. I. Title.
R135.3.G44 2010
610.938-dc22
2009046375
A catalogue record for this book is available from the British Library.
Set in 10/12. 5pt Rotation by SPi Publisher Services, Pondicherry, India Printed in Malaysia
I 2010
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To Florentina
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Contents
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List of Illustrations viii
List of Abbreviations x
Acknowledgments xii
Introduction to Babylonian Medicine and Magic 1
1 Medicine as Science 11
2 Who Did What to Whom? 43
3 The Politics of Medicine 56
4 Medicine as Literature 89
5 Medicine and Philosophy 118
6 Medical Training: MD or PhD? 130
7 Uruk Medical Commentaries 141
8 Medicine and Magic as Independent Approaches to Healing 161
Appendix: An Edition of a Medical Commentary 168
Notes 177
References 202
Subject Index 211
Selective Index of Akkadian and Greek Words 217
Index of Akkadian Personal Names 220
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Illustrations
Map
Map 1 The Near East (MarkW. Chavalas, The Ancient
Near East, Blackwell, 2006) 5
Figures
{g> 1.1 Medical tablet from Babylon mentioning Hammurapi's {$}
mother (BM 41293+44866; copy M. J. Geller) 16
1.2 Exorcists performing a ritual, dressed as fish-men apkallu sages (Vorderasiatisches Museum, Berlin; drawing
Tessa Rickards) 32
1.3 Clay model of a sheep liver used for divination, from Mari in Syria, second millennium BC
(Musee du Louvre; photo Florentina Badalanova Geller) 38
2.1 Ceramic plaque from the Assyrian period (c. 700 BC) showing an exorcist dressed as an apkallu sage
(photo Florentina Badalanova Geller) 47
2.2 Exorcism ritual carried out in a reed sutukku-hut, with one woman fumigating and another wailing; early first millennium BC (Collon 1987: No. 803;
photo courtesy D. Collon) 52
2.3 Exorcists trying to heal a patient in bed, Lamastu-amulet (Wiggermann 2007: 107, No. 2; drawing
F. A. M.Wiggermann) 55
3.1 Bust of Hammurabi, king of Babylon (Musee du Louvre Sb 95;
photo Florentina Badalanova Geller) 57
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Illustrations ix
3.2 Seal of physician Ur-lugal-edina (Collon 1987: No. 638; drawing courtesy D. Collon) 59
3.3 Bust of an Assyrian courtier (Musee du Louvre;
photo Florentina Badalanova Geller) 74
3.4 Ceramic plaque showing healer and patient, second millennium BC (Musee du Louvre AO 6622;
photo Florentina Badalanova Geller) 78
4.1 Healing goddess Gula with her dog, holding a scalpel in her right hand and a tablet in her left
hand (Collon 1987: No. 793; photo courtesy D. Collon) 93
4.2 Assur recipes BAM 116 and duplicate recipes (Babylonisch-assyrische Medizin) 99
4.3 Duplicate recipes (Babylonisch-assyrische Medizin) 100
4.4 BAM 104 and duplicates (Babylonisch-assyrische
Medizin) 105
4.5 AMT 56,1 and duplicates (Assyrian Medical Texts and Babylonisch-assyrische Medizin) 106
4.6 Healing goddess Gula with her dog, seated before
the god Latarak (R. Ellis, Fs. J. J. Finkelstein, figure no. 3;
drawing F. A. M. Wiggermann) 110
5.1 Patient being healed (Wiggermann 2007: 107, No. 1; W drawing courtesy FA. M. Wiggermann) 126 W
6.1 Scribes and officials fromTil Barsip (ninth century BC)
showing scribes writing on both leather and clay
(photo Florentina Badalanova Geller) 131
A.l Photo of MLC 1863 taken by A.T. Clay (photo courtesy
Ulla Kasten,Yale Babylonian Collection) 170
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Abbreviations
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AIPHOS Annuaire de I'lnstitut de Philologie et d'Histoire Orientales
et Slaves (Brussels) AMT R. Campbell Thompson Assyrian Medical Texts (London,
1923) ARM Archives royales de Mari
ArOr Archiv Orientalm
AuOr Aula Orientalis
BAK H. Hunger, Babylonische und assyrische Kolophone
(Neukirchen-Vluyn, 1968) BAM F. Kocher, Babylonisch-assyrische Medizin in Texten und
Untersuchungen, 1-7 (for 7 see Geller 2005) BE Babylonian Expedition (BE 17/1 = H. Radau, Letters to Cassite
Kings pom the Temple Archives of Nippur [Philadelphia,
1908]) BRM Babylonian Records in the Library of J. Pierpont Morgan (see
Clay 1923) BSOAS Bulletin of the School of Oriental and African Studies CAD Chicago Assyrian Dictionary
CBQ Catholic Biblical Quarterly
CH Codex Hammurabi
CH E Codex Hammurabi Epilogue
CRRAI Compte Rendu, Rencontre Assyriologique Internationale JCS Journal of Cuneiform Studies
JESHO Journal of the Economic and Social History of the Orient JMC Journal des Medecines Cuneiformes
JANES Journal of the Near East Society of Columbia University JNES Journal of Near Eastern Studies
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Abbreviations xi
JEOL Jaarbericht ex Oriente Lux
JRAS Journal of the Royal Asiatic Society
KAR Keilschrifttexte ausAssur religiosen Inhalts
LKA Literarische Keilschrifttexte aus Assur
MAOG Mitteilungen der Altorientalischen Gesellschaft
MLC Tablets belonging to the Pierpont Morgan Library (now in the
Yale University Babylonian Collection)
MSL Materials for the Sumerian Lexicon (Rome)
Or Orientalia
RA Revue d'assyriologie
SAA State Archives of Assyria (see Parpola 1993)
SBTU SpatbabylonischeTexte aus Uruk
STT The Sultantepe Tablets, ed. O. Gurney J. J. Finkelstein,
P. Hulin (London)
TCL Textes cuneiformes du Louvre (seeThureau-Dangin 1922)
TDP See Labat 1951
Ut. Lem. Utukku Lemnutu incantations (see Geller 2007c)
WZKM Wiener Zeitschrift fur die Kunde des Morgenlandes
ZA Zeitschrift fur Assyriologie
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Acknowledgments
This book was made possible by a grant from the Wellcome Trust, which allowed me to spend the 2005-6 academic year at the College de France and Ecole Pratique des Hautes Etudes, Paris, through the invitation of J.-M. Durand. Further work on the manuscript was carried out during two research visits to the Max Planck Institut fur Wissenschaftsgeschichte, Berlin, courtesy of Peter Damerow and Jiirgen Renn. These visits were funded by grants from the Alexander von Humboldt-Stiftung W (Wiederaufnahme Stipendium) and the TOPOI Excellence Cluster of the W
Freie Universitat Berlin, with Eva Cancik-Kirschbaum as my Betreurerin.
The manuscript received a thorough and highly critical reading from Irving Finkel, which resulted in a major redrafting of the text.
I would like to thank a number of colleagues who have generously helped in providing illustrations for this volume. Frans Wiggermann and Dominique Collon kindly sent along their original drawings as well as photos from their own archives, and Tessa Rickards provided her draw- ing of an object in the Vorderasiatisches Museum, Berlin. Ulla Kasten supplied an old photo from the Yale Babylonian Collection taken by A.T Clay, with permission to publish it. Beatrice Andre-Salvini graciously granted permission to publish photos from the Louvre taken by Florentina Badalanova Geller, to whom this volume is dedicated.
Finally, I would like to thank Galen Smith of Wiley-Blackwell for see- ing this work through to publication and Clare Creffield for copy-editing the manuscript.
9781405126526_3_posttoc.indd xii {©)- 2/2/2010 12:03:31 PM
Introduction to Babylonian Medicine and Magic
If a man has pain in his kidney, his groin constantly hurts him, and his urine is white like donkey-urine, and later on his urine shows blood, that man suffers from "discharge" (mwsw-disease).You boil 2 shekels of myrrh, 2 shekels of baluhhu-resin, (and) 2 sz7«-measures of vinegar together in a jug; cool it and mix it in equal measure in pressed oil. You pour half into his urethra via a copper tube, half mix in premium beer, you leave it out overnight and he drinks it on an empty stomach and he will get better. /g, Babylonian recipe for disease of the kidneys, BAM 7 35 ,*,
[If a] man has intestinal colic, he constantly scratches himself, he retains wind in his anus, food and fluids are regurgitated (and) he suffers from constipation of the rectum - its "redness" is raised and troubles him [with- out] giving him relief - you desiccate a lion skin and mix it with lion fat, you dry (it) a second time, crush and mix it in cedar oil, make a pessary and insert it into his anus.
Babylonian recipe for disease of the anus, BAM 7 151
Medicine today is technological and scientific, often making it difficult to cast our minds back to earlier ages when medicine was less under- stood and less successful. Actually, we need not go back very far in time, since any physician trained in medicine before the discovery of penicillin would attest to how relatively unsophisticated medicine still was, even by the middle of the twentieth century. As one physician recalls,
I graduated from medical school in 1938. Even in those days, medicine was more a priesthood than a science. A favorite examination question
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2 Introduction to Babylonian Medicine and Magic
was, "If you are lost on a desert island with only six drugs, which drugs would suffice for good medical practice?" The answer was arsenicals for syphilis, quinine for malaria, insulin for diabetes, liver for pernicious ane- mia, digitalis for the heart, and morphine for pain. All other medicines were pure placebo. (Rosenbaum 1988: 198)
After the discovery of modern life-saving drugs, therapy dramatically improved in most aspects of medicine, to the extent that medicine has made more rapid and successful progress during the past 60 years than in the entire cumulative previous history of Western medicine, from Galen to the twentieth century.
Nevertheless, we do not yet have the answers to all medical questions, and in some significant areas we are hardly better informed about human behavior and medical practice than were ancient and medieval practition- ers. Medicine remains an art, and tracing back the history of this art can help us better understand the processes of discovery and treatment.
Let us take one example, the problem of diet and health. Obesity has recently been recognized as one of the scourges of modern times, with little overall consensus as to how one should understand and act upon the issues involved. According to one expert, our modern ideas of diet were developed and promoted after the Second World War by the American W Heart Association, based upon studies comparing cholesterol and heart W
attack rates in countries around the world. The research concluded that high levels of fat in modern diets were specifically responsible for obesity and heart disease, and recommended a low-fat, high-carbohydrate diet. 1 After a low-fat diet did not have the anticipated effect, new diets were introduced to improve health and reduce obesity, one requiring total fat restriction while another recommended exactly the opposite, a high-fat low-carbohydrate diet. Subsequent studies embraced contradictory advice, advocating diets based upon a theory of "good" and "bad" fats as well as "good" and "bad" carbohydrates (Agatston 2003: 16-21).
Our modern scientific world dispenses a great deal of confusing infor- mation about health and prevention of disease, which is a trait modern medicine shares with its ancient counterpart. Moreover, diets and trendy medications tend to be the obsessions of wealthier classes in society, and this situation hardly differs from antiquity, when the best medical advice was only on offer to those patients who could afford the costly services.
When we turn to ancient Babylonian medicine, one question often asked is whether any part of Babylonian medicine was actually effective. Did it work? We have hundreds of drugs cited in Babylonian medical recipes, in addition to long lists of plants and minerals used for medicinal
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Introduction to Babylonian Medicine and Magic 3
purposes, often with descriptions of the drugs and of the diseases for which they could be used. We have no idea, however, how such data was compiled, since there were no clinical trials. How would ancient physi- cians know which plants were effective against which diseases? We can surmise that plants were identified over a very long period, perhaps going back to Neolithic times, and the use of such plants was determined by a hit-or-miss means of trying something to see what happens, and then keeping careful records of the results. The crucial point was to remember, later on, if the drug seemed to work.
One redeeming feature of Babylonian medicine is the lack of sur- gery, because of the substantial risks involved. Almost all Babylonian medical texts are limited to pharmacological preparations adminis- tered mostly as potions, salves, ointments, fumigations, or supposito- ries. Surgery would have been dangerous without either proper antiseptics or anesthesia, nor is there any firm evidence from Babylonia of bloodletting. For this reason, the Babylonian physician probably caused less harm to his patient than his later colleagues in medieval Europe.
Dissection and Disease Taxonomy
As we go back in time, the relationship between magic and medicine alters considerably, although not fundamentally. The technological basis for what we know as modern medicine has a long and tedious history, which actually made precious little advancement over many centuries. The major breakthrough leading to a scientific understanding of medi- cine came relatively late, in the fifteenth century, with dissection of the human body providing more precise knowledge of human anatomy. Meanwhile, autopsies were primarily an academic exercise, carried out exceptionally by some noted Greek physicians in Alexandria in the third century BC (von Staden 1998: 52). There are various practical reasons why the taboo of cutting open the human body was usually observed, even by Galen. First, before the invention of rubber gloves, dissection could have been dangerous since the researcher could easily contract a disease which had been the patient's cause of death (see Geller 2007: 187f.). Second, religious taboos no doubt played an important role, since disfiguring the human body was thought to have affected how the soul might appear in the afterlife. In Homer, for instance, the soldier in Hades is seen with his battle scars (Bernstein 1993: 30, 65). Apart from the taboo itself, the most probable reason for the lack of interest in
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4 Introduction to Babylonian Medicine and Magic
dissection in ancient and medieval medicine was the fact that knowledge of internal anatomy did not actually help in healing the patient. Knowing where the organs were located and how the blood circulated were impor- tant discoveries in themselves, but how did one convert this knowledge into effective treatment?
It is not particularly easy to classify diseases within Babylonian medi- cine, although they fall generally within similar categories in Hippocratic medicine. Some diseases are simply associated with parts of the body, such as head disease, tooth disease, eye disease, nose disease, even foot disease, as well as kidney disease and anus disease. Baldness was treated as a disease. There are varieties of skin diseases, including rashes and pocks, as well as leprosy-like conditions affecting the nose and mouth, but it is impossible to diagnose these conditions according to modern disease terminology.
A major development in understanding disease only came with the discovery of morbid anatomy in the eighteenth century in Padua and at St George's Hospital, London, where physicians began to realize that autopsies after diagnosis could provide important clues to diagnosing disease correctly (Porter 1997: 263f.). It took centuries, however, for this idea to develop from the days of Egyptian mummification, which was the last period when dissections were carried out on a regular basis as part W of embalming, or from third-century BC Alexandria, where a few Greek W
physicians practiced vivisection on prisoners.
What this effectively means is that ancient and medieval medicine had much in common, and that the fundamental relationship between doctor and patient remained fairly constant over the centuries. The rela- tionship between magic and medicine - the psychological and technical approaches to healing - was always present and was constantly evolving. We will see that although real technological advancement in medicine was slow in developing, knowledge about disease and healing improved over time, and theories about disease and healing were changing as well. Not every new idea is an advancement or an improvement on what came before, but the complex relationship between magic and medicine is usually affected by new theories of healing, or even by skepticism towards accepted theories.
Another factor determining how magic and medicine relate to each other is the complex relationship between doctor and patient, in the ancient world as in our own society. Within Mesopotamia, there is much we do not know about this relationship. Was the doctor paid, and how much? What was his status within society? Would men and women be
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Introduction to Babylonian Medicine and Magic
$
Map 1
2006)
The Near East (Mark W. Chavalas, The Ancient Near East, Blackwell,
#
treated by the same doctor? Was medical help readily available? How many doctors were there within a community, or was medicine only available to the royal household and those closely associated with either the palace or temple? Although there is much here that we would like to know but will probably never know, it is possible to make some reason- able assumptions based upon the data which we have. But first, it is important to clarify the nature of our sources.
The Sources
Mesopotamian society is better documented over the three millennia than any other ancient society, including Egypt. The many thousands of cuneiform tablets which survive because of the durability of clay provide
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6 Introduction to Babylonian Medicine and Magic
an enormous wealth of information, which is still in the process of being painstakingly collected and analyzed by a relatively small group of schol- ars who read Sumerian, Akkadian, Hittite, and other languages written in cuneiform script. We also have much data from other languages of the region, such as Aramaic, Phoenician, Ugaritic, and Hebrew, written in alphabetic scripts, although anything written on either parchment or papyrus had a much poorer chance of survival. Even cuneiform tablets and stone inscriptions often come down to us in a damaged or broken state, and much of the ancient written record was either destroyed over time or remains to be discovered. In other words, we will never have as much information as we would like and there will always be gaps in our knowledge. This means that we have to make clear distinctions between evidence and inference, by noting what information we have in the form of written or pictographic records, and then being direct about what inferences can be drawn from this data.
A good example of evidence versus inference as applied to the ancient world concerns the debate over levels of literacy in an ancient society such as Mesopotamia. The model we tend to use is that of medieval Europe, where levels of literacy are known to be low. The usual assump- tion is that scribes performed all tasks which required reading and writ- ing. Does the same apply to Mesopotamia? W The evidence from Mesopotamia is quite different from what we find W
in medieval Europe (see Charpin 2004: 31ff.; Cryer 1994: 138-41). The many thousands of cuneiform tablets dealing with simple transactions, such as loans or purchases, deeds, contracts, letters, and receipts, indi- cate that there was a sophisticated urban economy, usually based upon the activities of the palace or temple, as well as the business interests of important commercial families. The many documents show a great vari- ety of handwriting, from very formal to very cursive, and from sophisti- cated accountancy records to simple receipts. One could infer from this data that professional scribes were responsible for all these written records, and that the general population remained illiterate. 2 Moreover, since two prominent kings, Assurbanipal and Nabonidus, boasted of their skills in the art of writing, one jumps to the conclusion that only these two kings in first-millennium Assyria and Babylonia were literate (Beaulieu 2007: 473). Several factors argue against this point of view.
In the first instance, we usually assume that cuneiform script was diffi- cult to learn, 3 much more difficult, in fact, than learning an alphabet. The assumption is that the 600-odd cuneiform-sign repertoire of Sumerian and Akkadian was too cumbersome for traders and merchants, who ulti- mately invented a much simpler writing system - the alphabet - which
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Introduction to Babylonian Medicine and Magic 7
then spread throughout the world. By simply inventing a system of writ- ing consonants rather than vowels, the "original" alphabet boiled down a 600-odd character system into 30 characters or fewer, and this new sys- tem of writing is thought to have facilitated the spread of literacy
If we separate evidence and inference, things appear somewhat differ- ently It is true that the alphabet drastically reduced the number of char- acters for writing languages. Nevertheless, the assumption that an alphabet is easier to read than a cuneiform syllabary needs to be chal- lenged. 4 It is not easier. For a native speaker of Akkadian, learning to write cuneiform only required a knowledge of some 100 basic signs, and these signs are clearly phonetic (see also Charpin 2004: 52-60). This means that one has a different sign for BA, BU, BI, or MA, MU, MI, as well as AB or AM, or even BAB. The phonetic nature of the script, once one learns the signs, makes it quite easy to write Akkadian or even to read the Akkadian of a simple business document or private letter. Of course one had to be much better educated in the scribal schools to read more sophisticated court letters, literature, astronomical texts, medical texts, etc., but this is just as true today as then. Second, it is not neces- sarily easier to read an alphabet as such, despite the fact that it has many fewer characters, since the reader must supply the vowels in order to sound out the script accurately, and readings are not always obvious. W The script is not phonetic. Furthermore, the invention of the alphabet W
did not immediately occasion the abandonment of cuneiform scripts, which kept being used for almost two millennia after the introduction of the alphabet.
There is one other factor which may reflect the levels of literacy in Mesopotamia, namely the easy availability of writing materials. Cuneiform tablets were essentially cost-free, with clay easily available, and the stylus made of reed. Papyrus was relatively cheap but still had to be rolled and treated to make a sheet of writing materials, and writing required ink. Parchment was expensive, being made from animal hide. It is quite plausible, therefore, that once a Babylonian could master the mechanics of reading and writing simple cuneiform without too much difficulty, writing materials were easy to come by, and these two factors encouraged the spread of literacy.
The emergence of writing in Mesopotamia may have also been influ- enced by the context of an urban rather a predominantly rural society. Large cities, such as Eridu and Uruk, can be traced back to prehistoric Mesopotamia of the fourth millennium BC. Other large cities developed along the alluvial plain of theTigris and Euphrates, and these cities depended upon a highly developed system of dikes and canals for controlling irrigation,
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8 Introduction to Babylonian Medicine and Magic
which was made possible through the use of a large corvee of workers controlled by a central bureaucracy The landscape itself encouraged the development of urban culture, and the rivers were used as major highways for transporting goods (Algaze 2008: 51ff.). Already by the third millen- nium BC, we see a society characterized by widespread trading contacts, large-scale building complexes, great walled cities, and many different types of professional and artisan classes. The literature of the time also shows a preference for urban life, viewing the open countryside between cities as hostile territory rife with bandits and demons.
In effect, magical and medical literature from Mesopotamia originates from a relatively literate and urban society, in which some form of med- ical expertise, offered by either an exorcist, physician, midwife, or bar- ber, was probably available to anyone, either at the temple or in a shop or stall on the street. This may explain the differences in our magic and medical tablets, which range from clear library handwritings, often in many columns, to small tablets in cursive scripts preserving a single pre- scription or a simple magical spell. There were probably many different healers for different clients, depending upon their social status, wealth, or gender, and perhaps even specialists for different types of medical problems.
Is Medicine Magic and Is Magic Medicine?
In Babylonia, both magic and medicine served as strategies for healing the sick, marshaling the authority of religion whenever possible. The great English scholar Reginald Campbell Thompson published copies and editions and translations of Babylonian medical texts throughout the 1920s and 1930s, but he never attempted a synthesis explaining how the system actually worked and what made Babylonian medicine tick. The French scholar Rene Labat gave us an edition of the Babylonian manual of diagnosis and prognosis, but his publication made surprisingly little impact on the world of history of medicine, despite presenting much relevant material (Labat 1951). What was obvious from these early studies was that Babylonian medicine contained a fair amount of magic: incantations appeared alongside recipes within the medical corpus, and diseases were often thought to have been brought on by various gods and demons. The vast majority of Babylonian medical texts were pub- lished in cuneiform copy only by Franz Kocher from Berlin, which included many texts which could be classified as magico-medicine, inhabiting the grey area between pure magic and pure medicine.
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Introduction to Babylonian Medicine and Magic 9
In fact, the complex relationship between magic and medicine persisted within all systems of healing in the ancient and medieval world, although this relationship differs over the course of centuries as healing methods changed and improved. The psychological dimensions of therapy or heal- ing arts, which we will refer to as "magic," have always played an impor- tant role within the practice of treatments which we know of as "medicine." This fluid relationship between magic and medicine is dynamic, depend- ing upon the level of sophistication of healing therapies. Our attitudes towards magic and medicine today are quite different than those of our great-grandparents, who lived before the invention of penicillin and the invention of drugs which can prolong life. Even today, the patient often feels better once he enters the doctor's surgery, and the sight of the doc- tor's white coat and stethoscope makes an impression on the patient which become part of the healing process.
Our use of the terms "magic" and "medicine" is somewhat misleading, since ancient Babylonian scholars used no such terminology. Healing therapy consisted of a combination of therapeutic recipes and incanta- tions, since recipes were often accompanied by incantations. One modern approach to Babylonian magic and medicine avoids any categorical dis- tinctions between incantations and medical recipes as separate genres, but treats each type of text as a form of "therapy," usually for different W types of illnesses. Incantations are essentially appeals to the psychology W
of the patient, while medical recipes treat symptoms such as fever, pain, diarrhea, and other physical signs of disease, using potions, pills, salves, ointments, pessaries and suppositories, etc. At the same time, there is also ample evidence that exorcists could treat physical illnesses (Schramm 2008: 26f.; Bock 2007: 175; Jean 2006: 166), while "medicine" could use materia medica against mental illness. 5
The overlap between these two complementary methods of healing - recipes and incantations - are different means of achieving similar ends. Incantations frequently appearing in medical recipes provided the patient with confidence that the therapy itself had divine sanction and prece- dence and would work. Healing rituals used with incantations, in non- recipe contexts, provided for fumigations and massage as alternative means for purifying and healing substances to be applied to the patient. According to this approach, there is no need to assign one set of thera- pies to an artificial category - magic - and the other to another equally artificial category - medicine.
We can also attempt to imagine the situation from the patient's per- spective: how did one choose between visiting the exorcist and visiting the physician? On what did this decision depend, and was it a free choice
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10 Introduction to Babylonian Medicine and Magic
or was it determined by social or economic considerations (for which we have little evidence)? Perhaps, by the late first millennium, it made little difference, because an exorcist would have known enough about medi- cine (in its basic forms) or the physician would have known enough about incantations to be able to handle most ailments. On the other hand, there may have been a difference between primary care and spe- cialist care, which we cannot judge from the evidence; did a patient first visit an exorcist or a doctor? One final possibility is that a patient (who could afford to do so) would ideally visit both exorcist and physician, for treatments covering the full range of physical and psychological condi- tions. Later systems of medicine paid due attention to both mind and body; Maimonides, for instance, later advocated a balanced state of mind as well as a strict regimen for optimal health.
The scope of the present study examines how medicine (and to a lesser extent, magic) evolved in Babylonia at the end of a long period of gesta- tion and development, during a period extending over some 2000 years. It is not possible to trace every aspect of this development, since many things change over two millennia, including social and political milieux as well as basic scientific knowledge, apart from possible influences from elsewhere (Egypt and Greece). Our task will be to examine the end prod- uct of this process, to view state of the art Babylonian medicine in its W final period of maturity, in the second half of the first millennium BC. W
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Medicine as Science
Scientific theory and epistemology are normally reckoned as the great discovery of the Greeks. Thales, Euclid, Hippocrates, Aristotle, and many other thinkers from Greece and Asia Minor are considered to have launched a great intellectual revolution, which created a specific kind of "scientific" thinking. This revolution is thought to be the basis for mod- ern science, and especially natural sciences. The intellectual potential of Babylonian thinkers, on the other hand, with their own type of wisdom, W i s evaluated in very different terms: Babylonians are usually thought to W
have hardly indulged in theory but limited themselves to pragmatic and practical speculation about the physical world, without reference to hypothetical generalizations or methodological rules. Within the realm of medicine, for instance, Babylonians are known to have had no "theory of humors," as had the Greeks, and Babylonians saw diseases as being caused by demons and magical agents. This naturally has led to the con- clusion that Babylonian medicine was unscientific, or at least less scien- tific than that of the Greeks.
It is true that Babylonian thinkers have left us no theoretical works among the many thousands of surviving cuneiform tablets from Mesopotamia; philosophy was simply not a Babylonian literary genre. This does not mean, however, that philosophical arguments were unknown to Babylonian scribal schools or scholars, but that philosophi- cal writing was not part of the cuneiform repertoire. On the other hand, it is hardly conceivable that a complicated system of medicine like that used in Babylonia could have functioned devoid of theory. The problem is how to recognize and disinter Babylonian epistemology and theory from within the array of sources at our disposal.
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12 Medicine as Science
The view taken here is that "theory" within an ancient context requires three necessary preconditions, in order to identify what we would con- sider to be rational but non-technological thinking. These three precondi- tions are: imagination, deductive logic, and observation. Let us take each in turn.
Imagination: Ancient science sought to find a general explanation for natural occurrences, with one general aim, namely to reduce the impres- sion of randomness of what happens around us. There were countless numbers of events which imparted a feeling of "randomness" (in the way that quantum physics uses this term) among ancient peoples, such as movements of stars, changes in weather and climate, infinite varia- tions and changes among flora and fauna, etc. The structure of this uni- versal explanation is ambitious, namely the search for the simple (and generally valid) clarification of an endless number of happenings being brought about by a limited number of causes. In this way, the over- whelming randomness of the universe can be reduced to a relatively few factors.
Deductive logic: Babylonian epistemology bases itself upon logical deduction in which general patterns can be inferred from a myriad of details. A typical example of this kind of deduction can be seen in the relationship between the protasis and apodosis clauses of omens. The W basic formulation of all Babylonian omens is, "if so-and-so happens, then *Qp
so-and-so can result" (see Rochberg 2004: 257-9). Omens offer a strat- egy for counteracting a notion of randomness by reducing a great many "signs" into a relatively small number of results; even if gods ultimately control what happens, the patterns of signs or omens limit the number of possible explanations for otherwise seemingly random events.
As soon as one can find probable connections between, for example, a celestial event and corresponding incidents on earth, one can establish a system of quasi-causality for many different phenomena, thereby explaining otherwise seemingly arbitrary and haphazard occurrences. This is why Babylonian scholars developed a "database" of omens and signs in a system designed to infer and predict what would happen in the future based upon previous experience. If omen A was associated with event B at some time in the past, inference would suggest that the reoc- currence of A might lead to the reoccurrence of B. From a modern per- spective, the entire logic is fallacious, and we would dismiss the association of two seemingly unrelated events as the fallacy of "post hoc ergo prop- ter hoc," namely the fallacy of assuming that where two events are in sequence the second is caused by the first. 6 Nevertheless, we must admit that this type of deductive logic in Babylonia was not entirely without
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Medicine as Science 13
purpose, since establishing a relationship between data and inference is after all the beginning of methodical and scientific thinking.
Observation: In order for "observation" to qualify as a tool of science, the process must be formalized and calibrated. Rather than casual view- ing, scientific observation must be periodic and regular with results being recorded. Babylonian scholars systematically collected an enormous quantity of data and information about the world around them, organ- ized into relatively simple classifications, listing ordinary household objects, plants, stones, stars, as well as gods and illnesses; other lists recorded all kinds of ominous events in the world, based upon move- ments of celestial bodies and birds, climate and weather patterns, the shape and appearance of internal organs of animals, and much more. Classification and taxonomy are crucial ways of bringing order into a seemingly chaotic universe (see Veldhuis 1997: 2-8).
A large part of scientific thinking concerns observations of actions and reactions in the natural world, although ancient man had virtually no instrumentation or technology available to him (apart from simple meas- uring tools) in order to try to establish causality between two reacting phenomena. One of the main characteristics of ancient scientific think- ing is the general failure of ancient savants to validate the results or conclusions of others. Claims were never systematically checked, but W everything was based upon the authority of the claimant. This was as W
true of the Greco-Roman world as in the Orient; a common rhetorical device used by the Romans in courts of law was to discount the observa- tions of others by questioning the authority of the person making the observation, rather than by checking the facts, 7 a technique also employed by Galen.
"Scientific" Medicine
The three characteristics - imagination, deductive logic, and observation - are postulated as the essential intellectual basis for all ancient science, whether in Babylon or Athens. These same three prerequisites to scien- tific thinking are also to be found within the framework of Babylonian medicine, although in somewhat different forms. 8 We would redefine these three intellectual characteristics within Babylonian medicine in the following categories.
First, the function of imagination corresponds within Babylonian medicine to a related factor: magic. One might qualify this statement somewhat: the function of imagination corresponds to any phenomenon
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14 Medicine as Science
within Babylonian medicine which we would call "magic." We have already referred to the problem of "randomness," which needed to be addressed by Babylonian as well as every other system of ancient medi- cine. Magic offered a solution. There were and still are obvious questions relating to randomness, such as "Why am I sick and not my neighbor?" "Why do I have pain in my head/stomach/foot, and nowhere else?" "Why this illness and not some other?" "What has caused this illness?" The countless number of possibilities can be dramatically reduced by what we call "magic."
The system worked as follows: in the Babylonian view of the world, gods decided all matters dealing with human fate. Babylonian scholars grounded much of their scientific knowledge in an ancient belief system incorporating magic, in which illnesses were ultimately caused by demons or angry gods, or perhaps indirectly caused by these same fac- tors through, for example, ingesting bewitched foodstuffs. This belief system formed a useful general background explanation for the ultimate causes of illness, which the patient could readily accept. This general explanation of illness, however, would never be expounded as theory per se in any Babylonian tractate. On the other hand, in comparison with the Greek theory of "humors," the Babylonian idea of demons as invisible bearers of disease conforms in some ways more closely to mod- W ern notions of bacteria and viruses. Babylonian medicine in this respect W
may not be less rational than a Greek conception that disease was caused by internal bodily imbalances.
In fact, Greek schools of medicine held contradictory views concern- ing the causes of illness. 9 Hippocrates was not the only doctor in town. In contrast to the Hippocratics, the ancient Greek world knew other philosophies of medicine, such as Methodists and Empiricists, who argued that the search for causes of disease was a distraction preventing the physician from investigating a proper cure. According to this oppos- ing view, an effective cure was much more valuable than philosophical speculation about the potential causes of disease. In certain respects, the Methodists correctly evaluated the limitations of ancient medicine by insisting on a more practical approach to healing, pointing out that a philosophical theory of disease had only limited application to the actual healing of patients. Surprisingly, the Methodists, in the second century BC, introduced into the Greco-Roman world a type of medical practice which more-or-less resembled that of contemporary Babylonia, which concentrated on practice and recipes to the exclusion of theory. The growth of these anti-Hippocratic medical philosophies may have coincided with an increased general skepticism in the Roman world, as
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Medicine as Science 15
exemplified by the rise of the Skeptic school of philosophy, as well as fitting in with a general objection to all things Greek, as forcefully exp- ounded by Cato the Elder (Nutton 2004: 148, 162). As OwseiTemkin observes, "the methodist sect, because of its practical orientation and disdain of complicated theories, appealed to the temper of the Roman people" (Temkin 1956: xxix).
The role of deductive logic and analogy in Babylonian medical think- ing (our second category) needs further clarification. Beyond a general notion of ultimate causation of disease as a result of divine disfavor or simply fate, Babylonian medicine developed its own system for relating diseases to symptoms in a quasi-causal relationship. The logic was essen- tially the same as that for numerous types of Babylonian omens, as dis- cussed above, and a formal system of recording omens and potents was adopted by Babylonian medicine for diagnosis and prognosis (Oppenheim 1977: 224). In effect, symptoms became omens. The omen apodoses were prognostic, used to determine whether the patient would continue to live or die, and if the latter, when? After three days? Four days? Within a month?
There is a difference, however, between medical prognostic omens and all other types of omens. The difference is that the connection between the protasis and apodosis of medical prognostic omens is based upon a W reality not to be found in other types of omen literature (Oppenheim *Qp
1977: 294). In other words, in the case of medical omens, results were potentially capable of being substantiated or refuted. Ancient physicians, for instance, were capable of estimating for how long a certain fever was likely to last, or how life-threatening or dangerous a certain infection was likely to be, simply by repeated experience of observing fevers of the same type. The "post hoc ergo propter hoc" fallacy of other types of omens cannot be applied in the same way to the medical omens, since the connection between data and inferences was likely to be more real- istic, and one could note what actually happened after the occurrence of a sign, symptom, or "omen." In other words, medical omens could reflect real observations of "action-reaction" situations, the connection between disease as a cause (of changes in the body) and symptom as a sign (of changes in the body), while other types of omens could not make the same claim to causality 10
This brings us to our third point, namely observation as a function of epistemology. Since actual instruments (e.g. thermometers and stetho- scopes) were unavailable then, ancient physicians were entirely depen- dent upon observation. 11 Within the framework of medicine, we must include an additional factor, namely "experience," best understood in the
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16 Medicine as Science
<$
Figure 1.1 Medical tablet from Babylon mentioning Hammurapi's mother (BM 41293+44866; copy M. J. Geller)
French equivalent term experience also denoting "experiment." As Roger French comments regarding Alexandrian medicine, "experience was now not only a question of personal observation, but the experience of others, which could be read in books." 12 We need to explore how this combina- tion of "observation" and "experience" actually functioned.
A medical tablet from Babylon, dated roughly to the latter half of the first millennium BC, has an unusual opening line in what is otherwise quite an ordinary medical recipe for eye disease (see Figure 1.1). The tab- let begins with the line, " [If] Hammurapi's mother suffered from eye dis- ease ...". 13 The Vorlage of this tablet was obviously broken at this point, as noted by the scribe himself, and the actual symptoms ascribed to Hammurabi's mother were not preserved at the time the tablet was cop- ied. 14 The rest of the tablet contains eye-disease recipes which are known from other Late Assyrian and Late Babylonian sources (see Fincke 2000: 86-91). The scribe himself was no doubt copying from an older manu- script containing eye-disease recipes, but whether the original manu- script was actually from the time of Hammurabi himself is doubtful. Why should this tablet refer to Hammurabi's mother, who lived some 1500 years before this tablet was being copied? The most likely explanation is that the scribe was referring back to a celebrated case of eye disease which was recorded and remembered in a much later era. A similar
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Medicine as Science 17
case of retrospective attribution of medical recipes to a venerable old tradition occurs in an unusual colophon of a tablet devoted to fever occur- ring in the brain. The colophon reads:
Proven and tested salves and poultices, fit for use, from the mouth of ancient antediluvian sages from Suruppak, which Enlil-muballit, sage (apkallu) of Nippur, left (to posterity) in the second year of Enlil-bani, king of Isin. 15 (AMT 105; see Hunger 1968: No. 533)
Although the tablet itself is not earlier than the eighth century BC, the poultice is attributed to oral transmitted medical lore dating back to c. 1860 BC, more than a millennium earlier, and ultimately to mytho- logical sages from before the Flood; 16 nothing could be more authorita- tive. This particular colophon goes further in stating that experience gathered over a very long period of time, from ancient experts to con- temporary physicians, makes these poultices tried and true. In the absence of clinical trials, generations of usage of drugs effectively acted as a filter to determine which drugs were effective (and which not). 17
There is nothing particularly unusual about a medical tablet colophon claiming that a recipe is "tried and tested," although we are not given any indication of the testing process. 18 Occasionally tablets attest to the (& effectiveness of the drugs mentioned, such as an Assur tablet serving as (&
the equivalent of a modern Physician's Desk Reference listing various measures of common drugs, with the following appended note:
This lotion is effective and tested against jaundice and hepatitis. Lotion of oils (for) "sun-fever." (BAM 186: 10-13 [cuneiform text only])
We have no way of knowing what exactly is meant by "effective and tested," except the authority of the well-known Assur masmassu, Kisir- Assur, who "hastily excerpted" the recipe and wrote the tablet. What we have here is a good example of "experience," in which the scholar or physician brings to mind an earlier successful formula or treatment, which was noted and recorded. Vivian Nutton has found a similar approach within Greek medicine:
Case histories, the codified record of previous success, played an impor- tant role, providing a wider data bank for future use. The Empiricists were particularly keen on recording information on drugs and their effective- ness. . . . The weakness of experience . . . was that it dealt only with the past: when faced with an apparently new condition or new circumstances ... the Empiricist doctor had to start effectively from scratch and resort to a
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18 Medicine as Science
method of trial and error. Such criticism was countered by the principle that, having observed carefully the conditions of any case, the doctor should choose whatever therapy had worked in "similar" circumstances. (Nutton 2004: 148)
Academic Medicine
Babylonian science in the latter half of the first millennium BC formed an integral part of the school curriculum (Gesche 2001: 213-16; Hunger 1976) and these disciplines were characterized by large collections of data which were then studied and analyzed, in an attempt to explain many aspects of the physical world. Although mathematics, astronomy and astrology, medicine, magic, and divination do not all conform to our modern notions of "science," they nevertheless need to be perceived in terms of their methodologies and how they assembled data, as well as their applications to everyday life.
