Education for Doctors

Sources

Exorcists and Physicians. Writing in the fifth century b.c.e., Herodotus of Halicarnassus made the following observations about the practice of medicine in Babylonia:

They have no doctors, but bring their invalids out into the street where anyone who comes along offers the sufferer advice on his complaint, either from personal experience or observation of a similar complaint in others. Anyone will stop by the sick man’s side and suggest remedies which he has himself proved successful in whatever the trouble may be, or which he has known to succeed with other people. Nobody is allowed to pass the sick person in silence; but everyone must ask him what is the matter. (Histories)

This statement was untrue. As early as the third millennium b.c.e. there were two sorts of medical practitioners: the exorcist (Akkadian: ashipu), whose cures were magical, and the physician (Akkadian: asu), whose cures were basically medical. Some illnesses were believed to have natural causes, such as overexposure to heat or cold, overeating, eating spoiled food, or drinking too much of an alcoholic beverage. A disease, however, was believed to be caused by a demon in punishment for a patient’s sin. The exorcist’s job was to identify the sin and cast out the demon. Sometimes the exorcist and the physician used each other’s practices and

worked together. Little is known about how doctors were educated, but medical knowledge was apparently passed down from father to son. An early-second-millennium b.c.e. tablet refers to a woman doctor. A first-millennium b.c.e. tablet refers to an eye doctor, and veterinarians are also mentioned in Mesopotamian sources. As symptoms, prognoses, and treatments for diseases were recognized, they were organized into texts for exorcists and physicians. The Babylonians also recorded patients’ hallucinations and their meanings.

Texts for Exorcists. Diagnostic texts dealt with omens, signs seemingly unrelated to the patient’s illness that might be revealed to the exorcist as he went to the patient’s house. These omens served as predictions of whether the patient would recover or die. These texts also included lists of symptoms and related prognoses about the course the disease would follow. Incantations were used to exorcize the demon, and foul substances were administered as enemas, emetics, and inhalants to purify the body. Remedies were prescribed for specific demons. For example, in the case of epilepsy, the exorcist ordered the patient to place “the little finger of a dead man, rancid oil, and copper into the skin of a virgin goat; you shall string it on a tendon of a gerbil and put it round his neck, and he will recover.”

Texts for Physicians. Medical books for physicians link symptoms with appropriate medications. These texts include extensive lists of herbal remedies, some of recognized medicinal value, and they often include ingredients and methods for preparing medicines. Therapeutic medical texts identify and prescribe treatments for many kinds of illnesses, among them intestinal obstructions, headaches, tonsillitis, tuberculosis, typhus, lice, bubonic plague, smallpox, rheumatism, eye and ear infections, tuberculosis, diarrhea, colic, gout, and venereal diseases such as gonorrhea. In time, physicians began to use remedies that were related in shape or color to the disease. For example, jaundice was treated with yellow medicine. Some sources also mention contagious diseases, as in this letter written by Zimri-Lim, king of Mari (circa 1776 -circa 1761 b.c.e.), to his wife, Shibtu:

I have heard that the lady Nanname has become ill. She was in contact with many people of the palace. She meets many women in her house. Thus, give exact orders that no one should drink from the cup from which she drinks, no one should sit where she sits, no one should sleep in the bed where she sleeps. She should not meet with many women in her house. This disease is contagious. (Roux)

Training for Surgeons. Surgeons probably learned by training and observation rather than from textbooks. The Mesopotamians were largely uneducated about human anatomy and physiology. The organs were considered the seats of various emotions or intelligence. Because of a religious taboo against dissecting human corpses, the Mesopotamians’ knowledge of human anatomy was derived from what they observed while cutting up animals used in divination and food preparation. Skeletal remains from as early as 5000 b.c.e. show evidence of trephination, the removal of parts of the scalp and skull bone, usually to relieve headaches and epilepsy or treat a fractured skull. The Laws of Hammurabi (circa 1792 - circa 1750 b.c.e.) dealing with surgeons’ fees and penalties for botched treatments provide clues about some of the other sorts of operations a surgeon was taught to perform. Some surgery was simple, such as lancing boils. Surgeons also set broken bones, treated wounds, and even operated on eyes. The penalty for surgical errors could be mutilation and even death. In less serious cases of malpractice the surgeon was expected to return the patient’s fee.

