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History of Ancient Medicine in Mesopotamia & Iran
Last Updated: October, 2009


Science, including medicine, has a very long history in the Middle and Near East. Its origins go back to the ancient Mesopotamian period beginning with Sumerian civilization around 3,000 BC. There are many cuneiform tablets from cities as ancient as Uruk (2500 BC). However, the bulk of the tablets that do mention medical practices have survived from the library of Ashurbanipal at Nineveh (668BC) Assyria. So far 660 medical tablets from this library and 420 tablets from the library of a medical practitioner from Neo-Assyrian period as well as Middle Assyrian and Middle Babylonian texts have been published. The vast majority of these tablets are prescriptions, but there are a few series of tablets that have been labeled "treatises". One of the oldest and the largest collections is known as "Treatise of Medical Diagnosis and Prognoses." The text consists of 40 tablets collected and studied by the French scholar R. Labat.

Although the oldest surviving copy of this treatise dates to around 1,600 BC, the information contained in the text is an amalgamation of several centuries of Mesopotamian medical knowledge. The diagnostic treatise is organized in head to toe order with separate subsections covering convulsive disorders, gynecology and pediatrics. To the non-specialist they sound like magic and sorcery. However, the descriptions of diseases demonstrate accurate observation skills. Virtually all expected diseases exist; they are described and cover neurology, fevers, worms and flukes, venereal disease and skin lesions. The medical texts are essentially rational, and some of the treatments, (such as excessive bleeding) are essentially the same as the modern treatments for the same condition.

In these ancient texts, diseases are often blamed on pre-existing spirits: gods, ghosts, etc., and each spirit was held responsible for only one disease in any one part of the body. Ancient mythologies tell stories of diseases that were put in the world by supernatural forces. One such figure was Lamashtu the daughter of the supreme god Anu, a terrible she-demon of disease and death. It was also recognized that various organs could simply malfunction and cause illness. Medicinal remedies used as cures were specifically used to treat the symptoms of the disease, and are clearly distinguished from mixes or plants used as offerings to such spirits.

There were two distinct types of professional medical practitioners in the ancient Mesopotamian city-states. The first type of practitioner is called ashipu, who in older texts is identified as a sorcerer or the witch doctor. One of the most important roles of the ashipu was to diagnose the ailment. In the case of internal diseases or difficult cases the ashipu determined which god or demon was causing the illness. He also attempted to determine if the disease was the result of some error or sin on the part of the patient. He prescribed charms and spells that were designed to drive out the spirit causing the disease. The ashipu could also refer the patient to a different type of healer called an asu. He was a specialist in herbal remedies, and in texts is frequently called "physician" because he dealt with the empirical applications of medication. For example, in case of wounds, the asu applied washing, bandaging, and making plasters. The knowledge of the asu in making plasters is of particular interest.

Many of the ancient plasters (a mixture of medicinal ingredients applied to a wound often held on by a bandage) seem to have had some helpful benefits. For instance, some of the more complicated plasters called for the heating of plant resin or animal fat with alkali. When heated this particular mixture yields a soap-like substance, which would have helped to ward off bacterial infection. The two practitioners worked together and at times could function in both capacities.

Another textual source of evidence concerning the skills of the Mesopotamian physicians comes from the Law Code of Hammurabi (1,700 BC). There are several texts showing the liability of physicians who performed surgery. These laws state that a doctor was to be held responsible for surgical errors and failures. Since the laws only mention liability in connection with "the use of a knife," it can be assumed that doctors were not liable for any non-surgical mistakes or failed attempts to cure an ailment. According to these laws, both the successful surgeon's compensation and the failed surgeon's liability were determined by the status of his patient. Therefore, if a surgeon operated and saved the life of a person of high status, the patient was to pay a lot more as compared to saving the life of a slave. However, if a person of high status died as a result of surgery, the surgeon risked having his hand cut off. If a slave died, the surgeon only had to pay enough to replace the slave. At least four clay tablets have survived that describe a specific surgical procedure. Three are readable and one seems to describe a procedure in which the asu cuts into the chest of the patient in order to drain pus from the pleura. The other two surgical texts belong to the collection of tablets entitled "Prescriptions for Diseases of the Head." One of these texts mentions the knife of the asu scraping the skull of the patient. The final surgical tablet mentions the postoperative care of a surgical wound. This tablet recommends the application of a dressing consisting mainly of sesame oil, which acted as an anti-bacterial agent.

It is hard to identify some of the drugs mentioned in the tablets. Often the asu used metaphorical names for common drugs, such as "lion's fat" (much as we use the terms "tiger lily" or "baby's breath"). Of the drugs that have been identified, most were plant extracts, resins, or spices. Many of the plants incorporated into the asu medicinal repertoire had antibiotic properties, while several resins and many spices have some antiseptic value, and would mask the smell of a malodorous wound. Beyond these benefits, it is important to keep in mind that both the pharmaceuticals and the actions of the ancient physicians must have carried a strong placebo effect.

