Babylonian History of MedicineI

1. History of Medicine Babylonian Civilization Rivindu WickramanayakeGroup no. 041st Year 2nd Semester

2. BABYLONIA- Introduction • The Greek form Babylon (Βαβυλών) is an adaptation of AkkadianBabili. The Babylonian name as it stood in the 1st millennium BC had been changed from an earlier Babilli in early 2nd millennium BC, meaning "Gate of God" or "Gateway of the God" (bāb-ili) by popular etymology.

3. Babylonia • Type- Settlement • Area- 9 km2 (3.5 sq mi) • Builder-Amorites • Founded- 1894 BC

4. Geographical Location In the Past Now

5. ADMINISTRATION • Babylonia was an ancient Akkadian-speaking Semitic nation state and cultural region based in central-southern Mesopotamia (present-day Iraq). It emerged as an independent state c. 1894 BC, with the city of Babylon as its capital. It was often involved in rivalry with its fellow Akkadian state of Assyria in northern Mesopotamia. Babylonia became the major power in the region after Hammurabi ( 1792 - 1752 BC middle chronology, or 1696 – 1654 BC, short chronology) created an empire out of many of the territories of the former Akkadian Empire. King was the ruler.

6. King Hammurabi King Nebuchadnezzar II

7. BEGINNING OF BABYLONIAN MEDICINE • From records available in Babylonia, both magic and medicine served as strategies for healing the sick, marshaling the authority of religion whenever possible. What was obvious from early studies was that Babylonian medicine contained a fair amount of magic:incantations appeared alongside recipes within the medical corpus, and diseases were often thought to have been brought on by various gods and demons.

9. BASIC PRINCIPLES • There are three “preconceptions” for theory: 1.Imagination(the process of clarifying the randomness found in nature), • 2.Deductive logic(finding logical, causal relationships), and • 3.Observation (a formalized and calibrated set of data). The second model for determining the scientific nature of Babylonian scholarship is that the more mathematical a discipline, the more scientific it was.

10. THE SYSTEM OF MEDICINE The system worked as follows: • In the Babylonian view of the world, gods decided all matters dealing with human fate.Babylonian scholars grounded much of their scientific knowledge in an ancient belief system incorporating magic, in which illnesses were ultimately caused by demons or angry gods, or perhaps indirectly caused by these same factors through, for example, ingesting bewitched foodstuffs. • This belief system formed a useful general background explanation for the ultimate causes of illness, which the patient could readily accept.This general explanation of illness, however, would never be expounded as theory per se in any Babylonian tractate. On the other hand, in comparison with the Greek theory of “humors,” the Babylonian idea of demons as invisible bearers of disease conforms in some ways more closely to modern notions of bacteria and viruses.

11. Babylonian Queen of Night Ishtar (Healing Goddess) God Marduk

12. TYPES OF MEDICAL PRACTITIONERS AND HIERACHY • Concentrates on the exorcist and the physician, but also considers the evidence for the diviners. By examining the terminology used in medical and lexical texts for exorcists and physicians. • While the terminology for physician is consistently asû, there are two mutually exclusive terms for exorcist, mašmaššuandāšipu. Through analysis of the lexical lists and the context in which these terms were used it can be concluded that the two terms do not mean the same thing, but are synonyms.āšipuwas a more prestigious term used in scholarship and literature whilemašmaššuwas a term used more generally. Importantly, our translation of āšipuand mašmaššu as “exorcist” is far too narrow for the “exorcist” performed a wide variety of rituals of which exorcism was just one.

13. MEDICINE BASED ON LAW & ETHICS • The first instance is the regulation of physicians (asû) and barbers (gallābu) in Hammurabi’s Laws from the Old Babylonian period. The Babylonian king regulated what physicians could charge patients of the different social classes and what the penalties were for both physicians and barbers who committed malpractice. Noteworthy is the absence of exorcists from Hammurabi’s Laws. The prominence of the physician in the laws reflects the text’s focus on civil law and hence its interest in surgery. • The second instance is in the letters discovered at the city of Mari from the Old Babylonian period. The letters from the time of Yasmah-Addu and later show that there were staff physicians at the royal court. However, it is clear that the kings preferred the service of foreign physicians over the local staff.The prominence of the physician in the Old Babylonian courts is mirrored in the medical texts from the period, for the medical texts do not contain magical elements, rather they typically comprise medical prescriptions with a prognosis.

14. UNIVERSAL SYSTEM OF LAWS • Hammurabi is the best known and most celebrated of all Mesopotamian kings. He ruled the Babylonian Empire from 1792-50 B.C.E. Although he was concerned with keeping order in his kingdom, this was not his only reason for compiling the list of laws. When he began ruling the city-state of Babylon, he had control of no more than 50 square miles of territory. As he conquered other city-states and his empire grew, he saw the need to unify the various groups he controlled. • A Need for Justice • Hammurabi keenly understood that, to achieve this goal, he needed one universal set of laws for all of the diverse peoples he conquered.