We wonder whether Babylonians, in the course of collecting data on physical and perceived phenomena of their world, could have invented a rudimentary "scientific method" which might be comparable to scien- tific thinking today (Rochberg 2004: 96f.); the same question has been W directed towards Greek science (Russo 2004: 21ff.). Babylonians for W
most of their history inhabited a world which was mostly devoid of tech- nology, and the symbiosis of mechanics and science came later. Babylonians had few instruments for measurements or calculation, and virtually no telescopes or microscopes, or navigational instruments.
Of course technology is not a sine qua non for scientific thinking, since mental models can be used as tools for investigating physics, as has been demonstrated for Greek science (Renn and Damerow 2007), and for Babylonian mathematics (Damerow 2007). In the same way, we can inves- tigate Babylonian "sciences" (including medicine, magic, and divination) as intellectual disciplines, with one caveat. We will impose a rule of thumb, that the more "mathematical" a Babylonian discipline tends to be, the more "scientific" in our modern sense. Let us give a few examples below.
Mathematics, on a priori grounds, yields the best results as a scientific form of thinking. Although it has usually been understood that Babylonians developed little in the way of mathematical theorems or hypotheses, recent studies have shown that Babylonian scholars certainly understood and taught mathematics in a way which showed that they grasped the rudiments of Euclidian mathematics long before Euclid (Friberg 2007; but see Robson 2008: 281f.).
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Medicine as Science 19
The next important burst of scientific discovery occurred before the middle of the first millennium BC, when astronomers in Babylon began to make much more accurate charts of the movements of stars and plan- ets in relation to each other and to the sun and moon, to the extent that accurate predictions became possible. In this regard, complex calcula- tions of heavenly phenomena became increasingly important and moved mathematics on from its close association with algebraic geometry, with its origin in surveying of fields. The need to have mathematics serve the needs of astronomy may have given it a vital boost and even generated a new interest in mathematics, after the heyday of mathematics in the Old Babylonian period of the second millennium BC. This dramatic change in the need for new types of calculations can easily go unnoticed, since we have no mathematical or school texts which are designed to illustrate the logic of mathematical astronomy. Furthermore, the study of mathematics appears to have gone into decline by the mid-second mil- lennium BC, lying dormant for nearly a millennium.
By the mid-first millennium BC mathematical astronomy had become fundamental. Its calculations were basic tools of astronomy and served to kick-start mathematics within the school curriculum once again. Significant Babylonian advances in astronomy began taking place, based on an essential mathematical component, to provide accurate predic- W tions of the movements of the moon, constellations, and planets, as well W
as eclipses. The zodiac first appears in Achaemenid Babylonia and was adopted by Greek astrology. Aside from mathematics, astronomical data was gathered by daily observation of the heavens, recorded in "astro- nomical diaries" providing information about the moon, sun, and plan- ets, solstices and equinoxes, meteors and comets, the weather, market prices of certain commodities, the height of the Euphrates, and occasion- ally a significant historic event on the day, usually involving the king. The calculations of time intervals used in the diaries were probably based on the use of a water-clock, and the diaries are remarkable for the accuracy of the recorded data.
Materia Medica
The combination of observation and experience certainly benefited Babylonian therapy, which governed the use of plants and drugs in medi- cal recipes. The epistemological question is how Babylonian scholars managed to recognize the chemical effects of plants, without the benefit of laboratories or clinical trials. Nevertheless, they studied, listed, and
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20 Medicine as Science
categorized plants and minerals under a specific classification system, which they labeled with the Akkadian word siknu, meaning "nature" or "character," e.g. "the siknu of a plant/stone is ...". 19 This term siknu is significant since the Greeks used the term physis, "nature," in a similar sense, although such terminology is by no means universal in other sys- tems of ancient medicine. 20
The question therefore remains, how Babylonians could have discov- ered the effective properties of plants and minerals and what effect they would have upon the human body. That the Babylonians did indeed have some idea of what changes plants and minerals were capa- ble of producing in the body can be seen from Akkadian therapeutic texts themselves, which distinguish between "simple" and "complex" recipes. A "simple" is a recipe which employs a single-ingredient drug against a single illness. 21 We also find, on the other hand, numerous cases of complex recipes composed of combinations of plants, miner- als, and other ingredients, used as panaceas against one or more dis- eases.
We are far from understanding Babylonian medical recipes because we can only identify with accuracy relatively few of the ingredients. The dosage and amounts of the drugs also remain unclear to us. Hence, for the moment, drafting a proper taxonomy of Babylonian drugs is a hope- W less enterprise, nor can adequate comparisons be made with the works W
of Dioscorides andTheophrastus, in which plant and mineral names are much better understood than those of their Babylonian counterparts. 22 Nevertheless, some general features of Babylonian recipes can be noted. Babylonian physicians made clear typological distinctions between reci- pes aimed at specific ailments. For example, rectal-disease texts employed much more oil in recipes, while kidney-disease texts employed more minerals, and eye-disease recipes used more salves. Babylonian physi- cians had worked out a system for the use of simple and complex drugs, which we do not yet fully comprehend. 23
The great bulk of Babylonian medical recipes are concerned with pharmacological methods of alleviating symptoms, and there is quite a variety of methods for drugs to be administered. One of the most effec- tive methods of administering drugs was through fumigation, by which drugs were inhaled and could rapidly be absorbed into the blood- stream.
The materia medica of Babylonian recipes consisted of trees and plant matter (seeds, roots, sprouts, leaves, fruit, branches, even wood), grains such as barley and flour, and various spices and vegetables. There was a
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Medicine as Science 21
variety of liquids into which drugs could be dissolved, such as water, milk, fish brine, sesame oil, and urine, and in some cases drugs were fil- tered and distilled; alcohol (beer and wine) were excellent agents for dissolving drugs. In many cases, drugs could be mixed with animal prod- ucts such as sheep fat and lard, and less regularly in fish brine, blood, and bone marrow. Some exotic animal products were also used as materia medica, such as mongoose blood, turtle and mussel shells, and other animal viscera. Mineral stones could also be ground up, and the recipes call for animal or even human excrement (e.g. bat guano), but such Dreckapotheke have been shown to be secret names for ordinary plants (Kocher 1995).
Once the plants or other items have been gathered, there is a long list of how they must be treated and used to make up the recipes themselves: materia medica need to be "taken" in the first instance (i.e. gathered or selected), then weighed, washed, immersed, dried and desiccated, roasted and burned, crushed, pounded, cut up, beaten, diced, chopped, grated, pul- verized, sifted, pressed out, soaked and dissolved, kneaded, stirred, sprin- kled, saturated, spread, blended and mixed, poured out into vessels, warmed up and heated in an oven, cooked and boiled, and finally cooled. Each of these actions is governed by a rich and varied medical technical vocabulary (see Goltz 1974: index), with parallels in Greek medical reci- W pes. Drugs, consisting mostly of plants and minerals, were prepared in the *Qp
form of potions, salves, powders, pills, tampons, and pessaries, to be ingested, rubbed onto the body, applied as a bandage, or inserted into the anus, urethra, ears, or vagina through lubricated copper tubes or reeds. Not only was there a large variety of drugs, but there was an equally important variety of ways in which drugs could be utilized, in both simples and compound recipes.
Anatomical Science
Anatomy posed serious problems, even for experienced doctors, since neither Babylonians nor Hippocratics engaged in dissection or autopsy on human corpses. Babylonians, like Greeks, had little actual knowledge of workings of the internal anatomy, except for that gleaned from com- parisons with animal physiognomy. Only in the third century BC did Greek scholars in Alexandria, Herophilus and Erasistratos, 24 indulge in human vivisection, but this revolutionary approach to medicine was short-lived. 25
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Egypt, of course, had a clear potential advantage in the field of anatomical knowledge, due to the practice of mummification, in which the main internal organs were extracted and placed into canopic jars. This does not mean, however, that such knowledge was widespread or even generally appreciated. Judging from the extant Egyptian medical corpus, it is far from clear whether funerary experts mummifying bodies transmitted the fruits of their anatomical experience to Egyptian doctors (Nunn 1996: 43f., 65), and in any case embalming had little to do with medicine in Egypt (von Staden 1998: 29). In general, prior to the third century BC no scholars in antiquity had any real understanding of inter- nal human anatomy.
In Babylonia, much more was known about the internal anatomy of sheep than humans, judging by the very precise terminology for inter- nal sheep organs that can be found in divination texts. Although we have no single Akkadian word specifically designating the human heart, 26 Babylonian diviners identified no less than eight different areas of a sheep's heart (see Geller 2007: 188f.). Moreover, there is no clear evi- dence that diviners and physicians ever compared notes during the form- ative periods when Babylonian medicine was taking shape, in the Old Babylonian period in the first half of the second millennium BC. By the Hellenistic period, exorcists became the scholars responsible for copying W and recording divination texts (Robson 2008: 241f.), but this knowledge W
does not seem to have spurred on any new Babylonian studies of human anatomy. Nevertheless, despite the fact that the physician's observations were limited to the external anatomy of his patients, the combination of observation and experience led to some impressive results. Physicians were able to observe cases of "action-reaction," namely what specific changes came about in the body which were caused by disease. 27
Medical Predictions
By the mid-first millennium BC, the increased ability of Babylonian astronomers to make accurate predictions had a putative influence upon other sciences as well. The problem with other disciplines, such as medi- cine or magic, was the lack of any real mathematical basis for predictions regarding the physical and mental health of patients. Medics and magi- cians tried to introduce astral medicine and astral magic into their own calculations, hoping that the accuracy of predicting the appearance of planets might transfer over into predicting the onslaught or course of dis- ease. Although previously celestial divination and omens had traditionally
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Medicine as Science 23
focused on the changing positions of constellations and planets, or the sun and moon, to make general predictions about plagues or epidemics, the new astral medicine relied upon the zodiac and more accurate predic- tions of celestial motion to try to determine which specific diseases and treatments in individual patients were likely to be affected by celestial phenomena.
To determine the "scientific quotient" of Babylonian medicine, based upon our rule of thumb about a mathematical component, we should look at aspects of Babylonian medicine which demonstrate rudimentary scientific thinking, unaided by instruments. Babylonian healers were adept at observing symptoms of patients and recording them scrupu- lously. One of the staples of Babylonian therapy, the lengthy list of symp- toms comprising the so-called Diagnostic Handbook (Labat 1951; HeeBel 2000), allows us but few insights into ancient disease taxonomy, since symptoms were not assigned to the diseases which generated them, but rather to the parts of the human body which exhibited these symptoms. There is virtually no evidence that symptom lists were compiled from case histories, but they were largely a conglomeration of symptoms drawn from many different patients, for the purpose of describing dis- ease in general and not illnesses associated with any single individual. Nevertheless, in terms of scientific thinking the Diagnostic Handbook W represents one method for collecting and analyzing data, even if the W
underlying assumptions of the process do not conform to modern notions of diagnosis. 28
Three examples of diagnostic texts will help to illustrate these texts, with the first being an example of symptoms taken from the temples of the head:
If (a man's) temples are under pressure and he is hot (and) cold: hand of
Kubu.
If the temples are under pressure and his internal organs move: hand of
Kubu.
If the temples are under pressure and his internal organs keep swelling up:
hand of Kubu.
If the temples are under pressure and his ears do not hear (anything): hand
of his personal god being laid on him, he will die.
If his temple is in good shape, he will recover; if his temple collapses, he
will die. (Labat 1951: 32-3, 1-5)
The symptoms are described in a methodical but mechanical way, with no indication of the individual characteristics of a patient, or an awareness of other symptoms that might occur. The crucial question being addressed
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here is whether the patient will live or die, a concern that is also found in Diagnostic Handbook symptoms derived from the patient's face:
If (a man's) face is covered with a yellow paste, his lips are covered
with a film, his eyes secrete yellow (stuff), and his right eye squints, he
will die.
If his face is deformed, he will die.
If his face is deformed and his tongue is yellow, (in fact) his body is yellow,
he is ill in the stomach and will die (latest) on the third day. (Labat 1951:
74-5, 29-31)
Similar prognostic texts are known from aphorisms in the Hippocratic corpus (e.g. Lloyd 1983: 171). Not all passages demonstrate this pattern:
If a man's complexion changes, his eyes roll around, his eyes begin to squint, he constantly scratches his lips and his chin, blood flows from his nose without being able to staunch it: the Gallu-demon has seized this man. (After Labat 1951: 190-91, 14; see Iraq 19: 40)
This passage (from the end of the composition) describes a group of dif- ferent head symptoms and also provides a diagnosis; the attack of the Gallu-demon designates a certain type of illness. As with all other exam- v§? pies of the Diagnostic Handbook, we have no way of knowing in how W
many patients these same symptoms were noted, but such a passage is unlikely to be based on a single case history.
Medical Prescriptions
The largest genre of medical texts from Babylon were therapeutic texts, which begin with a symptom and then list drugs and procedures designed to relieve the symptoms (but not necessarily cure the disease). It is likely that a cure for disease was considered to be the province of gods (to be approached though magic and incantations, through an exorcist), while the physician's role was to treat symptoms. Among texts with a high "scientific quotient," therapeutic texts get a higher score than magical incantations, partly because of the mathematics rule of thumb we have been using (i.e. the more math, the more "science"). Therapeutic texts erratically (and not always) provide amounts or weights of each ingredi- ent in a recipe, presumably reflecting relative proportions of ingredients, and occasionally give information about dosage, e.g. drugs to be admin- istered three times a day, etc. Consider the following:
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If ditto (= diseased anus), grind up 5 sila of flax seed, sieve, and you steep it in milk,
bind (it) for 14 days on the chest and shoulder and he will improve; the ingredients [are checked].
When you have tied on these poultices on him, he drinks 1/3 sila of date- juice, 10 fewflZ-weight of oil and afterwards he should not drink any [other] drug; he keeps drinking it for six to eight days and [he will improve]. (BAM 7 37 ii 14-18')
These recipes, although exceptional, indicate both specific measured amounts and dosage of medication. Nothing comparable exists within incantation texts or their accompanying rituals. Furthermore, even when no amounts are recorded in medical texts, it was likely that the recipe itself was only a mnemonic and that many of the details regard- ing how to administer drugs were instructed orally rather than being written down. 29
There are some important distinguishing patterns of drug application for various ailments. For instance, eye-disease texts use more salves and ointments than drugs taken internally. Although one cannot assume that such general patterns reflect intuitive or rational thinking, they neverthe- less show that recipes were designed specifically for specific ailments and W that relatively few recipes were panaceas, used for any and all ailments. 30 W
Some recipes may have been widely used because of some desired medicinal effect deemed to be useful for more than one condition. We are not referring here to any modern notions of side-effects or medical prop- erties, but rather to what might have been perceived by ancient physi- cians as medically relevant. Many parts of the human body, for instance, were examined to see if they were hard or soft, or wet or dry, and drugs or diet could be administered in order to correct any abnormal condition, since this was considered to have serious consequences on general health. For example, drugs thought capable of drying a patient's loose stools (which were "wet") might also be thought effective in drying up a "wet" cough (which produced excessive sputum or phlegm). 31 Our ability to assess these conditions is severely hampered by our inability to identify ancient Babylonian plant and mineral names and hence drugs, in order to assess any chemical properties behind Babylonian prescriptions.
Types of disease classifications in medical texts differ from each other significantly. "Kidney-disease" and "rectal disease" were, transparently, seated in specific organs. The designation sudlu or "cough" for a type of disease refers to a symptom of the illness, while Hand of the Ghost refers to a potential cause of the disease (in theory, at least). Given
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that there were many facets to the Babylonian disease repertoire, it is unclear why very different conditions were often treated with the same prescriptions.
Regarding the overall structure and contents of typical medical trea- tises from Babylonia, the primary information comes from rubrics on medical texts themselves, which are intended to label the contents of the recipes, according to the conditions being treated (see Attinger 2008: 26f.). Typical rubrics are as follows: "if a man's teeth are 'ill'," "if a man's eyes are 'ill'," "if a man's 'heart' (e.g. bowels) is ill," "if a man's breathing is labored (lit. heavy)," "if a man suffers from paralysis (sassatu)." Other rubrics offer a bit more relevant information, such as, "if a man suffers from cough, turning into colic," 32 "if a man's neck sinews hurt, it is the Hand of a Ghost," or simply medical conditions generally ascribed to the Hand of a Ghost (Scurlock 2006: 5-20). One important series is more comprehensive than others, "if a man's brain (muhhu) 33 contains heat," which mostly concerns fever in the body 34 Migraine is referred to as a disease affecting the temples, which corresponds to numerous incanta- tions for headache within the magic corpus. Rubrics, however, do not always explain the nature of the disease, e.g. one set of recipes organized under the heading, "if a man suffers prematurely from groin pain" (Geller 2005: 102f.). Finally, we also find medical texts with rubrics that are W clearly magical in nature, labeling recipes as belonging to a category of W
us n -bur-ru-da, "breaking the spell" or zi-ku 5 -ru-da, " cutting the breath," 35 which are well known in otherwise magical contexts.
These rubrics do not, however, exhaust the full range of diseases which Babylonian medical texts aimed to treat. Aside from ailments just men- tioned, medical texts dealt with diseases specifically associated with a certain part of the anatomy, such as kidney disease, rectal disease, dis- eases of the lung and chest, gall bladder disease, and many kinds of skin ailments, diseases of the foot and tendon, and diseases affecting the mouth and nose which resemble some aspects of leprosy. Other diseases are more general, such as stroke and seizures, which would probably include forms of epilepsy. Baldness was considered to be a treatable dis- ease (or at least one for which we have recipes). Various kinds of fevers and paralysis are medicated, as are digestive problems and general inter- nal disorders, probably occurring almost anywhere in the abdomen. Childbirth was, in some sense, treated as a medical problem. The desig- nations and classification of diseases is not very different from what we find in the Hippocratic corpus, although in almost no instance can we expect to give a modern diagnosis based upon symptoms described in our ancient medical literature. One good example of this phenomenon is kidney disease caused by hypertension, for which the various symptoms
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and signs are not located in the kidneys (see George 2002), or venereal disease, which is known as the great imposter since it copies the symp- toms of other ailments.
At times medical texts provide clues to causes of diseases, and these often differ from the kinds of causes which are found within incantations (such as demons and vengeful gods). A good example of a disease cause is the eating of hexed foodstuffs causing digestive problems; in medical texts, it is not the hex itself which is the problem but rather the ingesting of food which has been cursed or magically altered.
Sumerian and Akkadian Therapeutic Magic
We must turn to other "sciences" as well, including magic. The oldest surviving types of magical texts come from the mid-third millennium BC, but these early texts are too rudimentary to allow much scope for analysis (see Cunningham 1997: 5-43). The next important phase of magical texts is found in Nippur, towards the end of the third millennium BC, this time in Sumerian only, and the same workshop in Nippur appears to have produced the one complete Sumerian medical text which has survived from antiquity (van Dijk and Geller 2003; Civil 1960). These W Sumerian incantations address medical problems, such as headache, W
along with many other types of catastrophic situations occasioned by the attack of demons, such as the interference with natural husbandry and even the malfunction of musical instruments (Krispijn 2008). The basic understanding of these early texts was that demons were capable of destroying all aspects of the world's natural order. 36
By the time we arrive at the great Sumerian scribal libraries of the Old Babylonian period, contemporary with Hammurabi, the literary text genres have developed considerably, and Sumerian incantations have become long and complex compositions; the process of translating these texts into Akkadian is beginning. By the first millennium BC these same incantations recur in bilingual Sumerian-Akkadian form, preserved in numerous copies in all major libraries in Mesopotamia.
The incantations are formal and formulaic, usually consisting of a dia- logue between Ea and Marduk in their roles as father and son, and also in their roles as God of Wisdom and Divine Exorcist. Marduk observes what is wrong with the patient or victim, reports back to Ea seeking advice about how to help, and after a brief discussion Ea tells Marduk what he needs to know. The ritual instructions, which follow as a sepa- rate section, usually (but not invariably) derive from Ea's advice, which confers legitimacy upon the exorcist's activities. There are, on the other
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hand, other types of formal literary incantations from Mesopotamia, mostly in Akkadian, which mainly deal with protection against witches and witchcraft. There is a third genre of more "down-to-earth" types of magic, concerned with the seamy side of life, such as rivalry at court or love magic, and these incantations are often somewhat more vulgar, both in content and language. This scheme is very skeletal but gives a rough idea of genres.
The essential formal elements of these incantations thus consist of a ritual solution to the patient's difficulties being communicated via a dialogue between Marduk and his father Ea. This dialogue becomes so integral to Mesopotamian magic that it is even repeated later on within Akkadian incantations, even when there is no Sumerian original source. 37 Here is an atypical example of the dialogue, with slightly dif- ferent dramatis personae:
Girra approached Marduk and spoke to him of this and in the quiet of his couch at night, (Marduk) listened to this matter. (Marduk) entered the temple, to his father Ea, and called out, "My father, Girra has approached the East, and news of them has reached (here).
Hasten to learn the ways of the Seven, and seek out their places." {£) "Wise son of Eridu," {S)
Ea answered his son Marduk.
"My son, the Seven among them dwell in the Netherworld, and have come here from the Netherworld. The Seven were born in the Netherworld, and were reared in the Netherworld.
They have approached here to tread on the edge of the Apsu. Go, my son Marduk:
As for the e'ra-wood sceptre of the (protective) spirits (rabisu), in the middle of which Ea is invoked by name, and along with the august Eridu incantation formula of purification, apply fire to the tip and base (of the sceptre), so that the Seven of them do not draw near to the patient.
Toss (the flame) like a broad net spread out in a broad place, so that it may constantly be present at his head at high noon, and both day and night.
Let (the sceptre) be held in his hand to light up the street and thoroughfare at night.
let (the sceptre) be present at the head of the distraught man in the middle of the night,
(even) during normal sleep in bed." (Utukku Lemnutu 13-15: 61-81 [Geller 2007c: 244f.])
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This dialogue has a calculated function within the context of the incantation. The officiating exorcist can claim that his incantation comes directly from the gods and that the patient is benefiting from the best possible magic available. Later Akkadian incantations adopt a similar strategy within other contexts, in which the exorcist declares that "the incantation is not mine," and that the spell comes directly from the gods. Nothing therefore depends upon the exorcist's own personal charisma. The dialogue between gods was intended to inspire the patient's confi- dence, since the patient's acceptance and internalizing of the words and ritual procedures becomes part of the healing process. The exorcist, how- ever, was not trying to dupe the patient into accepting a fiction, since he too would have believed in a dialogue between gods in the same way that the patient believed it.
Sumerian and Akkadian bilingual incantations were eventually com- piled into formal compositions or canonized texts by the end of the sec- ond millennium BC and formed a large part of ancient libraries. For the most part, these texts recognized the harmful attacks of many kinds of demons and recruited the gods against demons and adjured the demons to depart and not come back. Formal magic lays out the rules of engage- ment, that whimsical gods can send demons against humans for whatever reason, but usually because humans have upset the gods by committing W some transgression or violating some taboo. We rarely hear the patient's W
own voice in describing his difficulties, although his plight is catalogued in detail by the exorcist, who occasionally speaks in the first person. The patient himself, described throughout as a "man son of his god" and as the "distraught man," is the passive object of all that is happening around him, but the incantations are written from the perspective of the exor- cist, not the patient.
Other types of incantations take a slightly different view of man's affairs, although probably dating from a later period than bilingual com- positions. Dingir.sa.dib.ba (illulidi) incantations have the patient declar- ing that he does not know what he has done wrong (Lambert 1974: 270). These incantations express the patient's own anxieties in the first person and we hear his voice, expressing his fears, worries, or doubts. These types of incantations also include a lengthy confessional, based upon the assumption that the patient is ill or suffering because he violated some divine taboo, willingly or unwittingly (van derToorn: 1985, 42f.)
Another series of incantations are collected under the title "Surpu," which means "burning" referring to a specific ritual. Surpu incantations provide the long confessional of sins, defined as violation of an ancient taboo, and these taboos are delineated within the incantation itself.
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Surpu incantations also have much in common with formal Sumerian- Akkadian bilingual magic, probably originating in the second millen- nium BC. Tablet IX (equivalent to a "chapter") of Surpu consists of what are known as Kultmittelbeschworungen, incantations conveying sanctity on all instruments and paraphernalia used in the relevant ritu- als. The idea is that any cultic tool used in an exorcism needed to be ritually purified by reciting the appropriate incantation (Cunningham 1997: 112f.).
Formal magic also must deal with the attack of ghosts rather than demons, when a restless spirit returns from the other world to attack living humans. The texts give many different reasons for a ghost to re- emerge, usually involving not being buried with the proper funerary rites because the person died at sea or in the steppe, or simply had no living descendants to make the required periodic funerary offerings. Of particu- lar danger was the Ardat Lili, the Maiden Lilith, who never married or had children and died before having normal sexual relations, and she thus returns to seek out sex with susceptible human partners. The Maiden Lilith is no demon, however; she is a ghost, which means that she was not created by the gods with the expressed purpose of causing harm, but she herself was a victim in her own life and she is looking for compensation among the living. On the other hand, she is potentially as harmful as any W demon and incantations are needed against her visitation. Ardat Lili is W
usually portrayed as a victim, defended by her patron goddess Istar:
The evil demon took away the maiden from the palace of the steppe.
The one who was unnamed from the start pursued her relentlessly.
The incorporeal one pursued her relentlessly.
He struck her hand and placed (it) on his (own) hand,
he struck her foot and placed (it) on his foot,
he struck her head and placed (it) upon his head.
She therefore enters the pure gipar.
The woman (=Istar) shook the heavens and made the earth quake.
The proud pure Istar cried out in heaven and earth,
she burned, she was inflamed, she took an oath at the door of the upper
room:
"The evil Utukku and Alu demons must not enter the house,
the evil Utukku demon who seized him (the victim) must stand aside,
but may the good Utukku-spirit and genius be present at his side." (Utukku
Lemnutu 5 183-95 [Geller 2007c: 213f.])
This notion of the returning ghost was a well-known folk motif in antiquity, and the ritual for getting rid of a maiden lilith also appears in
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several different Akkadian contexts, for which the most effective ritual appeared to be the use of a marriage between male and female figurines, to attempt to alleviate the maiden ghost's sexual frustrations (Farber 2004: 117-32). Nevertheless, the actual descriptions of the attack of ghosts, like that of demons, is detached from any question regarding the patient's own thoughts or fears. Everything is in the third person.
In the third major type of incantation, Maqlu, we encounter a text of a completely different sort. For one thing, the subject matter concerns witches and witchcraft, not ordinary demons and ghosts. Also, texts appear in the first person, with the patient complaining that the witch attacks me, and hence the witch is addressed in the second person.
Because a witch has bewitched me,
A deceitful woman has accused me
Has (thereby) caused my god and goddess to be estranged from me (and)
I have become sickening in the sight of anyone who beholds me,
I am therefore unable to rest day and night. (Maqlu I 4-8, translation
Abusch 2002: 30)
I call forth (lit. seek out) against you (O witch) cult-players and ecstatics; I (for my part ) will break your bond. May warlocks bewitch you, I will break your bond. /gi May witches bewitch you, I will break your bond. /St\
May cult-players bewitch you, I will break your bond. May ecstatics bewitch you, I will break your bond. (Maqlu VII 92-7, translation Abusch 2002: 10)
At first glance, it seems that we ought to have in Maqlu a more inti- mate view of the patient in which he expresses his own fears and anxie- ties, but a more extensive look at the text leaves us in doubt. The text itself is repetitive in places and formulaic, almost like liturgy, and we assume that this lengthy and nicely phrased text was intended to be recited by the patient or by a proxy, such as the incantation priest. So although Maqlu is important for showing an awareness in magical texts of the patient's psychological state, it provides little more than general descriptions of angst, depression, and paranoia. 38
Incantations, for the most part, address the familiar problems of dis- ease and death threatening the patient, but magic is designed to deal with the more supernatural causes of disease, such as the revenge of an angry god, witchcraft, or the patient's own breaking of ancient taboos and the subsequent forfeiting of any divine protection against demons and disease. By its very nature of dealing with the supernatural (gods, demons, witches), magic is classified lower down on the scale of scientific
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Figure 1.2 Exorcists performing a ritual, dressed as fish-men apkallu sages (Vorderasiatisches Museum, Berlin; drawing Tessa Rickards)
%
texts, bearing in mind our rule based on mathematics as a necessary component of scientific thinking. Magical texts comprised one of the disciplines forming a major part of the school curriculum in Babylon (Gesche 2001: 214f.), and the Babylon tablet libraries contained many varieties of magical texts. Although magical texts were mostly poetic and can be considered important examples of belles lettres, at the same time incantations and their associated rituals were designed for very practical purposes of influencing human health and fortunes, and hence represent applied "science." Although the concept of magic itself was to alter the effects of supernatural forces (demonic attacks, curses, even fate), the real effect of such texts was to alter the psychological state of a patient by reducing levels of anxiety and neurotic fear. The "science" of magic is based upon a profound understanding of human psychology grasped by the composers of these incantations and consisted of an impressive repertoire of incantations for very different purposes, aimed at alleviat- ing feelings of guilt, helplessness, paranoia, anger, obsession, or other types of personality disorder. Nevertheless, there is little within magic that can be quantified or measured, and hence magic only merits a rather low score on our scientific quotient.
Examples of magical texts are numerous, and the following incanta- tion tablet from Persian period Nippur in Babylonia (c. 500 BC) is a prayer addressed to the sun god Samas and to Gula, goddess of healing, on behalf of a patient whose illness is ascribed either to the attack of
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demons, or to a worm. It is the alternative of supernatural and natural causes of disease which makes the incantation interesting from the point of view of ancient science:
Incantation: Samas, lord and sublime judge of heaven and earth,
Nintinugga (Gula), lady who brings the dead back to life,
who are able to heal kings and servants;
a man - tired, sleepless, and weary -
in whose body there is disease, malaria, Zamasta-demon(-disease),
jaundice, chill, 39 or parasites,
which destroy the whole of a man's body;
by the command of Ea, Samas, Marduk,
and Nintinugga (Gula), may disease go out!
As for malaria, ZamasZw-demon(-disease), jaundice, chill,
and parasites which are in his body,
may they (all) go out and may the man recover.
Incantation of Damu, Gula, and Dingirmah. Spell. (Nougayrol 1947: 41)
Psychosomatic Illness
The distinctions between soma (body) and psyche (soul) can be found W in the Hippocratic corpus, and the notion of psychosomatic illness can *Qp
be traced back to Plato, who writes, "When the soul is too strong for the body and of ardent temperament, she dislocates the whole frame and fills it with ailments from within" (Timaeus, translation Robinson 2006: 51). Similarly, older parts of the Hippocratic corpus described the diseased mind as exhibiting characteristic types of behavior, which include talking too much or not at all, exhibiting unmotivated or exag- gerated moods and emotions, or speaking more aggressively or greet- ing people more warmly than warranted by the occasion (Gundert 2006: 34f.).
No corresponding conceptual framework can be found in Akkadian, which lacks any term or concept of "soul," 40 but the distinction between physical and mental illness can be found in Babylonian medicine, although not expressed in the same philosophical form. An example of this phenomenon comes from Babylonian medical texts dealing with anti-witchcraft activities, of which we have a considerable number (Schwemer 2007: 165-79). Tablets dealing with witchcraft, however, differed considerably from anti-witchcraft tablets within the medical corpus. To illustrate the point, here are two examples of medical anti- witchcraft therapy:
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If a man is seized by the "Hand of a Ghost" (-disease), or is seized by "epilepsy" (bennu), or is seized by stroke (antasubbu), Saghulhaza(-disease) has seized him, Lugalurra(-disease) has seized him, "Hand of a God" (-disease) has seized him,
"Hand of a Goddess"(-disease) has seized him, "Hand of an Oath" (-disease) has seized him, "Hand of Mankind"(-disease) has seized him, the Alu-demon has overwhelmed him, insanity ("change of mind") has seized him, he is sick with ague (himittu), he faces rage, anger, and rejection of god and goddess, his ears buzz, he keeps having depression ("broken heart"), he forgets what he says,
he talks to himself, gets heated, vacillates, can't make up his mind, gives an order and changes his mind, he constantly sustains losses, fear at night, and all day long he is in a daze,
he has quarrels at home and brawls in the street, one looks at him with malevolence, he is cursed by many people. He swears in his mind to a goddess foolishly.
This is what that man [the witch] has over him by way of wrath of god and goddess!
In order to dissolve these (conditions) so that his anxieties not overcome him, and for
these sicknesses to be removed from his body, [perform the following ^ rituals] ... (Farber 1977: 56, 64; see Stol 1999: 65) ^
If a man's limbs tremble like (those of) a sick man,
... his feet and his stomach-lining are slack,
he speaks but nothing comes out,
he is robbed of his potency (lit. erection), his mood is always bad,
whether when urinating or
when he sleeps with a woman his semen is ejaculated (prematurely),
that man is not pure, god and goddess turn him away,
his command is not obeyed. (Farber 1977: 227, 237)
The texts above assume the format of medical rather than magical texts. Instead of the usual notations for magical spells, these passages both begin with the standard diagnostic phrase typical of medical texts, "if a man (suffers from) ...".This formal distinction between magical and medical tablets from Mesopotamia is a fixed tradition which is not subject to alteration, and the diagnostic format of the passages above should technically be classified as medical. On the other hand, the ritu- als which accompany these medical-like diagnostic descriptions of men- tal illnesses are more magical than medical. The first ritual (see Farber 1977: 56, 64) involves bringing an offering of ash-baked cakes to a
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shepherd, which is used to purchase a virgin kid. The next step is to sweep and wash the roof of the house and set up an altar to the goddess Gula, on which various offerings and libations are made (dates, flour, honey, butter, beer, and breads), with incense being burned. Some strands of the client's hair and garment hem are weighed in a balance in the presence of a chanting priest. The kid is then sacrificed and skinned, and the client recites an incantation. A similar ritual is performed for the second passage above (Farber 1977: 227, 237) in which the client is thoroughly purified over several days, an altar with foodstuffs is set up for Istar and Dumuzi, and a sheep is sacrificed. On this occasion male and female figurines with arms being bound behind the back are con- structed out of various materials (clay, gypsum, dough, fat), and appro- priate incantations are recited.
A comparable case is described in the following medical text describ- ing depression, for which the ritual prescribes a formal marriage cere- mony between a male and female figurine, accompanied by offerings and the sacrifice of a sheep.
If a man suffered a mishap but he did not know what had happened to him, he was constantly having regular reverses and losses, losses of barley ^g\ and of money [...], (or) losses of male and female servants, oxen, horses /St\
or flocks, dogs, and pigs, and even people were dying all at once: he kept having depression ("broken heart"). When he spoke, no one lis- tened, and calling there was no answer. Taking people's complaints to heart, he lies frightened in his bed. He has paralysis. No holy water has come near him, and he is fed up with god and king. His limbs are flaccid and he gets increasingly afraid, not sleeping night and day and having terrifying dreams. He keeps having paralysis. He has less bread and beer (and) he forgets what he says. That man has earned the anger of god and goddess upon him, his own personal god and goddess are upset with him. If that man suffers from the Hand of the Oath, Hand of the God, Hand of Mankind or suffers from moaning, or the guilt of father, mother, sister or brother family, relations, and kin has affected him, in order to resolve it so that his worries (i.e. melancholy) do not over- whelm [him]: (Ritual follows). (BAM 234; see Ritter and Kinnier Wilson 1980: 24-27) 41
Although the text does not specify why a ritual marriage is required, we can presume that the client's mental anguish is determined as being caused by the amorous intentions of a maiden lilith (ardat lilt), a
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feared succubus, and that the purpose of the marriage was to provide a spouse to address her sexual needs. In other cases, a similar diagno- sis of mental imbalance was attributed to sorcery (Stol 1999: 67). Although these texts are all examples of the grey area between medi- cine and magic, other medical texts dealing with mental problems resort to more traditional kinds of recipes for dealing with the symp- toms. A good example of this can be found in a late Uruk medical text from the third century BC, which deals with anxiety and depression (vonWeiher 1983: No. 22; von Weiher 1988: No. 85). 42 The patient imagines that he has a rival or enemy who causes him to experience hatred, perversions of justice, loss of breath, and aphasia when faced with authority (god or king), he suffers from anxiety day and night and in his dreams imagines himself to be the object of constant slan- der and gossip. The remedy for this poor mental state is various herbs and minerals being wrapped in a leather pouch to be hung from his neck. Although the prescription might appear more magical than med- ical to us, in ancient terms the use of drugs wrapped in a leather pouch was a standard medical procedure, seen to be more directly curative (like a potion) than like an amulet (see Farber 1973). A similar text (BAM 316) reads as follows:
^ If a man is constantly frightened and worries day and night; losses are suf- ^
fered regularly by him and his profit is cut off; people speak defamation about him, his interlocutor does not speak affirmatively, a finger of deri- sion is stretched out (i.e. pointed) after him; in the palace where he appears he is not well received; his dreams are confused, in his dreams he keeps seeing dead people; heartbreak is laid upon him; the wrath of god and goddess is upon him, god and goddess are angry with him; witchcraft has been practiced against him; he has been cursed before god and goddess; his omens are confused; (city) god, king, noble, and prince are annoyed with him; as many as seven times his case (lit. judgment) is not cleared up (lit. is not straight [ened out]) by diviner or dream interpreter; he is beset by speaking but not being heard (and responded to favourably). (Translation Abusch 2002: 31-2)
There is no doubt about the genre of this text, since it occurs within a medical prescription. The ritual (not translated by Abusch) is revealing about how Babylonian physicians dealt with this kind of psychological trauma:
Its ritual: you wrap in (a) leather (bag) taramus, imhur-lim, imhur-esra, erkulla, elkulla, amelanu(-p\ants),
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Medicine as Science 37
coral, tamarisk, (and) "mace"-plant;
recite over him seven times the incantation alah salah basinti
(and) the incantation arazu sutemab 43 and place (the bag) [on] his neck.
