MESOPOTAMIA

11 May

MESOPOTAMIA
Mesopotamia, the land  between the Tigris and  Euphrates Rivers,  was the arena of the growth and decay of many civilizations, including those known  as Sumerian,  Chaldean,  Assyrian,  and  Babylonian.  Although Egyptian   civilization  is  better  known,   we  will  begin  our  survey  of ancient civilizations with Sumer to emphasize the point  that  other,  less familiar areas also became urban  and literate at a very remote date.

Sumer flourished  some four thousand to five thousand years ago, but  by  the  first  century,  its  language  had  vanished  and  its  writings, in the form of cuneiform characters inscribed on clay tablets, were indecipherable. Scholars believe that the wedge-shaped symbols evolved from  pictures  used  in an  early  accounting  system into  abstract  signs that  represented  sounds  of speech.  Most  Sumerian  tablets  dealt  with mundane  economic  and  administrative transactions, but  thousands of others  record  myths,  fables,  and  ideas  about   science,  mathematics, and medicine. Scholars have even discovered cuneiform tablets contain- ing recipes, which provide intriguing  clues to eating, drinking,  and the role of cults and feasting in the ancient world. Other traces of the extent and complexity of ancient Mesopotamian civilization have recently been revealed  by surveillance  satellites.  These photographs reveal traces  of previously  unknown   settlements  and  networks  of  roads  long  buried under  the sands of the Middle East.  Some of the roads  were probably constructed four thousand to five thousand years ago to link the cities of Mesopotamia to neighboring  settlements  and distant  farmlands.

In Sumer,  the mastery  of agricultural techniques  led to dramatic

changes in population density and the establishment  of the bureaucratic apparatus needed for planning, storage, and redistribution of crops. The great mass of people lived as peasants,  but their productivity  supported a small urban  elite of priests, warriors,  and noblemen. Because law and medicine were ascribed  to divine origins,  the priests also assumed  the roles of judges, lawyers, and physicians.

The  cuneiform  texts  pertaining  to  medicine  can  be divided  into three  categories:  therapeutic or  ‘‘medical texts,’’ omen  collections  or ‘‘symptom texts,’’ and miscellaneous texts that incidentally provide information on diseases and medical practices. After analyzing numerous texts,   scholars   divided   the  medical   traditions  of  Sumer   into   two categories,  which have been called the ‘‘scientific’’ and  the ‘‘practical’’ schools.  According  to  this  scheme, the  ‘‘scientific practitioners’’ were the authors  and  users of the symptom  texts.  In contrast, members  of the  practical  school  concentrated on  empirical  medical  practices  and were the authors  and users of the medical texts.

The medical texts of the practical school followed a formal arrange-ment typical of Mesopotamian scribal practice.  Each  text contained  a series of units  or cases following the same general  format:  ‘‘If a man is sick (and has the following symptoms) .. . ’’ or ‘‘If a man suffers from (such and such) pain in (wherever it was) .. . ’’ The description  of the list of symptoms was followed by instructions for the medicines needed, their preparation, the timing and means of administration. The healer ‘‘dis- covered’’ the significant symptoms  by listening to the patient’s account of the illness, not  by performing  a direct  physical examination  of the patient’s body. Although most units conclude with the comforting prom- ise that  the patient  would get well, certain  symptoms  presaged  a fatal outcome.

In contrast, the ‘‘conjurer,’’ ‘‘diviner,’’ or ‘‘priest-healer’’ looked at the patient’s  symptoms  and circumstances  as omens that  identified the disorder  and predicted  the outcome  of the disease. Unlike  his ‘‘practi- cal’’ counterpart, the diviner performed  a direct  physical examination in order  to  discover  signs and  omens.  Clearly  the gods were at  work if a snake fell onto the sick man’s bed, because this omen indicated that the  prognosis  was  favorable.   But  wine-colored  urine  was  a  portent of  progressive,  debilitating   illness  and  pain.  If  the  priest  could  not wrest sufficient information from his direct examination  of the patient, he  could  find  signs in  the  viscera  of  sacrificial  animals.  Omens  pro- vided  by  animal  livers were  applied  to  the  patient,  whose  liver  was inaccessible.

Although   there  are  many  uncertainties  in  interpreting  ancient texts, tentative diagnoses of some of the disorders discussed in the cunei- form  tablets  are  sometimes  possible.  Mesopotamian physicians  were probably  familiar  with  a wide range  of diseases,  including  schistoso- miasis, dysentery,  pneumonia, and  epilepsy. Malnutrition would obvi- ously correlate  with  the  periodic  famines  alluded  to  in various  texts, but  even when food  supplies were adequate  in quantity, the daily diet was probably  monotonous and unbalanced. Descriptions of eye disor- ders, paralysis, swollen bellies, and the ‘‘stinking disease’’ are consistent with various vitamin deficiency diseases. A combination of poor quality foods and chronic infestation  with various parasites  would amplify the problem  of malnutrition and retard  the growth  of children.

