SCIENCE

Medicine

Although the treatment of medical problems included spiritual and magical practices as well as medical intervention, Mesopotamian doctors seem to have enjoyed considerable success in dealing with disease and other medical problems. A number of letters praise individual doctors or recommend remedies that have been efficacious, although others express anxiety about conditions that had failed to respond to treatment.

The city of Isin, whose tutelary goddess Ninisin (Gula) was associated with healing and midwifery, was a center of medical learning. In several texts individuals seeking to prove their medical credentials claimed to have trained in Isin.

Diagnosis. Because ill health was considered to have an external cause, whether due to punishment by the gods or bewitchment by an unquiet spirit, demon, or sorcerer, a major part of diagnosis lay in divination and magical ways of ascertaining the reason behind the illness. Compilations were made of observed signs and prognoses: the largest, Enuma ana bit marsi ashipu illiku ("When the exorcist is going to the house of the patient"), consisted of forty tablets, with some three thousand entries. Nevertheless there were also texts listing physical symptoms with instructions on preparing the appropriate medication and usually the observation that the patient "will get well," although in some cases death is said to be the expected outcome. Common recorded medical troubles included toothache, ear and eye problems, impotence, gastrointestinal ailments, skin diseases, incontinence, and respiratory disorders. Diagnosis could involve taking the patient's temperature and pulse, observing his skin color, looking for inflammations, and examining his urine.

Treatment. Two specialists dealt with illness. The ashipu (exorcist) used incantations and ritual actions to placate displeased gods and persuade them to turn away their wrath, drive away demons, lift curses, reverse spells, or lay troubled spirits responsible for an illness—but he might also prescribe a medical preparation. Conversely, the asu (physician), who dealt mostly with the physical symptoms, would probably administer his medicine with a charm or incantation. Physicians included women as well as men. Problems could be treated by either specialist, although from the mid-first millennium, there was more frequent recourse to the ashipu than the asu. One Neo-Assyrian court doctor, Urad-Gula, is listed at different times as an ashipu and as an asu: It is not known if his was a special case.

The story The Poor Man of Nippur gives a picture of the physician: clad in ordinary clothes but with a shaven head, and equipped with a libation jar and censer, he advertises his skills, saying that he comes from Isin, the city of medical learning. (In this irreverent tale, however, the Poor Man uses this disguise to create an opportunity for revenge: He beats up his patient, the Mayor, who has previously behaved badly toward him.) Other references show doctors also carried a bag containing herbs and sometimes incantation texts. Physicians like the disguised Poor Man of Nippur might seek private custom, but many were attached to royal courts.

Many of the treatments used were folk remedies, composed of herbs, animal material, or minerals, and administered as potions, enemas, or suppositories or used as ointments or poultices. Collections of prescriptions are known from Neo-Assyrian sources, particularly from Assur, but Sumerian medical texts from the Ur III dynasty also survive. These specified the injury or ailment and followed it with details of the appropriate treatment. Treatments involving incantations and the performance of rituals were often recorded in the same compendia as those using drugs. The three-tablet pharmacopoeia uru. an. na / mashtakal listed several hundred medicinal ingredients, including leaves, roots, seeds, and other plant material, salts, alum, and various types of powdered rock, and animal products such as blood, milk, fat, and bone. Many of the plants used probably had antibacterial properties. Often, however, the ingredients, particularly plants, are difficult to identify from their ancient names, making it impossible to assess how effective they would have been.

An Ur Ill-period tablet gives recipes for poultices and plasters, which contained ingredients such as mud, beer or wine, juniper, myrrh, honey, fat, and various plants. Resins were also a common ingredient, particularly terebinth. Beer and hot water were used to wash the affected area, which might then be rubbed with oil before the healing or soothing paste was applied. Oil could also be used as a wound dressing, applied on a fine linen bandage: This would have helped protect the wound from bacterial infection. Some recipes mention "essence of cedar," introducing the possibility that the Mesopotamians knew how to distil volatile oils.

One Neo-Assyrian text, compiled by the physician Nabu-le'u, gives a rare more detailed insight into treatment, listing medicinal plants, the complaints they should be used to treat, and the way they should be taken, including how

Often and at which time of day and whether the patient should take them on an empty stomach.