15. Stele of HammurabiThe Hammurabi Code of Laws is Inscribed on this. Hammurabi Code (King Hammurabi at Royal Court)

16. HAMMURABI’S LAWS FOR MEDICAL PRACTITIONERS • 215.If a physician make a large incision with an operating knife and cure it, or if he open a tumor (over the eye) with an operating knife, and saves the eye, he shall receive ten shekels in money. • 216. If the patient be a freed man, he receives five shekels. • 217. If he be the slave of some one, his owner shall give the physician two shekels. • 218. If a physician make a large incision with the operating knife, and kill him, or open a tumor with the operating knife, and cut out the eye, his hands shall be cut off. • 219. If a physician make a large incision in the slave of a freed man, and kill him, he shall replace the slave with another slave. • 220. If he had opened a tumor with the operating knife, and put out his eye, he shall pay half his value. To Next Page;

17. Continued; • 221. If a physician heal the broken bone or diseased soft part of a man, the patient shall pay the physician five shekels in money. • 222. If he were a freed man he shall pay three shekels. • 223. If he were a slave his owner shall pay the physician two shekels. • 224. If a veterinary surgeon perform a serious operation on an ass or an ox, and cure it, the owner shall pay the surgeon one-sixth of a shekel as a fee. • 225. If he perform a serious operation on an ass or ox, and kill it, he shall pay the owner one-fourth of its value.

18. This chart outlines fees and penalties for successful and unsuccessful procedures. There are no fees for unsuccessful bone setting and sinew mending because outcomes are usually not fatal; operations can be repeated until the result is satisfactory. Omission of fees for mushkenum(the middle class) indicate that the scribe failed to copy a section containing a penalty.Awelumwere the upper class; wardumwere slaves.

19. More Facts; • Hammurabi's Code required accusers to bring the accused into court by themselves. • A number of the laws refer to jumping in the Euphrates River as a method of demonstrating one's guilt or innocence. If the accused returned to shore safely, they were deemed innocent; if they drowned, they were guilty. This practice follows the Babylonians's belief that their fates were controlled by their gods.

20. Pharmacy in Ancient Babylon

21. VARIOUS TYPES OF TREATMENT AND SURGERY THAT WAS PREVAILANT • Hundreds of drugs cited in Babylonian medical recipes, in addition to long lists of plants and minerals used for medicinal purposes, often with descriptions of the drugs and of the diseases for which they could be used. • One redeeming feature of Babylonian medicine is the lack of surgery, because of the substantial risks involved. Almost all Babylonian medical texts are limited to pharmacological preparations administered mostly as potions, salves, ointments, fumigations, or suppositories. Surgery would have been dangerous without either proper antiseptics or anesthesia, nor is there any firm evidence from Babylonia of bloodletting. For this reason, the Babylonian physician probably caused less harm to his patient than his later colleagues in medieval Europe.

22. Seal of a Babylonian Azuwith reverence to the gods, a self-portrait and depictions of bronze knives, cups and needles. Translation: O Edinmagi, servant of the god Girra, who helps mothers in childhood, Ur-Lugaledinathe physician is your servant. (From A. Leix. Medicine and the Intellectual Life of Babylonia. Ciba Symposia 1940; 2:663 - 674.)

23. DIAGNOSIS AND TREATMENT OF SICKNESSES AND AILMENTS • It is not particularly easy to classify diseases within Babylonian medicine, although they fall generally within similar categories in Hippocratic medicine. Some diseases are simply associated with parts of the body, such as head disease, tooth disease, eye disease, nose disease, even foot disease, as well as kidney disease and anus disease. Baldness was treated as a disease. There are varieties of skin diseases, including rashes and pocks, as well as leprosy-like conditions affecting the nose and mouth ,but it is impossible to diagnose these conditions according to modern disease terminology. • They cover a wide range of ailments grouped roughly according to the part of the body chiefly affected. The leading treatises deal with ailments of the head, including mental troubles, infections, baldness, and affections of the eyes, ears, and temples; ailments of the respiratory and digestive organs, and of the muscles and ligaments. There were, besides, specialized works on pregnancy, child-birth, obstetrics, and diseases of the genital organs.

24. Clay model of a sheep's liver used for divination. Each of the designated individual fields has explanatory text with specific diagnoses. (From A. Leix. Medicine and the Intellectual Life of Babylonia. Ciba Symposia 1940; 2:663 - 674.)

25. HEALTH AND WELLBEINGOF THE CITIZENS • The textual evidence reveals some differences between the activities of exorcists and physicians. It seems theexorcist was responsible for the magical prevention of disease (warding off demons, angry gods, and witchcraft), visited the sick and made prognoses, and held priestly responsibilities at the temple. • The physician, however, seems to have been involved in treating existing symptoms (insect bites, kidney stones, etc.) and preparing medical recipes for sale and apothecary. These differences in practice can be somewhat understood in the light of their place of occupation. The exorcist was a member of the temple administration while the physician seems largely to have been independent, probably operating a street stall. • The exorcist received temple prebends (of which we have records) while the physician was an entrepreneur who could travel from land to land.