Because illness was regarded  as a divine punishment  for sins com- mitted by the patient,  healing required the spiritual and physical cathar- sis  obtained   by  combining   confession  and  exorcism  with  purgative drugs. Sumerian prescriptions include about 250 vegetable and 120 min- eral drugs, as well as alcoholic beverages, fats and oils, parts and prod- ucts  of  animals,  honey,  wax,  and  various  kinds  of  milk  thought to have  medical  virtues.  Medical  texts,  like  almost  all  Mesopotamian tablets, were anonymous. But some medical tablets provide enthusiastic personal  endorsements  and testimonials  for particular remedies. Medi- cations  are  said  to  have  been  tested  or  discovered  by unimpeachable authorities, such as sages and experts. Some remedies were praised  for their  antiquity  or  exclusivity. Of special interest  is a small cuneiform tablet   containing   about   a  dozen   recipes  recorded   by  a  Sumerian physician  about  four  thousand years  ago.  This  tablet  appears  to  be the oldest written collection of prescriptions.

The separation of magical and empirical aspects of medicine is a very recent development. Thus, it should not be surprising that Mesopotamian patients  considered  it prudent  to  attack  disease with  a combination of magic and  medicine. A healer who was both  priest and  physician  could increase   the   efficacy  of  drugs   by  reciting   appropriate  incantations. Although  the healer needed some knowledge of anatomy  and drug lore, precise knowledge of magical rituals  was more important because errors in this department could alienate the gods.

Hordes  of demons  and  devils were thought  to  cause diseases and misfortune;  each evil spirit tended to cause particular disorders.  As in the case of folk  medicine  and  so-called-primitive  medicine,  Mesopotamian healers also attempted to rid their patients  of disease-causing  demons by the administration of noxious remedies. Enveloped in the aroma  of burn- ing feathers, and liberally dosed with dog dung and pig’s gall, the patient hardly  seemed an  inviting  abode  for  demons  and  devils. The  magician might also try to transfer  the demon  into a surrogate  victim, such as an animal  or  a magical  figure.  Sometimes  healers  engaged  disease-causing demons in a formal dialogue, as in a conversation between the priest and the ‘‘tooth worm’’ recorded about 2250 B.C.E.  While an incantation entitled ‘‘The Worm  and  the Toothache’’  hardly  sounds  like a major  epic, this dialogue is a rich source of cosmological concepts and creation  myths.

Mesopotamian pharmaceutical texts reflect familiarity  with fairly elaborate  chemical operations for the purification of crude  plant,  ani- mal,  and  mineral  components. Plants  and  herbs  were  so  important to ancient medicine that the terms for ‘‘medicine’’ and ‘‘herbs’’ were es- sentially equivalent.  Drugs  made from  seeds, bark,  and  other  parts  of plants  were dissolved  in beer or milk and  administered by mouth,  or mixed with wine, honey, and fats and applied externally. In retrospect, it is logical to assume that  the wine used in wound  dressings provided some benefit as an antiseptic. Whether red or white, wine is a better anti- septic than 10 percent alcohol, but red wine seems to be the beverage of choice for fighting infection.

According  to the Mesopotamian legend known  as the Gilgamesh Epic,  human  beings  lost  possession  of the  most  powerful,  life-giving herb  in  creation  through   the  carelessness  of  Gilgamesh,  a  powerful hero-king  who  was  two-thirds   god  and  one-third   human   (by  what genetic mechanism  these ratios  were generated  is not  clear). The hero of the ancient  epic was apparently based on the exploits of a real king who  ruled  Babylonia  about  2700 B.C.E.   Some  six hundred  years  after his death, legends about the life of Gilgamesh were collected in the form of an  epic poem.  Thus,  The Epic of Gilgamesh provides  insights  into the lives and  beliefs of the people  who  lived in the land  between  the Tigris and Euphrates rivers in the second and third  millenniums B.C.E.

Despite  his god-like  qualities,  Gilgamesh  learns  that  he,  like all human  beings,  must  inevitably  succumb  to  illness and  death.  When his friend Enkidu  was stricken  with a serious illness, Gilgamesh  swore that  he would  never  give up  hope  of  saving  him  ‘‘until a  worm  fell out of his nose’’ (a striking omen of impending death). After many trials and tribulations, and  an awesome journey  through  the realm of dark- ness, Gilgamesh  learned  the secret of the herb of life and swam to the bottom  of the waters where the marvelous  plant  grew. Before he could take the herb of health  and healing back to Uruk,  the exhausted  hero stopped  to rest. While Gilgamesh  slept, a mysterious  serpent  slithered out  of his hiding place and  ate the herb  of life. As a result,  the snake shed its old skin and  was instantly  rejuvenated  while Gilgamesh  wept for himself and  all of suffering mankind.  According  to the epic, when Gilgamesh  returned  from  his journey,  he engraved  the story  of all his adventures  and  the  wonders  of the  city of Uruk  on  a clay tablet  for the instruction  of posterity. Thus, ever since the time of Gilgamesh, each time a snake  sheds its old skin its rebirth  reminds  human  beings that they must grow old and die. Nevertheless,  the epic tells us, even though great heroes may die they become immortalized  in the written record of their great deeds.

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