Like in the previous case of amulet stones and incantations being prescribed for psychological distress, this ritual calls for medicinal plants and drugs to be hung around the patient's neck, along with appropriate incantations being recited. 44 In both cases, medicinal plants and amuletic stones hanging on the patient's body are often used with somatic ill- nesses, which may show that these types of mental conditions resemble illnesses in which physical symptoms are attributable to psychic causes. The magical corpus was also designed to deal with a patient's anxie- ties, to help him recognize the hidden and harmful forces of the sur- rounding cosmos, to acknowledge the ultimate causes for misfortune and ill-health, and to try to reconcile the patient with whatever is acting against him. Mesopotamian man was full of fear of transgression, for which there were abundant opportunities, such as eating the wrong foods on the wrong day, or having intercourse with an unclean (men- struating) woman. Essentially, while magic intended to explore the ulti- mate causes of illness and misfortune, it employed a variety of strategies to reverse the processes. In some cases, the patient was asked to make ^P his confession from a long list of sins (Surpu Tablet II), while in other W
cases the magic threatened retribution and revenge against demons and purveyors of evil, such as malevolent witches (Schwemer 2007: 143). Other types of magic include curses against rivals and enemies, which are relatively less common, possibly because they originally represent a type of folk magic which belonged to oral tradition or in later times was more common in Aramaic. There are even cases of love incantations within Mesopotamian magic, in which black magic is employed to force a woman to abandon her family and run off with the subject of the incantation, but this type of incantation can be seen within the context of unrequited love as a type of sickness, for which the incantation serves as a means of relief from psychic torment (Geller 2003). Other kinds of incantations deal with fear of ghosts, bad dreams, sex with a succubus, or against dog-bite and snakebite, all of which intend to offer the patient some kind of relief against real or imagined harms. We have no incanta- tions, on the other hand, specifically designated to treat depression or obsessive-compulsive behavior, although Babylonian therapists had enough grasp of human psychology to recognize these disorders, and it is likely that magic was employed to deal with such problems in an indirect way.
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<$
Figure 1.3 Clay model of a sheep liver used for divination, from Mari in Syria, second millennium BC (Musee du Louvre; photo Florentina Badalanova Geller)
Magic could be summarized as expressions of anxiety and worry about angry gods, malicious demons, harmful witches. There is another level on which to understand magic, as expressions of human psychology without reference to the actual existence (or not) of gods, demons, and witches. The relationship between humans and gods, as expressed in prayers and religious literature, is that of child to parent or of servant to master, and a child's fear of punishment for misbehavior reflects a similar pattern of fear between humans and gods. Divine anger and punishment was thought to apply even when human transgression was committed unintentionally; the essential relationship between man and god in Mesopotamia was that of fear. Incantations expressing the patient's alarm at being the object of divine wrath are understandable within these terms. Nevertheless, it is difficult to ascertain from this literature when any particular patient exceeded the boundaries of normal fear of gods and became excessively anxious, or in modern terms, neurotic.
We are also faced with a perverse sort of logic within magic, namely that if a person is ill or suffers misfortune, then this is a priori evidence
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Medicine as Science 39
that the gods are angry with him. This argument is less a matter of anxiety and more a way of explaining the cause of illness in a way one could easily grasp: the gods are ultimately responsible for human fate and they are angry Appease the gods and reduce the chances of further illness or misfortune.
Divination
Omens formed one of the most important parts of Babylon's school cur- riculum (Gesche 2001; Cryer 1994: 139-40). In some ways, divination can be classified as the least "scientific" among Babylon's disciplines, since the entire concept of divination is based upon the logical fallacy that two events in sequence are thought of as being causally related. Hence, the entrails of a sheep with a specific characteristic were thought to forecast some significant contemporary events, usually affairs of state. Nevertheless, the result of this logical fallacy had certain fortuitous con- sequences as far as scientific thinking is concerned: the ancient divina- tion scholars collected large databases of ominous events (also from positions of celestial objects, flights of birds, patterns of oil on water or smoke, unnatural births, and many other genres of omens). The practice W of collecting and sorting data, as well as analyzing data, must be seen as W
a process resembling certain aspects of scientific thinking. So although the aims of divination can be seen as heading off on the wrong tack, the methods and procedures of handling data, and the idea of drawing infer- ences from large amounts of data, should be seen as a type of forerunner to modern science.
In this way, the position of constellations or planets, or the sun or moon (e.g. eclipses) within the heavens was considered to be relevant to events happening on earth. It is difficult to know which discipline came first, astronomy or astrology. Was careful observation of heavenly bodies later applied to celestial divination, or did the "science" relating move- ments in the night sky to events on earth become the basis for astron- omy? Whatever the rationale for watching the heavens, astrology by the Persian and later Hellenistic periods was flourishing and developed hor- oscopes which later influenced Greek thought, later to become the com- mon pseudo-science of every newspaper in the modern world.
As for medical omens and the relationship between divination and medicine, the Diagnostic Handbook preserves its own unique style, which differs significantly from the way diseases and symptoms are usually described in therapeutic recipes (see Fincke 2006-7: 144f.;
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40 Medicine as Science
Stol 1991-2: 64f.). While therapeutic recipes open with an "if" clause defining the symptoms, they are not casuistic in the same way that legal or omen texts operate. "If" the patient suffers from a certain dis- ease or syndrome or ailment, the recipes provide instructions regard- ing what to do "in order to cure him," and as a result "he will get better" or "he will improve"; the conclusion is always positive. This differs fundamentally from the Diagnostic Handbook, which maintains the classical structure of omen texts, i.e. if such-and-such, then such- and-such (may result). In most cases the result will be that the patient will die, that his illness will be prolonged, or that he might survive and improve, and variations of these possibilities are given within a limited range of possibilities.
The search for parallels to the Diagnostic Handbook outside the genre of medical literature takes us to a group of first-millennium BC commen- taries which were primarily academic in origin, known as Multabiltu- omens (Koch 2005). This group consists primarily of highly specialized explanatory texts on liver divination, and the texts provide general guidelines for interpreting omens and omen texts, based upon specific rules of exegesis. Hence, the concept of "long" implies "success," so that if a certain key physiological feature of an examined liver is "long," this portends that the king will have success in battle (see Jeyes 1980: 23f.). W However, to proceed correctly one must know whether a "long" part of W
the liver anatomy is associated with the right or left half of the liver, since "long" on the left side may mean that it is one's enemy who has success. 45 This unusual divination text is highly theoretical and may reflect oral tradition (George 2008: 557) or discussions within the acad- emy, as do other types of commentaries.
It must be emphasized that Multabiltu-omens belong squarely to divi- nation and not medicine, despite the fact that an entire tablet (i.e. chap- ter) is devoted to omens taken on behalf of a patient. The seventh tablet begins with the phrase, "if you perform an examination of the liver (tertu) for the well-being of the patient ..." (Koch 2005: 154). What fol- lows is a series of technical omens referring to an animal liver, with a typical protasis (or "if'-clause) as follows: "if you perform an extispicy (liver examination) and there are two 'paths' to the right of the gall blad- der and two 'paths' to the left of the gall bladder ...". Then comes the actual prediction, most commonly, "the patient will die" (Koch 2005: 155: 13', 158, 560), but there are variations on this theme, such as, "the calmed patient who ate food and drank water will [have a relapse] of his illness [and die]," or the patient "will change his residence and get well" (Koch 2005: 155, 12-14). Occasionally the patient will contract a disease
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Medicine as Science 41
but then recover or the illness will linger (Koch 2005: 156, 17-18). Such expressions are similar to those found in the Diagnostic Handbook.
One telling medical comment found in Multabiltu refers to the physi- cian's withdrawing treatment from a patient in cases with a fatal progno- sis. The interpretation of one such omen is that "the patient will get worse; depart quietly, do not perform any [treatment]" (Koch 2005: 156, 16). 46 It was not the diviner's task to offer or withhold medical treat- ment, so we have to presume either that the physician was an interested party to this particular omen, or that the information would be commu- nicated to the physician, if appropriate. In any case, we have little infor- mation regarding the use of divination for patients, except for the meager references in the Neo-Assyrian letters and diviners' reports.
Other omen hermeneutics resemble diagnostic omens, such as diseases being labeled as the Hand of (a certain) God, and in MultabiltuTabletVU we indeed find the "Hand of Marduk," "Hand of Istar," as well as the "Curse of Ea," all designations of disease. One particularly revealing omen stipulates:
If, ditto [= you perform the divination], and you perform (it) for the "Hand
of a God," the patient will live until his appointed time, but after his
appointed time he will die. (Koch 2005: 155, 13) # #
This omen is inserted out of sequence with the rest of the omens, which usually refer to an anatomical feature in the animal's liver, but uniquely not here. Obviously, the problem was to determine whether the disease was indeed caused by the "Hand of the God," or to determine precisely which god had brought the disease. In any case, this omen is predictive and not therapeutic, and the result will be that the patient will live or die according to his destiny decided by the gods.
The similarities between the omen apodoses of Multabiltu and the apodoses of the Diagnostic Handbook are unmistakable, and there seems to be only one inference to be drawn, that these texts derive from the same scribal source. On the surface, this conflicts with the supposition that omen divination was composed and copied by diviners 47 while diag- nostic omens by exorcists. In fact, the authorship of these texts is more complicated. It is probably true that in the second millennium BC dis- crete genres of texts were composed by the professionals who actually used the texts, so that incantations were composed by exorcists and div- ination texts by diviners, etc. By the time of Assurbanipal's great library, however, the situation has already changed. No less than five Multabiltu texts found in Nineveh were copied by the renowned scholar
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42 Medicine as Science
Nabu-zuqup-kena in 711 BC (Koch 2005: 267). Although Nabu-zuqup- kena refers to himself as tupsarru, "scribe," his wide knowledge and the impressive range of texts he copied show him to be a master of cunei- form literature. Certainly not a diviner, he took an interest in academic divination texts, such as those found in the Multabiltu corpus.
So although these large compendia of scientific texts found in Nineveh or Assur libraries go back to earlier prototypes from the second millen- nium BC, it seems likely that strict lines separating the professionals from one another was steadily breaking down in the first millennium (see Parpola 1983: 8). One of the Multabiltu texts found in the late Uruk library was copied by the prolific scribe and masmassu-exorcist Iqisa (Koch 2005: 209), who had a vast repertoire of tablets under his belt, including scholarly commentaries.
Since the Diagnostic Handbook was arguably the original (or older) composition upon which MultabiltuTabletVU was modeled, this would tell us little about the milieu in which the Diagnostic Handbook itself was composed. It is true that the Diagnostic Handbook is attested already in the Old Babylonian period, from about 1700 BC. Nevertheless, the rapid growth of scholarship during the first millennium produced a much broader range of texts than had been known earlier, and it is likely that scientific literature grew up within the academy as schools became more W widespread and specialized. It is also highly probable that the Diagnostic W
Handbook, like Multabiltu, was essentially a scholarly or theoretical composition, used to teach the theory of diagnosis, rather than a vade mecum which the doctor would carry with him to the patient's bedside, to look up the appropriate symptoms while examining the patient. It is quite possible, in fact, that the Diagnostic Handbook was never actually used by practicing physicians, but was a speculative treatise on diagnosis, much as we might find in the Hippocratic corpus or in Aristotle. The therapeutic recipes, on the other hand, probably existed in small single- tablet formats that may have actually represented prescriptions from the practice of medicine, and these were later copied into the great library and medical archives which we find in Nineveh, Assur, Babylon, Uruk, and other sites.
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As we have seen, Babylonian healing therapy was divided between the activities of the masmassu-exorcist and the as«-"physician," each oper- ating within his own area of expertise, although not in a way intuitively obvious to modern medical practitioners. According to Paul-Alain Beaulieu, in later periods "prevention and cure, spiritual as well as phys- ical, were both placed under the care of the exorcist" (Beaulieu 2007: 479). The exorcist was responsible for magical prevention of attacks of W demons, angry gods, or even witchcraft and unfavorable omens, and he W
could also act as attending physician who visited the patient on his sick bed to give a prognosis, predicting the nature and course of the disease (see below). The exorcist had all the social advantages of being a priest. The flsw-physician, on the other hand, appeared to have acted more as an apothecary who prepared the complicated recipes and drugs. As a lay- man, he had no access to the temple and presumably operated from a corner shop in the street or from his home. The exorcist operated prima- rily under the assumption that disease was ultimately caused by divine will or fate; the asu, while generally agreeing with this position, concen- trated more on natural causes of symptoms (bites, excessive exposure to draughts or sunlight, kidney stone, etc.).
In order to better understand the respective roles of exorcist and physician, it may help to delve into some basic terminology. There are two different terms for "exorcist" in Akkadian, and many in Sumerian. The Akkadian term asipu, a more literary term for exorcist, refers to the professional priest who mastered the "art of exorcism," asiputu. These terms are difficult to etymologize since the cognate verb wasapu "to exorcise" is probably derived from the noun and probably only
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44 Who Did What to Whom?
denotes that which the asipu was supposed to do (i.e. perform exorcisms); the circular logic tells us little (see Cavigneaux 1999: 254f.; pace Jean 2006: 19f.); Aramaic, Mandaic, and Syriac cognates are likely to be derived from Akkadian. The other word for "exorcist," masmassu, was the most commonly used term within private letters and colophons of tablets, and since this term is much more widely attested in documents than asipu, it is the term for exorcist which we prefer. 48 Unlike asipu, it is a word we can attempt to etymologize.
The word masmassu may derive from a root masasu, "to wipe," with the Sumerian word and logogram mas.mas possibly being a Semitic loan- word. A similar pattern occurs with the Akkadian word kaskassu, "over- whelming," derived from the root kasasu, "to overpower." The term masasu "to wipe" is not a medical term, nor is it related to mussu'u, "to rub or massage," which is genuine medical terminology. On the other hand, "wiping" is one of the key types of ritual acts, as we know from Surpu incantations (see above) which prescribe wiping the patient down with flour to remove his sins. 49 The original meaning of mas.mas/ masmassu may have originally derived from a term for physiotherapist, only later becoming identified as an exorcist.
An explanation of the meanings behind these professional offices deserves fuller elaboration. For a long time we thought we knew the dif- W ference between asipu and asu, as expounded in the famous article by W
Edith Ritter (Ritter 1965). The asipu, we were told, dealt with asiputu "exorcism"; and handled all matters of magic. The asu employed asutu "healing arts" and acted as the doctor. All seemed so very simple.
We now wonder if these magical/medical titles in Mesopotamia are to be taken any more seriously than the title of Dottore in commedia dell'arte. Revisionists now dominate and we are no longer as certain about the roles of doctors and exorcists, magicians and sorcerers and apothecaries. The extant corpus of medical texts, for instance, contains many examples of medical texts which were either owned or copied by exorcists. Furthermore, it is not clear who actually composed the incan- tations within the medical corpus, since they seem so very different from incantations within formal exorcisms. On the other hand, was it really part of the physician's brief to write spells? The patient's role within this scheme is also unknown, since we never encounter a proper dialogue within Babylonian medical literature in which the patient is formally asked to describe his symptoms. It seems that the therapist was expected to know what was wrong with the patient without having to ask, like a diviner interpreting his signs, or like a good general practitioner or acu- puncturist.
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Who Did What to Whom? 45
Professional Title Classification
One of the hallmarks of Babylonian scholarship was the lexical list, one of the genres of non-administrative documents to appear in the very beginning of writing, even in early archaic pictograph tablets. The lexical lists became a favorite mode of recording data, usually in the form of a list of Sumerian words or a bilingual list of Sumerian words with an Akkadian translation, and in some cases translations into other languages as well. Even many of the Sumerian unilingual lists were probably bilin- gual, with the Akkadian equivalent words being recited orally within the school curriculum. One of the oldest lists in the Sumerian lexical corpus is a list of "professions," with early antecedents going back to the third millennium BC, although late versions of this list also include a group of Sumerian designations for "exorcist." The following is a "non-canonical" excerpt from the professional list:
[mas]-mas = mas-ma-su "exorcist"
tigi = a-si-pu "exorcist" (lit. harpist)
ka-pirig = MIN (ditto) "exorcist"
mus-DU la " laah DU = mus-la-la-ah-hu "snake-charmer"
/g\ lu- gi5 gam-su-du 7 = mus-si-pu "exorcist" /st\
(MSL 11 102: 204-8)
Items on this list of exorcists are all synonyms for the masmassu (not asipu), and as such include the snake-charmer and harpist, as well as a rare word for exorcist, mussipu, who carries a curved staff, mentioned once only in the standard magical compositions (Surpu VIII 41). According to this excerpt, masmassu is not identical with asipu, but a synonym.
Another listing of exorcists is "canonical" and more complete, with more information regarding synonyms for asipu:
[tigi]
= a-s[i-p]u
"exorcist"
[l]u-tu 6 -gal
= KI.MIN (ditto)
"exorcist"
(lit. man having a spell)
ka ka -tu 6 -gal
= KI.MIN (ditto)
"exorcist"
(lit. mouth having a spell)
ka-ku-gal
= KI.MIN (ditto)
"exorcist"
(lit. [one] having a pure mouth)
k a ka-ap-ri-igp irig
= KI.MIN (ditto)
"exorcist"
(lit. lion-mouth?)
sim-mii
= KI.MIN (ditto)
"exorcist"
(lit. plant-grower)
inim-ku-gal
= KI.MIN (ditto)
"exorcist"
(lit. [one] having a pure word)
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46 Who Did What to Whom?
H e-™KAxAD.KU
= KI.MIN (ditto)
"exorcist" (lit. snake-charmer)
ligru
= mus-lah 4
"snake-charmer"
aus-lah 4
= KI.MIN (ditto)
"snake-charmer"
(MSL 12 133: 146-55)
This second listing of Sumerian terms for exorcist is varied and some- what idiosyncratic, with some overlap with the first list above. The first entry is tigi or "harpist," whom we would probably associate more with liturgy than with incantations, and the list ends with the term nigru or "snake charmer," which probably alludes to the substantial corpus of Sumerian and Akkadian incantations for snakebite and dog-bite, etc. (see Finkel 1999; Jean 2006: 184); nevertheless, the job of snake-charmer would hardly describe the exorcist's primary occupation or concern. The lexical list also defines sim.mu or "apothecary" (lit. grower of medicinal plants) as an exorcist, although some would prefer to see the asu- physician as an apothecary (Scurlock 1999: 78). So already three of the entries for exorcist appear controversial. The entries lu-tu 6 -gal, ka ka -tu 6 - gal, and ka-ku-gal all allude to the common designation for exorcist in Sumerian incantations, lu-mu 7 -mu 7 , literally "incantation-man."
The next entry which strikes our attention is ka.pirig, which is glossed as ka-ap-ri-ig, giving us no doubt about the reading of these signs. W According to the Diagnostic Handbook, the standard manual of progno- W
sis and diagnosis, it was the ka.pirig who went to the patient's house to take the omens, note the symptoms, diagnose the patient's condition, and make a prognosis; the ka.pirig has no other identifiable role within the medical or magical corpus. The question is what the term actually means. Although we have some representations of priests officiating in lion outfits, probably in magic ritual contexts (Oppenheim 1943: 32), it is unlikely that pirig means "lion" here. Ungnad made the ingenious sug- gestion that we might have a learned writing for ka.abrig, meaning the "mouth" or "word" of the abriqqu-priest, another learned poetic term for an exorcist (Ungnad 1944: 253), although the idea cannot be sub- stantiated by further proof. Whatever the meaning which lies behind the writing, the ka.pirig is identified in these scholastic lexical lists as an exorcist (dsipu). On the other hand, the Diagnostic Handbook never refers to the therapist making house calls as either dsipu or masmassu, but only as '"ka.pirig, which probably indicates something more than an alternative orthography for exorcist. 50
One late lexical list of professions (actually referring to types of ummdnu or "professor") was popular in the late scribal school curriculum (Gesche 2001: 130f.); the names are given below with a more precise translation of the Sumerian terms, although each is translated by dsipu "exorcist":
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Figure 2.1 Ceramic plaque from the Assyrian period (c. 700 BC) showing an exorcist dressed as an apkallu sage (photo Florentina Badalanova Geller)
(cf. colophon of the Diagnostic Handbook) ("mouth-washer")
(metalworker)
(functionary)
("incantation-man")
(see below)
(masmassu-exorcist)
(variant of w mas)
(variant of masmassu-exorcist)
("distraught man" = patient)
(baru-diviner)
(baru-diviner)
(lion-man)
(leopard-man)
This listing of asipu synonyms affords plenty of surprises. 51 The Sumerian words for exorcist include the one who performs the "mouth-washing"
'"ka.pirig
= asipu
w ka.luh
= asipu
w zabar
= asipu
w zabar.dab s
= asipu
w en
= asipu
w mas
= asipu
'"mas.mas
= asipu
w me
= asipu
'"me.me
= asipu
'"pap.hal
= asipu
w hal
= asipu
w ad.hal
= asipu
w pirig
= asipu
'"pirig.tur
= asipu
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48 Who Did What to Whom?
purification ritual ( w ka.luh), as well as the bam or diviner ( u hal and w ad. hal). 52 The '"ka.pirig features as well, but we have a new entry, the w zabar, the "bronze man," who may have been responsible for making figurines. We even have the w pap.hal as exorcist, which is most peculiar. Although pap.hal in this list is elsewhere translated simply as "man," we know this term from numerous occasions in bilingual incantations where it refers to the patient or victim; he is the man who walks about restlessly, with worry and fretting. But in this list, he is an asipu. Everything, in fact, seems to be subsumed under the title of "exorcist," at least in academic contexts of late scribal school curriculum, which supports Beaulieu's observation that exorcism was the most prominent discipline in first- millennium Babylonia (Beaulieu 2007: 477).
The Exorcist in Sumerian Literature
The word mas. mas occurs first within Sumerian literature in a remarka- ble passage describing a contest featuring one Urgirnunna, a mas. mas who was expert in nam. mas. mas, "magical arts" (Akkadian masmassutu). Within this epic account of rivalry between Enmerkar, King of Uruk and Ensuhgiranna, King of Aratta, a fivefold contest ensued between the mas. W mas-exorcist Urgirnunna, defending Aratta, and Sagburu, a witch defend- *Qp
ing Uruk (Black et al. 2006: 3-11). The mas. mas-exorcist created various animals ex nihilo by throwing something magical into the river; he con- jured up a carp, a ewe, a cow, an ibex, and a gazelle, while Sagburru in turn conjured up an eagle, a wolf, a lion, a leopard, and a tiger. Sagburru won. The point is that the Sumerian term mas. mas in this story really means "wonder-worker" and the abstract term nam. mas. mas refers to "wonder-working", having nothing to do with therapy, healing, incanta- tions, or even exorcism. On the other hand, the epic relates that Urgirnunna, the mas.mas-"wonder-worker," resided in the Gipar temple of Aratta, which can only mean that he was a priest. We are left to specu- late how the Sumerian word for a wonder-working priest later became a standard term for exorcist and healer.
Masmassu or Asipu?
In colophons and in numerous texts from the first millennium BC, the Sumerian logogram (lu.)mas.mas was the most popular title for "exorcist," which often leaves us in some doubt as to whether to use
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Who Did What to Whom? 49
masmassu or asipu as an Akkadian equivalent for Sumerian mas. mas. There are reasons, however, for suspecting a bipartite division among Babylonian exorcists. The terms asipu and masmassu tend to be mutu- ally exclusive since we hardly ever find a listing with both titles; we have personnel either described as asipu or described as masmassu. Among Middle Assyrian professional titles from the late second mil- lennium BC, we find both asipu and the logogram mas. mas (= masmassu), but not both together; it is either one title or the other (see Jakob 2003: 528f.). Among later first millennium BC lists of wine consignments from Nimrud, we find officials on the wine lists being "diviners," "exorcists," and "physicians" (listed under their respec- tive logograms w hal, w mas.mas, and w a.zu) (Kinnier Wilson 1972: 74). In colophons, very occasionally we find the scribe recorded syllabi- cally as a-si-pu, but far more common is the logogram (lu.)mas.mas (Hunger 1968: 159, 167f.).The "Haus des Beschworungspriesters" at Assur is really a household of masmassu-exorcists, which is the term used consistently to describe the owners or writers of the tablets from this house (Pedersen 1986: ii, 45f.).The same pattern appears in Neo- Assyrian letters, which always refer to the exorcist with the Sumerian logogram mas. mas, yet the exorcists are said to practice asiputu "exorcism." 53 On the other hand, the so-called Exorcist's Manual (a list W of incipits of magical and medical texts for scholastic purposes) refers ^P
to itself as masmassutu, not asiputu (Jean 2006: 63). Another esoteric text advises that "when you work with plants, stones, and trees, or masmassutu, use its commentary" (Reiner 1995: 130). Is this simply the same as asiputu?
We have some nagging doubts. Although many different types of activities are included within a general category of masmassutu or asiputu, we may be dealing with sub-specialties. As we have already seen, there is the particular label ka.pirig for the therapist who actually diagnoses the patient, never the asipu or masmassu. Another category of exorcist may have been the sim.mu, the "plant-grower," or apothecary. There may be other categories which need further investigation, such as the exorcist who specializes in performing the ka.luh (mis pi), the cultic "mouth-washing" rituals (Shibata 2008), or the exorcist who performs Namburbi rituals (Caplice 1967).
But what was the masmassu if not an asipu? 54 In fact, the traditional translation of "exorcist" for asipul masmassu is somewhat restrictive. What he does is usually more than simply perform "exorcism"; the exor- cist was responsible for an entire range of rituals, in addition to the occa- sional exorcism. 55 One difference does appear to emerge within the
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50 Who Did What to Whom?
patterns of our evidence, that asipu may have been a prestige term of scholarship and literature while masmassu comes from the actual par- lance of practice and everyday life.
Priest vs Layman
The exorcist was a priest, 56 while the as«-"physician" was a layman and entrepreneur. This difference is of crucial importance in understanding how healing was delivered. Individuals described as exorcists functioned as priests in the temple and also held appointments at court. 57 We do not actually know whether the exorcist was a priest who acted as an exorcist or an exorcist who acted as a priest; we do know that his role became increasingly important within the temples in later periods and by the Hellenistic period "exorcistic arts" (masmassutu) dominated the school curriculum, which was mostly confined to temples (Beaulieu 2006: 202). The exorcist was supported by prebends, a share of the temple income, although he was probably entitled to private income as well. But what about the asm? We have evidence for asiputu-prebends, but no evidence for asu prebends in administrative records. 58 For one thing, this suggests that the asu could not enter the inner temple precincts. The late Akkadian W term for a priest in general was erib blti, "one who could enter the W
temple," which left the asu out. It is also perturbing that the asu more or less vanishes from our records by Late Babylonian times, in the latter half of the first century BC.
This is pretty much as things should be; we expect the exorcist to be a priest, since his incantations derive their power and authority from his personal relationship to the gods of incantations, usually Ea and Marduk. The asu, on the other hand, has his own relationship with Gula, goddess of healing, but his primary task is not related to the cult. In broadest terms, one goes to the exorcist if one needs a namburbi-ritual to undo a bad omen (see Caplice 1967), but one goes to the asw-physician if one has a nosebleed. Between these two poles is a full range of various options to choose from.
As a trained craftsman and entrepreneur, the asu has something in common with another important figure of Babylonian intellectual circles, the bam "diviner," who was also not a priest, as far as we can tell. 59 The bam was responsible for predictions about the future (mostly affecting the king and nation) based upon examining the entrails of animals, usu- ally rams, and this type of divination was known as barutu. This particu- lar type of divination is attested in both second and first millennia,
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Who Did What to Whom? 51
although it seems to have faded away as a profession after about 500 BC in favor of the priest-astrologer-scribe whose predictions were based upon observations of movements of stars and constellations. 60 Like the asil, there is no record of any barutu prebends, although it is conceivable that the bam as a freelance specialist could offer his services to the temple (for payment) as well as to a private individual (including the king). 61
There is one further important difference between asu, baru, and masmassu: the former two could travel wherever they wished, while the masmas su-exorcist did not normally travel but was attached to the tem- ple or palace. This distinction has consequences which can be traced in our sources. When the Hittite king wishes to invite an expert in healing from Babylonia, he invites a Babylonian asw-physician, not an exorcist, and he also invites Egyptian physicians (Burde 1974: 5, 6 n. 15). Mari letters speak of an asu coming from another city, Mardaman. In the par- ody of the Poor Man of Nippur or the Isin physician (see below), the asu travels from one place to another to ply his trade. In Hittite, the Sumerian logogram for physician in Mesopotamia, lii.a.zu, was borrowed into Hittite script and used to designate the primary healing professional, who acted as magician as well as doctor; he performed rituals as well as checking oracles (Burde 1974: 9).
What actually happened when patients met a healer, and where did this W meeting take place? We do not know if the asw-physician ever met a W
patient, except for the occasional reference in the royal correspondence to a court physician visiting his patient. Unlike the exorcist, we cannot place the asu in any designated healing location. Although the temple of Gula (the patron goddess of healing and the asu) has been suggested as a pos- sible healing venue (Avalos 1998: 114-28), this is hardly possible since the asil was not a priest. So where did he practice? Probably on the street, sit- ting on his rug and dispensing drugs. This might explain why the asu evap- orates from Late Babylonian and Seleucid period archives. He was a private healer offering his services for money, and probably not very much money: we have no records of any of his private transactions because most late records are from temple archives or from large family businesses, like that of the Murasu or Egibi families (see Wunsch 2007: 238f.). Small transac- tions tended not to be recorded, in the same way that one never keeps a receipt from the shoemaker. The asu has simply dropped out of sight.
Nor does the asu appear to use any designated surgery or treatment centre, such as the reed-hut or sutukku associated with the magic rituals, magic circles, and incantations belonging to exorcism (see Figure 2.2). What about the sick person's own house? Could the asu have made house calls? Here again, the texts tell us otherwise. The Diagnostic
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Figure 2.2 Exorcism ritual carried out in a reed sutukku-hut, with one woman fumigating and another wailing; early first millennium BC (Collon 1987: No. 803; photo courtesy D. Collon)
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Handbook specifically says that it was the ka.pirig-exorcist who visited the patient at home, and not the asu. The asw-physician may have been an apothecary, a herbalist, even a perfumer, but he had no need of a bedside manner, if we are correctly informed by our texts. It was the exorcist and not the physician who examined the patient from head to foot and recorded the symptoms, and it was the exorcist who needed to have an extensive knowledge of medicine in order to be able to do so. Yet there is a final irony to this story. It was the asu who actually won out in the end. The asu survived in Aramaic literature, in the form of the asya, the doctor, and Aramaic magic bowls offer asuta as the main ben- efit of their magical spells, while after the demise of Akkadian, the asipu and masmassu disappear virtually without trace. 62
Quacks and Quacksalvers
While on the subject of medical-magical professional terminology, we noted many terms for exorcist but only one term for "doctor," asm. What about a word for quack or quacksalver? Akkadian appears to have none, but then again, neither does Greek.
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Who Did What to Whom? 53
Nevertheless, one can safely assume that quacks existed and that anyone with enough nerve could present himself as a master-apothecary The temptation to act as a quacksalver must have been compelling, since there were no actual formal qualifications or diplomas for becoming an asu, except for the scions of wealthier families who studied in the scribal schools and learned to deal with medical recipes and asutu.'We have no way of knowing how widespread this training was among actual practi- tioners of medicine. Moreover, physicians were often itinerant, probably for good reason. Although locals would know if someone declared him- self to be a physician without training or apprenticeship, an unscrupu- lous charlatan might well present himself in another city as an expert asu, and his foreign origins may have helped render his reputation as healer more exotic.
Furthermore, it would be difficult for an unsuspecting member of the public to know whether any prescribed medicine was legitimate or bogus. Recipes were often composed of garden herbs which were readily available and many may have relied upon a placebo effect, particularly if the patient believed that the remedy could work. Babylonian medicine, moreover, was hardly technical. Little training was required in the use of instruments, and surgery was probably performed by the barber (gallabu), if by anyone. The administration of drugs was no doubt most effective in W the hands of someone with a convincing manner and friendly disposi- W
tion, since "real" drugs sold by an asu and those sold by a quacksalver were probably of similar medical value.
Measures were no doubt taken by physicians to prevent poaching of patients by quacksalvers. One such measure was the common usage of Dreckapotheke within Babylonian medicine, which turn out to be Decknamen or secret names for quite ordinary drugs. The idea is that a lay person, or in this case a fraud posing as a doctor, would not be able to understand and use medical recipes, since it would become immedi- ately obvious to the patients that the disgusting ingredients in the fake recipes, containing feces and blood, etc., did not resemble professional drug preparations. This may also be the idea behind a satire ascribed to an aluzinnu or "jester," in which the jester poses as an exorcist. The jester as exorcist offers obviously comic recipes of foodstuffs intended to parody hemerologies (texts identifying lucky and unlucky days of the month). A sample recipe reads as follows:
The month of Kislimu: what is your diet? You shall dine on onager dung in bitter garlic and emmer chaff in sour milk. (Milano 2004: 252)
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54 Who Did What to Whom?
The satirical recipes themselves are drawn from the same materia med- ica used in medical recipes, and what emerges from the humor is that the doctor's prescriptions are thought to be as effective as ordinary house- hold and farmyard substances.
Another Babylonian tale, intended to amuse its audience, concerned a down-and-out but resourceful fellow named Gimil-Ninurta of Nippur. 63 Having decided to exchange what little he had for one good meal, he purchased a goat, but was anxious that his relations would insist on par- taking with him. He decided to offer the goat to the mayor as a gift, with the idea of being invited to dine royally with mayor. The mayor accepted the goat but threw Gimil-Ninurta out.
Gimil-Ninurta plotted his revenge against the mayor by various ruses, one of which was disguising himself as a physician from the city of Isin, the city whose patron deity was Gula, goddess of healing arts. As a visit- ing asu enjoying the reputation of the city of Isin, Gimil-Ninurta was invited to treat the mayor, who was most impressed with the physician's credentials, and even remarked that "this physician is skillful!" Gimil- Ninurta insisted on treating the mayor in a dark chamber where no one else would enter, where he tied up the mayor's hands and feet and inflicted blows on him from head to foot.
The satire of this story is based on a popular view of the physician as W one who could inflict pain and suffering on a patient in the course of W
normal medical treatment. In other words, what the public expects from a physician's treatment is lots of pain. A good example is a typical treat- ment for bladder or kidney problems, which entailed the insertion of a bronze tube into the urethra, through which drugs were blown into the patient's penis, a painful procedure which probably offered little medical efficacy. Any attempt at surgery in Babylonia would also have involved the patient in a great deal of pain and discomfort, since there was little in the way of anesthesia. The Poor Man of Nippur tale shows that a quack- salver could hardly be distinguished from an asu, since the mayor never realizes that Gimil-Ninurta was only posing as a physician.
We usually think in terms of a bipartite division between the healing professions, a kind of therapeutic dualism: doctors versus magicians, recipe writers versus incantation experts, or asutu versus asiputu. The question is whether this division between healing professionals allowed for an easy entree for unscrupulous frauds. Another humorous compo- sition from Babylonian scribal schools (George 1993: 63ff.) tells of a Mr Amel-Baba, of the city of Isin, who manages to heal a patient of the effects of a dog-bite by reciting an incantation. We cannot be sure about Amel-Baba's professional status, since he is considered to be neither
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aummM0
Figure 2.3 Exorcists trying to heal a patient in bed, Lamastu-amulet (Wiggermann 2007: 107, No. 2; drawing F.A. M. Wiggermann)
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physician (asu) nor exorcist per se, but he derives his reputation from being a priest (sangu) of Gula, goddess of healing. In any case, he heals his patient with an incantation, not a medical recipe. The fact that the text considers Amel-Baba to be a quacksalver is obvious from what follows. The patient invites Amel-Baba to his own city of Nippur, in order to pay for services rendered, but it transpires that Amel-Baba is so ignorant that he cannot follow simple directions given to him in Sumerian, still spoken in the streets of Nippur. The image of the exor- cist as scholar is exploded in this story, to the amusement of its audi- ence, and the text itself was composed for recitation by "apprentice scribes" (samallu) of Uruk.
The picture which emerges from this evidence gives a diversified view of types of Babylonian healers, with a rich vocabulary and various app- roaches to therapy. This should hardly surprise us, since there was no single standard qualification to distinguish objectively a "qualified" practitioner from an unscrupulous quack or inspired charismatic miracle-worker. What remains is for us to see how therapists, exorcists, and physicians appeared in actual documents and records.
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The Politics of Medicine
Politics and medicine always go together, for several reasons. For one thing, rulers and ruling classes, like everyone else, require the services of doctors and healers, but they are in a position to afford medical services, even to the extent of inviting physicians of repute from abroad. Second, health-care provision in general is equally important to the population at large, whether provided by the state or not, and will always be a matter of public concern. The decisive question is whether the ruling powers W take responsibility for public health, in the same way that charge was W
taken of restoring temples or maintaining public order and military activities. Finally, periodic incidences of plague or epidemic will neces- sarily concern the body politic as a whole. 64 The way, therefore, that soci- ety organizes (or fails to organize) health-care provisions is a matter of politics and should be seen in this light.
Medicine and healing in Mesopotamia was more or less divided between the two healing professionals, the asw-physician and the exor- cist. Outside this system was the midwife, whose function probably went beyond childbirth to include gynecology and pediatrics, and the barber, who may have handled minor surgery. The usual assumption is that exor- cists and physicians handled most aspects of healing, including diagnosis, dispensing drugs, and treating patients. Some healers at least may have charged high fees for their services, so that it would have been unlikely for ordinary members of the public to use their services (Attinger 2008: 3). Nevertheless, this type of system of health provision, provided both by the priest and the layman, was part of the fundamental structures of the state. We have no records which tell us how comprehensive or readily available such services were to ordinary citizens, although it is conceiva- ble that the office of a priest (as exorcist) might have been part of the
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The Politics of Medicine 57
v$7 Figure 3.1 Bust of Hammurabi, king of Babylon (Musee du Louvre Sb 95; ^57
photo Florentina Badalanova Geller)
public services offered by the temple, to all classes of society. On the other hand, if the exorcist and asu were only affordable to upper classes of society, the poorer classes must have had other kinds of health care of which we know nothing.
Health care in Babylonia was occasionally regulated or controlled by the state, at least to an extent, and for this we turn to Hammurabi's Code, laws 206-25. We turn to the Code as a unique source of informa- tion regarding the social role of medicine during Hammurabi's reign in the early second millennium BC, following Pascal Attinger's use of this material in his excellent survey of Mesopotamian medicine. 65 We are less interested in the type of medicine per se mentioned in the Code but more interested in the status of the physician vis-a-vis other classes in society. In fact, the asw-physician is one of the few "professions" mentioned in the Code, since it was unusual in an essentially agrarian society for the affairs of a private professional entrepreneur to be regu- lated by law. Nothing comparable is known for the baru-diviner or
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58 The Politics of Medicine
exorcist, whose activities were not deemed to require regulation of any sort. Hammurabi's Code controlled the activities of the asw-physician even to the extent of stipulating under what conditions he could charge for his services, it being understood that a physician would normally do so.
CH 206 If a man (or "gentleman," awllu) has hit a man in a fight and
inflicted him with a wound, that man shall take an oath, "I did not strike knowingly," and he shall be answerable (for payment) to the physician (asu).
The rule applied here is that someone causing personal injury to another person of equal social standing, even if he claims it to be unintentional, is responsible for the injured party's medical expenses. There is no doubt about the asw-physician charging for his services.
The next group of laws stipulates how much the asu is able to charge different social classes in society, depending upon whether the patient was a better-off "gentleman" (awllu), a less well-off poor man or "com- moner" (muskenu), or even a slave (warduj.The rates of pay are variable according to the social status of the patient. On the other hand, payment {g) for medical services ranges between 2 and 10 shekels of silver, which is {$}
the equivalent at the time of purchasing 600 to 3000 liters of barley, a considerable sum of money, which would only be affordable by upper classes in society (Attinger 2008: 3). 66
CH 215 If a physician [asu] made a serious wound (incision) on
a man (or "gentleman") with a bronze scalpel and healed the man, or opened a man's temple with a bronze scalpel and healed the man's eye, he shall charge 10 shekels of silver (as his fee).
