Saturday, November 29, 2014

2000-539 B.C.: Assyro-Babyonian physicains

Code  of Hammurabi
The ancient Greek historian Herodotus (484-425 B.C.) observed that there were plenty of physicians in Egypt and no physicians in ancient Mesopotamia.  Yet the evidence seems to disagree with Herodotus, that there were plenty of physicians in Mesopotamia, perhaps even as early as 4000 B.C. when the Sumerians were forming the first civilization, says Henry E. Sigerist in his 1951 book, "A History of Medicine: Primitive and Archaic Medicine.  (Sigerist, page 425)

Herodotus said:
They have no physicians (in Babylon), but when a man is ill, they lay him in the public square, and the passers-by come up to him, and if they have ever had his disease themselves or have known any one who has suffered from it, they give him advice, recommending him to do whatever they found good in their own case, or in the case known to them; and no one is allowed to pass the sick man in silence without asking him what his ailment is.
There is evidence that much of this statement is true, as there were laws requiring anyone passing by to ask the sick: "What is ailing you."  If this passerby knew of the remedy due to past experience, he was required to share the remedy.

Pierre-Victor Renouard, in his 1867 history of medicine, said this time of medical therapy was common early on in most ancient civilizations.  He said they essentially went by the axiom: (16, page 570)
The same cause, acting under identical circumstances, produces, always, the same effect. (16, page 570)
When applied to medicine, Renouard said, the axiom means:
A treatment which has procured the cure of any disease whatever, will cure, also, all diseases identical, or rather homogeneous to the first. (16, page 570)
So this would explain the logic of the sick lying in the streets in the hopes a passerby would recognize the symptoms and offer a remedy.

Medical historian Henry Sigerist agreed with the notion that there were "no physicians in ancient Mesopotamia," although he said it was an incomplete statement.  He said: (Sigerist, page 425)
Herodotus' statement about Egyptian physicians, about the many specialists, is fully confirmed  by Egyptian literature and also by archaeological findings.  In Babylonia, however he must have been grossly misinformed.  Perhaps he meant that the Babylonians had not the kind of physicians he encountered  in Egypt, that great variety of specialists.  There can be no doubt that patients were occasionally placed in front of the houses or even on the market place and that the neighbors gave their opinion about them.  This still happens with poor people all over the east.  but we have an infinity of documents to prove that all ancient civilizations of Mesopotamia had physicians, and not only one category but several.  Patients, therefore, were not left to the mercy of their families or of neighbors but received expert treatment according to standards prevailing at the time. (Sigerist, page 425)
Medical historian John Hermann Baas also noted that there was evidence of physicians existing in Babylon, although he stated that the profession began through the interventions of Chaldean priests, who, along with their Chaldean friends and relatives, were scattered all over Babylon.  (Baas, page 25)

Alexander Wilder, in his 1901 history of medicine, explains that Herodotus might have been referring to the "'atroi (magoi) or the professional mediciners, like Demokedes, and the Asklepiades and Hippokratians who were members of an oath bound or sacerdotal order.  Before his time, the Chaldean priests, including the Asaphim, had been exiled by Dareios Hystaspis and had migrated to Pergamos. This probably accounts for the assertion of Herodotus." (1, page 17)

Wilder notes that the...
..."practice of placing the sick in the public thoroughfares, is shown by other writers, 'Is it nothing to you, all ye that pass by?' demands the Hebrew prophet;  'Behold and see, whether there be any pain like mine."...It is recorded that wherever Jesus went the sick were brought and placed in his way in the expectation that he would restore them to health.... to suppose there were not physicians in the Euphraatean countries during the archaic period, would be preposterous." (1, page 17)
Priests were educated, and well educated, at schools near the temples.  As was usual for ancient societies, anyone who was educated was well versed in all subject areas, such as writing, math, science, weights and measures, legends, myths, magic, lore, medicine, etc.  If you were educated, you were probably trained in just about every area of knowledge available at that time. (Sigerest, page 432)

