The Non-Mystic in Ancient Mesopotamian Medicine
Ancient Mesopotamian medicine consisted of mystical and practical practices. Many scholars identify systems or processes that resemble modern empirical methods amongst the practical practices, either directly relating similarities in the process of thought, or making indirect statements that suggest the application of some empirical systems. Other scholars are outspoken on the fact that our current understanding of the history of medicine informs scholars in inaccurately assigning empirical basis to Ancient Mesopotamian medical practices. In this essay, I seek to explicate the argument that, while practical medical practices in Ancient Mesopotamia may reflect some application of reason, the mystical/religious basis of medicine at the time inhibits any relation to modern empirical notions. I seek to establish that ultimately conclusions cannot be made on the empirical nature of these attributes solely because they relate to sense-based experience.
Ancient Mesopotamian medicine was multi-faceted and consisted of both a strain of what is more modernly considered medicine and one that consisted of more mythical, magical understandings. The former was concerned with the natural realm, viewing the initiating factors of diseases as stemming from natural causes, such as bugs or food, and seeking to alleviate the symptoms of them. The latter strain viewed the cause of disease as being spiritual, stemming from the anger of a demon or a god, and seeking to utilize incantations in alleviating the symptoms of, and preemptively preventing the disease.
Many authors attribute the utilization of therapeutic methods, and systems of classification, to an empirical system of medicine. The way that these authors identify applications of empiricism is through reflecting the notion that the therapeutic techniques or organizational structures present in Ancient Mesopotamia arose out of sense-based experience or exist to service cumulative knowledge generation from said experience. Many of the instances of scholars suggesting the presence of empirical-like systems in Ancient Mesopotamia happen through direct relations between processes of thought, drawing similarities between the way of thinking at the time, and the way of thinking throughout modern medical history.
An initial example of this direct relation can be found in Aulus Cornelius Celsus’ account of the Assur Muṥṥuu ritual tablet from the Neo-Assyrian Empire. The tablets dealt with the topical application of healing balms as well as listing different incantations that are used to treat various afflictions. As such, the tablet serves as a representative example of how non-magical and magical elements were juxtaposed in tandem. The tablet features many symptoms, referring to common medical complications such as paralysis and weakness in the limbs.
Celsus suggests that the ritual to which the tablet speaks (the process of rubbing) offers a cohesive method of relief for the listed symptoms. Celsus’ reasoning for this assertion is based on the understanding in current medicine that methods of massage or rubbing can alleviate symptoms of paralysis and stiff limbs. In this instance, what is apparent from the tablet is that symptoms have been collectively listed in the same text that depicts rituals to alleviate symptoms. The argument of customs or tradition arising out of sense-based experience is an acutely empirical one, characteristic of 18th century enlightenment philosophers such as David Hume. As empirical notions have been the basis for modern Western medicine, it is apparent that Celsus’ interpretation of the tablet’s relative purpose is reflective of some modern empirical systems.
An additional instance of direct relation of modern empirical thought processes to Ancient Mesopotamia medicine is in John D. Comrie’s introductory lecture on medicine among the Assyrians and Egyptians in 1500 BC. The lecture comments on prescriptions taken from the tablets of Nineveh which outline the usage of modernly recognizable remedies in medicinal practice such as sesame oil, the syrup of dates and honey. These practices are however spoken of in relation to the modern understanding of the medicinal usages of these remedies. However, the complicating factor is identifying the proof of these remedies being utilized in some of the same ways, and for some of the same medicinal purposes that they are currently known, as this information is not present in the tablets.
The application of empirical-like systems in Ancient Mesopotamian medicine are additionally developed through indirect statements from scholars defining systems of rational thought amongst Akkadian sources. A representative example of said sources is the Diagnostic Handbook (Sakikku) by Esagil-Kin-Apli from the 4th Dynasty of Babylon. Esagil assembled diagnostic omens to identify the divine sender of diseases, which were perceived as messages from deities. The handbook applied a logical set of assumptions to assess patients in diagnosis. What importantly emerges in the first three chapters of the Diagnostic Handbook is the notion that observation of a patient’s symptoms is crucial, dictating that inspection from head to foot is needed by the deity Ea. The prominent focus on the crucialness of observation in developing diagnosis reflects attributes of empiricism, as general empirical theory similarly values observation as the preliminary.