CH 216 If he (the patient) is a commoner, 67 he shall charge 5 shekels of
silver (as his fee).
CH 217 If he (the patient) is a gentleman's slave, the slave's owner shall
give the asw-physician 2 shekels of silver.
This type of eye surgery described in the Code of Hammurabi was prob- ably far from common and is never mentioned in medical texts. Rarely does a medical text, in any case, refer to the use of a scalpel. Furthermore, the risks of performing such surgery were very high, for the asw-physi- cian as well as for his patient, since if anything went wrong, the physician's
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The Politics of Medicine
59
hand could be cut off (in theory, at least), although we never hear of such drastic punishments for medical malpractice.
CH 218 If an astt-physician has made a serious wound (incision) on a
man with a bronze scalpel and caused the man's death, or opened a man's temple with a bronze scalpel and blinded the man's eye, they shall cut off his hand.
CH 219 If an aszi-physician made a serious wound (incision) on a com-
moner's slave with a bronze scalpel and caused the slave's death, he shall replace the slave with a similar slave.
CH 220 If he opened his (the commoner's slave's) temple with a bronze
scalpel and blinded his eye, he shall weigh out silver equal to half his value.
Another type of treatment regulated by Hammurabi's Code dealt with treating fractures, also an area of medicine not covered by the extant therapeutic medical corpus; there is not a single surviving treatise on how to set broken bones. A further clause governed treatment of a sore or sick tendon (ser'anu), a general term for the soft tissues of the body
<$
Figure 3.2 Seal of physician Ur-lugal-edina (Collon 1987: No. 638; drawing courtesy D. Collon)
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60 The Politics of Medicine
(in contrast to the bones), but in both cases the risks to doctor and patient are greatly reduced (with no threat of punishment for malpractice), and the fees are much reduced on a sliding scale. The payment for this treatment, at a rate of 5 shekels and 3 shekels respectively, is considera- bly cheaper than the physician's charges for surgery (CH 215-16). On the other hand, charges for healing a slave (2 shekels) are the same in both instances, and probably represented a minimum or basic fee for services rendered.
CH 221 If an asw-physician mended a man's broken bone or healed a
sore tendon, 68 the patient shall pay the physician 5 shekels of
silver. CH 222 If he (the patient) is a commoner, he shall pay 3 shekels of
silver. CH 223 If he (the patient) is a man's slave, the slave's owner shall pay
the asw-physician 2 shekels of silver.
There is no special term for veterinary surgeon in Akkadian and it is safe to assume that the asu performed this function as well. The fees are much lower, as is the penalty for malpractice. A sixth of a shekel of silver would purchase 50 liters of barley, which is a generally affordable /g\ sum as a fee (Attinger 2008: 3, 75). Note that the owner of the ox or /g\
ass is not assigned to any social class, as either awllu, muskenu, or wardu.
CH 224 If a veterinarian (lit. asw-physician for an ox or ass) has made a
serious wound (incision) on an ox or ass and healed it, the owner of the ox shall pay the asfi-physician one sixth (of a shekel) of silver.
CH 225 If he has made a serious wound (incision) on an ox or ass and
caused its death, he shall pay one quarter of its value to the owner of the ox or ass.
The next section immediately following the laws regulating the asu refers to the gallabu-barber, who indulged in a type of surgery involving the branding of slaves.
CH 226 If a barber shaved off the mark of a slave without an owner
(and) not his own, they shall cut off that barber's hand.
Although no fee is stipulated, the barber faces the same malpractice penalty as the asu, in having his hand cut off. The barber may have
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The Politics of Medicine 61
served as a cheaper surgeon than the asil, used specifically for matters dealing with slaves, but later dropped out of the medical record. 69 This may be because of the lack of any real records dealing with surgery, which was probably not considered to belong to the art of medicine, as in medieval Europe. Nevertheless, it is conceivable that the barber con- tinued to offer some type of medical services to lower classes in society in later periods.
The Code of Hammurabi ends in an epilogue containing a medical curse against anyone who defaces it:
CH E 50ff. May Ninkarak (Gula) daughter of Anu, who speaks in my
favor in the Ekur temple, make a serious illness break out in his limbs, a malicious demon 70 or a grievous wound (simmu) which cannot be soothed, which no asw-physician knows anything about nor can treat with bandages, and like the bite of death cannot be eradicated.
The flsw-physician is faced here with disease and lesions, which he can- not diagnose, recognize, or treat, all caused by the goddess Gula, who is normally the patron goddess of healing. Like the exorcist, the physician was also dependant upon gods for his ability to treat patients, and gods ^fc could equally prevent such healing if the patient was morally culpable. ^fc
The ultimate basis for healing and illness was ascribed to divine will, a notion shared by both physician and exorcist.
What is clear, however, is that the exorcist as healer is never men- tioned in Hammurabi's Code, and it is difficult to know why this is so. One reason might be that the social status of the asw-physician was higher in this period than that of his exorcist colleague, although as a priest one might imagine that an exorcist commanded respect. The fact that the exorcist was associated with the temple may also have been a factor in his exclusion from the Code, which deals primarily with civil law associated with the palace rather than cultic regulations associated with the temple. One final suggestion as to why the physician is exclu- sively mentioned in the Code is because of the type of medicine speci- fied, related to surgery, setting bones, and veterinary medicine, rather than the pharmacological remedies which we find in our medical cor- pus, for which legal regulation was not deemed to be necessary. In addi- tion to controlling how much the physician could charge, it is clear that the Code seeks to protect the public from the unlucky or unscrupulous doctor who harms his patient, which was obviously seen as a potential threat to society.
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62 The Politics of Medicine
Letters from the Kingdom of Mari (Syria), Eighteenth Century BC
One of the elusive aspects of ancient medicine is the encounter between doctor and patient, which was a special relationship, even if the encoun- ter may not have been held strictly in private but was witnessed by other members of the family This dialogue between doctor and patient usually concerned the general welfare, habits, pains, bodily functions, and state of mind of the patient. Although ancient medical literature is replete with instructions to the physician and with general reports of what phy- sicians have found when meeting patients, rarely do we get actual records of an actual interview between doctor and patient.
One of the unique characteristics of Akkadian administrative archives is the large quantity of official and private letters which survive, thanks to the durable nature of the clay upon which they were written, and a substantial number of these letters refer to meetings between a doctor and his patient. The earliest of such archives containing medical informa- tion is to be found in the city of Mari, in Syria, during the eighteenth century BC, representing chancery documents from the royal palace of Mari. Mari was a major capital of a kingdom which dominated northern ^ Syria in the third millennium and well into the second millennium BC. (ffi
By lucky chance, a number of letters refer to physicians (the asu), prob- ably in the employ of the royal palace, who were asked to treat patients in the royal circle. 71
The most prominent medical practitioner appearing in the Mari archives was the asw-doctor and sometimes surgeon. 72 Although Mari chancery letters refer to a cadre of palace doctors as part of the state bureaucracy, 73 nonetheless the physicians most highly prized and recom- mended were brought from a neighboring country, which is a frequently recurring pattern among palace physicians.
One letter sent between members of the ruling family refers to a par- ticular physician and the drugs he prescribed:
Say to Yasmah-Addu, thus speaks Isme-Dagan, your brother: The drugs, 74 from which your physician (asu) made me a plaster, are
excellent. Whenever a sore (simmu) 75 occurs, this plant (accompanying the
letter) will heal it immediately.
Here now I have sent you Samsi-Addu-tukultl, an apprentice asu, so that
he promptly notes (the effects of) this plant. Send him back to me. (Durand
2002: 305 No. 65 = ARM 4 65)
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The Politics of Medicine 63
The ailment concerned is a skin disease of some type, for which a suc- cessful remedy was found using the external application of plants, although how many and which plants are not specified. The disease itself, simmu, can refer to sores, wounds, or many types of skin ailments, which were to be treated by external applications or bandages. The relief from simmu afforded by the plaster is immediate. It was a chief physician (whose name is not recorded) who prepared the medication, while the apprentice or junior physician was charged with the application of the remedy 76 We have no way of knowing what happens if the remedy does not produce the desired effect, but in any case the apprentice-physician was not to be blamed.
A second important letter sent to the King of Mari concerns fever.
Speak to my Lord, thus (speaks) Daris-libur, your servant.
Regarding the plants (employed) against "sun-fever," of the physician {asu) from Mardaman and of the staff physician, about which the Lord has written to me. I have sent their plants, which were gathered on a mountain, under seal with my signature to my Lord, and (I have sent) these physi- cians with La-gamal-abum, together with their plants.
My Lord has already tried the remedy for "sun-fever" of the staff physi- cian, but I have (also) tried the remedy for "sun-fever" of the Mardaman <*\ physician and it is good. I tried it many times together with Hammi-sagis fc,
and it is good. Abu-ma-nasi (also) drank it and it was good.
Now for the moment, it isn't necessary that we have my Lord drink a mixture of these drugs. Let him take these drugs separately, and let some- one in charge administer the potion to my Lord. (Durand 2002: 306 = Finet 1957: 134f.)
This letter contrasts the recommendations of the local "staff-physician" with the more exotic and perhaps more respected foreign physician from a distant place, Mardaman. The medical problem in question is himitseti, a fever which may also be related to sunlight or sunstroke. 77 The medical novelty in this letter is the opposition between drinking a cocktail of "mixed" drugs in contrast to "simples," that is each drug or plant being taken individually to see if it is effective or not. This is an early indication within Babylonian medicine of rudimentary "trial and error" and repre- sents a rational approach to drug therapy. This is not to say that the Babylonian asu had anything resembling a laboratory in his house where he could test the efficacy of drugs, or even that a Babylonian physician systematically recorded the effect of any drug on a patient; no extant medical texts describe the actual testing of a drug, either on humans or on animals. We do get a frequent remark in later tablets attesting that a
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64 The Politics of Medicine
recipe has been "tested" (bultu latku), but the practicalities behind this expression are never explained. How any drug was "tested," or by whom, or under what conditions, is never recorded.
This letter alludes to the matter of confidence in the physician, which may have had important psychological benefits for healing the patient. The presence of a foreign physician, whose services were no doubt more expensive, appears to be more attractive than the services of the "staff physician," who was part of the existing court bureaucracy. The very existence of a court staff physician is noteworthy, but importing a foreign physician is known from many other examples, usually at a royal court. The example from our Mari letter is an early example of this phenomenon.
A foreign physician appears in another Mari letter:
A youth who is in my service is ill, and a sore has appeared below his ear which has produced an abscess. The two asw-physicians who are at my disposal have bandaged it but his simmu (sore) hasn't changed. Now, it is imperative that my Lord send me a Mardaman-physician or else a medical expert so that he examines the youth's lesion (simmu) and bandages it so that his lesion will not persist. (Finet 1957: 131 = Durand 1988: 552)
^k Local physicians are again compared unfavorably with physicians ^k
brought from afar or an "expert" (asu hakammu), whose expertise is considered superior to that of local doctors. The writer of the letter is certain, moreover, that better medical advice will cure the lad. The condi- tion to be treated is also a simmu, described here as a sore on the ear which has produced an abscess (lit. issue), probably containing pus. 78 The recommended local treatment was a bandage, not radically different from that recommended by the foreign or expert physicians.
Another disease attested at Mari was bennu, "seizure," a broad term including epilepsy. One court letter refers to a woman, Simatum, described as having been "seized" by an angry god, who had mutilated her fingers and had caused her to suffer from bennu (Durand 1988: 553 No. 312). Since there is no reference in the letter to her seeing a doctor, we can assume that the reference to "seizure" is layman's terminology rather than a professional medical diagnosis.
Mari letters refer to ziqtu, a medical condition affecting the foot, which is a disease known from later medical texts (Durand 1988: 553, 567). The relevant part of one letter reads,
When the [letter] of my Lord was received, on that day I was ready to depart, but ziqtum (severe pain) arose in my foot, (while) in the palace, 79
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in all of my sinews, right into the sole of my foot below and throbbing upwards right into my belly. ... In five days, my foot will be healed. (Durand 1988: No. 266)
The writer of this letter describes his own illness, similar to how a patient would discuss his condition with his doctor; technically, the patient's own observations are "signs," while those of the doctor are "symptoms." The word used to describe the condition, ziqtu, literally means a "bite," 80 and in this case the author could have used the word metaphorically, meaning a "stinging sensation" appeared in his foot, although in later medical texts the technical term refers specifically to a painful condition affecting the skin. The correspondent, writing to the kingYasmah-Addu, expects to be healed within five days, although we have no way of knowing upon what his prognosis is based. Without other corroborative evidence, it is best to assume that there is no technical medical terminology or professional judgment expressed in this letter.
One letter addressed to the Mari king (probably Zimri-Lim) cites a report by an administrator who complained directly to Hammurabi that "oil is not being applied to patients" and "their faces are not being examined" (Durand 1988: No. 273). Both procedures refer to standard ^P medical practice. Various oils served as a common soothing agent for all W
kinds of sores and ailments, and examining the face of a patient was a basic tenet of prognosis and diagnosis, exemplified in prognostic omens in the Diagnostic Handbook. What is interesting in this letter is not the medical information, but rather the fact that basic medical provisions, including materia medica, were expected to be provided by the king or society in general. A report sent back to Hammurabi in Babylon about poor health-care in the region was a potential source of embarrassment and a bad reflection on the King of Mari.
There was a limit, however, to what the king could provide. One letter from Mari refers to the case of a doctor (asu) who refused to come to Mari to work for Yasmah-Addu, the king (Durand 1988: No. 267). The doctor's brother wrote to explain that the doctor had previously lived at Mari for three years and lived in poverty, and the writer wanted to know what his doctor brother would be given by way of support. Even assum- ing that the claims made in this letter are somewhat exaggerated, what surprises us is the independence of a physician who felt able to refuse the king's invitation of service. Under these circumstances, it seems that doc- tors were influential enough to resist being regulated or controlled by royal authority. 81
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Physicians in Babylonia (Eighteenth-Seventeenth Century BC)
Evidence for exorcists in this period is sparse, and what few references we have to healing professionals usually mention the asw-physician only Two contracts from the city of Larsa, for instance, provide infor- mation from daily life about the local asw-physician, who was involved in the sale of a house. One contract, dating from the fifteenth day of the sixth month of the sixth year of king Samsuiluna (c. 1743 BC), docu- ments the sale of a house which borders on a temple of Samas; the house is being sold by an asu, Apil-ilisu, and a second contract dating from exactly one month later documents the sale of a neighboring property (Farber 1999: 135-40). The exceptional feature of these docu- ments is that eight witnesses to one contract are high-ranking priests or temple administrators from the Samas Temple, 82 although the vendor, an asu, is a layman. 83 It is clear from these two documents that the vendor, the physician Apil-ilisu, was a successful and respected profes- sional within his local community.
^ Second-Millennium BC Medical Corpus ^
Since archival records of the second millennium give prominence to the physician over the exorcist in most health matters, it would be instructive to look for confirmation in an actual medical text from the so-called Old Babylonian period. We must bear in mind that first-millennium medical texts usually contain a mixture of therapeutic recipes and incantations, showing the considerable influence of magic on medicine in later periods. The following medical tablet from Nippur, dating roughly from the eighteenth century BC, includes recipes for a variety of ailments, and provides a very different picture of medicine from what we find in later medical literature.
1 If a man is behexed, you dry out armarium, red salt,
2 kidney of a sheep which has not yet tasted grass,
3 (and) eminum-plant, he will eat (them) and get better. 84
4 If a man suffers from jaundice,
5 you soak licorice root in milk,
6 you leave it out overnight (lit. under the stars), you blend it
7 in pressed oil, have him drink it and he will get better.
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8 If a man (has) a worm in his tooth,
9 you crush "sailor's excrement" 85 in pressed oil;
10 if it is a tooth on the right which aches,
11 you pour (the oil) on a tooth on the left and he will get better.
12 If it is tooth on the left which aches,
13 you pour (the oil) on a tooth on the right and he will get better.
14 If a man is covered with red spots, you blend malt-flour
15 in pressed oil in equal measures,
16 you apply (it on the patient) and he will get better.
17 If he does not recover, you apply a hot tincture and he will get better.
18 If he does not recover, you apply hot tuhhu-residue and he will get better.
19 If a man has been stung by a scorpion,
20 you apply bull's saliva and he will get better.
21 If a man's eyes are unwell, you strain (through a cloth) hartitu(-red flower),
22 you apply it (as a bandage) and he will get better.
23 If a man is burning up with "sun-fever," you blend tillaqurdu,
24 cinders, groats-flour, mastakal,
25 and old brick in refined oil,
26 and [ and he will get better].
+ 24 cinders, groats-flour, mastakal, ,
^ 25 and old brick in refined oil, ^
27 If a man is ... [..
28 [
Reverse
29 If a man is behexed 7 [ ]
30 you apply (the fruit) of libaru against fever [and he will get better].
31 If a man's forehead is thick,
32 you apply tamarisk-seed and [he will get better].
33 If a man is bitten by a dog, it being the case that a "puppy" is not born, 1
34 you apply mastakal and sakirutu in ghee,
35 he will consume it and get better.
37 If a man (has) a worm in his tooth,
38 you dry out the peel of [....], apply it and he will get better.
39 If a man's innards are inflamed,
40 he drinks black cumin in best-quality oil and he will get better.
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68 The Politics of Medicine
41 If a man is behexed, he drinks nuhurtu root (dissolved)
42 in refined oil and he will get better.
43 If a man is ill in the anus, you dry out raw meat and (roast it),
44 you blend it with refined oil, you cool it down and he will get better.
45 If afterwards an abscess stings him, you soak the plucked wool
46 in boiled tincture, (apply it) and he will get better.
47 If a man's feet "lick the ground,"
48 you heat up water in a cauldron and bathe him,
49 after he vomits, you cool (him) down with oil and he will get better.
50 If a man head is burning up with "sun-fever,"
51 you press his head with powder,
52 you pour oil (on him) and he will get better.
53 If he is hot (feverish), you add oil and he will get better.
54 If a man is constantly inflamed in his internal organs,
55 he drinks nlnu in beer and he will get better. (BAM 393)
The first thing to notice is that this recipe contains no magic and not a ^, single incantation. The tablet is not arranged in a head-to-foot format, ^
which we expect from first-millennium BC diagnostic texts, but it associ- ates diseases according to other organizing principles. The text alternates between diseases for which a cause has been determined (such as witch- craft, worm in a tooth, a dog-bite, etc.) and other diseases for which no cause is known (sick eyes, swollen chest); in the latter case, it is difficult to differentiate between a disease and its symptoms (Geller 2006: 10; Schwemer 2007: 28 n. 24).
If we compare this medical text, from the early second millennium, with medical matters raised in royal correspondence, we find that techni- cal disease terminology of the medical corpus is not reflected in the lay- man's language of contemporary letters, but the lack of incantations within recipes supports the assumed primary medical role in this period of the asu over the exorcist.
Epidemics
There were times when the offices of the exorcist may have been in demand, especially during epidemics, which are occasionally mentioned in Mari letters (Durand 1988: 544-9). According to one letter sent to the
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king, Yasmah-Addu, an epidemic affecting the neighboring city of Tuttul caused many people to be ill, but with few deaths, while in another city, Dunnum, at least 20 persons were reported to have died from the pest, with the result that many people abandoned the city for the mountains. Mari, on the other hand, is reported to have been spared from this out- break (Durand 1988: 561 No. 259). Similarly, a second letter to Yasmah- Addu reports an outbreak of disease in the cities of Zurubban and Zapad, two cities not in immediate proximity to each other, indicating on this occasion a more widespread epidemic (Durand 1988: 563 No. 261). Another letter addressed to Yasmah-Addu reports that the epidemic, (called here "the hand of the god," a term we also encounter in medical texts), had resulted in the deaths of weavers, craftsmen, and agricultural workers (Durand 1988: 565 No. 264). It is possible that these workers, as part of the corvee, lived and worked in close quarters and in poor condi- tions, which encouraged the spread of disease.
It is not clear what measures could be taken to combat an epidemic, other than abandoning the site. One letter to Yasmah-Addu explains that the epidemic had passed but survivors had delayed in burying the dead until the proper omens had been taken (Durand 1988: 564 No. 263), indi- cating that diviners were also present, in addition to exorcists and lamen- tation priests. Speedy burial of the dead and ritual purification were W probably the only defense against contagious diseases, and the acts of W
purification (through washing and burning) known from ritual texts may have reduced the chance of further infection, if the disease was caused by bacteria. After the burials had taken place, the exorcists and lamentation priests purified the city (Durand 1988: 564), but the activities of the asu are not mentioned in this connection in the Mari archives, perhaps because the asu would have little to offer by way of effective remedies.
Generally, however, within the extensive corpus of Mari letters and letters from Babylonia proper, as well as contracts and law codes, we find few references to exorcists, and matters dealing with medicine appear to be in the hands of the asw-physician. This is not coincidental, since archives from Mari and elsewhere are palace rather than temple archives, in which case we should not be surprised to find the secular asw-physician, who was not a priest, rather than the reported activities of the temple- associated exorcist. Moreover, we have little information about exorcists, since most early-second-millennium temple records refer more com- monly to the paslsu or isib/isippu, two types of purification priests, 87 titles which later mostly fall out of use. This represents a troubling dis- juncture in our documentation, since we have a wealth of incantations from the second millennium BC (see Cunningham 1997: 131-59), but
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70 The Politics of Medicine
only a very few medical texts, and even fewer medical texts from the third millennium (Attinger 2008: 9-18). On the other hand, what data we have seems to indicate that the asu was the key medical figure of this period, in Mesopotamia itself, as well as in Syria.
Middle Babylonian Letters (c. Fifteenth Century BC)
Another group of letters from several hundred years later in the latter half of the second millennium BC offers a further opportunity to eavesdrop on the therapist-patient relationship, although this time in Babylonia itself, rather than in Mari. The letters come from the city of Nippur, in the heart of Babylonia, and were composed by several different writers, although the majority of letters appear to have been written by one Sumu-libsi, who never describes himself as an asu, nor do his colleagues. One assumes that they are physicians because their letters describe ill patients and treatments recommended for their recovery. The question of Sumu-libsi's professional status is not straightforward, since this particular group of tablets belongs to temple archives, from where we might expect to find records of the exorcist rather than asu. Sumu-libsi was either an exorcist with serious medical W expertise or an asw-physician who was called in to treat temple personnel. *Qp
One of Sumu-libsi's letters describes a female patient, known only as "Ayyaru's daughter," who suffered from an undescribed illness, but for which the treatment was a poultice to be applied at night (Parpola 1983: 492). On this occasion, however, the writer reports that the girl had felt better and had fallen asleep, without anyone applying her nightly poul- tice. She asked for the bandage in the morning because she was not feeling well, with the implication being that the relapse was caused by the lack of proper treatment. Sumu-libsi promised to investigate. One key phrase in this letter refers to the girl's state of health, "whereas before she was feeling much better, now she does not feel well." 88
In a second letter, Sumu-libsi describes the symptoms of "Mustalu's daughter" (Parpola 1983: 493). Sumu-libsi reports that the girl suffered from an attack of fever (ummu) in the night, but at first light he had given her an unspecified "drug" (sammu). The result was that the fever was "constant" (mithar), that is, not vacillating between high and low tem- peratures. Sumu-libsi also reports that her feet are cool, and that while she had previously been coughing, she no longer does so. 89
It appears that both of these girls were suffering from the same ail- ment, as is shown by a third letter from Sumu-libsi, according to which
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the "inflammations" on the chest of both girls have given off "perspira- tion" (Parpola 1983: 493). It then turns out that the same is happening with other girls, such as the daughters of messieurs Kuri, Ili-ippasra, and Ahuni, but the daughters of two ladies, Babati and Bitti, are in a better state; their "inflammations" produce no "perspiration." He reports that these latter two are in stable health.
A subsequent letter from Sumu-libsi from the same archive follows on from the first two in sequence (Parpola 1983: 494), since he reports that inflammations of Mustalu's daughter are healed and she no longer coughs, although he makes no reference to Ayyaru's daughter. He reports on the other patients as well, all female: the daughters of Kuri and Ahuni are healed 90 and can return to their training, 91 although a new patient, Etirtu, now shows symptoms of the same disease. Furthermore, Ili-ippasra's daughter has an inflammation showing a red- dish discoloration, although her disease appears to have improved. 92 Babati's daughter, mentioned as improving in a previous letter, is now not doing well, since she continues to cough and suffer from inflammation.
The combination of symptoms gives a rough idea of the nature of the illness which had spread among a group of female musicians living or working in the same quarters. The condition is characterized by the pres- W ence of "inflammations" occurring on the chest or ribs or back. Other W
symptoms are coughing and fever. A final letter of Sumu-libsi reports his observations over a two-day period in which he notes that his patient (probably a woman, Etirtu) was seized by fever (ummu), and she was unable to finish eating a single meal with porridge (papassu), a type of barley gruel which was medicinal (Parpola 1983: 495). These symptoms probably reflect an infectious disease.
Sumu-libsi also refers to the services of his colleague, one Belum- balati, 93 who treated Huttirmu's daughter. In fact, we have a remarkable letter from Belum-balati, reporting on his treatment. A patient suffering from a chest condition required a poultice and a potion for the wind- pipes. For a second patient, Belum-balati justified his diagnosis by quot- ing the incipit of a medical text: sum-ma LtJ ki-ma ek-ke-tu 1 [ik-kal-su], "if a man (suffers) when a skin disease [causes him pain]." Belum-balati's letter goes on to complain that he cannot properly prescribe a bandage because one essential ingredient was unavailable:
When I prescribed a bandage for him, the asu-plant was missing, and my Lord knows that if (even) one herb is missing, he will not get better. (Parpola 1983: 495 12-15)
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72 The Politics of Medicine
The exactitude of this remark is impressive, with its assertion that a compound medical recipe made up of several drugs is ineffective unless all active ingredients are present. On the other hand, the missing drug, asu, was rather commonplace and used in a variety of different recipes, and does not appear to be either exotic or rare. The fact that Belum- balati quotes a medical incipit and cites a rule about recipes - that no ingredient can be omitted - is no doubt intended to prove his medical qualifications. 94
This same writer, Belum-balati, discusses a further case of a woman suffering from a cough, for which the treatment caused unwanted side- effects, and she now suffers from some kind of abdominal cramps (kis libbi), for which yet another potion had to be prescribed. This letter is an important witness to how drug preparations developed from "simples" (one drug to treat one disease) into compound recipes, some later con- taining as many as 90 different drugs. Acting as an apothecary, the ancient physician probably prescribed a drug and noticed whether it produced any undesired side-effects, and, if so, then the recipe had to be altered to treat the side-effects as well. 95 Another incentive to create compound recipes came from patients, who may have thought compound recipes more effective than a single-ingredient drug. 96 This may be the reason why Belum-balati's letter ends with a request list of 12 urgently required W drugs, many of which can be identified in the later medical corpus. 97 W
Letters and documents from Nippur and Boghazkoy provide unparal- leled data about the practice of medicine in the second millennium BC, and they predominantly refer to the activities of the asu rather than the exorcist. Although the orientation of the archives (palace versus temple) might explain the more frequent references to physician over exorcist, another explanation is possible. The role of exorcist and physician throughout the second millennium most likely reflected a clear division of responsibility and tasks, with the exorcist essentially magico-religious in his orientation and the physician's interests being magico-medical. This clear division, however, did not persist through the next millennium, when we see how roles of exorcist and physician radically change during the course of time.
Literary Hypochondria
In addition to a large corpus of Assyrian and Babylonian letters dealing with medical matters, we have reports of patients complaining about their illnesses or mental distress. One is in the form of a famous literary
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autobiographical composition known as Ludlul bel nemeqi, the Poem of the Righteous Sufferer, ascribed to the Babylonian courtier Subsi-mesre- Sakkan, who would have flourished in the late second millennium BC (Lambert 1967: 21-62; Foster 2007: 32-4). The writer complains that he suffers from slander and treachery, but that none of the professionals (diviners, dream interpreters, or masmassu-exorcists) offered helpful advice; the author is referring to various kinds of rituals and treatments designed to deal with such problems. He then lists the various illnesses from which he suffers, including headache, cough, chills, infection, fevers, and paralysis, among others, for which neither the diviner nor the exor- cist provides a satisfactory diagnosis. Finally, however, an exorcist sent by Marduk manages to effect a cure. The literary nature of this poem, which remained popular throughout the first millennium BC, makes it unlikely to have been based upon any identifiable actual person or situ- ation. On the other hand, if the poem is based on real life, only a king or senior court official would have been able to afford to commission a text of such literary value.
A second text comes from a recently excavated stele from Syria, from one of the banks of the Upper Euphrates, in the vicinity of Terqa and Dura- Europus, dating from approximately the eighth century BC. In this stele, the local ruler, Adad-bel-ardi, describes his miseries and illnesses in remarkable W detail, in language reminiscent of the Poem of the Righteous Sufferer. 98 He W
begins by recounting his early childhood illness, which included sores cov- ering his whole body. Among other ailments of the head and neck, he developed blurred vision and arthritis-like symptoms in his hands.
Day and night, sleep afforded my feet no rest,
I stopped (normal) human nourishment, I became like a dead man.
He explains that despite making offerings to gods, he received no succor or favorable attention, even from his own personal god. He finally recounts that,
I had no relief from dreams or divination. I did not reach to using
medicine,
(nor) to the exorcist casting spells, and my head was pushed away.
This unusual stele is a unique "case history" from Mesopotamia, recording the patient's own report of his medical condition and refer- ring to himself by name. The stele is a personal prayer addressed to Nabu, and in many ways resembles the woes expressed by Subsi-mesre- Sakkan.The specific illnesses of which the writer complains are not the
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74 The Politics of Medicine
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Figure 3.3 Bust of an Assyrian courtier (Musee du Louvre; photo Florentina Badalanova Geller)
technical disease terms found in the extensive Babylonian medical corpus. The first of these, sibit nakkapti, refers to an attack of the tem- ples, perhaps referring to migraine. The second condition is labeled sihlu, which means "piercing pain," although the term is not used for acute pain in the medical corpus. This text is a description, in layman's words, of chronic illness which has afflicted the patient since childhood. The stele ends with a plea to the gods to alleviate his illness, and the com- plaints about ineffective remedies probably show the limited range of therapies available in the seventh century BC, even to a member of the ruling class."
Such autobiographical accounts of personal illness are rare but not entirely unique in the classical world. One celebrated example is the second century AD account of Aelius Aristides, who at one time was a patient of Galen (Nutton 2004: 277-9; Lloyd 2003: 213-15). A notori- ous hypochondriac, Aristides kept a full record of his many illnesses. According to his Sacred Tales, Aristides was critical of his many doctors
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The Politics of Medicine 75
and turned to Asclepius for help, much as Adad-bel-ardi turned to the gods after rejecting the services of doctors and exorcists.
Neo-Assyrian Court Letters
We have many letters from Assyrian and Babylonian savants at the Assyrian court corresponding with the kings Esarhaddon and Assur- banipal, during the years of their respective reigns (681-c. 630 BC). These letters provide invaluable information about how medicine and healing magic was practiced in everyday life, at least at the royal court. There can also be little doubt about the political importance of these letters, since physicians and exorcists, as well as diviners, lamentation priests, and scribes, all enjoyed royal patronage and were supported by the king. It is also abundantly clear that decisions affecting the king, including matters dealing with his private health, were also affairs of state affecting the country as a whole.
Scholars at the Assyrian court needed to justify their appointments. The letters mention exorcist (masmassu), physician (asu), lamentation singer (kalu), scribe (tupsarru), and diviner (bam). Two of these, the exorcist and lamentation singer, also functioned as priests, although W whether in a dual capacity - as priests working in the palace - is difficult W
to say. The idea of priests on secondment to the palace would not neces- sarily be a conflict of interests, but the converse was also possible, i.e. laymen working in the temple. 100 In effect, the exorcist and lamentation priests, in the late first millennium BC, could have had a broader range of professional options than either the asw-physician or bam-diviner, as non-priests.
One important letter among the court correspondence (SAA 10 160) was written by Marduk-sapik-zeri, probably to Assurbanipal (see Hunger 1987: 162). 101 The king claimed himself to be generally better versed in scribal arts than any of his predecessors (Hunger 1968: No. 329), includ- ing specialized disciplines such as extispicy (barutu) (Hunger 1968: No. 325), and even if this is an exaggeration, scribes within his court would have to take these claims into consideration. If Assurbanipal valued his own expertise in technical matters so highly, scribes would no doubt have to claim superior abilities in order to be appointed to work in the royal administration. This is what we find in a letter of Marduk-sapik- zeri in which he applies for a position within the palace administration for himself and for his hand-picked team of 20 scholars (SAA 10 160). The writer is otherwise unknown in administrative archives, which could
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76 The Politics of Medicine
mean that his application failed. In any case, he begins his letter by showing off his abilities in interpreting celestial omens, probably based upon the well-known series, Enuma-Anu-Enlil (for which, see Rochberg 2004: 66-78). To display his skill, Marduk-sapik-zeri reinterprets a potentially bad omen about silting up of the Tigris and Euphrates and declares the omen to be favorable, since the logogram (IDIM) for "silt" (sakiku) can also mean "well" or "spring" (nagbu), hence portending prosperity rather than catastrophe. Marduk-sapik-zeri then goes on to give his credentials, being the son of a kalu-priest, but also having learned various purification rituals and even diagnosis (examining "healthy and sick flesh"), which implies that he had mastered healing arts in addition to physiognomic and standard omens. There is no doubt about the comprehensive nature of Marduk-sapik-zeri's education, if what he writes is correct.
There are some troubling aspects to this letter. Among his team of experts whom Marduk-sapik-zeri recommends to the king's services, several individuals are referred to as "refugee[s] (halqu) from Assyria," which might make sense if these scholars had escaped from Assyria to Babylonia during the revolt of Samas-suma-ukin against Assurbanipal in 652 BC. 102 The fact that Marduk-sapik-zeri could have been on the losing side in the revolt (i.e Babylonia) may explain why neither he nor his W comrades are heard of again. W
The other question is whether this letter makes a realistic or exagger- ated case for the competence of Marduk-sapik-zeri and his cronies. One of the scholars named Aqrea, a refugee from Assyria, had been a slave, since his face and hand had been branded with his owner's name; nev- ertheless he was described as someone accomplished in the art of exor- cism (asiputu) (SAA 10 160: 11). Unlike Greek slaves in Rome, there is no tradition in Mesopotamia of slaves being scholars. 103 Most of the other members of the group were trained in a single discipline, either lamentations (kalutu) or exorcism (asiputu), although some scholars were claimed to have mastered more than one area of study. One excep- tion is another refugee from Assyria, a certain Kudurru, who had stud- ied scribal arts (tupsarrutu) and exorcism (asiputu), in addition to being competent in one other discipline (possibly divination). Another scholar with the same name, Kudurru, could handle both terrestrial and celes- tial omens, a plausible combination. On the other hand, normally scribes who dealt with celestial omens were priests, 104 while terrestrial omens were handled by non-priests (baru). Finally, one scholar (whose name is lost) among this group had emigrated from Elam, probably as a result of wars between Assurbanipal and Elam at this time. He had mastered
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extispicy and celestial omens, as well as Sumerian esoteric literature and commentary texts, and he could be classed as a genuine academic (SAA 10 160 reverse 1-3).
The only claims which appear to be extraordinary are those made by Marduk-sapik-zeri about his own competence, since the list of his accom- plishments reads like a catalogue of the entire school curriculum. He never actually refers to his own professional status, either as a kalu or masmassu or tupsarru. It may be that even if one had studied these dis- ciplines, one was not entitled to refer to oneself as a kalu or masmassu or tupsarru until one held an actual appointment in either a temple or palace bureaucracy, since there were no diplomas or recognized aca- demic or professional qualifications. 105 One could only establish creden- tials as a professional by acting in a professional capacity. But what happened with those professions, such as asu or baru, which had no priestly status to support professional qualifications?We can only assume that one's reputation was based upon successful results. This may be why Marduk-sapik-zeri's letter began with his own interpretation of celestial omens, by which he hoped to convince the king of his professional competence.
Once appointed to the royal court, questions of power and status within the state bureaucracy would naturally surface. One of the prob- W lems facing courtiers was the corvee or ilku-service, which affected W
scholars as well as other members of society. Two letters, one from an asu (in fact, the King's Physician) and another from a scribe, complain about the corvee obligation imposed upon them, despite their responsibilities at court (SAA 10 324 and 143). Professionals at court objected to the fact that they were still subject to normal tax obligations.
Since temple personnel had zZfew-obligations to the temple, 106 we find exorcists also complaining about their working conditions and scale of remuneration. It was not unusual, in fact, for exorcists to com- plain to the king. One such complaint dates from a letter written by the Chief Exorcist, Adad-sumu-usur. He wrote to Esarhaddon twice in 667 BC (SAA 10 224) to ask that his son Urad-Gula be reinstated at court, and his petitions seemed to have worked, since letters dating from a year later thank the king for allowing Adad-sumu-usur's entire family to act as royal exorcists (SAA 10 227). 107 Such unabashed nep- otism is not surprising, since it is likely that Adad-sumu-usur was part of a large family of priests, all of whom shared the occupation of exor- cist (Jean 2006: 190). Urad-Gula succeeded his father as Chief Exorcist, 108 but he, too, wrote to the king with complaints. Perhaps he, like his father, was subject to depression, and like his father did not
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Figure 3.4 Ceramic plaque showing healer and patient, second millennium BC (Musee du Louvre AO 6622; photo Florentina Badalanova Geller)
hesitate to inform the king of his state of mind, but in any case the tone of the letter shows how influential and virtually unassailable was the position of a high-ranking exorcist at court (Glassner 2007: 136-8).
Urad-Gula's lengthy letter to Assurbanipal (SAA 10 294) is a cata- logue of his lifetime woes, beginning with his impoverished early years, and ending with his impoverished present state. The tone of familiarity in Urad-Gula's letter to Assurbanipal is impressive. In his second letter (SAA 10 289), Urad-Gula complains about a rival receiving financial benefits, while he received nothing. Compared to other letters of com- plaint (e.g. SAA 10 171 and 173), those of Urad-Gula display a sense of security which may be a general reflection on the status of the masmassu within the Assyrian court, having unparalleled influence
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over the king. One attractive suggestion is that Urad-Gula had been one of Assurbanipal's personal tutors (Jean 2006: 118). The relationship between the chief masmassu and the king may have been one of patron- age, through which Urad-Gula's father requested a position for his son, and through which Urad-Gula complained to the king from a sense of entitlement (Westbrook 2005: 222f.). In any case, the position of Chief Exorcist seems to been more secure than that of other scholars. 109 By contrast the letters of the Chief Physician (asu) are businesslike and formal, showing no sense of familiarity or personal relations with the king, and in fact we only have one archive of a royal physician among the many court letters.