There were basically three types of priests who specialized in health and healing: (Sigerist, page 432)
  1. (Seer Priest (baru):  He specialized in divination. He was basically responsible for assessing the patient and making a diagnosis, and he studied the stars and liver (or other organ) of a sacrificed animal and determined the prognosis (Will the patient get better? Will the patient die?).  He he thought it was necessary, he'd recommend an ashipu to heal you.(Sigerist, page 432)
  2. Exorcist or Incantation Priest (ashipu):  He used magical words and motions to drive out the evil spirits or demons.(Sigerist, page 432)
  3. Healing Priest (asu, azu):  He was the physician. He's the one who used magical incantations and herbal remedies to heal you. (Sigerist, page 432) Azu comes from Sumerian "A" for water and "Zu" for knows. He was famous for his knowledge of water in treatment of sickness)(Biggs)
Chances are, however, that these specialties didn't develop until the Chaldeans blended into Mesopotamian culture near the end or after the Sumerian Civilization. They came from the north, and brought with them knowledge of herbs, astronomy, astrology, and hepatoscopy.  As these people blended into Babylonian and Assyrian culture and were readily accepted, so to was their knowledge and medical practice.

As noted by Sigerist:
Health was considered a great good. 'May Shamash and Murduk give thee health' was a formula frequently used in Babylonia letters of Hammurabi's time.  And in Assyria the letter writer addressed the king with 'May Ninib and Gula give to the king my lord happiness and health.' Hence, disease was a great curse and the position of the sick man in society was aggravated particularly by the views that illness was a punishment for sin.  This at least was the case as soon as the Semitic (Chaldean) influence became strong. (Sigerist, page 425-6)
Babylonia and Assyrian civilizations existed for nearly 2000 years side by side, with Babylonia in the southern regions of Mesopotamia, and Assyrians in the northern regions of Mesopotamia.  They worshiped similar, and often the same, gods, and so too they shared pretty much the same medicine.  Priests became physicians, and they had various remedies to aid the sick and injured.

The Babylonians were the first to determine the importance of rest, and therefore people were strictly prohibited from treating the sick on the 7th day of the week, or the Sabbath day.  This was a day reserved for resting, feasting and worshiping the gods and demons.  (Bradford, pages 7-8)(Baas, page 28

This is noted in the following translation from a cuneiform tablet by George Smith: (Baas, page 28)
"The seventh day, feast of Mnrodnch and Zir: Panibti, a great feast, a day o rest. The prince of the people will eat neither the flesh of birds nor cooked fruits He will not change his clothing. He will put on no white robe. He will bring no offering. The king will not ascend into his chariot. He will not perform his duties as royal law-giver. In a garrison city, the commander will permit no proclamations to his soldiers. The art of the physician will not be practised."
Physicians also didn't perform any of their miracles on the 7th, 14th, 19th, 21st, and 28th days of the month because they were considered unlucky.  So if you were sick on those days you had to use whatever remedies you had access to. (Garrison, page 434)  

Average citizens did have access to their own herbal remedies and magic words, such as the following incantation asking for help from the gods for an internal disease: (Baas, page 28)
"Let the witch sit upon the right;
Let her leave the left side free!
Adisina, do thou tie the knot,
Hind up the head of the sick.
His limbs in like manner with fetters!
Seat thou thyself on his bed,
With the water of youth besprinkle him!"
They were also able to perform their own rituals and celebrations.  So, in this way, as in ancient Egypt, every citizen was a physicians. Although the better educated members of society looked to physicians and his medicine for aid, only to resort to incantations and prayers when all else failed. (Bradford, pages 7-8)

The asu were famous for their incantations, but they were also famous for their herbal poisons.  In this way, they earned a bad reputation.  Surely what they did might help the sick, if by no other means than by creating hope, although their herbal remedies also made some people sicker, and they killed some.  And some priests/ physicians abused their power.  So, this forced various societies to create laws to protect physicians from the magical abilities of these priests/ physicians.