The fourth chapter of the Diagnostic Handbook focuses on neurological syndromes that range from epilepsy and seizures to ghosts and spirits. The notion that mysticism was the underlying grounding for Ancient Mesopotamian medical thought emerges within this focus as neurology, a concept now understood as being within the brain, was viewed as being solely of external cause. This attribute reflects the important role of interpretation in drawing connections on former thought processes, as the Spurlock Museum has the chapter titled as, “Neurology”, immediately suggesting the close relation between the former practices and our current understanding of neurology as per modern medical history.
Tablet 33 of the Diagnostic Handbook contains instances in which diseases are listed multiple times with the “hand of the god” label alongside them. The placement of a disease within the tablet is comparable in similarity to additional tablets. Some scholars, such as Henry Sigerist and Nils Heebeel have taken these labelings and placements as a system of classification that reflect a thematic focus. Diseases which have external manifestations and symptoms alike within these tablets have been found to be classified by the same initial letter, reflecting a grouping. The classification reflects the establishment of a system in which knowledge can be rationally confirmed through a comparison of experiences. This system reflects empirical notions in servicing cumulative knowledge generation from observed experience.
In Magic and Medicine in Ancient Mesopotamia by Strahil Panayotov, the Assur Medical Catalogue (AMC), inscribed during the 8th or 7th century BCE is discussed. The catalogue consisted of therapeutic recipes, rituals and incantations. Panayotov suggests that the list is displayed vertically and in series, reflecting dozens of logically connected medical compositions. This point is furthered within the AMC when seemingly logical thematic connections are applied in prescriptions for “potency-sex-pregnancy-birth”. Panayotov’s interpretation suggests that the rational connections between these stages reflect the notion that there is an observed rational connection amongst their prescriptions.
In contrast to both the direct and indirect academic assertion that the systems present in Ancient Mesopotamian medicine reflect empirical-like groundings is the fact that the modern understanding of the history of medicine informs scholars in inaccurately assigning attributes of empiricism to Ancient Mesopotamian medical practices.
An example that illustrates this notion is Panayatov’s criticism of JoAnn Scurlock’s, The Sourcebook for Ancient Mesopotamian Medicine. Scurlock wrote on the two distinct professional medical practitioners in Ancient Mesopotamia, the Asipu and Asu. The Asipu were advisors on risky decisions, they utilized repeatable, consistent processes, considering alternatives and collecting data. Scurlock equated the Asipu to pharmacists and Asu to physicians. Panayotov criticized Scurlock for this suggesting that equating modern medical understandings (based in empirical thought) with that of Ancient Mesopotamians is inaccurate as the mystical underlying basis for Ancient Mesopotamian medicine removes the Asipu too distinctively from the empirical responsibilities of a pharmacist.
Furthemore, in the Sorokina TS History of Medicine, the notion that modern medical practices have been often applied inaccurately to Ancient Mesopotamian thought is explicated. Refuting the notion that Akkadians developed strict hygienic and healthy dietary rules, the book states that the Akkadians did not write anything on regimens and in cases in which they appear to, they were not pertaining to disease curing or prevention. The text would suggest that modern conceptions of observing positive health changes from adhering to a hygienic, healthy dietary regimens have influenced historical thought. Furthermore, this notion suggests that practices we have observed to be beneficial for our health, may have been occured in the past with the same benefits, but without the observational methodology.