Urad-Nanaya, Chief Physician to Esarhaddon
Esarhaddon's Chief Physician, Urad-Nanaya, was not in a particularly advantageous position at the Assyrian royal court, since he faced formida- ble rivals and competition. His most immediate rival was the Chief Exorcist, Adad-sumu-usur, who had a much closer personal relationship with the king, and it was often the case that the Chief Exorcist offered /^v medical advice which was similar to that which he himself gave. Urad- ^t\
Nanaya took the opportunity on one occasion of complaining about Adad-sumu-usur, who had prohibited the princes, Assurbanipal and Samas-suma-ukin, from going outside before the twenty-second of Tishri (SAA 10 314 and 328). 110 In any case, Urad-Nanaya challenged this pro- hibition, insisting that Adad-sumu-usur be questioned regarding an unfa- vorable omen behind his ruling, with Adad-sumu-usur being forced to admit that there was none. It is easy to envisage disagreements between the two professions regarding interpretations of ominous signs. 111
A serious matter was raised by Urad-Nanaya in the spring of 670 BC (month of Iyyar). Although the letter itself includes some medical advice for the king, the first part of the letter concentrates on politics:
Because of this speech of the king, Assur and the great gods bound and handed over to the king these criminals who plotted against the (king's) goodness and who, having concluded the king's treaty together with his serv- ants before Assur and the great gods, broke the treaty. ... (SAA 10 316)
Urad-Nanaya congratulates the king on arresting a group of "criminals" (parrisute) who "broke a treaty" which they had concluded with the king before Assur and other state gods (SAA 10 316). But is this really a
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rebellion, and if so why would it concern Urad-Nanaya? The Chief Physician, judging by his letters, was an extremely sober and practical professional who hardly engaged in personal exchanges with the king, unlike his exorcist colleagues, who regularly complained to the king about very personal matters. Why would a physician comment on an internal criminal matter which had nothing to do with his duties as physician?
The political events mentioned in this letter concern Urad-Nanaya directly but have not been properly understood. All palace professionals had been required, two years earlier in 672 BC, to swear an oath of alle- giance (adii) to the crown, and the list included every scribe (tupsarru), diviner {bdrvi), exorcist (masmassu), and augur (ddgil issuri, lit. "bird- watcher") (SAA 10 6 and 7). Furthermore, the "criminals" mentioned in Urad-Nanaya's letter were not criminals in the legal sense, but rather "cheats" or "quacks." The same word (parrisu) was used by the court astrologer Nabu-ahhe-eriba in a letter to the king in the very same year (670 BC), a few months later, in which the writer complained that an astrol- oger colleague supplied the king with wrong information about a sighting of Venus and what this would portend. Nabu-ahhe-eriba pulls no punches, calling his rival a "lightweight," "fool," and "fraud" (parrisu) (SAA 10 72: 9-10). In a similar fit of temper, Urad-Nanaya is actually complaining about W his professional colleagues, whom he calls "frauds" or "quacks" (parrisute), W
who had sworn an oath of allegiance to the king but subsequently abro- gated it by offering poor professional advice and service. Urad-Nanaya was not commenting in a casual way about contemporary politics, but he was accusing his professional rivals of incompetence and deceit.
Urad-Nanaya finally gets to the real point by reporting that he is send- ing the king some medicinal plants. In this regard, he was faced with the usual dilemma of physicians, whether to dazzle the patient with techni- cal science or use layman's language to explain the treatment. Both approaches can be useful, and in fact Urad-Nanaya uses both. In this let- ter, he recommends the following drugs:
The plants which I am sending to the king are the two which they call "BU and "Hat-ti. 112 They do not resemble each other.
The one which is like the base of a ring is heavy and very expensive. (SAA 10 316: 15-19)
Urad-Nanaya anticipates the king's obvious question, "what are they good for?", to which he provides the answer, that these plants are useful
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for counter-charms against witchcraft (usburrudu) and specifically for women in labor (who especially required anti-witchcraft charms).
Neither plant can be found with these names in the medical corpus. Scribes required specialized training to read and write scientific litera- ture, such as omens and medical texts, and it is doubtful whether the king himself would have understood the meaning of technical plant names. On the other hand, the purpose of the letter was to inform the king about a new drug, and a technical name did not need to be under- stood in order to make the desired impression. In fact, the name of the plant could be entirely bogus and still have the desired effect. The second plant, called "Hatti or "Hittite"-plant, could refer to a foreign plant brought from Syria, giving this plant exotic status. The description of this plant as having "the base of a ring" is unclear to us, but the fact that the plant was said to be "very expensive" or "very rare" (uqur adannis) would not have escaped the king's approval. Recent research has shown that expensive placebos are more effective than cheap ones. 113 The point is that Urad-Nanaya does not expect the king to be familiar with the pharmacopeia, but he needs to impress upon Esarhaddon that he is pre- scribing new and exotic drugs to deal with the royal ailments, perhaps counting on the placebo effect of new drugs as well as any actual medical properties they may have possessed. W Since his royal patient suffered from a variety of chronic illnesses, W
Urad-Nanaya did not always take the same tack when offering medical advice to the king. For Esarhaddon's ear problems, he recommended the use of fumigation, which happens to be one of the most effective meth- ods of introducing drugs into a patient's body, often being quicker than swallowing a substance. One of Urad-Nanaya 's own medical tablets, cop- ied by his disciple, contains a recipe for ear problems listing "9 drugs for fumigation of the ears" (see Geller 2007b: 13 and 18). In this particular case (SAA 10 323), Urad-Nanaya recommends two drugs, commonly used in medical ear-disease recipes, to be dripped into the ear. In his let- ter to Esarhaddon, Urad-Nanaya prescribes these drugs by their techni- cal Sumerian names ( Mm gig and Mmd mas) rather than by their generic Akkadian terms, kanaktu and nikiptu, since these plants were well- known by their Akkadian names in non-medical usage as aromatics and hence may not have seemed like legitimate materia medica. Urad- Nanaya's own medical tablet for ear maladies employs these same drugs (Geller 2007b: 12, 70). 114
We have some idea about Urad-Nanaya's pharmaceutical repertoire, since this cautious physician left us a list of drugs he used for fumigation, salves, and potions, mostly intended for diseases of the ears, although
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these same drugs could also be used for seizure (saharsubbu) and paralysis (simmatu), since some drug preparations usually had multiple applications (SAA 10 327). Urad-Nanaya's list was his own inventory of what was available to treat conditions which were not easily treatable, such as a seizure, paralysis, aphasia, and ringing in the ears.
Urad-Nanaya labeled his drugs as bultu, napsaltu, and nepesu, "recipe (or remedy), salve, and ritual" - three useful ways of categorizing the various uses for materia medica. Texts often refer to a bultu latku, "a tested recipe." The end product of the prescription is a potion, band- age, salve (as in this context), suppository, etc., but this is not sufficient. Many times recipes are accompanied by an incantation to be recited as well as a ritual to be performed. Each of these categories - recipes, oint- ments, and rituals - required its own brand of drugs.
Urad-Nanaya responds to the king's complaint about having a "fever" 115 by prescribing the rather simple solution of rubbing bird fat on the skin in order to protect the king from the effects of draughts, and when the king regularly washes his arms in the bath, the water should not be hot (SAA 10 318). There is nothing particularly remarkable about this recipe, since bird fat (usually referring to the fat of a goose) occurs in medical texts (Herrero 1984: 53), as does bathing in hot water (Herrero 1984: 97). W A letter from Urad-Nanaya to Esarhaddon dating from early 670 BC W
(SAA 10 315; Parpola 1983: 229) again refers to fever, this time as huntu, for which Urad-Nanaya prescribes a lotion (marhusu). Esarhaddon suf- fered from chronic fever, for which Urad-Nanaya struggled to find a rem- edy that would work and each time promised that the condition would abate. On the other hand, Urad-Nanaya's positive assessment of the effectiveness followed "best practice" as far as medical texts were con- cerned; conventional medical recipes always end with a final note that the "patient will get better" or "will improve." Nevertheless, he thought it best not to pull any punches with his royal patient by trying to pro- mote his skills beyond what was possible to accomplish; Urad-Nanaya realized that chronic fever was not likely to be cured by the drugs at the disposal of a court physician. When asked face-to-face by Esarhaddon why he cannot find a correct diagnosis, Urad-Nanaya candidly replies that he cannot fathom the king's symptoms (sakikkesu), and that the king could order diviners to check the omens to verify Urad-Nanaya's medical advice. The level of Esarhaddon's fever probably posed difficul- ties for Urad-Nanaya, and since there were no thermometers or instru- ments for taking precise measurements, Urad-Nanaya warns Esarhaddon that "perhaps the king will give off sweat" (SAA 10 315 reverse 14f.),
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indicating a high fever. On another occasion, Urad-Nanaya reported to Esarhaddon that one of his sons had periodically suffered from huntu- fever, but he reassures Esarhaddon that his son's "symptoms" are healthy 116 We have no reason to believe that Urad-Nanaya was being overly optimistic in the latter case, since he seems to give sober assess- ments of medical conditions, at least as far as medical technique at the time would allow.
In the event, Urad-Nanaya also prescribes another type of treatment for Esarhaddon's fever, in this case a type of bandages called silbu (pi. silbanu), which probably gets its name from the criss-cross pattern of the bandages. Urad-Nanaya gives clear instructions for the application of these bandages: "just like they did it one or two times (before), let them apply them crosswise." 117 Urad-Nanaya even assures the king that he will come and "enlighten" 118 others as to the correct procedure for using these bandages; as Chief Physician, we can assume that Urad-Nanaya had a staff of other healers under his command.
Another letter of Urad-Nanaya refers to treating a skin lesion or scab (sikru) behind the ear in a young child of the palace (SAA 10 319). Urad-Nanaya writes that he applied a dressing and afterwards opened the bandage (lit. "rag," sirtu) and removed the pus, as much as on the tip of a small finger (see Parpola 1983: 252). Again Urad-Nanaya was fol- W lowing his own medical practices, as we can see from an Assyrian medi- *Qp
cal text which offers rich descriptions of pus (as well as blood or another fluid) flowing from a patient's ears, for which a tampon was a standard remedy; this particular tablet was copied by one of Urad-Nanaya's disci- ples (see Geller 2007b: 4 and 18). However, in his letter to the king Urad-Nanaya avoided all medical jargon but used layman's language when discussing the prescribed remedy. In any case, since technical lan- guage of medical texts would normally been written in Sumerian logo- grams, it is unlikely that anyone untrained in this literature would have been able to comprehend the obtuse terminology.
Urad-Nanaya also wrote to Esarhaddon about remedies for nosebleed (SAA 10 321), a condition also suffered by one of Esarhaddon's sons (SAA 10 324: 8-10). The medical intervention recommended was a tampon containing the seeds of the plant mastakal, a drug commonly used in many kinds of medical remedies. Urad-Nanaya wrote out the common Akkadian name of the drug rather than its Sumerian logo- gram ("in.nu.us) by which it was usually known in the technical literature. The tampon was also to be mixed with the "blood" of cedar, to be wrapped in red wool (tabribu). The "blood" of cedar is another common ingredient in medical texts when dealing with ears, as can be
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seen again in one of Urad-Nanaya's own ear-ailment recipes, copied by his apprentice, recommending 15 plants which are to be wrapped into a tampon, sprinkled with "blood" of cedar, and put into the patient's ears (Geller 2007b: 18). Urad-Nanaya's letter prescribing a tampon against nosebleed for the prince is essentially the same as his medical recipe, but using a "simple" rather than "complex" drug formula to treat the ail- ment; in other words, in his letter Urad-Nanaya prescribes a single drug instead of a combination of 15 different ones for a tampon. This pattern is typical of medical court letters, which tend to refer to simple rather than compound drug remedies.
Within Babylonian medicine, a tampon was used for all kinds of ail- ments requiring insertion into some part of the anatomy, particularly ears, but also the vagina (Herrero 1984: 107), usually to staunch bleed- ing or pus. Urad-Nanaya used a type of "red wool" (tabribu) for his tampon, although the wool is much better known in medical texts by its Sumerian logogram, s ' B he.me.da. Not only is Urad-Nanaya using layman's language, but he employed the Assyrian dialect word for "red wool," rather than the terms nabasu or tabarru known from contemporary Babylonian dialects. The same is true of other expressions used by Urad- Nanaya, such as his instructions that one should wrap the materia med- ica into a tuft of wool (nipsu) (SAA 10 321 reverse 14), a term so far W unattested in medicine. *Qp
One other ingredient mentioned by Urad-Nanaya was the use of the "dust of the crossroads" (SAA 10 321 reverse 6), which occurs fairly frequently in incantation rituals and represents as much magic as medi- cine (Geller 2000: 336). Urad-Nanaya also recommends reciting the appropriate incantation over the tampon before inserting it into the nos- trils, reflecting contemporary medical practice. The grey area between magic and medicine is obvious from the physician's correspondence with Esarhaddon, since while advising Esarhaddon on his attacks of fever, Urad-Nanaya promises to send (in addition to a salve) a leather bag con- taining a phylactery, probably consisting of amulet stones (SAA 10 315 reverse 15-18). Such sacks of amuletic stones, strung on a string and hung around the patient's neck, are frequently prescribed to counteract the effect of psychological distress (see von Weiher 1983: 109-21), although Urad-Nanaya may have judged that Esarhaddon required treat- ment for his poor state of mind as well as for his fever. Even a physician like Galen was not occasionally averse to the use of amulets if it improved the patient's mental state (Nutton 2004: 268f.).
We can also detect a degree of professional rivalry in some of Urad- Nanaya's letters when commenting on treatment delivered by other
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practitioners. He complains, for instance, that others are treating with tampons "without knowing (what they are doing)" (SAA 10 322 reverse 8). Urad-Nanaya criticizes other practitioners for placing tam- pons against the nasal cartilage and failing to staunch the flow of blood; he explains that tampons must be placed at the nostril openings, which will cause shortness of breath but also stop the bleeding (SAA 10 322 reverse 14-17). Unfortunately, he does not specify whether an exorcist or another court physician was responsible for this malpractice. Urad- Nanaya's letter is a rare instance of an explanation of how medicine was administered, no doubt the kind of information learned at first hand as an apprentice physician.
Urad-Nanaya seems to be able to handle almost any type of medical problem that arose, including dentistry. He mentions that Esarhaddon had written to him about his teeth, to which he responded that there are "many cures for teeth," although without recommending anything spe- cific (SAA 10 320 reverse 4-5). This information is useful because of the nature of "tooth-disease" recipes, which recommend substances like alum for treatment of the gums but at the same time rely upon the cele- brated incantation of the "worm in the tooth" for dealing with other kinds of tooth problems (Collins 1999: 262f.; Foster 1993: ii 878). Nevertheless, tooth disease remained within the province of the asu, as W Urad-Nanaya's letter indicates. W
One wonders how a physician such as Urad-Nanaya spent his time. We can assume that he visited patients, since he continually reports on their state of health: "The king's son (enjoys) very good health. (When) I came to the king's son, he told me that 'all my body (lit. flesh) has improved' " (SAA 10 323: 7-11). According to the Diagnostic Handbook visiting the sick was the speciality of the ka.pirig-exorcist, not the physician, so the fact that Urad-Nanaya visits his patients may show how the theory was not always followed in practice. Otherwise, Urad-Nanaya makes one ref- erence to his routine: "I am now busy cooking up (materia medica) in a (stone) burallu-vessel" (SAA 10 323 reverse 9-11), a type of cooking vessel otherwise unknown from medical texts. Urad-Nanaya was prob- ably owning up to the fact that he spent a large part of his time making up recipes, in the capacity of asu as apothecary.
The concocting of recipes was not simply a manual activity of mixing ingredients but also involved keeping meticulous records, as Urad- Nanaya comments to Esarhaddon in a letter dated to June 669 BC, refer- ring to purging a patient (perhaps the king himself): "In all recipes it is said as such: '(if) he purges (bile) through his mouth or his anus, he will get better' " (SAA 10 326 3' - reverse 3'). 119 Although this quotation
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from the medical literature may have been intended to impress Esarhaddon with the writer's erudition, it also shows Urad-Nanaya's familiarity with current practices, since the citation occurs many times in medical texts dealing with rectal disease: "he purges through his anus, he will get better" (BAM 7 34: 50 and 37 ii 21'). 120
It may have worried the Chief Physician that he was not unique in his professional judgment, since the Chief Exorcist, Adad-sumu-usur, offers nearly the same medical advice as Urad-Nanaya (SAA 10 217), at approximately the same time, in a letter to Esarhaddon (669 BC, around June), commenting about the king vomiting up bile. Adad-sumu-usur reports that the king's "natural state" (sikinsu annu) is not favorable, but after they "purged" the king "upward and downwards" (i.e. through mouth and anus) and induced sweating, he was better. The classic medi- cal terms in which Adad-sumu-usur describes the treatment are difficult to differentiate from what Urad-Nanaya advises, and in fact Adad- sumu-usur may even be referring to the purging that was originally pre- scribed by Urad-Nanaya. The dates of the correspondence show that exorcist and physician were consulted at about the same time regarding the king's condition, and that both physician and exorcist were aware of the patient's recent medical history. The question is whether physician and exorcist were working in tandem or in competition with each other & (see Jean 2006: 131-3). %
Adad-sumu-usur was one of Esarhaddon's chief exorcists, whom the king consulted regularly about his own health and that of his family. In 672 BC Esarhaddon wrote to him, lamenting the death of one of his chil- dren, to which Adad-sumu-usur frankly replied, "If (the illness) could be resolved, you surely would have given up half of your lands if you had been able to resolve it" (SAA 10 187: 10-12). Adad-sumu-usur was not being philosophical in his reply but was, with some subtlety, absolving himself for the failure to cure the child, since his use of the word "you" ("if you had been able to resolve it") suggests that someone else had been responsible for the unsuccessful treatment.
This is not the only strictly medical matter brought to the exorcist Adad-sumu-usur. Like his colleague Urad-Nanaya, he visited the princes suffering from huntu-iever, since he reports in one letter that the prince is very well because "the fever has left him" (SAA 10 193: 7-8). Nevertheless, we must not exaggerate the "medical" aspects of Adad-sumu-usur's report on Assurbanipal's fever, since in the same letter he recommends that the king be subjected to the "substitute for Ereshkigal" ritual, a magical ritual reserved for serious cases of illness (SAA 10 193: 14). 121 This dramatic ritual involved wailing for the dead, who were already
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anticipating descending to the realm of Ereshkigal, goddess of the Netherworld, and it was likely to have been reserved for conditions deemed to be very grave. At sunset, the patient takes a virgin goat to bed with him and holds it in his lap. They then enter a room where the ground has been freshly dug, where both patient and goat are thrown to the ground. The patient's throat is touched by a wooden dagger, while the goat's throat is cut with a bronze (or copper) dagger. The inner and outer body of the goat is washed, anointed, and perfumed; it is dressed with clothes and even shoes of the patient, with kohl being applied to its eyes. The patient then gets up and leaves the room, with the exorcist (masmassu) reciting various incantations and mourning rites, declaring that the patient "has gone to his fate," i.e. died. Funerary rites are then carried out for the virgin goat, in place of the patient, and the goat is properly buried. The fact that Adad-sumu-usur recommended this kind of ritual for Assurbanipal (and not for his brother Samas-suma-ukin) indicates the gravity of the huntu-iever and how non-medical therapies were employed side by side with drug therapy.
In this same way, Adad-sumu-usur sends three incantation tablets to the king (SAA 10 194 reverse 2'-6'), probably from his own library, which would have differed considerably from tablets sent by a physician. When the queen mother takes ill, Adad-sumu-usur recommends a group W of 10 incantations with their appropriate rituals; these were designed to W
counteract the consequences of a bad omen (so-called namburbi-rituals) (SAA 10 201; see Parpola 1983: 148). In other letters Adad-sumu-usur refers only to rituals being performed, without their associated incanta- tions, such as a ritual to counteract "weight loss" (SAA 10 200 reverse 5' and 212: 12; Parpola 1983: 156), as well as general usburrudu rituals against witchcraft, which incidentally had also been recommended by Urad-Nanaya on another occasion (SAA 10 200 reverse 6')-
On the whole, Adad-sumu-usur's advice given to Esarhaddon is not dissimilar from that of his physician colleague. He likewise advises the king against spending too much time in the dark (SAA 10 196: 14- reverse 6), probably to avoid being depressed. Furthermore, the exor- cist advises the king about his diet and general behavior, by offering the following good advice: "being short of temper without eating or drinking disturbs the mind and illness results (lit. descends)" (SAA 10 196 reverse 15-18e). It seems that Adad-sumu-usur takes a somewhat different approach to that of Urad-Nanaya. While the physician con- centrates on symptoms, the exorcist tries to look at the patient's behav- ior patterns, temperament, and diet, as a way of gauging his general health. We have no records of an actual diet or regime, except when
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88 The Politics of Medicine
ingesting drugs or when the physician occasionally advises the patient to reduce his intake of food and beer.
One of Adad-sumu-usur's most intriguing letters involves the testing of a new drug. He writes to Esarhaddon about a drug 122 which the king had previously asked about, and which the king himself claimed was "very good." Adad-sumu-usur suggests a kind of clinical trial: "Let us first have those slaves drink (it), and later let the princes drink (it)" (SAA 10 191: 11-13; Finet 1957: 137f.). At about this time, a formal oracular question was put to Samas by diviners during an extispicy, which was omens taken from the entrails of a ram. The question addressed to the Sun-god was whether the crown prince Assurbanipal was to drink a certain drug (SAA 4 187; Parpola 1983: 131). The diviner asks whether by drinking a par- ticular drugAssurbanipal would be saved and get well. It is easy to imag- ine that the problem of Assurbanipal's health was of such severity that more than one type of practitioner was asked to intervene and do what he could. After the diviner presumably received a positive answer from the omens regarding the effectiveness of this drug, Adad-sumu-usur was also consulted and suggested testing the drug. 123
The importance of Adad-sumu-usur's recommendation to have slaves try the drug is twofold. First, it appears to be a probable case of testing to see whether a drug works and what kind of pernicious side-effects it W might produce. We have no way of knowing whether the slaves in this W
case suffered from a similar ailment as the crown prince or, more likely, were healthy guinea pigs. This letter may offer a clue as to how the effec- tiveness of a drug could be noted and perhaps even recorded for future reference. The second important aspect of the letter is that it is written by an exorcist rather than an asw-physician. The stereotypical image of the exorcist primarily concerned with incantations and spells rather than with prescribing drugs or recipes turns out, in practice, to be inadequate.
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Medicine as Literature
Treating Babylonian medical texts as literature deserves special consid- eration. Like other literary compositions, medical texts or components of these texts exist in multiple copies, inviting comparison. Unlike other literary texts, however, medical texts combine prose and poetry, in which the recipes themselves are prose compositions, but frequently accompanied by poetic (even doggerel) incantations. Most but not all of Mesopotamian literature can be classified as poetry, but no other genre W of literature quite compares with the mixture of prose and poetry that W
one finds in the Babylonian medical corpus.
Three main types of medical texts constitute distinct literary genres. We have already encountered prognostic omens of the Diagnostic Handbook (Labat 1951; HeeBel 2000), with its listing of symptoms from head to foot from various "diseases." A second type consists of lists of plants and stones used as materia medica (see Schuster-Brandis 2008), or lists of diseases, usually belonging to the scholastic curriculum. A good example of this genre belonged to one Nabu-ile'i, an apprentice asu from Assur from a known family of scribes, and the inventory itself is desig- nated as belonging to asutu (BAM 1 1). The great majority of medical texts, however, consists of therapeutic texts containing a mixture of reci- pes, lists of materia medica, and incantations. These can either be small single-prescription tablets or large compendia, in which recipes are marked off by rulings, and groups of recipes intended for the same ail- ment are given, with the first entry giving the full symptoms, and subse- quent entries just having "ditto."
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Diagnostic Handbook
The Diagnostic Handbook is a good place to begin, from a genre view- point. Actually, the Diagnostic Handbook has been widely misunder- stood as referring to patients, when in fact it really refers to disease and to patients only as carriers of disease. It is worth emphasizing that this work is not a list of case histories of individual patients, but rather a list of how diseases show up in patients within set patterns that can be recognized and recorded. We have no idea how many observations of how many different patients have produced these symptoms, since each line of text may well represent symptoms drawn from a multitude of patients. 124
Although understood as diagnostic omens, the language and vocabu- lary of the Diagnostic Handbook hardly resemble those of other omen compendia. There is no real similarity either in language or contents, except for the general syntactical format of protasis and apodosis clauses. One might imagine, on the contrary, that the listings of symptoms in medical diagnostic omens would closely match descriptions of similar symptoms for the same ailments within the therapeutic texts. Stol has found some parallels (Stol 1991-2), but surprisingly few, when the entire {g> corpus is taken into account (see also Kinnier Wilson and Reynolds {$}
2007). In most cases, symptoms described in the Diagnostic Handbook use a much different language to that found in the therapeutic texts to describe the same disease and symptoms.
Here is an example from a prescription:
[If] his urine is like ass urine, that man suffers from "discharge."
[If] his urine is like beer dregs, that man suffers from "discharge."
[If] his urine is like wine dregs, that man suffers from "discharge."
[If] his urine is like clear paint, that man suffers from "discharge."
If his urine is like kasu-juice, that man is overcome by "sun-light" disease.
If his urine is yellow-green, that man [suffers] from stricture of the groin.
If his urine is white and thick, that man [suffers] from a dissolving calculus.
If his urine is like dusu-stone, that man [suffers] from a calculus.
If his urine is as normal, but his groin and epigastrium cause [him] pain, that
man suffers from stricture of the rectum (var. bladder). (BAM 7 5: 1-10)
Contrast this passage with a similar passage from the Diagnostic Hand- book, describing the very same symptoms of the color of the urine in kidney disease:
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[If] his [urine] is red, it is the hand of his god, (his disease) will be pro- longed; if his urine is yellow, [his] disease will be [prolonged; ditto, he is affected by sun-fever, he will die] .
[If] his [urine] is black, he is affected by the fatal disease, he will die; if his urine is dark, [he will die].
[If] his urine is continually blocked up, he will die; if his urine keeps flow- ing, [he will die] .
[If] his urine and his sperm keep flowing, he will die; if his urine is [....] like [..., he will die].
[If] his urine is like water, his illness will be protracted, but he will recover; if his urine is like pitch, [ditto] .
[If] his urine is like wine, his illness will be severe but he will get better; if his urine is like milk, [he will recover]. [If] his urine is normal, ditto.
[If] his urine is inspected and produces a fleshy-membrane, (the patient) was attacked from the steppe (i.e. by a demon).
[If] his urine is inspected and produces his actual flesh, he was attacked in the steppe. (BAM 7 49: 14-22')
The basic differences in these descriptions suggest that therapeutic reci- pes and diagnostic omens were composed in different scribal "work- shops."
Medical Incantations
We can readily appreciate why incantations would be used with magical rituals, since they are essentially dramatic affairs intended to impress the patient with elaborate and powerfully moving spectacles: fumigations, peeling onions and wiping the patient with flour, massage, scapegoat rituals, drum-beating, and other kinds of rituals (which we might con- sider as hocus-pocus). Medicine was, on the whole, much more subdued: the patient was treated with potions, suppositories, oiled reeds inserted into his penis, bandages, and amulet stones hung around his neck, as well as the occasional incantation. There is, however, a grey area between these two spheres of influence, consisting of incantations exclusively applied to Babylonian therapeutic prescriptions.
Incantations within medical recipes form a genre of their own. There is little point in trying to deduce worthy medical information from the incantations themselves, as if medical incantations had some particular role to play within diagnoses and treatment (Collins 1999: 64-122;
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Geller 2007a: 390, 396). On the contrary, the incantations within the medical corpus tend to be rather jejeune and simplistic, many with abra- cadabra-type formulae, more akin to nursery rhymes than sophisticated magic.
Several incantations are situated within medical prescriptions for eye dis- ease to treat cloudy vision, filmy eyes, eyes filled with blood, and so forth. One incantation within this corpus alludes to the dangers of surgery:
Incantation. Eyes with the porous blood-vessel, why have you been blurred
by chaff,
thorns, sursurru-irait, or river algae (var. algae tossed up by the river)?
Why have you been blurred by clods in the streets or twigs in recesses?
Rain down here like a star,
keep falling here like a meteor, before the flint(-knife) and scalpel of Gula
reach you.
An irreversible incantation, the incantation of Asalluhi-Marduk and the
incantation of Ningirimma, master of spells,
and Gula, master of healing arts, has cast (it) and I have taken (it) up.
Incantation spell.
Incantation for removing chaff, twigs and whatever from the eyes.
{g} (BAM 510 174-80) {g>
The point of this incantation is that blurred vision can be caused by various types of foreign objects in the eye, such as algae from the river, debris of plants, or dirt from the street. "Raining down" is probably a reference to tears washing out the intrusive objects, and the spell makes a threat: the foreign matter must leave the eye as soon as possible, with the speed of a falling star, or else the patient will be subjected to the surgeon's scalpel. The actual phrase used, "scalpel of Gula," is meant as an oblique warning that the sick eye had better heal itself before it requires the doctor's intervention. Since Gula was the patron goddess of asutu (see Figure 4.1), we can guess that a physician's scalpel is alluded to in this incantation, although we have no independent evidence to confirm that the asu acted as a surgeon.
The healing goddess Gula and her son Damu make frequent appear- ances in medical incantations, but often in a rather practical mode. The following incantation occurs within the same collection:
Incantation. The open eye is open, the open eye is open, the angry eye is angry, the open eye is angry,
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<$
Figure 4.1 Healing goddess Gula with her dog, holding a scalpel in her right hand and a tablet in her left hand (Collon 1987: No. 793; photo courtesy D. Collon)
the look is crouching, the look is evil, thick eyes, cloudy eyes,
porous [in (its) veins], the eye pissing blood like the sacrifice of a male sheep.
(The eye) is (affected by) "shadow-disease" like the water floating with the
swamp and seaweed, like the vinegar floating in the jug.
A mud-wall is built between them (the eyes), Nergal entered and his seat 125
is placed in between,
because of this "seat" within that one, preventing breathing
freely. The incantation is not mine, it (belongs to) Ea and Asalluhi,
the incantation (belongs to) Damu and Gula, the incantation (belongs to)
Ningirimma, mistress of incantations. O Gula - heal and receive your fee.
Incantation spell. (BAM 510 84-90)
It is the last line which engages our interest, since it repeats a phrase found frequently in medical incantations, asking Gula to heal the patient and to take her fee. The fact that this is a "fee" rather than a "gift" (as usually translated) can be seen from a late Uruk incantation which spells it out unmistakably. In this text the healer tells the patient that he deserves to be healed since "you have given a fee to the exorcist" (von Weiher 1983: No. 22, 113), and the patient afterwards declares before the god Samas, "I gave a fee to your servant, the masmassu-exortist, in
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94 Medicine as Literature
front of you." 126 Since the exorcist was an active priest in the temple, such a gift for services rendered makes good sense, and what we have here is a polite reminder that healing costs money.
The following brief incantation from the same text is a mixture of simple Sumerian logograms and Akkadian phrases, with some levels of meaning which we cannot fully comprehend, comparing the eye ailments to a storm:
Incantation. The open eye looks, the open eye sees, the cloudy eye is
clouded, the open eye is clouded.
The two eyes are sisters in between which a mountain is put across,
above them a knot is tied, below them a clay wall is built.
Which is their wind, which is not their wind?
Which is the onset of their wind, which is not the onset of their wind?
The storm ahead is dark, the surface of the pupil [of the eye is dark].
(BAM 510 121-6)
The image is clear: the two eyes are sisters, and the nose and mouth are described as a mountain and clay wall, from which wind emanates; these images may be based upon a doll or figurine. "Wind" is often a disease agent in medical texts, either as a draught or flatulence. The poem other- {g) wise tells us little about the disease itself or its causes, but there may be ^
a teleological image referring back to creation, judging by another incan- tation from the same eye-disease text:
Incantation. In the beginning before creation, the "water-carrier" (alalu)
came down to earth,
the seeder-plow bore the furrow and the furrow
the shoot, the shoot the seedling, the seedling the node, the node the ear
of barley, the ear of barley
the stye (in the eye). Samas gleaned and Sin gathered, and while Samas
was gleaning and Sin gathering,
the stye entered the lad's eye. Attend, Samas and Sin, and let the stye go out.
[Incantation spell] .
Incantation for removing a stye from the eyes.
(BAM 510 181-6)
Eye disease, in this case caused by an insect or something very small, originates from time immemorial when agriculture was first estab- lished (see Collins 1999: 95f.; Foster 1993: ii 854). According to the
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ontology of this incantation, agriculture led to disease in humans, and even beneficial activities such as sowing and reaping had harmful results, but no specific information given is relevant to actual diagnosis or treatment.
One very short incantation in this group poses the simple question asked by every patient: "Why me?"
[Incantation.] The veiled eyes, the confused eyes (with) porous blood vessels, [the] two (eyes) cry towards their mother Mami: "Why (does it happen) to us and (why) did you saddle us with asw-disease, blood, and wind?" Incantation spell. (BAM 510 163-5)
One distinction between magic and medicine is how each approach deals with the patient's personal trauma. The question "Why me?" is not likely to be answered by the asil, and the patient would probably be advised to go and ask the exorcist.
As mentioned, one of the main features of formal magical incantations is a bilingual Sumerian- Akkadian format, usually referring to a dialogue between Marduk and his father Ea. One incantation within the same group of eye-disease medical recipes is a bilingual Sumerian-Akkadian medical incantation, which resembles (in form at least) incantations from fa the realm of magic, as if borrowed from a masmassu-coMeague: fa
Incantation. The wind was blowing in heaven and a sore settled in a man's
eye.
It blew in from the distant heavens (Sum. and a sore settled in a man's eye.)
A sore was found in the sick eyes.
The eyes of that man are troubled, his eyes are blurred,
and when by himself that man cries bitterly.
Nammu (var. Nam) noticed that man's illness:
"Take crushed (var. cooked) kasu,
recite the Eridu incantation,
bind the eye of that man."
When Nammu (var. Naru) touches the man's eye with her pure hand,
may the wind which is swept into a man's eye be removed from his eye.
(BAM 510 151-61)
This incantation has some hallmarks of a formal bilingual incantation of a masmassu-exorcist. Instead of a dialogue, however, between Marduk and Ea, the protagonist is the goddess Nammu, Ea's mother, who appears in other incantations as patron goddess of the Apsu, the subterranean sweet waters. In this role, Nammu acts like Marduk: she "notices" the
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man's illness and has to decide what is to be done, although she has no one to whom to turn for advice. These conventions are quite rigid and cannot be easily altered by whoever composed the incantation.
There is an anomaly here, since an earlier version of this incantation from Sultantepe 127 has the river god Nam appearing in place of Nammu in later versions. The river god Nam was elsewhere invoked in namburbi incantations to counteract evil portents because the river carries off the bad magic which had been tossed away (Maul 1994: 85-9). Nam also appears in hemerologies, schedules of lucky and unlucky days in the month; if you asked Nam the river god a question on a certain day of the year, he would answer you with "news" (Labat 1939: 98f.). But mostly Nam is associated with the River Ordeal, in which the innocent man is thrown into the river and survives but the guilty is drowned, with his recov- ered body covered with sores and bleeding from his orifices; it is the god Nam who does the judging, one presumes, but our information is far from abundant (see Lambert 1965: 6, 9). In any case, the older variant from Sultantepe with the river god Nam does not conform to the usual tropes of exorcistic incantations, 128 and the later version of the incantation makes the goddess Nammu (rather than Nam) protagonist, perhaps because the incantation places the spell within the city of Eridu, Nammu's residence and gateway to the Apsu. Nammu notices the patient's sore eyes and takes W some remedial action, and that is about it. This medical incantation appears W
to have been altered to look like standard exorcism, but in fact it is far less elaborate than conventional incantations emanating from the exorcist's workshop. 129 Moreover, these medical incantations are not overly theo- logical in trying to pin the cause of disease on sin and transgression (see van derToorn 1985: 76). According to them, disease just happens.
There are some exceptions to this pattern. Medical texts dealing with childbirth contain rather more elaborate incantations, comparing the fetus to a boat on the water and the mother giving birth to the Cow of Sin, the moon god (Stol 2000: 64-70). We also find the famil- iar formal dialogue between Marduk and Ea, suggesting that these incantations were composed by an exorcist, rather than as an after- thought of an flsw-physician. These childbirth incantations within the medical corpus are exceptional, but childbirth is exceptional, for sev- eral good reasons. Childbirth is not a disease, it concerns women not men, and it can need serious magic to help it along. In some sense, childbirth medical texts may be considered as more conservative than other types of medical texts, but, if so, Babylonia is not alone in this. Within the Hippocratic corpus, the treatise dealing with diseases of women is also considered to be more conservative than other treatises,
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Medicine as Literature 97
containing more elaborate pharmacological recipes and exotic ingre- dients (Nutton 2004: 98).
An incantation is primarily an encounter between forces which try either to harm or to protect mankind. Malevolent forces can be anything from an evil demon to an evil or angry god, witchcraft, bad omens, envy (described as an evil eye or evil tongue), negative effects of violating a taboo, or just plain bad luck, and divine powers can be marshaled to help, as we know. The real subject of the incantation is usually the human victim. Is it the same in medicine? The simple answer is "No." The Diagnostic Handbook consists of long lists of symptoms drawn from patients, organized from head to foot, drawn from all kinds of diseases and affecting every part of the body - but we have no idea how many patients were behind each symptom. Ten? A hundred? The least likely possibility is that each symptom represents an individual case from a single patient. The same is true of the therapeutic medical recipes, which never refer to any specific patient by name or otherwise, and it seems obvious that these are not case histories. Recipes are aimed at a disease or diseases of any number of patients which share the same symptoms and signs.
This may ultimately explain why the medical corpus includes simple incantations, to give the impression that gods also maintain an active W interest in the patient's well-being and health. Introducing incantations W
into medical texts may have been an attempt to make the medicine some- what more personal. On the other hand, the last thing a physician wants is to be confused with an exorcist.
Therapeutic Prescriptions as Genre
A typical feature of medical texts shows duplication most often occur- ring with individual recipes, drawn from different contexts, rather than whole compositions being duplicated. In fact, the process of duplicating passages within Babylonian therapeutic texts is unique, when compared to other types of cuneiform literature. The usual pattern, outside of med- icine, is for a composition to exist in various manuscripts, which are mostly the same or similar. Incantations are a good example. Entire tab- lets and compositions appear in multiple copies, normally with variants among manuscripts. Not so with medical texts; often a single line of text, representing a single recipe, may be duplicated between one text and another, but within completely different medical contexts. We will see how this works.
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98 Medicine as Literature
Therapeutic texts are normally constructed from individual recipes or prescriptions, and each individual medical recipe therefore had a semi-autonomous status and could be cited freely between different genres of therapeutic texts. We do not understand the system behind these citations, but texts dealing with one medical condition might quote a recipe designated for a different ailment altogether.
