11 May

When the Greek historian  Herodotus visited Babylonia in the fifth cen- tury B.C.E.,  he reached  the remarkable conclusion  that  the Babylonians had no doctors.  The sick, he said, were taken to the marketplace  to seek advice  from  those  who  had  experienced  similar  illnesses. This  story proves  only  that  we should  not  take  the  tales  told  by  tourists   too seriously. As we have seen, Mesopotamia had  a complex medical tra- dition.  Both  the empirical  and  the  magical  approach to  healing  were well established,  but  eventually  the balance  of power apparently tilted in favor  of the magician.  Evidence about  the various  kinds  of healers who  practiced  the  art  in  the  region  can  be  extracted  from  the  most complete account  of Babylonian  law, the Code of Hammurabi. Today, Hammurabi (fl. 1792–1750 B.C.E.),  Babylonia’s most famous  king, is of more interest for the code of laws bearing his name than for his military and political triumphs.

Hammurabi founded the Babylonian  empire that unified and ruled southern  Mesopotamia (Sumer  and  Akkad)  for almost  two centuries. The  Babylonian   empire  was  eventually  destroyed  and,  in  538 B.C.E., the last of the Babylonian  kings surrendered  to the Persian ruler Cyrus the Great  and  Babylonia  became part  of the Persian  Empire.  Toward the end of his reign, Hammurabi commissioned  the creation  of a great stele portraying the king receiving the insignia of kingship  and  justice from the gods. Below this portrait were inscribed the 282 clauses or case laws now  referred  to  as  the  Code  of  Hammurabi. According  to  the inscription,  the  gods  who  had  made  Babylon  a great  and  everlasting kingdom called upon Hammurabi to ‘‘bring about the rule of righteous- ness  in  the  land,  to  destroy  the  wicked  and  the  evil-doers;  so  that the  strong  should  not  harm  the  weak.’’ In  an  epilogue  to  the  Code, Hammurabi called himself the ‘‘wise king,’’ who had taught  his people righteous laws and pious statutes,  and established order in his kingdom.

The code governs criminal and civil matters  such as the adminis- tration  of justice, ownership  of property,  trade  and  commerce,  family relations,  labor,  personal  injuries,  and  professional  conduct.  Replete with harsh  punishments, the Code of Hammurabi reveals the relation- ships that  governed  Babylonia’s  priests,  landowners,  merchants,  peas- ants,  artisans,  and  slaves. The  penalty  for  many  infractions,  such  as theft or harboring a runaway  slave, was death,  but many other  crimes were punished by amputations. Various clauses refer to illness, adoption, prostitution, wet nursing,  pregnancy,  miscarriages,  and malpractice  by doctors and veterinarians. Some laws actually did promote Hammurabi’s promise that the laws would protect the weak. For example, a man could take a second wife if his first wife became ill, but he had to support  his sick wife and allow her to remain in his house.

Criminal penalties were based on the principle of lex talionis, liter-ally, the ‘‘law of the claw,’’ that is, an eye for an eye, a tooth for a tooth. Retribution or punishment  was designed to fit the crime: amputation of the  hand  that  struck  the  father,  or  blinding  the  eye used to  pry  into secrets. Such punishments are  generally  referred  to  as ‘‘judicial muti- lation.’’ Given the number of clauses that specify amputations as punish- ment for various  offenses, one could imagine a fairly lively business for specialists in judicial mutilation. The penalties specified by the laws fell with different degrees of severity on the three classes that made up Babylonian society:  gentlemen,  or  seigniors;  commoners,  or  plebeians;  and  slaves, whose lowly status  was indicated  by a physical mark.  Slaves apparently carried  a 30-day  warranty against  certain  disorders.  For  example,  if a slave was attacked  by epilepsy within one month  of purchase,  the seller had to reclaim that slave and return  the purchase  price.

The laws of special interest to the history of medicine—those  per- taining to surgeons, veterinarians, midwives, and wet nurses—follow the laws dealing with assault. Nine paragraphs are devoted to the regulation of medical fees and  specifications  concerning  the relationship  between the  status  of the  patient  and  the  appropriate fees and  penalties.  The severe penalties  set forth  for failures  suggest that  practitioners would be very cautious  in accepting clients and would shun those that  looked hopeless  or  litigious.  The  laws  also  reflect  a  profound  distinction

between medicine and surgery. The physicians, who dealt with problems that would today be called ‘‘internal medicine,’’ were of the priestly class and  their professional  conduct  was not  governed  by the criminal  laws pertaining  to assault  and malpractice.

Because  internal  disorders  were  caused  by  supernatural  agents,

those  who  wrestled  with  such diseases were accountable to  the  gods. Wounds were due to direct human  error or aggression. Therefore, those who wielded the ‘‘bronze knife’’ were accountable to earthly authorities. Fees and penalties for surgical operations were substantial. If a doctor performed  a major  operation and  saved  the  life or  the  eyesight  of a seignior, his fee was 10 shekels of silver. The fee was reduced  by half for  operating   on  a  commoner,   and  was  only  two  shekels  when  the patient  was a slave. However,  if the surgeon  performed  such an oper- ation  and caused the death  of a seignior, or destroyed  his eye, the doc- tor’s hand should be cut off. If the physician caused the death of a slave, he had to provide a replacement.  If he destroyed  the eye of a slave, he had to pay the owner one-half his value in silver.

Just what operation was involved in ‘‘opening the eye-socket’’ or ‘‘curing’’ the eye is a matter  of some dispute. The operation could have been the couching of a cataract (destruction  of a lens that  had become opaque)  or merely lancing an abscess of the tear  duct.  While such an abscess  causes  intense  pain,  it  does  not  affect  vision,  whereas  cata- racts lead to blindness. Probing  or lancing might help in the case of an abscess, but  if poorly  done  such  interventions could  cause blindness. Presumably  eye surgery was only twice as difficult as setting a broken bone,  or  healing  a sprain,  because  the  fee for  such  services was five shekels of silver for a seignior,  three  for a commoner,  and  two for a slave. The veterinarian, also called the ‘‘doctor of an ox or an ass,’’ car- ried  out  various  surgical  operations, including  castration of domesti- cated animals.

Women served as midwives, surgeons,  and even palace physicians in  Mesopotamia, but  the  Code  of  Hammurabi does  not  specifically mention  female doctors.  The laws did,  however,  refer to women  who served as wet nurses (women who provided  breast  milk for the infants of other women). If a seignior gave his son to a wet nurse and the child died, her breasts could be cut off if she had taken in other infants with- out  informing   the  parents.   Obviously,  such  a  woman  would  never commit that  offense again.

In excavating the remains of ancient Mesopotamian cities, archae-ologists continue to unearth  thousands of cuneiform tablets. Most refer to mundane business transactions and political matters,  but as new texts are painstakingly deciphered our picture of Mesopotamian civilizations may well undergo  profound changes.

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