26. Model Liver of a lamb used in exorcist treatment

27. KINDS OF MEDICINE USED, THEIR SOURCES, PREPARATION AND USAGE MateriaMedica • of Babylonian recipes consisted of trees and plant matter (seeds, roots, sprouts, leaves, fruit, branches, even wood), grains such as barley and flour, and various spices and vegetables. There are • variety of liquids into which drugs could be dissolved, such as water, milk, fish brine, sesame oil, and urine, and in some cases drugs were filtered and distilled; alcohol (beer and wine) were excellent agents for dissolving drugs. In many cases, drugs could be mixed with animal products such as sheep fat and lard, and less regularly in fish brine, blood, and bone marrow. Some exotic animal products were also used as • Materiamedica, such as mongoose blood, turtle and mussel shells, and other animal viscera. Mineral stones could also be ground up, and the recipes call for animal or even human excrement (e.g. bat guano), but such Dreckapotheke have been shown to be secret names for ordinary plants

28. The materiamedica employed in treatment of these ailments includes a long list of vegetable, mineral and animal substances (including excreta), most of which are impossible to identify. A frequent method of use, after special preparation, was by direct application to the affected part, or by binding it on. The commonest method of administering was by mouth, and occasionally by the use of a rectal suppository. • There is no clear indication that the physician knew anything of the real nature of the ailment encountered or, except in the more obvious cases, the function of the organs affected. Among the long list of available remedies, a few, like • oil for stiff limbs, or • milk for stomach troubles, • salt peter and crushed ostrich shell for kidney stones, may have been beneficial, but some of the remedies employed seem to be entirely valueless. This may even have been realized at the time as indicated by the seeming indifference with which the physician moved through a long list of medications, shifting from one to another for the same disease.

29. Preparation and Sources of Medicine in Ancient Babylon

30. Preparation and Usage • Once the plants or other items have been gathered, there is a long list of how they must be treated and used to make up the recipesthemselves: • materiamedica need to be “taken” in the first instance (i.e. gathered or selected), then weighed, washed,immersed, dried and desiccated, roasted and burned, crushed, pounded, cut up, beaten, diced, chopped, grated, pulverized, sifted, pressed out, soaked and dissolved, kneaded, stirred, sprinkled, saturated, spread, blended and mixed, poured out into vessels, warmed up and heated in an oven, cooked and boiled, and finally cooled . • Each of these actions is governed by a rich and varied medical technical vocabulary, with parallels in Greek medical recipes. Drugs, consisting mostly of plants and minerals, were prepared in the form of potions, salves, powders, pills, tampons, and pessaries, to being ingested, rubbed onto the body, applied as a bandage, or inserted into the anus, urethra, ears, or vagina through lubricated copper tubes or reeds. Not only was there a large variety of drugs, but there was an equally important variety of ways in which drugs could be utilized, in both simples and compound recipes.

31. Treating a patient • No data was compiled, since there were no clinical trials to prove whether they were successful and reliable.

32. MEDICAL EDUCATION • Ancient scholars were trained and what evidence there is for professional development and scholarly practice. The scribes’ titles and the terminology used for tablet copying to reconstruct how a scribal school functioned. The scribal titles provide clues to some form of hierarchy, but no overall picture emerges of how scribes could progress. Particularly interesting is the analysis of the terminology in colophons which indicate the purpose of the tablet. Much attention is paid to the phrase anatāmarti, literally “for viewing,” but often understood to mean “for reading.” A convincing argument that anatāmarti had a more specific meaning, which was “reading for academic scrutiny.” • Assessing the evidence for theory in Babylonian scholarly practice, The late Uruk medical commentaries provide information about what the ‘professors’ (ummânu) taught their students. While the commentaries are not full treatises, they are evidence that the Hellenistic Babylonian schools were reinterpreting and explaining the received medical texts. Such evidence strongly suggests that theory was part of the teaching and learning procedures in the scribal schools of this period.The commentaries, and the archives in which they were found, indicate that the division between medicine and magic was gone, and that exorcists in particular studied all areas of Babylonian science. In this way, the Uruk commentaries provide an insight into one reason the exorcists were more prominent than the physicians in later Babylonian history.

33. Ancient Babylonian Tablets

34. Some famous Babylonian Physicians • The division between magic and medicine seems to have continued into the Middle Babylonian period as evidenced in an archive of letters from Nippur. Many of the letters in the archive were written by a medic, Šumu-libši,and his colleagues who worked in a temple. Unfortunately, Šumu-libši does not refer to his title so it cannot be determined whether he was a physician in the temple or if he was an exorcist with a good understanding of medicine . Šumu-libši used non-magical therapies for patients. Thus, in the second millennium, there was little overlap of magic and medicine in therapy.

35. Sources;

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