Let us look at a typical example. The following text is from seventh century BC Assur, from the private house of exorcists, which contained a considerable medical library as well as texts relevant to magic and exorcism (Maul 2004: 81f.), and it has duplicates from the Nineveh state library founded by Assurbanipal.
1 [If a man] suffers [from discharge], crush together kukru, ata'isu,
2 myrrh, and alum,
3 and he drinks it in strong wine on an empty stomach.
4 If ditto, "silver-lustre" -plant, puquttu seed,
5 paffisw-plant/stone, sapinu, (var. azallu-seed), baluhhu-resin,
6 ["donkey] -vulva "(-shell), shell of ostrich-egg,
7 myrrh, coral; (total) 9 drugs
8 for discharge, checked, he keeps drinking it in wine.
^ 9 If ditto, "pure"-plant, "mole-cricket," kukru, sunu, ^
10 madder, myrrh, baluhhu-resin,
11 sunu seed, taramus seed, sumlalu,
12 fat, and almond(wood); [crush] together these 11 drugs
13 and boil them in ghee, his thighs
14 (and) his buttocks [
Reverse
1-2'
3' put [ ] into it and pour it into his penis.
4' If ditto, urnu, ditto, ditto, ditto.
5' [If di]tto, crush fox-vine, ditto, ditto, ditto.
6' pea, myrrh, and horned alkali,
7' coral, alum; 5 drugs.
8' If a man repeatedly rises 130 because of his urine,
9' he keeps drinking (the drugs) either in beer or in wine or water.
10' Crush together imhur-lim, myrrh, ostrich-egg shell,
11' black frit, for 3 days in fish brine,
12' for 2 days in drawn wine, and for 3 days in
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Medicine as Literature 99
►
Assur plant list (B/4/W 164)
Assur recipes (BAM 1 1 6) Nineveh plant list (BAM 431 )
Figure 4.2 Assur recipes BAM 116 and duplicate recipes (Babylonisch-assyrische Medizin)
13' pomegranate-juice, and he keeps drinking it
14' [for a] stricture of midday.
%
15' Hurriedly excerpted for his [lecture] (colophon). (BAM 7 7)
The recipe concerns kidney ailments. Other texts duplicate no more than a single recipe from this composition, consisting of only a few lines. Two of the partial duplicates from Assur are lists of medicinal plants which include a section of drugs specifically for kidney disease. As for the materia medica it is likely that the medical recipe and lists drew upon some common source.
The great Nineveh library provides another example of a kidney disease text (see Figure 4.3), but only two lines of the Nineveh text dupli- cate the Assur text above (BAM 116):
Its ritual (du.du.bi): Crush together imhur-lim, myrrh, ostrich-egg shell, black frit, for 3 days in fish brine,
for 3 days in drawn wine, and for 3 days in pomegranate-juice, he keeps drink- ing it and he will improve. (BAM 7 2 ii 19-20)
What is unusual is that the Nineveh text writes du.du.bi "its ritual," to introduce these two lines; this type of du.du.bi rubric usually introduces an exorcistic ritual which follows an incantation (Herrero 1984: 26), and in fact these two lines immediately follow an incantation in the Nineveh tablet (BAM 7 2 ii 18). In other words, the same therapeutic recipe in an Assur tablet is employed as a "ritual" and follows an incantation in a Nineveh tablet.
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Medicine as Literature
$
BAM 7 Nineveh
fe,/r>Mir4ff rtFTX tfem,
tm= NMrffFi^fe
Hy= MpM^-f ^
■^
^rSjf^F*-/: ^ w- mjm- n* *=<fc
: HF- "-W 8
. ; :va
B/W 116 Assur
Figure 4.3 Duplicate recipes (Babylonisch-assyrische Medizin)
®
If we compare the contexts of these two tablets, we can see that both recipes from Assur and Nineveh were used within medical compositions to combat kidney disease. The Assur tablet is a single-column tablet and its contents, according to the colophon, were "hastily excerpted," either for a lecture or for application. The tablet contains various recipes which could have been drawn from a longer composition, while the Nineveh tablet is a multi-column library composition with many recipes against kidney ail- ments. We have two completely different genres of texts, one from Nineveh being a major compendium of medicine, the second from Assur being a teaching tool in which a few important or typical recipes have been excerpted and compiled. There is little otherwise in common between these tablets. Are these the same literary genre? I think not, because a library reference work is quite different from a textbook or digest of texts for pedagogic purposes. Tablets could be excerpted for a variety of rea- sons. For instance, another Assur tablet composed by the well-known Assur exorcist Kisir-Nabu introduces a recipe for making an ointment for
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Medicine as Literature 101
the anus and claims to have excerpted the recipe from many different sources and collected the information together into a single tablet; the colophon explains that this excerpt was made hastily for the purposes of performing a specific medical treatment (BAM 7 42); the tablet is excerpted ana sabat epesi, "for use." This kind of tablet should also be differentiated from a standard library reference work. 131
Another example of two different genres of medical texts which share common recipes occurs in recipes for a diseased anus, which also contain prescriptions employed in tablets dealing with "cough" (sualu). The pre- cise medical connection between rectal ailments and "cough" (which could include diphtheria or pneumonia) is unclear. The following text is a case in point.
-1 If a man's limbs are poured out, his chest and shoulders hurt him,
his arms, shins [and knees] hurt him, his testicle, either on the right side or
on the left,
1' bothers him, and he shows blood in his urethra, that man
2' suffers from stricture of the anus. To cure him, you heat in an oven (1. 9)
taramus, imhur-lim,
3' kukru, [ ], juniper, suddu,
4' sweet reed, ballukku, simessalu,
{jfc 5' cedar, supuhru-cedar, sunu, (&
6' urnu, hasu, nuhurtu,
7' nlnu, dates, malt-flour, beer,
8' wine-drops, ...-barley.
9' You pour (it) into the anus.
10' [If a man] suffers from rectal disease and his anus stings him,
11' mix [together] juniper, kukru, sumlalu, [and ]
12' [pour] kanaktu and a clump of malt in oil and beer into his anus.
13' If a man suffers from a sore anus and has piercing pain
14' and his belly cannot take in food and fluids (and) pours out mucous from
his anus,
15' to cure him: pour hasu (and) urnu in kasu-juice
16' into his anus.
17' If a man's bowels are bloated, his intestines
18' make a lot of noise like (that) of an isqippu-bird,
19' that man suffers from flatulence and "sun-fever".
20' His condition is of long duration, (it is) the Hand of the Ghost; in order to
cure him, heat in premium beer (1. 24) nlnu, 21' "mountain "-plant (azupiru), hasu, nuhurtu,
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102 Medicine as Literature
22' juniper, kukru, sumlalu, ballukku,
23' cuttings of aromatics, field-clod, - 11 plants,
24' filter and cool them, add oil into the (mixture),
25' pour it into his anus and he will recover. (BAM 88 = BAM 7 27)
These lines come from a single-column tablet (provenance unknown) dealing with rectal problems. The prescriptions in this tablet were known both in Assur and Nineveh, since they occur in no less than seven other manuscripts representing three different genres of medical texts. Let us describe a few of the other manuscripts. Two tablets (BAM 52 and 168) belong to the same prolific Assur scribe, Kisir-Nabti, and both probably come from the Exorcists' House in Assur. The colophons of both tablets explain that these manuscripts consisted of excerpts hastily made for treatment or pedagogic purposes (see Hunger 1968: No. 212); the colo- phon of one of the tablets, mostly devoted to diseases caused by cough (sudlu), specifies that the tablet was a "sixth excerpt of a collection of (medical) recipes, based upon a wax tablet from Assur, the original being from Uruk, written and checked" (BAM 52). Another tablet owned by the scholar Kisir-Nabti contains recipes from diseases caused by the Hand of the Ghost (a common cause of illnesses), as well as kidney and anal disease recipes (BAM 7 34). A third duplicate comes from Nineveh, a ^k four-column library tablet devoted mostly to diseases also caused by the ^k
^ Hand of a Ghost (BAM 471). All of these texts have different orienta- ^
tions and purposes within their own specific contexts.
One manuscript mentioned above deserves a closer look, and we offer below a selection of recipes from this prescription (BAM 168):
18 If a man suffers from "sun-fever," flatulence, paralysis, lameness, sassatu- disease,
19 Hand of the Ghost(-disease), Hand of the Oath, disease of the rectum, (or) any disease, in order to cure him,
20 10 shekels of "health"-plant, 10 shekels of tiatu, 10 shekels of ata'isu,
21 10 shekels of ham, 10 shekels of nuhurtu, 10 shekels ninu,
22 10 shekels of urnu, 10 shekels of clump of salt, 10 shekels of azupiru,
23 10 shekels of sibburratu, 10 shekels of "white" plant, 10 shekels of alum,
24 10 shekels of juniper, 10 shekels of kukru, 10 shekels of aktam, 10 shekels of salt,
25 10 shekels of madder seed, 10 shekels of sumlalu, 10 shekels of suadu,
26 10 shekels of baluhhu, 10 shekels of cedar, 10 shekels of myrrh,
27 10 shekels of "sweet reed," 5 shekels of sihu, 5 shekels of argannu,
28 5 shekels of barirdtu, 5 shekels of "sun"-plant: pound and sieve these 25 drugs
29 and aromatics together. Take premium beer, kasu-juice
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30 and strong vinegar, add this powder (of ground up ingredients) to it,
31 heat (it) in an oven, take it out in the morning, cool (it), add honey and pressed oil to it,
32 pour (it) once, twice, and three times into his anus.
45 If a man suffers from stricture of bladder, 2 shekels of myrrh, 2 shekels of baluhhu-resin,
46 juice of hasu, juice of nuhurtu, salt-water, the juice of all of these aromatics:
47 take a half sila of each of these juices, pound them together, boil (it),
48 you filter (it), cool (it), mix a half (sila) of oil with them. Crush 7 grains of "health"-plant,
49 add (it) into (the mixture), divide the fluids into 3 parts and
50 pour (it) into his anus once, twice, and three times, to relieve his constipation (lit. to cause the stopping up of his bowel to pass through).
51 If wrsw-sores are smashed (or) if the hemorrhoids are plucked off,
52 the illness will be relieved, his anus will be widened; this lotion
53 (is) for releasing from an oath (and) for all kinds of disease.
66 If a man's bowels need to relieve constipation (lit. cause a stoppage to pass) or crush sores and pluck out hemorrhoids,
67 weigh out juniper, kukru, nuhurtu, horned alkali, "health"-plant,
68 in equal measure, boil (them) in beer or vinegar, you filter it,
+ 69 cool it, put oil into it (var. honey or oil), pour (it) into his anus. ^k
70 If a man's groin hurts him at an inappropriate time, and his shins
71 cause him a stinging pain (var. he stretches out his feet), he is weak in his thighs and his knees (var. shins) gnaw at him with pain (var. are cold for him),
72 that man suffers in the rectum (already) during his youth. To cure him:
73 crush in equal amounts black kamunu, nlnu, kanaktu, "health"-plant,
74 ka.su, mix them in fat and make a suppository,
75 sprinkle (on it) cypress oil, insert it into his anus and he will improve.
76 If ditto, bat guano, nlnu, baluhhu-resin, "white" plant,
77 dates (var. of Dilmun), gourmet-salt, ox fat, these 7 (var. 6) drugs for a powerful suppository.
78 You dry out Dilmun dates, horned alkali, fat of the kidney of a male sheep,
79 kukru, juniper, sumlalu, baluhhu-resin,
80 abukkatu-resin - 8 drugs - insert a suppository
81 into his anus to stop flatulence; a proven remedy (var. a proven suppository which stops wind).
82 Kisir-Nabu son of Samas-ibni hastily excerpted (this) for application. (BAM 7 34)
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104 Medicine as Literature
Here we see a text covering a variety of different medical problems, and the colophon explains that these recipes have been hastily extracted for treatment (ana sabat epesi, "for use")- 132 One of the recipes gives amounts of drugs (either five- or ten-shekel amounts) for general conditions: fever, flatulence, rectal disease, several kinds of paralysis, and two categories of disease known by theoretical causes (Hand of the Ghost and Hand of the Oath 133 diseases), or simply used as a panacea ("any disease"). Another recipe in this collection describes an elaborate enema for bladder ailments (stricture). Further recipes refer generally to bowel problems and hemor- rhoids, and some of these prescriptions are older and already attested at Sultantepe, an eighth-century library found in modern Turkey. Every rec- ipe in this Kisir-Nabu excerpt tablet has a duplicate from some other man- uscript, which is not always the case with medical texts. 134
Sometimes we find a tablet containing unique medical prescriptions (i.e. no duplicates found as yet), but the tablet will also include a recipe which appears in many other manuscripts. For example, one Assur text with relatively few duplicated passages (BAM 104) has one line (1. 34) which occurs in three other manuscripts. One of these duplicates (BAM 152) is a four-column tablet containing recipes for ailments of the head, feet, and rectum. A second duplicate (BAM 95) is written in a "land- scape" format (with the longer side being its width rather than height), W and may represent an older text tradition, while the third duplicate from W
Sultantepe 135 certainly goes back to an older eighth-century text tradition (see Figure 4.4). 136
Let us return to the question of why the same drugs would be used within two different genres of medical texts, having entirely different medical uses and aims, for entirely different parts of the human body or organs. Two possibilities come to mind. One, recipes were associ- ated with each other as literary compositions and learned as such, and hence recipes which were thematically related (e.g. referring to dis- eases of the rectum) would often be copied together in the same sequence in different tablets. For example consider the following three recipes:
If a man's limbs are flaccid (lit. poured out), his chest and shoulders hurt
him,
his arms, shins [and knees] hurt him, his testicle, either on the right side or
on the left,
bothers him, and he shows blood in his urethra, that man suffers from
stricture of the anus.
To cure him, you heat in an oven (1. 7) taramus, imhur-lim, juniper, suddu,
sweet reed, ballukku, simessalu, [cedar], supuhru-cedar, sunu, urnu, hasu,
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105
BAM 152 Assur
BAM 95 Assur
$
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<■ *--■-, -tir, U$-
-^....^.-t.v-lif ■«■• ....■>-;p.._ t . (! :.
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,4*r -rf^ }=.r*»**stJrfis-rf«i- ■:■■■''■'/
B,4M 104 Assur
:-n--;s-" - ,-3V~-'>S" .•-''7*.r .vr ■■■■■■ Fi- v '--Tr~tT f>"ry.
bjjg*>- fee. >fft= t^-n~- & £■£, *$?- t*-$tf Jj^-jJ
,-.-^-*^i^ ^jy>- j „/"?*'■-.'- !^«-"- s^-;r/j .:
STT 97 Sultantepe
Figure 4.4 BAM 104 and duplicates (Babylonisch-assyrische Medizin)
nuhurtu, mnu, dates, malt-flour, beer, wine-drops(?), and ...-barley, and you pour (it) into the anus.
#
If a man suffers from rectal disease and his anus stings him and his bowels
are cramped and he is constipated,
boil vinegar and premium beer, cool it and pour it into his anus.
[If a man] suffers from rectal disease (and) it stings him: mix together juni- per, kukru, sumlalu, [
<boil> kanaktu (and) clump of malt in oil and beer and [pour it] into his anus. {BAM 7 32 1-11)
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AMT56, 1 Nineveh
$
#
B/W 88 Assur
6/4M182 Assur
Figure 4.5 AMT 56,1 and duplicates (Assyrian Medical Texts and Babylonisch- assyrische Medizin)
The recipes above come from a Nineveh manuscript (AMT 56,1), a single-column tablet (hence probably not a library tablet), written in Babylonian script, 137 which has recipes for rectal disease on the obverse and recipes for stiffness in hips and groin on the reverse. This Nineveh text has several duplicates for these lines, two of which are from Assur, both dealing with rectal disease (BAM 88 and BAM 182).
The Assur recipes duplicate the Nineveh recipe in the same sequence, but with one important difference: another two-line recipe intervenes (see Figure 4.5).
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Medicine as Literature 107
If a man is ill in the rectum and his anus stings him and his innards are bloated, he suffers from constipation; boil vinegar and premium beer, cool (it) and pour it into his anus. (BAM 7 32 8-9)
It is difficult to discover whether any literary scheme lies behind these complex arrangements.
This pattern repeats itself throughout Babylonian therapeutic medical literature, with one important exception: eye-disease texts. The British Museum houses a collection of three lengthy Nineveh tablets devoted to eye disease, and these tablets are unusual in being three complete manu- scripts of the same therapeutic text (BAM 510, 513, and 514). It is not easy to know why eye texts were copied as complete manuscripts while other recipe collections were not, but, nevertheless, the composition is in fact more complicated. These Nineveh tablets contain only a couple of indi- vidual recipes also attested elsewhere, but these same few duplicated lines appear in no less than three other Assur tablets. 138 When we finally find a duplicated eye recipe, it turns out to be popular, also known in Assur. An exceptional text from mid-first-millennium BC Sippar provides excerpts from a variety of medical texts dealing with many different conditions, but two lines of this text also duplicate a single recipe in the Nineveh eye- disease manuscripts (see HeeBel and al-Rawi 2003: ii 15-19). It is strange W that this is the same recipe duplicated in Assur. Hence, a single three-line W
recipe in a large Nineveh medical eye-disease text appears in various Assur medical sources and a Sippar school compendium, but few other dupli- cated passages are to be found. It is difficult to explain this pattern.
A different scenario appears in another Assur tablet from the Louvre dealing with ear disease (Geller 2007b), copied by an apprentice of Urad-Nanaya, the senior court physician at Assur. Many of its lines are also duplicated on the same Sippar extract tablet mentioned above (HeeBel and al-Rawi 2003), as well as duplicated recipes in other Assur tablets and tablets from Nineveh, Babylon, Uruk, and Nimrud, showing how widely popular individual recipes might be. It should not be surpris- ing that prescriptions for ear symptoms employ the same recipes as tab- lets devoted to the disease caused by the Hand of the Ghost, since the disease was often thought to be caused by a ghost whispering into the patient's ear (Scurlock 2006: 14). This kind of association of ideas can partially explain how similar recipes can appear in different medical con- texts. However, recipes may have been copied in several manuscripts with more regard to literary composition than to medical efficacy. Recipes often (but not always) occur in the same general sequence, even if another recipe intervenes.
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108 Medicine as Literature
The literary character of recipes can also be seen within the listing of materia medica, since plants and stones are often given in standard sequences, which were learned by the medical scribes (Tavernier 2008: 193f.). It is unlikely that we will find a medical reason for materia med- ica to be listed in a fixed sequence within recipes, other than that scribes found it easier to remember ingredients in this way
Poetry Within Therapeutic Prescriptions
The idea that medical recipes could be composed in poetic form rather than prose might seem alien to a modern reader, but such texts were well known in the classical world. A second-century BC priest of Apollo and physician from Claros in Asia Minor, one Nicander, composed a lengthy Greek remedy in 958 lines of hexameter verse against venomous crea- tures and their bites. His work was called Theriaka, the name later given to a recipe popular in the Roman world as an antidote and later general panacea (Watson 1966: 13 f.).
Despite the lack of evidence for poetic recipes in Babylonian therapy, medical texts are not entirely devoid of poetry. Incantations serve as the poetic component of therapeutic texts. Medical incantations are poetic W and often revolve around literary themes which have little specific appli- W
cation to the recipes. The passage below, for instance, shows recipes phrased in the second person in the form of instructions for treatment, while the interspersed incantations are in the first person singular, as abbreviated passages containing allusions to more cosmic motifs. The medical incantations themselves provide a literary structure which aims to define the role of the practitioner as a powerful figure, well connected with the powers governing heaven and earth.
If a man suffers from maskadu, he must keep drinking (from a potion) gourd, e'ra-seed, and kazallu, [crush] "field-clod"-plant, "scorpion"-plant. (Then) mix flour in premium beer, and when you make a concoction, [he will improve] .
Incantation. I impregnate myself, I impregnate my body, just as a dog and
bitch or pig and sow
have had sex in the steppe; just as a plough has seeded the earth and the
earth has received its [seed],
so I cast the spell that I receive (it) in myself and in my body,
and impregnate himself (and) [his] body and [cause the evil to depart] .
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Incantation for maskadu.
(BAM 7 31: 11' 13'; 18-21')
A somewhat different view of medical incantations is provided by an Assur text, KAR 73, now BAM 7 9-10 (see Bock 2008: 307f.).This sin- gle-column tablet contains two poetic incantations, with one medical extract between them sufficient to show that the context is medicine, not magic. The format of the tablet is unusual, since the incantation on the obverse is ruled while that on the reverse is not. 139 We give the reverse here only, since the obverse, although an incantation, is essentially a hymn to the healing goddess, Gula.
1 When (it is the case): if a man (suffers from) either pardannu or sahhihu- disease,
2 discharge or stricture or a rectal disease,
3 he constantly has dripping urine,
4 as if being struck down by a weapon - like a (menstruating) woman -
5 or whatever other illness which is not recognized,
6-7 its remedy (lit. ritual): you sprinkle pure juices of juniper in front of Gula, ^k you set up a small altar, on a roof, the place of ritual preparation, ^k
^ 8 (on which) you sprinkle dates and sasqu-f\our, you place mz'rew-cakes of ^^
honey and butter, 9 you set up an adagurru-vessel (and) you either make a pure offering or a prayer.
10 You set (on the altar) the shoulder, the fatty meat and the roast-meat,
11 crush together ham, ata'isu, sweet-plant, "single"-plant, sumuttu, sahlu,
12 and put (them) into premium beer, and place it before Gula.
13 Have the patient kneel and you fumigate your hand over him,
14 you withdraw and that patient raises up in [his] hand the premium beer which you set out and he recites thus:
15' Incantation. I beheld your face, [O Gula], august healer,
16' [ ], you are supreme and pre-eminent (var. the pure one),
17' I beheld this drug which I hold up before you.
18' On this very day, (the patient) has either pardannu or sahhihu-diseases, 19' either discharge (var. or stricture) or rectal disease or loin disease, or drib- bling of urine, or one is struck by a weapon like a (menstruating) woman, or whatever illness with which I am sick, 20' and you know what I do not know: am I to drink this drug? 21' With these drugs let me be healthy, let me be well, let me be happy, 22' so that I may praise your great divinity! [Incantation spell.] 23' "In every corner let them bless Gula,
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Medicine as Literature
Figure 4.6 Healing goddess Gula with her dog, seated before the god Latarak (R. Ellis, Fs. J. J. Finkelstein, figure no. 3; drawing F. A. M.Wiggermann)
%
24' who is supreme in spells and healing,
25' great is her medicine, Gula heals those who revere her.
26' By the command of Baba I will praise and call her name to everyone,
27' when I go before her." Three times you will have him recite it (the incanta- tion) and he will bow down,
28' he will drink this drug and bow down, and recite thusly:
29' "I drank this healing drug of my goddess,
30' [..] and I was cured." He says this three times and bows down.
31' [ ] he keeps drinking this drug and he will recover.
Again we note the characteristic first-person-singular orientation of the incantations, expressing the healer's special relationship with the god- dess of healing arts, Gula, while the therapeutic recipe takes the usual form of second-person instructions for treating the patient. Within the incantation, the patient is referred to in the third person, as if a character in a drama, while the incantation priest asks rhetorical questions about the effectiveness of the cure (but always anticipating a positive reply).
This is not to suggest that medical incantations have a fixed format or structure, since there is a great variety of themes expressed within them. In a Nineveh medical text which is partially duplicated in Uruk, one incan- tation is devoted to busanu-disease, which affects the nose and mouth:
Incantation. Bustinu, strong is his grip, it seized the uvula like a lion,
it has seized soft tissue like a wolf, it has seized the tender part, it has
seized the tongue,
its "seat" 140 is positioned in the windpipe(s). Go out, busanu, not to be
seized by you,
like death which shows the way [a one-way voyage], or a stillborn child
which cannot seize its mother's breast (var. milk),
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Medicine as Literature 111
you must not return to what was seized by you. The incantation is not mine, it belongs to Ea and Asalluhi,
the incantation of Damu and Gula, of Ningirimma, mistress of incanta- tions, Gula, life-giving mistress,
Gula who makes life secure, take your "gift" (i.e. fee). Incantation-spell. (Hunger 1976: Nos. 52 and 54, 55-61)
This incantation ends with the conventional formulaic lines explaining that the incantation belongs to the gods, not to the credit of the healer himself, since it would have been considered hubris for the healer to claim that the healing power comes from his own personal charisma. The healer himself was an instrument of the magic, but not the power behind it. The incantation itself provides some interesting and even important information, but within a magical framework which has little relevance to the therapies employed. The significant point is that the ill- ness, in this case busanu, has a "seat" or "topos" within the windpipe, which is the organ associated with the disease. The theoretical notion of the "seat" of a disease is expressed within the incantation because there is little scope for a therapeutic recipe to explain the thinking or theo- retical basis behind the medicine. Medical incantations provided a mechanism for expressing more general ideas about the nature of heal- W ing and disease. W
An obvious classification of medical texts differentiates between single recipes or prescriptions, usually on single-column or small tablets, and multi-column tablets containing numerous recipes, rubrics, and incantations. One assumes that the difference denotes individual prescriptions written out by the physician himself for the patient, as opposed to textbook or refer- ence works in which many recipes are collected and recorded, perhaps taken from tablets containing a single recipe. As for single-column tablets contain- ing relatively simple texts, late examples from Achaemenid Babylon exhibit a consistent alternating pattern of medical recipes and incantations being written in either vertical or horizontal (i.e. portrait or landscape) formats; tablets with a portrait (vertical) orientation tend to be asutu while those with a landscape (horizontal) orientation are asiputu (Finkel 2000: 146). This shows clear distinctions being made within late scribal schools between the physical shape of tablets dealing with medicine (asutu) and those deal- ing with magical arts (asiputu). Scribes had to learn to write both. Nevertheless, it is not possible to prove that these single tablets were col- lected and copied into larger compositions.
A clear distinction can also be seen between medical recipes which give the amounts of each ingredient to be used, and those which do not. This is
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112 Medicine as Literature
distinct from dosage, which is rarely specified. It may be that weights of materia medica (typically one or two shekels of each ingredient, or frac- tions thereof), reflect a more precise genre of medical practice, which attempts to calibrate the amount of each ingredient (see Finkel 2000: 146 f.). The argument against this assumption is that, in most cases, the amounts given are standardized, so that the same amount (e.g. one shekel) of each drug is prescribed, which makes little sense in reality. One would hardly expect this in either a cooking or medical recipe, since the values and effects of individual ingredients are very different from each other. 141
It is more likely, however, that recipes are schematic. Some weights and measures might be mentioned in order to give the recipe more authority, or to distinguish a medical recipe from a list of commonplace foodstuffs. We find this difference in later systems of medicine, such as in Maimonides' Regimen for Health, in which he lists foods which people ought to eat to maintain good health, but when Maimonides lists similar ingredients to be used as a drug, he usually specifies the precise amount of each ingredient to be used in the recipe. There are clearly different genres here: recipes without amounts and those with amounts.
The following treatment for kidney disease is an example of a recipe with weights of materia medica (BAM 7 9; Bock 2008: 311ff.).The rec- ipe consists of a long list of 33 drugs, each beginning with the amount of W 2 shekels, in three columns: 142 W
2 shekels of puquttu, 2 shekels of azallu, 2 shekels of "dog's-tongue" plant
2 shekels of fox-vine, 2 shekels of raisins, 2 shekels of sibburatu-plant
2 shekels of cucumber, 2 shekels of gherkin, 2 shekels of ....
2 shekels of madder, 2 shekels of aktam, 2 shekels of nuhurtu-plant seeds,
2 shekels of root of male mandrake, 2 shekels of pig-fat plant, 143 2 shekels of
kukru, 2 shekels of juniper, 2 shekels of sumlalu-plant, 2 shekels of simessalu, 1AA 2 shekels of abukkatu-plant resin, 2 shekels of suadu, 2 shekels of myrrh, 2 shekels of male nikiptu, 2 shekels of female nikiptu, 2 shekels of .... 2 shekels of azupiru, 2 shekels of sumuttu, 2 shekels of.... 2 shekels of samidu, 2 shekels of "detox" plant, 145 2 shekels of ....
2 shekels of nitku, 2 shekels of
2 shekels of peas, 2 shekels of lentils, 2 shekels of
2 shekels of madder, 2 shekels of pomegranate, 2 shekels of . . .
2 shekels of e'ra-wood, 2 shekels of .... 2 shekels of
2 shekels of sunu, 2 shekels of alamd, 146 2 shekels of kamantu, 2 shekels of coral, 2 shekels of sea-pebble, 2 shekels of sea-...., 2 shekels of sea-stylus, 2 shekels of "donkey- vulva" shell, 2 shekels of yellow
ochre,
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Medicine as Literature 113
2 shekels of kalgukku, 2 shekels of musu-stone, 2 shekels of loadstone,
2 shekels of zalaqu-stone, 2 shekels of frit, 2 shekels of black frit,
2 shekels of sumlalu, 2 shekels of pallisu-stone, 2 shekels of sapinu-stone,
2 shekels of alluharu, 2 shekels of qitmu, 2 shekels of alum,
2 shekels of pumice, 2 shekels of kak.na 4 , 2 shekels of ostrich-egg shell,
2 shekels of block salt, 2 shekels of red salt, 2 shekels of steamed salt, variant:
half a shekel of each of the salts. Total of 9[4] drugs soaked for "stricture."
There are two other drug-inventory tablets from Nineveh, probably from the same archive, which give the same listing of drugs and have the same rubric, "in all: 94 drugs, these to be soaked." 147 In the Nineveh inventories, only the drugs used against kidney-disease are listed with their two-shekel weights (as in the text above); no other drugs in the lengthy inventories have associated measures.
What do we make of a list of ingredients duplicated in very different texts (one a medical recipe and the other an inventory of medicinal plants), but both extracts having the same format? Can we call this a literary convention ("two shekels" plus drug) or is there something special about this particular group of drugs used against kidney ail- ments? Variant readings within texts can also point to readings based {g> upon literary rather than medical considerations. The final line of a {$}
kidney-disease recipe reads, "Vi shekel of block salt, % shekel of red salt, Vi shekel of steamed salt" (BAM 7 11: 34'). This line relates to a final phrase in a similar recipe which reads, "2 shekels of block salt, 2 shekels of red salt, 2 shekels of steamed salt, variant: % shekel [of each of] the salts" (BAM 7 9 32f.). It is likely that the latter scribe was working from two sources, and that the variant was more literary than medical.
Occasionally medical texts give listed weights in fractions of a shekel, such as "handfuls" (BAM 7 16). Other texts have various weights of ingredients, as one might expect, as in the following extract from what can be considered an ancient Physician's Desk Reference text: 148
1 Two shekels kukru, two shekels . . .
2 two shekels ballukku, half shekel juniper,
3 two shekels fine reed, one shekel [drawn] vine,
4 half shekel ata'isu, one shekel raisin,
5 half shekel mint,
6 half shekel busdnu-pX&nt
7 one shekel imhur-lim-plant, one shekel imhur-esm-plant
8 two shekels cucumber, (all of which) you heat in beer.
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114 Medicine as Literature
9 You (then) put oil and honey into it, [knead it] into a powder.
10-12 This lotion is effective and tested against jaundice and hepatitis. 13 Lotion of oils (for) "sun-fever." (BAM 186)
The colophon of the tablet tells us that this tablet belongs to Mr Kisir- Assur, exorcist (masmassu) of Assur, and that the recipe was "hastily extracted for a use in a treatment."
Other examples of Babylonian recipes list minute amounts of drug weights, such as eye salve prescriptions giving amounts as an eighth of a shekel (bitqu), 15 "grains" (= a twelfth of a shekel), and a twenty-fourth of a shekel (vonWeiher 1983: No. 50).
Such Akkadian recipes have equivalents from the Greco-Roman world, such as a recipe for the "windpipe" recorded by the Roman physician Celsus in the first century AD:
4 grams each of Cassia, iris, cinnamon, nard, myrrh, frankincense
1 gram of saffron,
30 peppercorns boiled in IV2 liters of raisin wine until the consistency of
honey. (Celsus [Loeb], 2 5 25)
Note how the major ingredients all share the same amounts (4 grams).
Compare this with a Greek recipe against gout and sciatica, attributed to
{§> Proclus, which looks altogether too schematic: {§)
9 ounces of germander
8 ounces of centaury
7 ounces of birth- wort
6 ounces of geniat
5 ounces of huperikon
4 ounces of Macedonian parsley
3 ounces of meon
2 ounces of agarikon
1 ounce of phou
2 kotylae of Attic honey. (Tecusan 2004: 623)
The question is whether these amounts were real or imaginary, in all our ancient medical sources.
The Babylonian Background to Greco-Roman Pharmacology
In 66 BC the Roman world was transformed by the news of the defeat of King Mithridates of Pontus, but the effects of this victory were further
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reaching than could have been anticipated. According to accounts preserved by both Pliny and Galen, Mithridates had perfected an antidote against poison, and it proved to be so effective that he was unable to poison him- self after his defeat but had to be killed by a soldier. The Romans found an entire library with recipes, and the Roman Lenaeus was ordered by Pompey to translate and copy the recipes for Rome. Although Lenaeus' work does not survive, there are reports that the Mithridates antidote or theriac caused a sensation in Rome because, as Pliny remarks, plants had not been studied by Roman physicians. Although not the first recipe of its kind, the Mithridates antidote was widely quoted as a compound recipe against ven- oms (a theriac) and poisons, and even as a general panacea; it became popular among drug-sellers throughout the Empire (Watson 1966: 81).
The question is why the Mithridates antidote became so popular in Rome, since similar preparations had been known to Greco-Roman med- icine for centuries. Antiochus III of Mesopotamia, for instance, was reported to have developed a theriac against venoms already in the sec- ond century BC, which consisted entirely of herbs and may have relied upon more ancient Babylonian sources; other theriacs were known from further west (Watson 1966: 13). There are several factors, however, which may have influenced the reputation of the Mithridates antidote. One is that we are not told in which language the recipes were written, W although scholars assume them to have been composed in Greek. W
Nevertheless, Pontus was located in the Orient, in Asia Minor, and the recipes may have been based upon a much older tradition of medicine (in the local language?) than that preserved in Greek, similar to the the- riac of Antiochus III. Another factor is the information that Mithridates had first tried out his antidote on criminals; records of such experimenta- tion are rare. 149 Finally, the Mithridates antidote became famous as a panacea partly because it was a compound recipe consisting of some 90 ingredients, while in Greco-Roman medicine it was often the practice to rely upon pharmaka or "simple" drugs, i.e. single drugs employed against single conditions.
A famous example of a theriac was recorded by the first-century AD Roman Celsus, ascribed to Mithridates. The recipe reads as follows:
1.66 grams of costmary
20 grams of sweet flag
8 grams each of hypericum, gum, sagapenum, acacia juice, Illyrian iris,
cardamom
12 grams of anise
16 grams each of Gallic nard, gentian root, dried rose leaves etc. (Celsus
[Loeb], 2 5 23; see Watson 1966: 5-6)
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We see in this compound recipe that although some ingredients appear in various amounts, other ingredients with identical measured amounts are grouped together. The same pattern can be seen in Babylonian medical texts specifying amounts of ingredients (see above).
As to why the Mithridates antidote became so popular, we need to examine the state of healing arts within the broader reaches of the Roman Empire as well as among its immediate neighbors, particularly in Mesopotamia, to gauge the proper medical context of theriacs and anti- dotes. In order to do this effectively, it is necessary to consider systems of medicine in the ancient world, rather than writings of individual phy- sicians. We propose some general comparisons between so-called Hippocratic medicine and Babylonian medicine, although recognizing many sub-divisions within these two general categories of approaches to healing. 150 Essentially, Babylonian medicine was an extremely conserva- tive system of healing, already well-established by the early second mil- lennium BC, consisting of recipes and drugs used to treat diseases which were identified by careful examination and documentation of all exter- nal bodily symptoms as well as urine and other indicators of bodily func- tions. Disease was considered to be the result of external attack on the body, either by demons, or from natural causes such as bites, draughts, or poisoned food. The earliest phases of healing arts in Greece were W probably very similar, as can be seen from early treatises within the W
Hippocratic corpus, which relied upon careful scrutiny of external symp- toms. As in Babylonia, early Greek medicine expressed prognosis in the form of signs and omens, as indications of whether the patient was likely to live or die or survive for a limited time. Like Babylonian medicine, pre-Hippocratic medicine (referred to by the Hippocratics as hoi archaoi - the "ancients") considered disease to be the result of demonic attack, which often called for magical means to counteract it. Finally, like Babylonian physicians, Hippocratic physicians had only a rather vague idea of internal anatomy because few physicians conducted autopsies on human corpses (see von Staden 1998).
Hippocratic medicine as a general system departed from traditional Babylonian medicine in the fifth century BC by developing a new approach to both diagnosis and therapy. The primary notion of external attack by demons was replaced by the theory of humors or internal bal- ance/imbalance within the human body, which had to be corrected through the use of diet, purgatives, and eventually minor surgery in the form of venesection. Writers usually consider Greek medicine to be more "scientific" than its Babylonian counterpart, in the same way that Greek
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mathematics improved upon that of its predecessors. In a comparable way, once a theory of humors was developed to explain all manner of disease, the practitioner could dispense with a cumbersome system of preparing prescriptions which had to be tailored to each individual condition and ailment. In other words, the simple rule replaces the exhaustive database. Although not necessarily more effective for the patient, the new Hippocratic methodology took its place among other emerging disciplines in Greek science, as begun by Thales and his con- temporaries. 151
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Medicine and Philosophy
According to legends about Hippocrates, which no one takes seriously, he destroyed the medical archives of his rivals from the mainland city of Cnidos (or, alternatively, he destroyed all the medical books on his own island of Cos [Temkin 1995: 54]). The fact that alternative versions of this story were reported about Hippocrates may tell us something about his reputation, if not his life. The impression persisted among later Greeks that Hippocrates was an iconoclast who not only forcefully broke with his med- W ical predecessors, but took active steps to destroy their work and methods. W
In some sense, he succeeded admirably. Hippocrates' innovations were aimed against a rival system or at least an older system of healing arts, which resembled Babylonian medicine in many respects. In the older strata of the corpus, pre-Hippocratic medicine was usually seen as being either old-fashioned or archaic. The precursors of Hippocratic medicine certainly lack the hallmarks of Greek medicine, such as a theory of humors, a focus on diet, 152 and minor forms of surgery (see Geller 2007: 191-3). In other words, pre-Hippocratic medicine from Greece comprised a system which most closely resembled that which we know from Babylonia. This system is characterized by very large collections of hundreds of plants and drugs, forming the basis for therapeutic recipes. Symptoms were also painstak- ingly collected from head to foot, although the derived insights were expressed as omens predicting whether the patient would live or die.