In fact, this can be noted by many of the passages in the ancient stone tablets, or books.  In fact, Akkadian kings were forbidden to "take medicine for the ailments of the body."  (Wilder, page 17)

There was initially no formal method of payment of physicians, even though they were required to take care of the sick, particularly the kings and princes.  Although their services were appreciated, and often they were paid in the usual methods of the time, which included gifts of "large and small draught oxen, cows, horses, and camels." (Bradford, page 7-8)

In the 17th century B.C., however, a mighty ruler by the name of Hammurabi established a uniform code for everyone to follow, including physicians.  The code worked out great, because not only did it increase respect for physicians, it established a formal method of payment for them.  

Hammurabi was a mighty Amorite king of Babylon who gained fame as a great warrior and disciplinarian.   He fought the neighboring nations of Babylonia, including Larsa, Eshunna, Mari, and Assur.  He also fought a 30 year war with Elam, and defeated them.  (Sigerist, page 286)

In this way, he spread the boarders of Babylon, and spearheaded the process of assimilating the cultures of these other nations. 

Hammurabi was the 6th king of Babylon, ruling the city, civilization and the empire from 1792 to 1750 B.C.  While he was a great leader, perhaps he gained his harsh reputation for his strict rules, many of which influenced medicine for the Babylonians and future generations.

He did not write laws, per se, but he had the laws that already existed inscribed in stone and placed at the temples for all to see.  If you were not aware of the laws, this was no excuse.  The laws were pretty intense: an eye for an eye, a tooth for a tooth, and a limb for a limb  

They also applied to physicians to assure they did nothing to make their patients worse off by their remedies.  This was necessary to protect the people from the magic of priests/ physicians, but it also had the end result of improving respect for them as well.

The laws were basic, and included: (Garrison, page 56)
  • Adequate fees
  • Carefully prescribed remedies
  • Regulations to assure remedies were safe  (Garrison, page 56)
These laws were inscribed in stone and set near or inside the temples for all to see.  This way there was no excuse for anyone to be ignorant of the laws. In total there were 282 laws (for a full list of laws click here), with Laws 215 to 223 pertaining specifically to the physicians. The laws created regulations for them to follow, although they also provided for respectful payment for their services:

Here are some of the laws pertaining to physicians:
  • 215:  If a physician makes a large incision with an operating knife and cure it, or if he open a tumor (over the eye) with an operating knife, and saves the eye, he shall receive ten shekels in money.
  • 216:  If the patient be a freed man, he receives five shekels.
  • 217:  If he be the slave of some one, his owner shall give the physician two shekels.
  • 218:  If a physician make a large incision with the operating knife, and kill him, or open a tumor with the operating knife, and cut out the eye, his hands shall be cut off.
  • 219:  If a physician make a large incision in the slave of a freed man, and kill him, he shall replace the slave with another slave.
  • 220:  If he had opened a tumor with the operating knife, and put out his eye, he shall pay half his value.
  • 221:  If a physician heal the broken bone or diseased soft part of a man, the patient shall pay the physician five shekels in money.
  • 222:  If he were a freed man he shall pay three shekels.
  • 223:  If he were a slave his owner shall pay the physician two shekels.
There is an epilogue to the laws, which includes a long promise, part of which includes:
"LAWS of justice which Hammurabi, the wise king, established... May Nin-karak, the daughter of Anu, who adjudges grace to me, cause to come upon his members in E-kur high fever, severe wounds, that can not be healed, whose nature the physician does not understand, which he can not treat with dressing, which, like the bite of death, can not be removed, until they have sapped away his life."
While Assyrian and Babylonian priest physicians were initially all trained the same, over time they each became specialized in a particular disease as occurred in Egypt.  You'd have one physician for the eyes, one for the liver, one for prophylaxis, one for divination, etc.  (Garrison, page 56)

So now, thanks to such laws, the sick and injured were less likely to fear the priest/ physicians.  If you were in need of medical attention, surely you could attempt to heal yourself, and surely you could lie in the streets and hope to find someone with the remedy, yet you also had access to physicians, even if they were merely priest/ physicians.  

References:  See post "2000 B.C.:  Assyrian physicians will treat your dyspnea"

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