doctors and medicine

   Healers no doubt existed in Mesopotamia well before the advent of cities in the late fourth millennium b.c. However, it was not until writing was invented and the healers began writing down their cures that tangible evidence for medical practices in the region began to accumulate. The oldest-known medical text in the world was discovered in the Sumerian city of Nippur. It dates to the late third millennium b.c. and was recorded in cuneiform symbols on a clay tablet. A much larger store of medical information - consisting of roughly eight hundred tablets - was found in the palace library of the Assyrian king Ashurbanipal at Nineveh.

   Common Medicines These tablets list some 370 substances purportedly possessing medicinal properties, about 250 of them derived from plants and the rest from minerals. The plant substances include tree bark and gum; roots; leaves; seeds; fruits, including pears, dates, and figs; spices such as thyme and myrrh; castor oil; and licorice. Among the minerals listed are potassium nitrate (saltpeter), sodium chloride (salt), and sulfur. Doctors kept many of these substances in containers, and when need arose they poured one or more of them into a liquid such as milk, wine, honey, or beer. The patient drank the liquid, ingesting the medicine in the process. To make an ointment for the skin, appropriate medicinal substances were added to animal fat or wax. Some healing substances were injected directly into the eyes, ears, rectum, vagina, or penis.

   The exact amounts of the medicinal substances to be used for a particular cure were decided by the individual doctor. Two general kinds of physicians existed in Mesopotamia - the asu, who primarily relied on these substances to effect physical cures; and the ashipu, who employed spiritual cures. From time to time a doctor might feel the need to resort to both physical and spiritual methods. The symbol used by Sumerian doctors to identify themselves was a staff with snakes encircling it. This image was later adopted by ancient Greek physicians, who inspired its adoption by the modern medical profession. Mesopota-mian doctors often plied their trade on the grounds of religious temples, so some temples were thought of as medical clinics as well as places of worship.

   The surviving Mesopotamian medical texts reveal that these doctors diagnosed and treated a wide variety of conditions and diseases, with mixed success. Among them were typhus, smallpox, bubonic plague, gonorrhea, gout, tuberculosis, epilepsy, colic, diarrhea, and various intestinal problems. Some forms of mental illness were also recognized, though not properly understood. The germ theory of disease was unknown, of course, and was not discovered and proven until the nineteenth century; yet it appears that some doctors were aware that a disease could be passed from person to person and therefore that it was helpful to limit a sick person's contact with other people.

   Because no one in ancient Mesopotamia knew about the existence of germs, it was assumed that most illness was caused by evil spirits or demons sent by the gods to punish humans. (This was the main factor that differentiated Mesopotamian doctors from Greek doctors. The latter came to reject the idea of divine causes of disease and advocated that sickness had natural causes.) Something like six thousand different demons were recognized, and it was a doctor's job to identify which specific demon was making his patient ill. It was thought that the demon or spirit afflicting the patient was punishing the person for some kind of sin; thus, it was seen as necessary to perform appropriate religious rituals to counteract the bad effects of the supernatural visitor. In some cases exorcism, or the act of driving a demon from a person's body, was called for.

   Common Practices Some Mesopotamian doctors also performed surgery, although very little specific information about the actual operations has survived. More plentiful are references to surgeons in law codes, which set fees for surgical procedures and recorded the penalties doctors suffered if their surgeries failed. Fees were set on a scale based on the patient's ability to pay. A doctor treating a commoner was allowed to charge only half as much as he charged a noble, and the fee for treating a slave was somewhat less than half of that for treating a commoner. As for penalties for malpractice, a surgeon who caused the death of a noble had his hand cut off.

   Some mention of dentistry is also made in ancient Mesopotamian texts, though there do not appear to have been doctors who specialized in this area. People believed that tooth decay was caused by an insidious worm that had been spawned in a swamp when Earth was first created. The traditional story of how the gods allowed this worm to feed on people's teeth was as follows:

   Came the worm before Shamash [the sun god]. Before Ea [god of freshwater] came her tears: "What will you give me to eat and destroy?" "Ripe figs will I give you," Ea answered. [Then the worm asked,] "What good are ripe figs to me? Take me up and let me reside between the teeth and the gums [of humans], so that I may destroy the blood of the tooth and ruin their strength; the roots of the tooth I will eat." [The gods then granted the worm's request.]

   To remove an infected tooth, the doctor grasped it with a medical instrument, perhaps a kind of forceps, cursed the worm three times in a row, then yanked. Afterward the patient was instructed to rinse several times a day with a mouthwash made of beer and sesame oil.

   See also: divination; exorcism