Patients undoubtedly believed that the doctors were capable of healing them. Therefore, visiting the doctor psychologically could reinforce the notion of health and wellness. Temples belonging to gods and goddesses of healing were also used for health care. Gula was one of the more significant gods of healing. The excavations of such temples do not show signs that patients were housed at the temple while they were treated (as was the case with the later temples of Asclepius in Greece). However, these temples were sites for the diagnosis of illness and contained libraries that held many useful medical texts. The primary center for healthcare was the home. Most of the healing processed took place at the patient's own house, with the family acting as care givers. Outside of the home, other important sites for religious healing were nearby rivers. These people believed that the rivers had the power to care away evil substances and forces that were causing the illness. Sometimes a small hut was set up either near the home or the river to aid the patient and their families.

While many of the basic tenants of medicine, such as bandaging and the collection of medical texts began in Mesopotamia, other cultures developed these practices independently. In Mesopotamia many of the ancient techniques became extinct after surviving for thousands of years. It was the Egyptian medicine that seems to have had the most lasting influence on the later development of medicine, through the Greeks. In the fifth century BC, the Greek historian and traveler Herodotus commented on current medical practices in Egypt; "the art of healing is with them divided up, so that each physician treats one ailment and no more. Egypt is full of physicians, some treating diseases of the eyes, others the head, others the teeth, others the stomach and others unspecified diseases".

The ancient Egyptian texts of the Old Kingdom (2,635-2,155 BC) contain at least 50 physicians, mainly from their names on the individual tombs. The later periods also give detailed information about physicians and their practice. Although most physicians were men, female physicians existed as well. The title ‘Lady Director of Lady Physicians’ proves the existence of a group of women who practiced as doctors. Physicians were literate, some were scribes and others were priests at the same time. Most inherited the profession from their fathers but needed to be trained in the field. The profession was organized hierarchically with the Chief Physician at the top and the lesser titles following, such as Master of Physicians, Director of Physicians, Inspector of Physicians, Plain Physicians and auxiliaries such as Bandage personnel, etc.

Texts deal with diagnosis, treatments and prescriptions. Surgery and mummification processes that were used by the ancient Egyptians still amaze modern experts. All the major and common diseases are known and treated. Ailments are attributed to spirits, ghosts and revenge by gods and goddesses. Texts dealing with gynecology cover fertility, sterility, pregnancy, contraception and abortion. Women were tested to decide whether they could conceive or not. However, the Egyptians were behind Babylonian doctors who had gone further and designed the first pregnancy tests known in history. This test involved placing in the women’s vagina a tampon impregnated with the juice of various plants in a solution of alum. This was left in position either overnight or for three days. Pregnancy or non-pregnancy was indicated by color changes between red and green. The test used the pH value of the woman’s secretions in her vagina to determine her pregnancy status.

Rational thinking and sound medical observation were used alongside magic and sorcery. Magic was based on the assumption that an object with certain qualities, or an action of a certain kind, could be used to create sympathetic action (healing) or to repel something evil. Magical elements were included in medical texts and were added to the prescriptions and medicines appropriate for the treatment of diseases. Some conditions like sterility and impotence in men used magic extensively while other easier ailments relied mainly on medicinal treatments. The heart was extensively studied with arteries; however, it is not clear if they fully understood the circulation of blood. In fact, the heart was considered to be the organ of reason instead of the brain, although this later organ was extensively studied as well. Anatomy was well understood and dissection was a common procedure.

There are many medical papyri providing detailed descriptions of surgical procedures and other topics related to medicine. The collections are massive and medical knowledge is organized and detailed. Such organization of knowledge is a prerequisite for major advances in science. Indeed Greeks made extensive use of Egyptian science and medicine and created their own school of medicine that dominated the ancient civilizations for centuries to come. By the time Hippocrates began his scientific medicine in his native city Cos, the city was already the headquarters of the Asclepiadae, a professional association of physicians under the patronage of Asclepius, the god of healing. These practitioners were familiar with Mesopotamian and Egyptian medical knowledge and used such texts extensively. However, the Greeks based their medicine on empirical knowledge and separated the supernatural from scientific information.

The first major Iranian dynasty the Achaemenids (550 BC) promoted the development of culture and science extensively. The great scholars such as the philosopher Heraclitus of Ephesus, the Babylonian astronomer Kidinnu and even the historian Herodotus were Persian subjects. The ancient cultures of the Egyptians, Babylonians, Elamites and others continued to exist and develop. Babylonian physicians were all over the territories and served all people including Persians. Xenophon relates that when the Greek soldiers who served under Cyrus the younger passed through the territory of Babylonia, they found sufficient number of physicians—even in the villages—to treat the wounded warriors. Texts describe how physicians used medicine, prayers and magic. They would often model images of evil spirits out of clay and shatter them, in order to restore the ill to health.

The Achaemenids made Babylon one of their major capitals and extensively used the texts at the temple libraries. The library and museum at the Persepolis was built to rival the Babylonian archives famous in the ancient world. The Greek and Egyptian physicians were invited to join the Achaemenid court and served the royal household. Persians also adopted the tradition of paying the physicians according to their rank and gender. The archives at Persepolis indicate that physicians and midwives who delivered boys were paid double the amount they got when the baby delivered was a girl. The records do not indicate severe punishments if the sick person died, as was the case under Hammurabi. Texts also show lists of plants, herbs and other substances used for medicinal purposes. Drugs are taken internally; mercury, antimony, arsenic, sulfur and animal fats were also prescribed. All are basically the same as the Babylonian medicine and prescriptions.

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