Knowledge of Mental Illness. Medical practitioners were also taught about mental illnesses. Texts mention that the royal family of Elam in southwest Iran seemed to suffer particularly from mental illness. Other texts mention the psychological basis of sexual impotence. Omen literature interprets dreams of falling, flying, and walking around naked. One text explains that if a man dreams about being naked in public, “troubles will not touch this man”; if a man dreams of committing “bestiality with a wild beast, his household will become prosperous.”

MURSILI’S ILLNESS

The Hittite king Mursili II came to the throne in the latter half of the fourteenth century b.c.e., after his brother Supiluliuma I died in a plague brought back from the Levant by his soldiers. Confronted with widespread disease and revolt, the young king seems to have lost his voice. In modern terms, this physical symptom could be seen as an obvious manifestation of emotional stress, but the Hittites consulted an oracle, which attributed the king’s malady to the displeasure of the storm god in Kummanni, a city in a southern province of the Hittite Empire:

Thus says His Majesty Mursili, Great King: I was driving to the ruined town (belonging to Kunnu) when a storm came up. On top of this, the storm-god repeatedly thundered frightfully so that I became afraid. Speech became small in my mouth and came out of me only sparingly. I had put this matter completely out of my mind when years later it began to come to me repeatedly in a dream. In a dream the hand of the god touched me so that my mouth went to the side. So I instituted an oracular inquiry, and the storm-god of (the town of) Manuzziya was indicated. I consulted the storm-god of Manuzziya by oracle, and it was indicated that I should give him a substitute ox, roasted in the fire, and also roast some birds. I consulted the oracle further concerning the substitute ox, and it was indicated that I should give it in its (proper) place in the Land of the town of Kummanni in the temple.

Mursili appears to have obtained relief by placing his hands on the ox, sending it and other gifts to the god, and then performing other sacrifices at home.

Source: Gary Beckman, “The Aphasia of Murshili II,” in Civilizations of the Ancient Near East, 4 volumes, edited by Jack M. Sasson (New York: Scribncrs, 1995), III:2010.

Sources

Benjamin R. Foster, Before the Muses: An Anthology of Akkadian Literature, 2 volumes (Bethesda, Md.: CDL Press, 1993).

Samuel Greengus, “Legal and Social Institutions,” in Civilizations of the Ancient Near East, 4 volumes, edited by Jack M. Sasson (New York: Scribners, 1995), I: 469–484.

Herodotus, The Histories, translated by Aubrey de Sélincourt, revised, with an introduction and notes, by A. R. Burn (Harmondsworth, U.K.: Penguin, 1954).

A. Leo Oppenheim, The Interpretation of Dreams in the Ancient Near East (Philadelphia: American Philosophical Society, 1956).

Erica Reiner, Your Thwarts in Pieces, Your Mooring Rope Cut: Poetry from Babylonia and Assyria (Ann Arbor: Horace H. Rackham School of Graduate Studies, University of Michigan, 1985).

E. K. Ritter, “Magical Expert (= äšipu) and Physician (= asû): Notes on Two Complementary Professions in Babylonian Medicine,” in Studies in Honor of Benno Landsberger on his Seventy-fifth Birthday, April 21, 1965, edited by Hans Gustav Güterbock and Thorkild Jacobsen, Assyriological Studies, no. 16 (Chicago: University of Chicago Press, 1965), pp. 299–321.

Martha T. Roth, Law Collections from Mesopotamia and Asia Minor, second edition, Society of Biblical Literature, Writings from the Ancient World Series, volume 6 (Atlanta, Ga.: Scholars Press, 1995).

Georges Roux, Ancient Iraq (London: Allen & Unwin, 1964).

H. W. F. Saggs, Civilization before Greece and Rome (New Haven & London: Yale University Press, 1989).

Marten Stol, “Private Life in Ancient Mesopotamia,” in Civilizations of the Ancient Near East, 4 volumes, edited by Jack M. Sasson (New York: Scribners, 1995), I: 485–501.