One of the noticeable differences between Hippocratic and Babylonian medicine is the lack of cuneiform texts dealing with diet and regimen. While Greek medicine invested a great deal of interest in diet and exer- cise and ways to preserve good health, Babylonian medicine was prima- rily focused on how to treat or alleviate symptoms and distress caused by an already existing ailment; little attention was paid in medical texts to
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prevention. 153 Disease can either be physical or psychic, and in ancient Babylonia could express itself through symptoms such as pain and fever and loss of appetite, or through anxiety, insomnia, impotence, or other "maladies d'esprit." While apotropaic magic may have been used to keep demons at bay, no medical recipes were designed to promote healthy living or prevent disease from occurring.
This cultural contrast ignores the much more complex relationship between "medicine" and "magic" which existed in Babylonia but also per- sisted within the Greco-Roman world as well. It is true that Babylonian medicine incorporated demons and incantations which we usually con- sider to be "magic." Nevertheless, the pattern of magical and medical texts within Babylonia generally shows two complementary approaches to heal- ing. We have some long and complex compilations of incantations aimed at either avoiding or treating the attack of demons or ghosts or witchcraft or diseases, resulting from cultic guilt or divine wrath. On the other hand, the oldest medical text which we possess, in Sumerian, gives recipes without a single reference to either demons or incantations. Later Babylonian medi- cal recipes deal with diseases and symptoms without necessarily referring to divine wrath, guilt, or demons, although incantations are often included among the recipes. The precise relationship between medicine and magic in Babylonia remains thorny and complicated. W The same, however, could be said of Greek medicine. The advent of W
Hippocrates and Hippocratic medicine in no way displaced belief in gods, demons, and the supernatural as components of Greek medicine. The pop- ularity of the healing god Asclepius is one indication of the prominence of religion in therapy, as best exemplified by the popularity of his temples in the Greek world, even on Cos itself. The many dedicatory inscriptions from these temples offering thanks for healing are not the only evidence for belief in magical forms of healing; stories abound in Greek and in other languages about great charismatic healers who could heal through a word or by applying spittle to a patient. Apollonius of Tyana serves as a good example of a "wonder-healer" whose very touch had healing properties, and there seemed to be no shortage of adherents in the ancient world. Tatian, an "Assyrian" living in Rome in the second century AD, complains about popular belief in illness demons and the use of amulets against them, and he even argues against the use of drugs (pharmakeia) against illnesses, confirming that such notions were current at the time in the Greek-speaking world (Tatian [Loeb]: 33, 16-18). This is hardly the attitude inherited from Hippocratic medicine, but most probably reflected much of popular belief at the time, even if not shared by practitioners of medicine for the upper social classes, which forms the bulk of our medical literature.
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120 Medicine and Philosophy
Within Greek medicine, the role of the philosopher is thought be unique and entirely consistent with the emergence of Greek science. Hippocrates' contemporary Democritus claimed that "the medical arts heal diseases of the body, whereas wisdom relieves the soul of pas- sions" (Temkin 1995: 8; see Edelstein 1967: 349-66). This distinction between physician and philosopher was reiterated by Aristotle, and Galen also remarks that "it is for [the philosophers] to shape the health of the soul itself because of something that is greater, whereas it is for the physician to do on behalf of the body, lest it easily slip into disease" (Temkin 1995: 14). These statements, emanating as they do from the perspective of Greek science, recognize tension between philosopher and physician, but at the same time ignore the competition for the patient's soul offered by Asclepius cults or charismatic healers in the Greco-Roman world who relied upon magic and incantations. It is this dichotomy between treating the soul and treating the body which inter- ests us, since a similar dichotomy exists within Babylonian medicine and a similar tension between those who healed the mind and those who healed the body 154
The comparative paradigm is by no means perfect. Babylonians had no concept of the "soul " in the Greek sense, and the very idea of a Babylonian "philosopher" seems like an oxymoron. Although Babylonians aspired to W wisdom and learning, including astronomy, medicine, mathematics, lexi- W
cography, and grammar, and even natural science in the forms of descrip- tions of stone and plants, this is hardly to be construed as contemplative philosophy. Even if late period texts in Babylonia could be shown to embody abstract ideas or observations, if not hypotheses, we would still hesitate to call it "philosophy," that quintessentially Greek pursuit.
There is no Akkadian word for "philosophy," nor does any other Semitic language have a "lover of wisdom." The concept of wisdom (Akk. ihzu) 155 does exist, and the closest equivalent phrase in Akkadian to "philosopher" is bel nemeqi, "master of wisdom," a title applied to the god Marduk but never to any mortal scholar or savant. Within the Babylonian Weltanschauung, only a god could be a real "master of wis- dom," since no human could attain to such intellectual heights. In fact, not only is the god Marduk bel nemeqi, "master of wisdom," but he is also bel sipti, "master of exorcism" par excellence. This accords well with the general idea of healing in Babylonia, since the exorcist never puts himself forward as a charismatic healer in his own right, but views himself solely as representative of Marduk, sent by Marduk himself as his agent. In Babylonia, gods heal and man is only the conduit. Man possesses knowledge, gods possess wisdom.
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One other potential candidate in Babylonia for a "lover of wisdom" was the apkallu or primordial sage, with whom the exorcist identified in order to establish his prestige and gravitas. The apkallu, however, was an icon, an antediluvian figure who would have been comparable in the Middle Ages to a patron saint of exorcism, but even in Hellenistic Babylonia the apkallu was never envisaged as a philosopher.
There is an alternative approach to this notion of philosophers healing the soul and physicians healing the body Several famous Babylon schol- ars in antiquity, known especially from colophons of tablets dealing with Babylonian "sciences" (astronomy, divination, and magic) might be con- sidered as Babylonian "philosophers." One is the famous scribe Esagil- km-apli who is thought to have lived in the eleventh century BC, but whose contribution continued to be recognized by scholars even in the Seleucid period (Finkel 1988: 143ff.). He was not only a priest but remem- bered as a "scholar" (ummanu) who was credited with having compiled editions of loosely connected compositions dealing with the arts of the exorcist, such as diagnostic omens, physiognomic omens, and an assort- ment of all the major magical texts. 156 Esagil-km-apli's range of expertise also included medical and therapeutic texts which we would usually asso- ciate with the physician rather than the exorcist, and he is claimed to have been the author of an exorcism manual, a single tablet which lists W incantations and medical texts by their incipits (Jean 2006: 73-4), as a W
catalogue of all major texts relevant to the training of an exorcist. Unfortunately, we do not know very much about how a Babylonian ummanu taught and how he explained difficult texts to his students; there was no doubt more abstract or theoretical speculation going on in the scribal curriculum than we are informed about.
The second Mesopotamian savant who appears frequently in colo- phons was something of a specialist in divination. Nabu-zukup-kenu flourished in Assyria in the second half of the eighth century BC, and his forte was astronomy and astrology, judging by colophons on tablets. His tablet archive included multiple copies of astronomical omens and ter- restrial omens, works on augury and oracles, and a copy of the Gilgamesh epic. His oeuvres also included several tablets of esoteric hermeneutics (Frahm 1999: 79). There is no doubt about the considerable learning and enormous spectrum of expertise commanded by Nabu-zukup-kenu, but one would hardly refer to him as a philosopher.
Another candidate for Babylonian "philosopher" may be the Assur exorcist Kisir-Assur, who owned a considerable library of cuneiform tab- lets in the seventh century BC dealing with magic and healing arts, as well as esoteric wisdom. The range of subjects is again very impressive,
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122 Medicine and Philosophy
judging by the tablets actually excavated from the house (Maul 2004: 79-96; Pedersen 1986: 44f.; Livingstone 1986: 260). Aside from the impressive collections of incantations of all types (including namburbi- omens and incantation rituals), Kisir-Assur's private library contained many examples of medical prescriptions. Like his predecessor Esagil- km-apli, there is no doubt that Kisir-Assur was an "exorcist" rather than "physician," judging by his title (mas. mas) in colophons. At the same time, Kisir-Assur was essentially a scholar who collected a wide range of tablets on healing arts, including medical texts which contained recipes without incantations, but we have no reason to assume that Kisir-Assur practiced as anything other than what he claimed to be - an exorcist.
Judging by these examples of famous scholars, we can see that Babylonian scholarship divided into various disciplines and even sub- disciplines. One area of specialization was divination and astronomy, which demanded an extensive knowledge of all kinds of omen texts, but not necessarily expertise in magic, incantations, or medicine. The other area of specialization was that of the exorcist, who needed to know a great deal about the large repertoire of Sumerian and Akkadian incantations but at the same time something about omens and medicine in general.
For centuries the learned exorcist shared his clients with another heal- ing technician, the asw-"physician," who at that time was responsible for W drugs and drafted and prepared prescriptions. The colophons of tablets W
from the Nineveh library clearly show the division between the two pro- fessions, the exorcist and physician. Medical colophons, for instance, refer to the patronage of healing gods Ninurta and Gula, while incanta- tions almost always rely upon the assistance of gods Marduk and Ea. By the late first millennium BC, as we have seen, this distinction between exorcist and physician was breaking down. 157
In Babylonian terms, is there any equivalent to the Greek philosopher "healing the soul"? Although not exactly a philosopher, the Babylonian exorcist had to comprehend all aspects of the cosmos and man's relation- ships within it.The exorcist was responsible for helping the patient to divert the anger of the petulant gods or the unseen dangers of demons, ghosts, witchcraft, black magic, or slander - in other words, treating the patient's psyche. Greek Heilkunde, like its Babylonian neighbor, also never freed itself from belief in magic and demons and divine intervention. In both systems, there is a recognizable component of healing the psyche (or the soul) through means other than what we call "medicine" (i.e. the use of drugs, diet, or surgery). So although the Babylonian exorcist was never a philosopher per se, by the seventh century BC he had become a scholar of the healing arts and a master of all aspects of his discipline.
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Innovation
But things change, and sometimes we can even tell when they change. At some point early in the fifth century BC certain innovations were introduced into traditional Babylonian medicine. One such innovation was astral medicine, in which appropriate apotropaic and healing ritu- als were to be performed during propitious times determined by the zodiac. Texts describing the correspondences between rituals and zodiac signs date from the Hellenistic period, but an earlier version, dating from 619 BC, gives the same rituals without any reference to zodiac signs (Reiner 1995: 108ff.; 111). Astral medicine and astral magic were thus incorporated into traditional literature some time after this date.
Another innovation was probably introduced by a family of scribes from Uruk in Babylonia which flourished in the reign of Darius, roughly contemporary with Hippocrates himself. Anu-iksur was a member of this distinguished family of scholars consisting of priests and exorcists, whose work we will discuss in a later chapter. Many tablets from the family archive belong to his brother Rimut-Anu and his father, Samas-iddin, also distinguished scribes in their own right, who were active during the Persian period, c. 400 BC (Hunger 1976: No. 11; Robson 2008: 227-62). {g> Rimut-Anu owned several medical tablets, each of which is significant in {$}
its own right. The first of these tablets is the so-called exorcism manual ascribed to Esagil-kin-apli (mentioned above), which is known from cop- ies from Assur and Nineveh in Assyrian script, as well as later copies in Babylonian script from Babylon and Sippar (Jean 2006: 63); Rimut- Anu's copy indicates that this important catalogue of incantation and medical texts was also studied in Uruk during the Persian period. Two other tablets in Rimut-Anu's possession are unique and perhaps even more important. The first of these is a list of diseases ascribed to one of four internal organs, the heart, the stomach, the lungs, and the kidneys (see HeeBel 2004: 113). Here is an extract from the final section (Hunger 1976: No. 43, 25-31):
from the kidneys "stricture"
ditto impotence
ditto anal disease
ditto muscle disease
ditto barrenness
ditto womb which is twisted
ditto "gas" retention
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124 Medicine and Philosophy
There is no ancient explanatory commentary on this puzzling text, which appears to be a radical departure from any previous attempt at disease taxonomy within Babylonian medicine. One possibility is that each of these diseases is thought to have a "seat" or residence within a particular internal organ, which may have parallels within Hippocratic medicine (Geller 2004a: 37). In any case, external symptoms are pre- sented as manifestations of diseases associated with internal organs, without reference to divine intervention, anger, or demonic attack. Another of Rimut-Anu's medical tablets is a listing of diseases according to each one's individual "nature" or "property" (siknu), associating characteristic symptoms with a disease name. 158 The final section of the tablet lists ailments with the conventional designation of "Hand of a God" (e.g. "Hand of Gula," "Hand of Marduk," "Hand of Samas"), but redefines these terms with specific disease names, such as various skin ailments or jaundice or sores (HeeBel 2000: No. 33). As HeeBel com- ments on this text, "this shift of focus from the interest in the divine origin of sickness to the mechanisms of nature and the bodily origin of diseases represents, then, a small 'revolution of wisdom' within late Babylonian medicine" (HeeBel 2004: 114).
Although Rimut-Anu and his brother Anu-iksur refer to themselves by the title of "exorcists" (mas.mas), most of the medical tablets found at W fifth-century Uruk typically belong to them (Hunger 1976: No. 12; W
Pedersen 1998: 212). Anu-iksur also owned the largest known collection of commentaries on medical tablets, which may not be coincidental but reflects fresh thinking about medicine and anatomy, rather than merely copying traditional medical recipes. At the same time, by the Persian period, Uruk exorcists had become the most prominent scholars of their day. A contemporary library from Uruk's Eanna temple contains some 250 tablets dealing with incantations, medicine prayers, omens, and astronomy, and the few surviving colophons on these tablets ascribe them to exorcists (mas.mas). 159 This suggests that an exorcist, in order to perform his duties properly, had to be a good all-rounder.
The mystery, in fact, is what happened to the archives of the physician, who disappeared from colophons from the Achaemenid period onward. It is possible that a late private medical archive simply remains to be found by archaeologists, but circumstantial evidence allows for other inferences to be drawn. We have many hundreds of school texts from Babylon and Sippar from the latter half of the first millennium and even a few from the first century AD. These extract tablets give students the opportunity to practice reading (or copying) a variety of texts on a single tablet, usually consisting of lexical texts, belles lettres, omens, personal
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Medicine and Philosophy 125
names, and other genres; many contain extracts from incantations (see Gesche 2001: 214), but not a single extract tablet cites prescriptions or medical texts.
These late extract tablets from Babylon and Sippar, however, do not tell the whole story Ironically, the medics seem to have disappeared from view but the medical tablets continued to be copied and used. As noted above, Irving Finkel published an archive of late Achaemenid copies of incantation and medical texts in both portrait and landscape formats; the texts are cursive and hardly look like finished library copy (Finkel 2000). Despite the fact that the tablets are more medical than magical, this archive is likely to belong to an exorcist. Another collection of such tab- lets belonged to a scholar named Tanittu-Bel from Babylon, some of whose tablets can be dated to the thirteenth year of Alexander the Great, bringing us down to 323 BC (Finkel 1991). 16 ° Although never referring to him specifically by title, Tanittu-BePs archive mostly consists of incan- tations and related literature, including rituals for massage and fumiga- tion. A further late archive from Uruk includes many similar tablets, copied by a versatile local exorcist named Iqisa, who also had an abiding interest in medicine, as we will see below. 161 The consistent picture is that despite the presence of substantial late archives belonging to diviners and exorcists, not a single contemporary medical archive is known that W belonged to an asw-physician, either anonymously or by name. W
Let us summarize our argument thus far. The system of Babylonian medicine down to the eighth century BC (prior to Hippocrates) involved collaboration between the exorcist and physician, with a clear division of textual content between incantations and medical recipes. The exorcist's training began to evolve as he familiarized himself with therapeutic remedies, as well as with the numerous genres of incantations and magical rituals.
Subtle changes occurred during the Persian period, perhaps influenced by the Zeitgeist; scribes and scholars began to enumerate diseases with- out attributing their causes to either gods or demons. It is during this same period that the asw-physician virtually disappears from colophons and texts, although medical texts continue to be copied and owned by scribes who are exorcists. It seems that exorcists not only incorporated medicine more fully into their curriculum, but indulged in some new thinking about medicine. But while all this was happening, where was the asw-physician?
Could exorcists have actually usurped the role of the physician? Herodotus famously observed that Babylonians did not have doctors, but when ill one simply lay down in the street and waited for people to come
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Figure 5.1 Patient being healed (Wiggermann 2007: 107, No. 1; drawing courtesy F.A. M. Wiggermann)
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along and give medical advice. One wonders how Herodotus got it so wrong, since we have so much evidence about medicine in Babylonia. Perhaps Herodotus entered a temple and asked the priests about doc- tors, and was simply told, "we don't have any," referring to the asu. Herodotus then drew his own conclusions.
Whatever information or misinformation Herodotus reports, it is prob- ably no coincidence that significant changes occurred in Babylonia in his day. We know from a famous but apocryphal legend that Hippocrates declined to take up a lucrative position as physician at Darius's court. While Hippocrates was imposing a new understanding on Greek medi- cine by de-emphasizing gods and demons as causes of disease, a similar esprit may have been taking place at the same time in Babylonia, espe- cially among scribes from the cities of Babylon and Uruk. Babylonian scholars in the early fifth century BC not only developed a keen interest in expounding medical texts, but attempted to classify diseases without reference to deities, in more natural rather than supernatural terms. Hippocrates would probably have approved.
Ascendance of the Exorcist and Decline of the Physician
The records from colophons of tablets show that the exorcist became a dominant member of the temple elites, while other scholars, particularly bam and asu, seem to disappear from our records. We can account for this change from various possible perspectives. The archives that we have in late periods are often from temples, which means that those professions allied to the priesthood will naturally be better represented than secular
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or non-priestly professions, such as the asil. On the other hand, there is another way of thinking about the changes that took place between the status of the two healing professionals.
By 539 BC, Cyrus the Great had conquered Babylonia, setting in motion the expansion of the Persian Empire which would eventually extend "from India to Ethiopia," as claimed in the Book of Esther. Persian rule dominated the entire Near East for the next two centuries, ushering in a period of unprecedented globalization, in which the region was united by political stability and a common language, Aramaic. Although Akkadian continued to be used as both administrative and literary lan- guage throughout Mesopotamia, Aramaic eventually replaced Akkadian as lingua franca and became the language of cross-border communica- tion, as well as being a widely spoken language in the region. Persian influence also spread throughout the region, and certain fundamentally Persian notions of eschatology, dualism (good and evil, light and dark), and of a final epoch became widely acknowledged.
Although indigenous records are virtually non-existent, Greeks living at the Persian court have important things to say about the role of physi- cians and exorcists under Persian rule. Ctesias, a Greek physician and historian, claims to have been invited to serve as personal physician to Artaxerxes II (Briant 2002: 264f.). Other Greek physicians were known W at the Persian court, mostly by name only, although Ctesias tells the lurid W
tale of one Apollinides at the court of Artaxerxes I, who fell in love with the king's sister and was buried alive after her death. Herodotus also speaks of one successful Greek physician, Democedes (Briant 2002: 265), who persuaded Darius not to execute his many Egyptian court physicians, because of their incompetence. With Greek and Egyptian doctors being prominent at the Persian court, why is there no mention of local doctors? However, these court physicians were not the only medical practitioners who served the Persian kings. Xenophon and Strabo report that Cyrus ordered medicinal plants to be collected to maintain the health of his soldiers, and Briant infers that "there is little doubt that the specialists to whom Cyrus appealed were none other than the magi" (Briant 2002: 267).
But who were these magi? Descriptions of their functions are general and vague, based mostly on eyewitness accounts by foreigners (Greeks) rather than Persian sources. Strabo describes Persian sacrifices in the simplest of terms, essentially consisting of dry wood being burned on an altar, often with aromatic substances being added and incantations being recited by magi. This type of offering most closely resembles Babylonian fumigation rituals, used in both magic and medicine. Essentially all we
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know from Greek eyewitness accounts is that magi worshipped at fire altars, which is hardly remarkable, nor do we have any idea of the special expertise or training required to perform such ritual tasks. The Greek term magoi also had pejorative connotations, as in the Hippocratic cor- pus (On the Sacred Disease 1 2), which refers to magoi along with quacks and charlatans (see Burkert 2004: 108-9).
The main deities worshipped were Ahura-Mazda and the sun (Mithra), and a goddess Anahita, whose character was influenced by Mesopotamian Istar (Briant 2002: 245-54). The most distinctive feature of Persian ritual was the sacrifice of horses to gods, which is unprecedented in Mesopotamia. Although actual Persian sources on the activities of the magi are rela- tively scarce, the main sacerdotal activities of the magi are clear, and we know that they relied upon blood sacrifices and incantations for their rituals. According to one classical author, Diogenes Laertius, the magi insisted that only their prayers and incantations were heard by the gods, and for this reason the magi practiced divination as well; other sources speak of magi acting against demons (Burkert 2004: 120f.).The sketchy descriptions of the interests of the magi are actually quite close to the activities of the exorcist in Babylonia, whose chief function, as described by Paul-Alain Beaulieu, was "to prevent and conjure up the punishments sent by the gods" (Beaulieu 2007: 479). There are a few references to the W magusu in Akkadian, referring to the activities of the magus as a Persian W
official/priest who had considerable power within the temple administra- tion. 162 The word magusu soon falls out of use in Akkadian, possibly because the role of the magus was so closely identified with that of the masmassu that the loanword became redundant.
Magi were prominent at the Persian court, and there is little to distin- guish them from Babylonian priests who performed similar functions. The masmassu would certainly qualify as the Babylonian priests correspond- ing most closely to magi. Although Persian policy under Cyrus and his successors intended to avoid suppressing local religion in favor of Persian religious practice, nevertheless the social status and prestige of the magi may have influenced Babylonian society under Persian domination.
Hence, new conditions introduced by the Persian court influenced what happened in Mesopotamia proper during this period and after- wards. First, the fact that Persian kings preferred foreign to local physi- cians may have had a role in reducing the prestige of Babylonian physicians, at least as far as the ruling classes were concerned. The down- grading of the local Babylonian asu, for some unknown reason, may partly explain why this profession all but disappears from Akkadian records. It may be that the asu was no longer considered to be an
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established profession, although non-literate classes no doubt used his services. Still, since asutu was still being copied by scribes, it seems that exorcists had taken over knowledge of these texts.
Second, the prominence of magi at the Persian court may explain why the exorcist's own stock in trade rose in relation to other priests, since he becomes the dominant figure in later temple archives, judging by colo- phons and other data. The advanced social and professional status of the magi may have influenced the situation in Babylonia, where the expand- ing scholarly interests of the masmassu-clans seemed to have dominated the scene from the Persian period onwards. 163
See also Daniel 4:4, in which Nebuchadnezzar has a dream and assem- bles his scholars to interpret it: hartumim, asapim, haldim, and gezarim. The hartumim (of whom Daniel, under his Babylonian name Belshazar, held the title rah hartumim) are dream interpreters (in this context, see Radner 2009: 224). The asapim are exorcists, from Akkadian asipu (rather than masmassu, which is not loaned into Aramaic). Haldim were Chaldaeans (astrologers), and gezarim (lit. cutters, dissectors) are divin- ers. Which would correspond to magi? We would suggest asapim (asipu) as the closest match, considering the involvement of magi in both magic and rituals. The Book of Daniel, as a detached witness, probably reflects with some accuracy the status of exorcists in the Neo-Babylonian court W under Persian rule. W
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Medical Training: MD or PhD?
Little is known about the actual late schools, except for what can be derived from the numerous exercise tablets which have been found in excavations from sites like Babylon, Nippur, and Sippar (Gesche 2001; Lucas 1979; Cavigneaux 1981). A scribal school may have consisted of a single scholar (ummdnu) with a small number of students (between two and four) at any one time, for a course of study which lasted some 10 years (Wiggermann 2008: 211). If this is the case, the intimate relationship W between teacher and pupils could easily have fostered conditions under *Qp
which the master's interpretations of texts were preserved as oral tradition by successive generations of students. These traditions, then, would have formed the basis for later commentary texts, in the form of notes on how the master understood an anonymous textus receptus of the scribal curriculum.
The institutional background is important if one is trying to establish whether specific training was available to scholars who acted as physi- cians or exorcists. Although it is a given that in the ancient and medieval world no such recognized qualifications existed, nevertheless we do find designations of various levels of scribal training in colophons of tablets, and these might provide some relevant information. A good example of the various stages of training occurs in a tablet from Assur emanating from the scribal family of asw-physicians under Esarhaddon, probably dating from c. 670 BC.The tablet's colophon reads:
First extract, finished. Written by Shulgi-enu, (impressed with) the finger- nail of the apprentice scribe (samallu) and novice (agasgu), disciple (sanduppu) of Urad-Nanaya, "specialist in medicine," 164 disciple (sanduppu) of Eteru, Assur scribe (tupsarru) and disciple {sanduppu) of Adad-uballit, Assur scribe. (JMC 10 [2007]: 14)
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Here we see several levels of scribal attainment, on a tablet which is lengthy and full of complicated medical data but nicely written. On the other hand, Shulgi-enu's tablet does contain erasures as well as many tiny glosses which translate logograms which were difficult for or unfamiliar to a student scribe (and many of which are too small to be legible today). In fact, many of these glosses represent the same kind of notes that occur in medical commentary tablets. 165 Occasionally, Shulgi-enu seems to gloss words incorrectly, or at least over-interprets text, as in one case in which the materia medica are to be heated over coals (1. 57) but the scribe has glossed "frit" (nitku, a type of glass) for coals, which seems unlikely. Some other glosses seem very elementary: the young Shulgi-enu glosses two Sumerograms which are extremely common in medical texts, mean- ing "you dry" and "you crush" materia medica. 166 In another line (41), he glosses the syllabic writing of the same word (ta-sdk) with sa-ka, since he was not sure how to read the sak sign, although this is a common read- ing in medical texts. On the whole, we see the competent hand of an apprentice, whose writing looks professional enough but who may not have been familiar with all the particular idioms of medical literature.
These glosses may provide clues to how texts were read or rather read out in the scribal schools, at the same time as these texts were being
Figure 6.1 Scribes and officials from Til Barsip (ninth century BC) showing scribes writing on both leather and clay (photo Florentina Badalanova Geller)
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expounded by the master scribe (ummdnu). We would like to know whether the terms used in Shulgi-enu's colophon for "scribal apprentice" (samallu), "novice" (agasgu), and "disciple" (sanduppu), imply some kind of hierarchy of recognized qualifications for a scribe who specialized in copying medical texts; even if he could copy them, does this make him a doctor? Let us look at the qualifications of other students and their status within the scribal school, judging by colophons of other tablets.
Academic Titles
The most common designations of a scribe were tupsarru "scribe" and samallu "merchant, agent," and both of these terms could be modified by sehru, "junior." 167 Numerous tablets from libraries and archives are copied by scribes who refer to themselves as tupsarru, samallu, or agasgu, and in such cases we conclude that they are "library" copies, rather than simply school exercise tablets that could be discarded. The question is whether these titles reflect some sort of progression within scribal training. An answer to this question might decide whether a phy- sician in Babylonia in the late first millennium BC could have earned some recognized qualifications as a healer or practitioner. W For instance, the term agasgu "novice" can refer to either a physician W
(asu) or exorcist (masmassu) (Hunger 1968: 158). 168 In earlier Sumerian texts, this word refers to the academically poorest student in the class and not necessarily the youngest. When used in colophons of tablets, it is unlikely that a later Babylonian scribe would refer to himself as a "dunce." We can probably assume that the original Sumerian meaning of this word had changed a millennium later.
One Assur scribe, Nabu-le'i, puts his signature to the colophon of a medical text as "novice physician" (asu agasgu), coming from a family of Assur scribes who were not themselves physicians (BAM 1 4 27). 169 The tablet in question is a list of medicinal plants or drugs, and although the script looks competent there are clear errors in the text (as noted by Kocher, BAM 1 p. xi).
A copy of a tablet from an original from Babylon was made by one Nabu-etir, who describes himself as samallu masmassu agasgu, an apprentice novice exorcist; the text is a hymn to Gula, the goddess of healing (Lambert 1967a: 115). We would interpret this to mean that Nabu-etir had achieved the academic status of samallu in general terms (whatever this might mean), but he also achieved the rank of agasgu in his work on academic exorcism, during his scholarly career.
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We get some idea about the academic hierarchy in Sultantepe from tablet colophons.
1 Nabu-etir from Sultantepe describes himself as a "junior appren- tice" (samallu sehru) (Hunger 1968: No. 402) and "disciple" (mar mummu) of someone whose name is unfortunately broken. The term mar mummi is unusual; the mummu was actually a rather grandiose name for the scribal school, literally "workshop," named after the bit mummi in the temple, the workshop where idols were restored. The bit mummi was also a place associated with esoteric knowledge. 170
2 A more complex Sultantepe colophon tells us that Nabu-rihtu-usur was, like Nabu-etir above, "junior apprentice" (samallu sehru) and "dis- ciple" (mar mummi) of Nabu-aha-iddin, the "head" scribe ( w sag) (Hunger 1968: No. 354 [= STT 38]).The "head" scribe Nabu-aha-iddin also identi- fies himself elsewhere as an "apprentice" (samallu) (Hunger 1968: No. 359 [= STT 247]), probably referring to a slightly earlier stage in his aca- demic career. It was probably as an "apprentice" that Nabu-aha-iddin had also copied tablets for the "reading" (tamartu) of Qurdi-Nergal (Hunger 1968: Nos. 386, 389 [= STT 161, 172; see also STT 203]).
3 Returning to the colophon above (Hunger 1968: No. 354 [= STT 38]), the junior apprentice Nabu-rihtu-usur and disciple of the "head"
W scribe Nabu-aha-iddin, had written his tablet for the "reading" (tamartu) W
of one Qurdi-Nergal. This information allows us to establish some sort of hierarchy:
"junior apprentice" (samallu sehru) "disciple" (mar mummi) of the "head" scribe for the "reading" by Qurdi-Nergal
The disciple Nabu-rihtu-usur worked under Nabu-aha-iddin (as "head"); when both these scribes functioned as samallu-apprentices, their tablets were copied for "reading" by Qurdi-Nergal. Was he ummdnu? We know Qurdi-Nergal from other colophons in which he refers to him- self as a "junior apprentice" (samallu sehru) (Hunger 1968: No. 353 [= STT 192]), although this probably refers to an earlier period in his academic life. Moreover, another colophon (probably written by his son) bestows upon Qurdi-Nergal the august title of "priest (sangu) of (the gods) Zababa and Ba'u" associated with three different Assyrian cities (Arba'il, Harran, and Sultantepe itself) (Hunger 1968: No. 373 [= STT 64]); this may well be a later colophon. We seem to have tablets giving us information about various phases in Qurdi-Nergal's career, beginning
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with his student days and ending with his position as high priest, by which time he was no longer active in the scribal school, where his son was now a scholar.
We must try to determine to what "reading" (tdmartu) in this case precisely refers, since these colophons show that someone "reading" held a more senior position than an apprentice or even "head" scribe. Another Sultantepe scholar, Nabu-etiranni, composed a tablet colophon in which he specifically refers to "reading" (tdmartu) on behalf of sev- eral colleagues, one of whom was a priest (sangu), the second an agasgu, the third a "junior physician" (asu sehru), and the fourth a "junior apprentice" (samallu sehru).
For the "reading" (ana tamarti) of Bel-aha-iddin, a priest (sangu), ...., [for] the "reading" of [...] an agasgu-apprentice, for the "reading" of Rimut-ill, junior physician (asu sehru), and for the "reading" of Zera-ukln, junior samallu-apprentice, hastily extracted for their "reading" (ana tamartisunu hantis nasih). (Hunger 1968: No. 382 [= STT 301]) 1
\171
This colophon is intriguing because of the institutional information it would provide if only we understood the procedures alluded to. First of all, it shows that scholarly texts could be interdisciplinary, to be read by W or for students at different levels and disciplines. Second, we can assume W
on a priori grounds that a "junior" (sehru) level is less advanced than the level itself, so that a samallu sehru would be less advanced than a samallu apprentice.
Furthermore, although the title asu is a professional title rather than an academic one, it may be that "junior physician" (asu sehru) desig- nates a certain academic level of training and is hence a label which belongs exclusively to an academic context, rather than as a full-fledged professional title. One exception is the title "priest" (sangu) occurring in this colophon, which looks like a professional title but is possibly qualified by some term (such as "junior") in the lacuna following this word.
One important scribe of the city of Assur was Kisir-Assur, who was a prodigious copyist of tablets and signed many with his name and titles. We see him progress from samallu sehru to samallu masmassu, then to masmassu, and finally to masmas bit Assur (Hunger 1968: 19), a kind of cursus honorum for scribes. This progression distinguishes between titles within the scribal school system (samallu) and those borne by the pro- fessional beyond the academy, namely masmassu. The samallu, whether an "apprentice" or not, copies texts within an academic context, and the
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title is dropped once the scribe takes up a position outside the scribal school. This is the same progression we noted above in Qurdi-NergaPs career from "junior apprentice" (samallu sehru) to priest.
The Meaning of ana tamarti "for Reading"
There are a number of ways that a tablet could be used within academic contexts, according to the many colophons which we have. One rather uncommon expression is ana tahsistu, meaning the tablet is written "as an aide-memoire." In other cases, the tablet could be read ana ihzi, for the "grasp" or understanding of the reader, or as a "norm for learning." A colophon of an astronomical tablet records that the scribe wrote the tablet ana ahazisu, "for his grasp," referring to his own understanding of the task (Neugebauer 1955: 117 [No. 192: 5]). A more common expres- sion is that a tablet is written ana sitassi, for "reading out" of the text. The colophon provides nothing in the way of context, so we cannot tell whether "reading out" implies formal recitation or simply reading the tablet aloud (as was normal practice).
Perhaps the most intriguing expression is ana tamarti, for the "reading" (lit. "viewing") of the tablet (discussed above). Occasionally words adapt W to new meanings. In later periods, for instance, tamartu takes on special W
significance, since the bit tamarti refers to the Greek theatre in Babylon, literally "house of viewing" (van der Spek 2001: 447). The expression ana tamarti appears in colophons in Sultantepe (late eighth century BC), as well as in Assurbanipal's official royal colophons from Nineveh which insist that the king himself personally wrote, checked, and collated the tablets in his library, all far from likely. These colophons claim credit for Assurbanipal in the first person: "I wrote, checked, and collated this tablet from the collection of the scholars, I used it for the 'viewing' (tamartu) of my majesty within my palace." 172 Considering the anonymous scribal cul- ture of Babylonia, it is surprising to find such a claim expressed in the first person referring to the king; the expression ana tamartu may simply allude to Assurbanipal's self-proclaimed literacy (Fales 2001: 43; Villard 1997: 135-49). There is no reason to give him credit beyond that.
The term tamartu, however, is also used by a scholar we have already met, Nabu-zukup-kenu, who incorporated a fair amount of personal information in his colophons (see Frahm 1999). At the end of an astro- nomical omen tablet, for instance, he writes: "for the tamarti of my son, for half a year ... I 'thickened' (i.e. worsened) my eyesight, and checked it hastily and collated it" (Hunger 1968: No. 299). This is a remarkable
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statement about monitoring his son's progress, but what is meant by ana tamarti? The colophon records that "he had it written for his (own?) reading" (Hunger 1968: No. 297); in other words, Nabu-zukup-kenu did not actually copy the tablet but employed it for his "reading" (tamartu).
Further clues are provided by somewhat earlier Sultantepe tablets, which use this expression in a conventional way One Sultantepe colo- phon comments that a scribe: "wrote (the tablet) and collated it for his (own?) reading" (ana tamartisu) (STT 136). What do we make of this? The semantics of the verb amaru, to "see, view," include "read a tablet," as well as to "check" or "inspect" or even to "see the results" of a mathe- matical calculation.
We return to a Sultantepe tablet (STT 301) which we discussed above in relation to various categories of scribal "apprentices" mentioned in the colophon. The tablet was copied for "reading" by other colleagues for a specific purpose, which may have something to do with the fact that it too is a type of commentary 173 These colleagues are not young stu- dents but already have professional qualifications; one is a priest (sangu), another is a "physician" (asu), although still part of the academy. It seems clear that the meaning of tamartu is more than just reading, but has more to do with an academic scrutiny of the tablet itself. Since the two major roles of schools and school training are to teach and examine W students, it is possible that tamartu refers in this case to an examination *Qp
or examining of students, inspecting or evaluating their accomplish- ments. This would also make sense for Nabu-zukup-kenu's tablet for the tamartu of his son's work, which he complains nearly caused him to go blind. It is hardly coincidental that this kind of academic terminology appears in colophons of commentary tablets, which represent the upper- level work of the academy.
Another unusual reference to tamartu occurs in a Late Babylonian eso- teric commentary tablet, which is certainly from an academic milieu. The text deals with astrology and omen matters, and its colophon categorizes it as a text coming "from the 'questions and answers' (mas'altu) of a 'scholar' (ummdnu)" (Biggs 1968: 52ff.; see also Finkel 2006: 141). This genre of "questions and answers" is known from Greek and Latin apocry- pha as a type of hermeneutics, as well as from medieval and later apocry- phal literature, and refers to a special category of erotapocritic literature, usually referring to esoteric subjects. 174 These tablets are all said to have originated as "questions and answers" (mas'altu) of an ummdnu-scholar.
One esoteric commentary which refers to itself as a mas'altu ("ques- tions and answers") is a single-column tablet belonging to Nabu-sum- lisir, from a priestly family devoted to the god Bel-sarbi. The colophon
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then says that "a lamentation priest (kalu) of (the god) Bel-sarbi wrote and checked the tablet for his tamartu" (Biggs 1968: 54, 21). The ques- tion is why a lamentation priest, who functioned as a temple singer, would be interested in a tablet dealing with astrology and omens; the tablet itself is hardly intelligible to anyone not immersed in esoteric scholarship, associating astrology with unnatural or unusual births which were seen as portentous. Whatever the reason, the word tamartu here means more than merely perusal of the tablet, and in fact must have a more definitive purpose. We may presume that the tamartu has some specific academic role, similar to other cases discussed above. We suggest that this tablet represents an examination of the lamentation priest, to demonstrate his scholarly credentials. The person doing the examining (i.e. tamartu) is the most senior authority in the academy, which is reflected in the hierarchical statements of various academic colophons. Finally, the term tamartu appears in the opening line of the standard list of exorcism incipits ascribed to the twelfth-century BC scholar Esagil- km-apli (Jean 2006: 63ff. [= KAR 44]): "Incipits of the Series belonging to the art of exorcism (masmassutu), established (kunnu) for instruction (ihzu) and testing (tamartu), all to be read out." The terms here are relevant to an academic context, since the line informs us that various editions of incantations have been compiled and "fixed" (kunnu) for W academic "instruction" (ihzu) as well as for "testing" (tamartu). No W
other meaning of tamartu quite fits this context, since "reading" or "viewing" text editions of incantations would hardly follow "instruc- tion." This important incipit refers specifically to the two main tasks of a scribal school, as mentioned above: teaching and examining pupils.
The Case of Anu-iksur of Uruk
An archive of medical and medically related commentary tablets from Uruk, from the fifth century BC, belonging to an exorcist named Anu- iksur, has a lot to tell us generally about procedures within the ancient scribal academies. In my view, Anu-iksur was more than a mere copyist of tablets or even collector of tablets, since it is most likely that he was the actual master who was responsible for many of the Uruk commen- taries from this period. No less than 11 commentary tablets were labeled as coming from "the mouth of the 'professor' (ummdnu), the lecture (malsut) of Anu-iksur" (see Hunger 1976: No. 50, 42; Robson 2008: 233-5). CouldAnu-iksur have been the ummdnu-" proiessor" mentioned in the colophons, whose oral teachings were being committed to writing?
