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THE rich lands between the Euphrates and Tigris rivers, Mesopotamia, now a part
of Iraq, frequently have been called “the cradle of civilization”. Contemporary
with Egypt, there were organized communities in the twin valleys as long as 6,000
years ago, with evidence of the existence of physicians as early as 3,000 B.C. When
Mesopotamian peoples began to record the happenings of their day on clay tablets
or stone. Medicine was a well-recognized profession.
Unlike the case in Egypt, the peoples, languages and governments of Mesopotamia
underwent many changes throughout the years during which ancient civilization flourished
there. Although various groups such as the Sumerians, Akkadians, Amorites, Assyrians
Elamites, and Chaldeans, Paraded across the historico-political stage of this ancient
land, the ancient indigenous culture prevailed and absorbed each group of newcomers.
In spite of political vagaries, there was basically one Mesopotamian civilization,
which is often loosely called Babylonian, Social, religious, and way-of-life patterns
varied title, and the practice of the healing arts seems not to have changed considerably
throughout the millennia. In ancient Mesopotamia, the basic concepts concerning
disease and its treatment were apparently religious.
Seals of Sumerian physicians, at least 5,000 years old and ancient Sumerian prescriptions
are known. Also, there is a rather extensive documentation on Mesopotamian medicine
written in cuneiform script on clay tablets. However, one of the oldest documents,
and one of significance to medicine, is the Code of Hammurabi. This is one of the
oldest known law collections, promulgated by the Babylonian King Hammurabi, toward
the end of his reign. There is no agreement among authorities as to the time of
Hammurabi’s reign. Dates as early as 2123 B.C. and as late as 1686 B.C. are
given. There fore, the origin of the Code can be placed only in the general area
of 2000 B.C. obviously it is a codification of much older laws and customs.
This extremely interesting document, preserved on a pillar of back diorite standing
now in the Louvre, in Paris, France deals with all phases of economic and family
life in ancient Mesopotamia. Of its 282 paragraphs, 11 refer to the practices of
physicians and veterinarians. Several substantially similar translations are available.
Excerpts of one by Charles Edwards, of London, paragraphs 215-224, follow;
“If a doctor has treated a Freeman with a metal knife for a severe wound,
and has cured the Freeman, or has opened a Freeman’s tumour with a metal knife,
and cured a Freeman’s eye, then he shall receive ten shekels of silver.
“If the son of a plebeian, he shall receive five shekels of silver.
“If a man’s slave, the owner of the slave shall give two shekels of
silver to the doctor.
“If a doctor has treated a man with a metal knife for a severe wound, and
has caused the man to die, or has opened a man’s tumour with a metal knife
and destroyed the man’s eye, his hands shall be cut off.
“If a doctor has treated a slave of a plebeian with a metal knife for a severe
wound and caused him to die, he shall render slave for slave
“If he has opened his tumor with a metal knife and destroyed his eye he shall
pay half his price in silver.
“If a doctor has healed a Freeman’s broken bone or has restored diseased
flesh, the patient shall give the doctor five shekels of silver.
“If he be the son of a plebeian, he shall give three shekels of silver.
“If a man’s slave, the owner of the slave shall give two shekels of
silver to the doctor.
“If a doctor of oxen or asses has treated either ox or ass for a severe wound,
and cured it, the owner of the ox or ass shall give to the doctor one sixth of a
shekel of silver as his fee.”
Here is rather grim evidence of a regular, recognized medical profession existing
4,000 years ago that attempted at least minor surgery, observed its legal responsibility,
and operated on a government controlled sliding fee schedule, all based on the social
status of the patient. The influence of this code spread far beyond Babylonia, as
is demonstrated in the Old Testament and in ancient Jewish philosophies of “
an eye for an eye and a tooth for tooth.” Abraham, originally a citizen of
the Mesopotamian city-state of Ur, founded the Hebrew nation at about the same period
that Hammurabi ruled Babylon. “ Through Judaism, Christianity and Islam ancient
Mesopotamian institutions have survived to the present day in the West and in the
East,” says Sigerist.
Ancient Mesopotamians believed that the air was filled with disease-producing demons
who could attack humans when the gods, offended by some sin of the patient, stopped
protecting him. Also, sorcerers could mobilize these demons. Hammurabi’s code
provides ordeal , and even the death penalty, for such acts by sorcerers.
Divination was developed to an extraordinary degree by Mesopotamians. Many tech3niques
were used. Their systems of dream-interpretation still influence the superstitious
today. Their stargazing, though done for magical rather than scientific reasons,
acquainted them with a number of important astronomical facts. They left amazingly
precise clay models of sheep livers, because the livers of sacrificed animals were
another source of prophecies and divinations. Priests were trained to be specialists
in the observation of this organ.
Divination also was used for the “diagnosis” of disease. That is, practitioners
attempted to determine what sin the patient had committed, what god had to be pacified,
and what demon had to be driven out. Treatment then consisted primarily of prayers
and animal sacrifices to the gods, and of exorcism(the recitation of spells) to
drive out the spirits. Often great poetic beauty was achieved in these chants. In
addition, drugs and physiotherapeutic measurers were employed.
The separation of medicine and priest craft seems not to have advanced as far in
Mesopotamia as it did in Egypt, yet there is evidence of a tendency in this direction.
In the famous book on prognosis, “When the incantation priest goes to the
house of a sick man..” the observation of symptoms may be found replacing
the observation of omens. Case histories set down on the clay tablets of Babylonia
are less elaborate, but similar in style and content to those of Egyptian papyri.
They consisted of descriptions of symptoms, prognosis, and indications for treatment.
Certain pathologic conditions, such as migraine, otitis media, jaundice, pleurisy,
and kidney stones, may be recognized from the texts of the clay tablets.
The armamentarium of the ancient Mesopotamian physician was very rich in drugs-even
though the drugs were credited with magical rather than pharmacodynamic values.
Hyoscyamus, hellebore, mandrake, opium, hemp, and belladonna as well as mineral
and animal substances have been identified as elements of Babylonian prescriptions.
Thompson reports having found 250 vegetable substances and 120 minerals in an “Assyrian
Herbal” reconstructed from cuneiform tablets found in King Ashurbanipal’s
library. Even by modern standards, some of the therapy prescribed seems quite rationsl.
For instance , poppy and mandrake were used to relieve pain and to produce sleep;
mustard for counter irritation ; elaterium for catharsis; sulfur for scabies; cannabis
for neuralgia and mental depression; belladonna as an anodyne, to relieve bladder
spasm and dysmenorrheal, and for asthma.
Like that of ancient Egypt, ancient Mesopotamian medicine, especially its drug lore,
undoubtedly had a certain influence on early Greek medicine, and thereby, indirectly
on modern medical practice. Of incomparably greater medical importance, however,
as Ackerknecht points out, was the powerful influence that Babylonia exerted on
Judaism, transmitting to it many of its myths, theories, and laws, including the
idea of contagion and isolation and the weekly day of rest. It is from Judaism that
the world’s Western civilization inherited these concepts. Both of these ideas
have been of immeasurable importance over the centuries in the prevention of disease.
THE PICTURE
A Babylonian throne room, around 2000 B.C. is the setting for this painting. Central
figure is the physician, defending with dignity his professional practices against
the complaints of a dissatisfied, litter borne patient who seeks invocation of the
drastic penalties of the Code of Hammurabi. The king, the scribe with his stylus
and tablet of soft clay, court attaches, guards, priests, friends of plaintiff and
of defendant, and the usual bystanders comprise the cast of this critical drama
of medicine 4,000 years ago.
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