The dominant point in rebuttal to the presence of empirical systems in Ancient Mesopotamia is the inoperable bridge between Akkadian texts and our modern history of medicine. H.F.J Horstmanshoff wrote on this in Magic and Rationality in Ancient Near Eastern and Graeco-Roman Medicine. Hortsmanhoff praised both Sigerist and Heebel in their analysis of Ancient Mesopotamian Medical literature as neither of them sought to connect it to a wider history of medicine without first refuting empirical bias. This attribute is important in regards to the arguments of Celsus and John D. Comrie whose attempts to understand Ancient Mesopotamian medicine through the lense of modern medical practice reflect the inherent bias of empiricism, as it suggests the same epistemological system being used in diagnosis and treatment as today.
Furthemore, both Horstmanshoff and M. Stol arise examples that refute the classification system of the Diagnostic Handbook eliciting recognizable systems of reason that reflect empirical-like systems. Within the Diagnostic Handbook, although diseases are presented in similarity through their shared prefix (Heebel’s interpretation of grouping of diseases), there is no distinction between a word which might be considered a general category of a disease and a specific disease. As such, if the organization of the diseases adheres to a system of classification dictated by rational, it is not detectable among the prefix group classifiers. Furthemore, there are instances in which the same symptoms are listed with different disease names. Importantly, this attribute would suggest that there is a difference in classification of a disease according to attributes other than observation. This point is furthered by different symptoms referring to epileptic-like seizures but being associated with separate gods. This attribute would suggest that the classification within the handbook is largely of religious basis, as much as it pertains to rational thought.
Furthemore, Hortsmanshoff purports that the Diagnostic Handbook is for the sake of prognosis, determining the plausibility of a patient living and predicting the course of a disease. This notion contrasts assertions of Panyotov, in which his focus was the relief or treatment of these diseases. Hortsmanshoff admits that the Diagnostic Handbook presents observations, but rather than observations of diagnosis, observations of good and bad signs. Ultimately the handbook under this purpose would serve as an informant to the judgement of the “physician”. This analysis of the handbook suggests a lack of discernible logical order, instead suggesting that religion, magic and science were holistically approached at the time. This understanding serves as a contrast to that of rational basis, if a rational basis cannot be presupposed upon these texts, then an approach based in observational reliance will not provide accurate findings.
Ultimately it is apparent that scholars identified processes that resemble data-based observation methods modernly practiced. However it is likely that even if these similarities can be identified, a current empirical understanding of medical history has allowed processes to be misidentified, or inaccurately interpreted. Religious basis was intertwined with scientific thought, the distinction between modern and Ancient Mesopotamian medical thought suggests that conclusions cannot be made on the empirical nature of Ancient Mesopotamain attributes solely because they relate to sense-based experience.
M. J. Geller (2004). Cornelis Tilburg (eds.). West Meets East: Early Greek and Babylonian Diagnosis. Magic and rationality in ancient Near Eastern and Graeco-Roman medicine. Brill Publishers. ISBN 978-90-04-13666-3. PMID 17152166.
Marten Stol (1993), Epilepsy in Babylonia, Brill Publishers, ISBN 90-72371-63-1
R D. Biggs (2005). Medicine, Surgery, and Public Health in Ancient Mesopotamia. Journal of Assyrian Academic Studies. Brill Publishers.
Oppenheim, A. Leo (1964). Ancient Mesopotamia: Portrait of a Dead Civilization, The University of Chicago Press.
Walid Khalid, Abdul-Hamid (2014) Jamie Hacker Hughes (eds.) Nothing New under the Sun: Post-Traumatic Stress Disorders in the Ancient World, Early Science and Medicine Journal (19), Brill Publishers.
Panayotov, Strahil (2018). Magic and Medicine in Ancient Mesopotamia, Ancient Magic and Divination. Brill Publishers.
Bock, Barbara (2002) When You Perform the Ritual of Rubbing: On Medicine and Magic in Ancient Mesopotamia. University of Chicago.
Sigerist, Henry E. (1951) Primitive and Archaic Medicine, A History of Medicine Vol. 1. The Johns Hopkins University Press