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One argument in favor of Anu-iksur being the author of these commentaries rests upon the meaning of the phrase, ana malsuti, "for the lecture of." The use of the term malsutu "lecture" is not prevalent outside of Uruk. There is the exception of several appearances of the term in the colophons of several medical texts copied by an important Assur scribe, Kisit-Nabu, but all of these Assur tablets were copied from Uruk originals (BAM 52, 106, 147). This scribe, probably a contemporary of Assurbanipal, was an exorcist from an important family of exorcists (Pedersen 1986: 46), who signed his colophons with the notation, ana tamartisu "for his reading" (i.e. for examination purposes) or in one case, ana malsutisu, "for his lecture." 175 The term malsutu appears in Assur in a copy of a normal medical tablet, while the term malsutu, as used later in Uruk by Anu-iksur, refers exclusively to commentary tablets. 176
One possibility is that, if Anu-iksur himself was ummdnu, any tablet designated as being from the "mouth of the ummdnu" could have been composed by his students who took notes, much in the same way that Aristotle's students provided posterity with his thinking on natural sci- ence. Supporting evidence for this idea exists, since several Uruk colo- phons specify that although the tablet belonged to Anu-iksur, it was his son Anu-usallim who actually copied the tablet (Robson 2008: 235f.), which we would understand as transcribing and recording Anu-iksur's W lecture notes. The same pattern occurs in later Uruk colophons, in the W
tablets of the Uruk scholar Samas-etir, copied by Anu-aba-uter, who later becomes an ummdnu in his own right. Anu-aba-uter's own tablets are copied, some dozen years later, by younger scribes, including his own nephew (Robson 2008: 248-51). The pattern appears to be that if com- mentary tablets are said to come "from the mouth of the ummdnu," the owner of the tablet is the ummdnu, but if colophons omit this expression but refer by name to the tablet owner, he is the ummdnu and the tablet has been copied by a son or disciple. Tablets ascribed to Anu-iksur fol- low both of these patterns.
Anu-iksur's title of "junior exorcist" (masmassu sehru) (Hunger 1976: No. 41, 11') places him firmly within the academy, 177 although we should ask whether this status rendered him sufficiently qualified to be consid- ered an ummdnu. Could one be an ummdnu and masmassu sehru at the same time? One thing is clear, that the title of ummdnu is never actually conveyed in colophons on the writer or owner of the tablet, nor does this title ever seem to be one of the hierarchical levels in scribal schools. 178 In other words, Anu-iksur is never referred to as ummdnu in colophons, nor are any other scribes granted this title, nor do we see the status of ummdnu as part of the career structure of scribal schools, as one might
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have expected. One does not seem to progress from "apprentice" to "professor" in any professional hierarchy.
This means that the expression "from the mouth of the ummanu" (sa piummdni) simply means, "on expert authority." For the moment, there- fore, our hypothesis is that Anu-iksur was responsible for composing these commentaries, that it is his name which gives the commentaries authority, and that these notes belong to his lectures in the scribal acad- emy 179 On the other hand, it may be that everyone simply knew who the ummanu at any time was within the school, without having to mention him by name, in the same way that the title "Pope" is sufficient in itself to identify the person holding this position.
Another supporting argument for the "owner" of a commentary tablet being its "author" is this: commentary tablets do not usually duplicate each other in the way that other texts are duplicates. Commentary texts did not operate within the curriculum in the same way as the literature upon which they were commenting. Even in cases in which several medi- cal commentaries were composed in different scribal schools on the same original composition, the commentaries differ from each other. A good example is provided by three commentaries expounding the first tablet of the Diagnostic Handbook. All three commentaries are from Uruk (with one belonging to Anu-iksur) and are said to have originated as "questions W and answers" (mas'altu) of an ummanu. 160 Three extant commentaries W
on the same text do not duplicate each other. The fact that we have three commentaries on the opening tablet of the Diagnostic Handbook shows not only how popular it was, but also how difficult it was to understand. The fact that commentaries are not duplicated shows that we are dealing here with an innovative literary genre of the first millennium. 181
Colophons of cuneiform tablets frequently mention the copyist or owner of a tablet but rarely refer to the person who actually composed a literary or scientific text. There are a few exceptions. A small number of texts are ascribed to specific authors, such as Sm-leqe-unnini, who is cred- ited with being the author of Gilgamesh, and Kabti-ilani-Marduk, who composed the Erra Epic, while the authors of the Poem of the Righteous Sufferer (Ludlul bel nemeqi) and a Hymn to Gula are both known by name (Foster 2007: 6). Scientific literature in particular is characteristi- cally anonymous, with libraries of tablets being copied generation after generation by local scribes with no indication of authorship. Nevertheless, three Babylonian scholars, Suma-iddina (Greek Soudinos), Kidinnu, and Nabu-rimanni, who appear in colophons of Babylonian astronomical tab- lets, were known to Strabo by name (as well as to other Greek authors), implying that these late scholars were either great authors or great teachers
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(Schnabel 1923: 222-7; Neugebauer 1955: 1 16). It is hard to imagine that mere scribes as copyists would have made enough of an impact to become known internationally, and we must assume that these Babylonian schol- ars were, in fact, interpreters and teachers of Babylonian science.
Returning to Uruk colophons, our supposition is that the Uruk scholar Anu-iksur, when referring to his lectures, means just that: he is the one who composed the commentary for use in his lecture, which would be the basis for expounding the difficult terminology of the basic text, e.g. from the Diagnostic Handbook or a medical text; Anu-iksur might also provide a phrase from which a discussion of medical principles could take place. The fact that anonymity in Babylonian scientific writing is beginning to change, from the Persian domination onwards (after 525 BC), is in keeping with what we know from Greek writing from the same period, when authors began writing treatises in their own name.
While it is difficult to decide the question of scribal qualifications based upon internal evidence only, a brief glance at what was happening in the Greco-Roman world provides additional perspective on this ques- tion. The best evidence for an ancient medical curriculum comes from third-century BC Alexandria, where we find discussion of what subjects were appropriate for the study of medicine. The medical curriculum of that important centre of learning included medical lexicography and W critical literary analyses of medical texts, especially in reference to the W
Hippocratic corpus, which were by then difficult to comprehend (Valance 2000: 101). This is not so different from Uruk commentaries.
Within the Greco-Roman scene in general, rhetoric and philosophy remained core disciplines of higher education, and these subjects were applied to medicine as well. Rhetoric was essential for a learned doctor to counter competition from others who might be providing health ser- vices, especially if practitioners of folk remedies were themselves illiter- ate. Persuasive rhetoric combined with a grounding in philosophy and logic would put the doctor ahead of his competitors, since Greco-Roman medicine was essentially an entrepreneurial affair (Valance 2000: 98f.).
There is no evidence from Babylonian schools that rhetoric was part of the curriculum, but the varied nature of training in Alexandria may reflect changes in curriculum in Babylonia. Instead of intense specialization based on professional training, the Late Babylonian scribal curriculum may have become more comprehensive, with a student-exorcist being expected to have a more well-rounded general exposure to many genres of texts, including medicine and divination. This might partly explain why so many different genres of tablets were being copied by exorcists or students of exorcism, as can be seen in late archives such as at Uruk.
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Uruk Medical Commentaries
We need to explore whether ancient medical commentaries may provide clues to contemporary Babylonian medical theory or offer more general medical aphorisms which help interpret Babylonian medical texts. What we are specifically looking for are statements in medical commentaries which are somewhat more complex than the typical A = B word defini- tions, or deconstructing Sumerian terms (logograms) by etymologizing component parts, often incorrectly It is the commentaries which most W likely reflect the actual teachings of the ummanu. 182 We can neither W
entertain or rule out (without supporting evidence) the possibility of formal discourses, since colophons speak of texts being hastily extracted for a "lecture" (malsutu), but one can only surmise what this term actu- ally means, in institutional terms. Nevertheless, medical commentaries offer opportunities for trying to reconstruct, at least for the latest periods of Babylonian medicine, some kind of theory of medicine recorded by Babylonian scholars themselves.
Commentaries on the Diagnostic Handbook and General Themes of Prognosis
Among the most important and longest ancient commentary tablets are three commentaries from Uruk, expounding the first tablet of the Diagnostic Handbook, referred to above (George 1991); all probably date from the fifth century BC. One commentary was written by Enlil- belsunu, an academic (i.e. "junior") exorcist (masmassu sehm). W3 A second commentary was signed by Anu-iksur, probably a contemporary of Enlil-belsunu (George 1991: 152, 162). A third Uruk commentary
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looks very much like the hand of Anu-iksur as well, although the colophon is broken. Would the same scholar have put his stylus to two different commentaries on the same text? It is certainly possible that Anu-iksur was responsible for both Uruk commentaries on the same text. 184
The first two tablets of the Diagnostic Handbook are extraordinary and differ markedly from the rest of the series. These tablets are con- cerned with general omens, similar to terrestrial omens, while the rest of the composition is mostly concerned with prognosis and diagnosis (see Fincke 2006-7: 146). Specifically, the omens of the first tablets of the Diagnostic Handbook deal with signs and portents which the exorcist encounters en route to the patient's house, and these signs are open to divinatory and lexical interpretation, i.e. they are a means to determine whether the patient will live or die. This type of omen was probably, at least in its original form, more the province of the foara-diviner than the exorcist. It may therefore be the case that these commentaries were required in order to make the opening tablets of the Diagnostic Handbook more relevant to medicine. There are some general medical principles expressed within these commentaries, which should be noted.
Pandemic fever
^P The first tablet of the Diagnostic Handbook records an omen stipulating *$p
that if the exorcist, while going to the patient, happens to spot a black, white, or red pig, various deductions can be made regarding the likely fate of the patient:
If he (the exorcist) sees a black pig: that patient may die; (alternatively) he may suffer acutely but then recover.
If he (the exorcist) sees a white pig: that patient may get better; (alterna- tively) stress (dannatu) may take hold of him.
If he (the exorcist) sees a red pig: that patient may die within three months, (alternatively) within three days.
If he (the exorcist) sees a spotted pig: that patient may die from dropsy; it is worrying, one should not approach him. (TDP 1 6-9; George 1991: 142f.)
The Diagnostic Handbook makes several general medical observations about the patient which reoccur elsewhere in diagnostic omens: the ill- ness may be fatal, or alternatively prolonged and curable; the illness may improve but the patient will still suffer considerable distress; the patient may survive for a determined period, or the illness may be beyond hope and perhaps contagious (not to be approached). All of these medical
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predictions are taken up in the commentaries, which try to make medical sense of this passage. First of all, both Enlil-belsunu and Anu-iksur agree that the Sumerian logogram used for "pig" (sah) can also indicate li'bu- fever, as is known from an ancient lexicon (see George 1991: 146f., 155). In other words, the word for "pig" might be a secret coding for a com- mon illness (pandemic?) rather than simply an ominous sign, and the exorcist is looking for an indication as to whether the illness might be fatal or whether the patient will eventually survive after a protracted period. We will see how this idea plays out in the commentaries.
Fasting
Both scholars add a qualifying statement (although not in the same sequence) about a medical prediction that the patient "may get better; (alternatively) stress (dannatu) may take hold of him." The commentators reinterpret the meaning of Akkadian dannatu, based upon another com- mon meaning for dannatu as "famine": "if the patient has experienced malnourishment (dannatu) he may get better, if he has not experienced malnourishment (dannatu), he may die" (George 1991: 146 6a-b). 185 Elsewhere in the Diagnostic Handbook, an infant (or young child) faces a fatal prognosis because its stomach cannot retain food and its teeth fall W out, and it will experience "malnourishment" (dannatu) for 15-20 days. W
Similarly in the Diagnostic Handbook, a patient may die if lack of nour- ishment (dannatu) has taken hold of him, to the extent that he has reduced his intake of food, his lung whistles, and he has fever (HeeBel 2000: 257: 71 [= Labat 1951: 22]). The Enlil-belsunu and Anu-iksur commentaries both rely upon a general rule, that if a patient fasted, he may recover; if not, he was likely to die, applied in this specific case to li'bu-iever, which was the agreed interpretation of "pig" in this context. Similar points were often raised in Greek medicine, such as the Hippocratic aphorism stating that "diseases caused by over-eating are cured by fasting; those caused by starvation are cured by feeding up" (Lloyd 1983: 266). 186
Contagion
The last omen given in the extract above stated that seeing a spotted pig can indicate dropsy (aganutillu), 1S7 and if the patient's condition becomes worrying (naqud), one should not approach the patient (TDP 1 9). This statement encounters no comment from either scholar, perhaps because no medical logic can be found to support this omen. However, the rule not to approach a patient with an acute illness is applied by Anu-iksur to
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another diagnostic omen: "If an ox butts him, that patient is in worrying state, one should not approach him" (TDP 1 18). The commentary relies upon an alternative designation of the Sumerian logogram for "ox" (gu 4 ) as "ghost" (gedim), which makes the rule more generally applicable and medically relevant; seeing a ghost (threatening disease) suggests the dan- ger of contagion, to be avoided by not approaching the patient (George 1991: 148 18b).
Quarantine
Both Enlil-belsunu and Anu-iksur rely on the image of the "black pig" to introduce a method of hermeneutics which involves citing relevant explan- atory literature. Both scholars deduce a passage from terrestrial omens (Summa alu) to explain the idea of an exorcist seeing a black pig; the omen states that "if a pig enters a bedroom, a captive woman (asirtu) will enter the owner's house"; 188 Anu-iksur adds the comment that "the expres- sion 'captive women' (asirtu) actually means to confine (eser) the patient" (George 1991: 146 6b), perhaps referring to quarantine (Akk. esertu/ isirtu), and hence a medical "rule" is once again being promulgated. 189
In effect, the commentaries of Enlil-belsunu and Anu-iksur add impor- tant medical information to a text from the Diagnostic Handbook, which W itself looks like a casuistic omen. Once the commentators agree that the W
exorcist sighting a "black pig" may in fact refer to seeing li'bu-iever, the subject changes from divination to medicine. Both scholars relate this equation 190 to another omen, also referring to unusual behavior of a pig, but now reinterpreting the omen. Instead of a "concubine" entering the house (causing domestic strife), "confinement" (a homonym) befalls the house, which was a way of protecting against a type of fever occasionally described as a pandemic. 191
Rule of thumb
Anu-iksur took an interest in the Diagnostic Handbook observation that "the patient may die within three months or within three days" (TDP 1 8), which is vague and requires clarifying. Anu-iksur's comment gives the needed clarification: "If the patient is in a worrying state (naqud), he can die within three days; if he is not in a worrying state, he can die within three months" (George 1991: 148 8b-c).The time phase of prog- nosis is related to the perceived severity of the illness, and this statement intends to provide a general guideline for prognosis upon which the practitioner can rely.
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Anatomy
The Uruk archives record other commentaries on the Diagnostic Handbook which are not found in other libraries, probably produced by Anu-iksur for his students. One Uruk tablet (Hunger 1976: No. 40) is a short commen- tary on the Diagnostic Handbook Tablet 36 and although the underlying Diagnostic Handbook text is broken, we can partially reconstruct the text from the commentary itself. The source text refers to aspects of hair on the head and prognoses which can be derived from the state of the scalp. This particular passage refers to a harimtu, a prostitute, who is "swollen and belches; she will die." The obvious question is why? The commentary explains as the reason for her symptoms that she has been struck on the head, with a clarifying explanation that "being hit on the head is being struck on the brain." 192 There next follows an unidentified quotation, "thus did I recite a lament for you," but the relevance is unclear; perhaps the idea is that an incantation or lament should be recited at this stage, because the situation is hopeless. The commentary returns to the subject of scalp hair, which is why it is appended to this particular section of the Diagnostic Handbook. "The hair on her head is red" (presumably because of the blood) appears to be the actual diagnostic omen, and a commentary then explains that "red" can be interpreted as "strewn" (or "thin on top"), ^ which may allude to baldness or alopecia. The association of ideas is that v&
one case of hair being red when caused by flowing blood is related to a second case when the natural hair colour is red.
The next symptom quoted in this same commentary refers to the eyes, stating that "the 'vine' of the patient's eyes is stretched so that the eyeball pops out," 193 and this same comment occurs verbatim in another commen- tary on the Diagnostic Handbook in which bloodshot eyes immediately follow upon symptoms of baldness. 194 No other connection between these two commentaries can be established, and statements like these may sim- ply represent anatomical lore which was widely circulating at the time.
The commentary turns next to the nose: "At its base is dripping 195 (which makes it) difficult to arouse (someone) or put (one to sleep)." The commentary explains this as "sneezing, 196 the nature 197 of which does not change." These last two comments appear to be simple medical observations.
Causes
Still looking for general principles among Uruk commentaries, we find a commentary on Tablet 3 of the Diagnostic Handbook:
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If a man is hot from his head to his midriff, but cold from his midriff to his feet, a murderous god has affected him; he has stolen something secret 198 from a ship and god of the harbour "seized" him, he will malinger but get better. (Labat 1951: 28, 86-7)
The commentary adds, "whatever (it was) of the boat which he stole, [he returned]" (Hunger 1976: No. 29, 4'); the restoration is conjectural but plausibly explains how a man could be seized by a deity/demon on moral grounds but still escape death by an act of contrition, which the original text fails to explain. The commentary, in this case, makes the traditional text more "rational" by explaining how death was avoided. 199
The same passage of the Diagnostic Handbook reads, "if he is ill from head to midriff but is healthy from his midriff to his feet, he will be ill by the new moon; his illness will be prolonged but he will get better" (Labat 1951: 28, 89). The commentary adds one comment, "the outgoing month" (Hunger 1976: No. 29, 6'), meaning that the illness which already began in the previous month will persist at least until the next month. Vagueness is clarified in the commentary.
As we have seen, commentaries often function by comparing different texts, or by quoting from another text as a way of bringing traditional or relevant material to bear on a particular subject. One of the Uruk medi- ^P cal commentaries, probably belonging to Anu-iksur, expounds the fol- W
lowing line of the Diagnostic Handbook, Tablet 4: "if a man's temple is affected (lit. struck), Hand of the Sibitti." 200 The symptom expressed here is so general and uninformative that the text itself tells us little of value in medical or diagnostic terms.
To explain this line further, Anu-iksur quotes from the first tablet of the Erra Epic, a relatively late composition (c. 700 BC) which deals with plague and death as one of its main themes. The commentary quotes the following line from the epic: "Ami, king of the gods, had sex with (Mother) Earth, she bore him seven gods and they were named the Divine Seven (Sibitti)" (Erra 1 29; see Hunger 1976: No. 30, 16-17). Anu-iksur's remark is intended to explain the disease name "Hand of the Sibitti"; the Sibitti are a group of seven gods who also qualify as demons and are hence responsible for disease and misfortune, well attested in incantations.
Is there anything other than literary allusion to this quote from the Erra Epic? The point being made is that the seven Sibitti gods or demons are no less significant than Samas, Istar, or other gods mentioned in this same context, but the Sibitti have an ancient pedigree going back to creation itself. The commentary asserts that although we recognize the label "Hand of a God" as a general label for disease (HeeBel 2000:
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356f.), in fact the cosmological associations behind disease names need to be taken into consideration and may offer relevant background information.
The question is whether the reference in the Erra passage to the Sibitti being spawned by Anu (heaven) and Mother Earth may actually have some bearing on the diagnosis. The commentary itself provides the excuse for posing this question, since it interprets the part of the body concerned in a strange fashion. The logogram for the temple of the head is sag.ki, which Anu-iksur deconstructs (in good commentary fashion): SAG = man, KI = woman (Hunger 1976: No. 30, 15). These equations, while unexpected and surprising, surely have some bearing on the diag- nosis, but it is not yet clear what the connection is until we look further into the commentary itself.
The source text from the Diagnostic Handbook Tablet 4 records two other symptoms of the temple which read, "If the temple on the right/left hurts him and his right/left eye is inflamed and he sheds tears," it is the "Hand of the Ghost" (alternatively "Hand of Istar") (Labat 1951: 36, 31-2). Anu-iksur then takes up the meaning of "shedding (tears)": "pour- ing out (tears) refers to a man's wife" (Hunger 1976: No. 30, 14). The point of the passage now acquires quite a different meaning: the symptoms affecting the temple are concerned with psychological rather than physi- W cal symptoms, since the commentary suggests that tears flow because of a W
trauma associated with a man's wife (either the patient's own wife or someone else's). When all comments on this passage are assembled, a new picture emerges: health problems of the "temple" (usually associated with migraine) may relate to sexual relations, and symptoms of depression (shedding tears) may result from tension or trouble between man and wife. The quote from Erra suggests that sex can sometimes have negative results, as was the case with Anu having spawned the feared Sibitti demons.
Matters dealing with the toilet were also of interest to Anu-iksur as a possible cause of disease. He wrote a commentary on a therapeutic text and commented on the fact that a patient's tongue was swollen (Hunger 1976: No. 47, commenting on ibid. 46). Anu-iksur explained being swol- len as being enlarged, associated with the "lurker-demon (rdbisu) of the toilet." Anu-iksur then cited a proverbial hemerology (often quoted in antiquity), a text giving information about lucky and unlucky days of the month, which says that "if (the patient) enters the toilet (on that day), Sulak (the toilet-demon) will strike him" (CAD M/2 234; see Hunger 1976: No. 47, 15). Anu-iksur explained why: since he can etymologize Sulak's name as "(one having) unclean hands," 201 therefore Sulak will
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strike one who enters a toilet with his unclean hands (Hunger 1976: No. 47, 4-5). Anu-iksur returned to this subject again, referring to dirt from a hole being from a refuse heap (possibly latrine), citing a prover- bial phrase, "I poured dirt from a hole over my hand" (Hunger 1976: No. 50, 38-40). Without having the underlying text we cannot be sure of the context, but contact with dirt from the toilet suggests some awareness of the effects of poor hygiene.
Psychic causes
The recognition of physical symptoms having psychological dimensions is occasionally expressed in commentaries in a simplistic way. Another of Anu-iksur's commentaries refers to a man's speech changing 202 as a symp- tom of disease. The source text (from the Diagnostic Handbook Tablet 6) reports that a patient's "speech keeps changing and he continually wan- ders about" (Labat 1951: 64, 60'; Hunger 1976: No. 32, 8f.). Anu-iksur's comment on the passage reads, "delirium is usual for him" (Hunger 1976: No. 32, 9), giving a more precise explanation for "wandering about" in this context. Babylonian medicine was well aware of psychosomatic dis- ease or disease resulting from mental illness (Stol 1999).
In this same commentary Anu-iksur explains what it means to find a ^P man's voice sounding like the cry of an animal (probably a bird), with W
the prognosis being that the patient would die within a day (Hunger 1976: No. 32, 11; based on Labat 1951: 68, 87'). The commentary refers epigrammatically to a proverb: "death is the face of the Anzu(-storm)-bird," i.e. the potentially terrifying emblem of the god Ninurta (Hunger 1976: No. 32, 12). This cryptic comment is immediately explained: an-zu-u : an-su-u : i-sip-\pu]; anzu (the bird) recalls the word for "dream interpreter" 203 who is a type of priest (isippu).The patient's voice was therefore altered by hyste- ria, perhaps as a result of a frightening vision or dream, comparable to see- ing the terrifying Anzu-bird. Such brief comments or notes are suggestive of much more detailed discussion within the scribal schools.
The effect of demons is not ignored by commentaries when referring to disease. One commentary passage mentions that the patient's "feet [turn] inward, his shins turn inward," and Anu-iksur succinctly com- ments: "binder-demon" (Hunger 1976: No. 31, 34f.). In other words, the deformity referred to might be caused by a demon who "binds" magi- cally, or a disease named after him. Why is this important medically? Because Anu-iksur associates a specific symptom with a specific cause, even if the cause is a term for a demon. This has to be distinguished, however, from magic, since medical texts and commentaries focus on
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specific symptoms caused by demons without considering other kinds of associated distress, as expressed in incantations.
Medical Terminology in Commentaries
More needs to be said about terminology within commentaries. Sometimes the word-for-word equations are asymmetric, which justifies our search for another level of meaning. One such equation is the Sumerogram sa.gig, which can be equated with an Akkadian loanword sakikku, a general term for "symptoms" occasionally employed by the Assyrian Chief Physician Urad-Nanaya in his correspondence with Esarhaddon (Parpola 1993: Nos. 315, 320). Anu-iksur, in one of his com- mentaries, is thinking along the same lines and defines sa.gig as "all diseases" (naphar mursi), referring potentially to any disease. Another Uruk medical commentary from one Samas-aha-iddin (perhaps a disci- ple of Anu-iksur) also defines sa.gig as "all diseases," but adds a more literal definition: "sore tendon." 204 Other learned commentaries, how- ever, define the important logogram sa.gig in different ways. One unsigned commentary to Tablets 13 and 14 of the Diagnostic Handbook narrowly explains sa.gig as kissatu, a type of skin ailment (Dougherty W 1933: No. 406, 17). Another commentary defines it as a more commonly W
attested disease, maskadu, a type of ailment associated with paralysis (see CAD M/l 368). Instead of the very limited definition of "sore tendon/sinew," or a definition based upon a specific condition, Anu-iksur offers a much broader definition embodied in the ancient name of the Diagnostic Handbook itself, namely safezfefett-symptoms. The student is being told to consider symptoms from all diseases as part of analogous thinking, rather than simply drawing conclusions from a local presenta- tion of individual symptoms.
It is important to note how commentaries attempt to clarify vague symptoms. The fifth tablet of the Diagnostic Handbook concerns dis- eases of the eyes, mainly dealing with symptoms of the eyes, eyelids, eyeball, and all anatomy related to the eye. One passage can now be restored to read, "if his eyes are flayed, his lungs spit out his saliva and it flows from his mouth." 205 Anu-iksur explains this to mean that "he coughs and [expectorates] his phlegm" (Hunger 1976: No. 31, 31-2; based on Labat 1951: 50, 12). The general medical observation here is that cough- ing and expectorating are both associated with the lungs, but expelled in a different way from saliva dribbling from the mouth. Akkadian termi- nology is vague since there is no clear differentiation between "spittle,"
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"mucous," and "phlegm" in the Akkadian medical thesaurus, which explains the focus of this commentary.
Fevers
One of the most difficult phenomena to explain in ancient medicine was the appearance of fever, either as a symptom or a disease in its own right. Without instruments or blood tests, an ancient physician had diffi- culty in distinguishing different types of fevers, except by rudimentary observations or noting regular patterns of the occurrence of fevers, spik- ing high temperatures punctuated by periods of cooling or chills. One such type of fever was li'bu (Stol 2007: 11-15), which we already encoun- tered in commentaries on the Diagnostic Handbook, but the subject is elaborated in other Uruk commentaries as well. One commentary, prob- ably from Anu-iksur (Hunger 1968: No. 30, with a damaged colophon), is based upon Tablet 4 of the Diagnostic Handbook dealing with symp- toms associated with the temples of the head. The source text reads:
If his (the patient's) temples, his epigastrium, and neck vertebrae con- stantly trouble (lit. "seize") him, and he shows no (signs) of low-grade fever or perspiration, by midday his pubic hair falls out, it is the Hand of W Maiden Lilith, he is infected with li'bu-iever. (Labat 1951: 34, 20-1) W
The first issue that concerned Anu-iksur is the relationship between the disease name ("Hand of Maiden Lilith") and the statement that the patient is "infected with li'bu-disease." To Anu-iksur's students, this con- nection may have been far from obvious. We have already encountered the picturesque disease terminology used by Babylonian medicine, often conferring upon diseases rather colorful names (usually "hand of" a god or demon), and such terminology can also be found in the early Hippocratic corpus (Geller 2004a: 20-1). Even if such disease nicknames were technical, they never completely lost the magical or religious con- notations from the sphere from which they were derived.
The Hand of Maiden Lilith is a case in point, since there is a rich magi- cal literature associated with this ghostly figure. She is the classic succu- bus who comes at night to seduce human males (or cause nocturnal emissions), because she died before puberty and the chance to have a lover or children. She was widely feared, although diseases labeled with her Hand were not necessarily transmitted sexually. Anu-iksur takes this matter up in his note explaining the verb la'dbu: "to be infected by li'bu- disease (means) the Lilu-demon spurned (or divorced) her" (Hunger
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1976: No. 30, 7). This puzzling comment turns out to be an allusion to another text from Uruk archives, an incantation which refers in its open- ing to this Maiden Lilith escaping into the desert from the Lilu-demon who had chosen her (von Weiher 1983: No. 6, 1-3; Farber 1989a; Geller 2007: 213f. [= Ut. Lem. 5 183f.]). Anu-iksur gives a simpler version of this tale: the Lilu-demon spurned her. Being spurned and loveless is what made this demon so dangerous, although there is no explicit reason given by Anu-iksur to explain any connection with li'bu-disease; the relation- ship between a demon and disease often appears to us to be arbitrary. 206
Once Anu-iksur's commentary has established that Maiden Lilith's per- sonal predicament leads to infection, the next step is to define the disease itself more precisely. Anu-iksur tells us that "to be infected (la'dbu)" refers specifically to the disease li'bu, and the disease li'bu is synonymous with ze'pu, a word for a "mold" for casting metal objects, or later, a coin. Anu-iksur then elaborates on this equation in another of his commentar- ies, in which he associates the ze'pu-mold and li'bu-iever with di-hu (di'u), "headache-fever" (Hunger 1976: No. 38, 10; see Stol 2007: 15-18, translating di'u as "malaria"). The question is how to distinguish li'bu from other kinds of fevers, such as ordinary "heat" (utmnu) or "sun- fever" (himit seti). Anu-iksur's explanation employs the analogy of a ze'pw-casting mold or coin, which is hard on the surface but is associated W with high levels of heat. The exact analogy between li'bu-iever and a cast- W
ing mold are not clear, since this could refer to a description of the patho- logy of the fever or to an associated symptom, such as an abscess. Nevertheless, what is important is the logic of the commentary in which a fever is defined by processes outside the sphere of medicine.
Sometimes we find a commentary within a commentary. Tablet 13 of the Diagnostic Handbook contains a rather rare word, hum, a type of stomach cramp: "if a patient cries, 'my stomach, my stomach!' he has stomach cramp (and) internal distress - it is the Hand of Istar" (Labat 1951: 126, 43). One commentary on this passages cites the word for stomach cramp (written hu-us-sa), neatly defining it as "to roast, which is (also) to burn" (Dougherty 1933: No. 406, 10), and then adds another explanation: "Commentary and oral tradition on (the text) of 'if a patient's [right] hand [hurts him]'"; this latter phrase is the incipit of Tablet 11 of the Diagnostic Handbook (Labat 1951: 88, l).The connec- tion between these two different parts of the Diagnostic Handbook (Tablet 11 and 13) is far from obvious to us. However, what is more clear is that there is an attempt to define stomach cramps through an analogy of "roasting" or "burning" (samu, kabdbu), although neither of these terms appear elsewhere in medical literature. These are rather
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rare words drawn from cooking, which may not be coincidental. As Jacques Joanna points out:
The fields from which Greek physicians drew visible evidence in order to deduce by analogy the internal functioning of the human body were quite varied, among them plants, animals, and arts; but cooking in the broad sense of the term remained the preferred field of reference. (Joanna 1999: 319)
The fact that a similar medical analogy was used by both Babylonian and Greek scholars is certainly worthy of note.
This same commentary also explains two words, pasittu and imtu, although we cannot identify the exact passage in the Diagnostic Handbook from which they are taken. The first word, pasittu, is a name of a female demon as well as a type of disease, characterized by symp- toms of stomach pain and fever. The commentary adds: "pasittu is that which contains bile" (Dougherty 1933: 406, 4). Although bile was a pri- mary component of the Greek theory of humors, its role within Babylonian medicine is far from clear. Nevertheless, the commentary relates pasittu to descriptions of disease in medical texts which refer to the patient vomiting bile. The second term, imtu, "poison" or even "spit- tle," adds another clue, since ancient scholarly glossaries also equate ^ imtu "poison" with martu, "bile." 207 We may be dealing with a poison ^$7
here, which is an aspect of Babylonian medicine hardly noted, although antidotes featured prominently in Greco-Roman medicine (Watson 1966). One reason for the lack of antidote recipes may have been that poisons were considered to belong to magic, like eating bewitched food, and therefore not the proper focus of medicine.
Physiognomy as diagnosis
Anu-iksur also took an interest in physiognomic omens, a branch of "medicine" (in a wider sense) in the ancient world, similar to diagnostic omens. Anu-iksur copied tablets of physiognomic omens, but he also wrote learned commentaries on such texts as well, much as he had done for diagnostic omens (Bock 2000: 99). In one case, Anu-iksur draws a medically relevant interpretation from a physiognomic omen predicting wealth and poverty:
If a man has the head of a chameleon, and it is determined that he will be raised up (to wealth) but not collect (sulu u la kasaru), he will be impover- ished and his inheritance [ ] (Bock 2000: 246)
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Anu-iksur then comments:
His wife will bend over for him,
she will shrivel it up: as for his wife, he has not belittled her.
(Sum.) "bir" = (Akk.) "shrivel" (kalasu).
Alternative explanation: as for his wife, he can submit to her. (Bock
2000: 254)
We would interpret Anu-iksur's comments in the following way. The statement that "his wife will bend over for him" is intended for her to show him respect or offer him sex. 208 The next statement is surprising: "she will shrivel it up" probably refers to his penis. 209 Why is he impo- tent? The next phrase explains, "as for his wife, he has not belittled her." 210 Finally, Anu-iksur offers an alternative explanation: "as for his wife, he will submit to her." 211 The future of a man with a chameleon forehead is not rosy, since the predictions are that his family will aban- don him and he will end up in poverty. The first explanation in the com- mentary is that his wife will be submissive to him, which may seem positive, but Anu-iksur then qualifies this meaning. He argues that actu- ally the man will be submissive to her, resulting in his losing his sense of masculinity, unless he learns to put his wife in her place and take the {§> upper hand. If not, he is doomed to suffer the fate predicted in the omen. {§}
In other words, Anu-iksur has altered the prediction, interpreting the man being "raised up" (sulu) to refer to his sexual potency, while the expression la kasaru is interpreted as "not to bind" or restrict his wife, the combination of which will have bad results.
Iqisa
Anu-iksur was not the only Uruk scribe to write commentaries. A full and colourful Uruk medical commentary was probably composed by the prolific Uruk scholar, Iqisa, who lived some 75 years after Anu-iksur (see Robson 2008: 238; Hunger 1976: No. 13); the text is edited in full in the Appendix in this volume (Clay 1923: No. 32, cited hereafter as "Appendix"). Although the colophon of this tablet is damaged, one rea- son for ascribing it to Iqisa is because the commentary's source is a medical text from an Uruk tablet that belonged to this same Iqisa, according to its colophon (Thureau-Dangin 1922: No. 34; see Hunger 1968: No. 100).
We will limit our comments to various interpretations of medical texts. Iqisa's source text reads:
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If a man has stroke, epilepsy, Hand of the God-disease, (or) Hand of
Istar-disease,
in order to get rid of it, its ritual is: take a male kid,
recite into its right and left ears (the incantation) "An evil god, ditto"; you
slaughter it. You take tears from the pupil of the eyes, 212 you take the cover
of the cavities of head and neck (and) the fluid of its irises . . . (Thureau-
Dangin 1922: No. 34: 1-5)
Early on in his commentary Iqisa explains the disease names, the first of which, "stroke," 213 he reinterprets as follows: "the patient chokes and keeps spitting up phlegm" (see below, Appendix: 1). This is not a philological explanation but a medical one, since the general description of stroke in the Diagnostic Handbook mentions saliva (ru'tu) running from the patient's mouth (Labat 1951: 80, 2), but Akkadian ru'tu can refer to both "saliva" and "phlegm" (see Stol 1993: 8f.); Iqisa comments that a choking patient is likely to produce phlegm (or mucous) rather than saliva. 214
Iqisa proceeds to explain the second disease name, often mentioned together with stroke, which is a type of "epilepsy" known by the rather poetic title of "Lord of the Roof." 215 Once again, our learned scholar defines this disease medically (avoiding any play on words): "'epilepsy' is (when) the right or left eye squints (lit. turns away)" (Appendix: 2; Stol ^P 1993: 16). The phrase is actually a citation from physiognomic omens *9p
rather than medical literature, but in this case applied by Iqisa to describe a disease symptom.
We cannot identify the third-mentioned disease, the "Hand of the God"-disease, in modern terms, and this time Iqisa explains the nature of the disease ontologically by providing some background to the patient's medical history: '"Hand of the God'(-disease) (occurs when) the (patient) curses the gods, speaks blasphemy, (and) smashes whatever he finds" (Appendix: 2). In this case, the patient's disease is thought of as well-deserved divine retribution, and the expression "Hand of the God" is interpreted literally rather than metaphorically as a technical disease-name. The next disease on Iqisa's list is similar, known rather widely as the "Hand of Istar"-disease, but in this instance the commen- tary gives a psychosomatic description of the patient's condition: "(the patient) keeps having stomach cramps (hussi) and internal distress and he keeps forgetting his own words" (Appendix: 3). 216 None of these descriptions appears in the source text (Thureau-Dangin 1922: No. 34).
Iqisa also expounds the meaning of the "Hand of the Ghost," a com- mon disease designation in Babylonian medical and magical literature. The commentary remarks that this condition occurs "(when) both (the
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patient's) ears ring, (a poultice) is excessively applied, (and) he cannot introduce his teeth to food" (Appendix: 3). The image of the ghost roaring into the patient's ears occurs frequently in therapeutic texts as a description of how the ghost can alter the patient's health, but this com- mentary is more specific. The patient loses all appetite and even lacks the strength to eat, which is a physical manifestation of what is essentially a psychic trauma caused by the attack of a ghost. In fact, Anu-iksur also comments on a similar passage in one of his commentaries based on a therapeutic text incipit: "if a man's ears roar through the attack of the Hand of a Ghost(-disease)," to which Anu-iksur comments: "his (ears) keep ringing ... the ghost has opened his ears." 217 Anu-iksur then puns on the word for ghost (etemmu) by etymologizing the word as the "one who gives an order" (temu), meaning that it is the ghost who is actually responsible for the patient's condition, rather than an abstract disease ascribed to a ghost on some remote grounds. A wandering unspecified ghost (murtappidu, segu) is actually responsible for causing the commo- tion, rather than the patient's being able to identify the ghost of a relative or ancestor who may be causing the difficulties (Stol 1993: 26).
Materia medica in commentaries
^9y In this same commentary (see Appendix), Iqisa often embarks on expla- W
nations of materia medica, many of which are standard recipe ingredi- ents. We find several drugs which can be classified as Dreckapotheke, which are usually disgusting or distasteful ingredients, but these turn out to be secret names of quite ordina