Prophylaxis. Epidemic disease and the dangers of dirty water were known. The possibility of contagion was recognized, and sometimes whole villages were evacuated to prevent the spread of disease. A royal letter from Mari spoke of one of the palace women having an infectious illness and advised that a cup, seat, and bed should be kept for her exclusive use to avoid the other palace women catching the disease from her.

A midwife attended women in labor. Both during pregnancy and after giving birth, mother and child were often protected by amulets to shield them from the baleful attentions of Lamashtu, the demonness responsible for miscarriage, death in pregnancy or labor, stillbirth, and death in infancy. Amulets worn as protection against demons often depicted the demon on one side and a text exorcising it on the other.

Surgery. The asu dressed wounds, set limbs, and performed simple surgical interventions such as lancing boils. A basic knowledge of human anatomy was probably acquired from the study of animal anatomy (important in divination) and from practical experience of treating war casualties and accident victims. Hammurabi's law code refers to setting a broken nose and healing a sprained tendon. Some more serious operations might be performed, but, according to Hammurabi's code, if the patient did not recover the surgeon was liable to have his hand cut off. Two types of surgery were listed in Hammurabi's inscription: a major operation by which the patient's life would be saved and "opening the eye socket," both performed using a bronze lancet. An incomplete tablet from Ashurbanipal's library hints at an operation in which the chest was opened to allow an abscess to drain. In another, better-preserved text, an abscess under the scalp was to be lanced and, if necessary, infected bone scraped away; if the abscess had not ripened, heat was to be applied to bring it to a head. One OB legal text may refer to a cesarean section performed on a dead woman. Surgical techniques were probably passed down from teacher to pupil: There are no texts discussing surgical practice.

Natural Sciences

The people of Mesopotamia had a good practical knowledge of the properties of clay, sand, metal ores, bitumen, stone, and other natural materials, using them to manufacture pottery, faience, glass, soap, metals, lime plaster, waterproofing, and other useful things. Metallurgy involved scientific skills such as smelting and cupellation; textile manufacture, the chemical treatment of hides and the manipulation of various dyes and mordants; the creation of glass required particular skills and knowledge; and extraction and distillation may also have been practiced. Surviving literature, however, suggests the Mesopotamians had little intellectual interest in the pure investigation of the physical and chemical properties of materials, which had no place in the school curriculum, and the emphasis in learning was on copying and repetition rather than investigation and en-

Quiry. Technological knowledge seems largely to have been transmitted orally and by example, from practitioner to pupil (and often from father to son). Only doctors, astronomers, exorcists, and other ritual specialists have left volumes of observational data concerning their disciplines. The rare exceptions to this were recipes, for alloying metals, for making glass in various colors, for mixing dyes, and for making perfumes, generally with a colophon urging the initiated reader to keep the information from unauthorized eyes.

The Mesopotamians were, however, deeply interested in the way the world was ordered by the gods. Many different versions of the Creation story were current: Literary accounts generally included a section on the creation of humanity and the organization of the world. Among the earliest texts, when writing was still in its infancy, are classificatory word lists, which are a form of taxonomy, and which were to become a regular part of education in school. These divided the world up into categories such as domestic and wild animals, birds, fish, trees, plants, and minerals. Within each category the entries were listed in an ordered or hierarchical fashion: for example, the body parts started with the head and worked down. Technical terms and chemical substances were also listed. Another popular literary form was the disputation, in which two opposing parties discuss their contribution to a particular activity or field of operation, boasting of their own achievements and denigrating their rival. For instance, Hoe and Plough dispute their relative importance in agriculture (see chapter 5); other disputations take place between Sheep and Grain, Bird and Fish, Ploughman and Shepherd, and Ox and Horse.

Biology was generally written about only insofar as it had a bearing on the accepted forms of scholarship. Animal physiology was studied in minute detail for divination, with attention focused on particular organs, notably the liver. Animal behavior was also relevant to divination. One practical text deals with training horses. Again, it is probable that there was a great body of knowledge transmitted orally: Those who worked with animals, such as shepherds, would have had practical expertise in treating the ailments of their charges, gaining knowledge that was only occasionally recorded in veterinary medical texts.