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Mesopotamian medicine


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Mesopotamian medicine

  1. 1. History of Medical and Health Sciences Mesopotamian Medicine Dr.Akram Abood Jaffar Ph.D.
  2. 2. References and suggested reading <ul><li>Eleanor Robson, 'Medicine and healing: curing the body, calming the spirits',  Knowledge and Power , Higher Education Academy Subject Centre for Philosophical and Religious Studies. </li></ul><ul><li>Medicine in ancient Mesopotamia. Indiana University. Web page </li></ul><ul><li>Medicine, past, present and future. The past. Mesopotamian medicine. Web page. </li></ul><ul><li>Spiegel AD (1997): Hammurabi's Managed Health Care. Managed care magazine. </li></ul><ul><li>Biggs RD (2005): Medicine, Surgery, and Public Health in Ancient Mesopotamia. Journal of Assyrian Academic Studies. 19:1-19 . </li></ul>Click on a bullet to view the link
  3. 3. Objectives <ul><li>After the end of this session, students should be able to discuss: </li></ul><ul><li>What is meant by Mesopotamia? </li></ul><ul><li>Why the first civilization developed in Mesopotamia? </li></ul><ul><li>What are the features of Mesopotamian civilizations? </li></ul><ul><li>How cuneiform writing provided sources to study Mesopotamian medicine? </li></ul><ul><li>What are the Mesopotamian concepts of disease and healing? </li></ul><ul><li>Who provided healthcare in ancient Mesopotamia? </li></ul><ul><li>What are the sources of Mesopotamian medicine? </li></ul><ul><li>What are the rational methods of treatment? </li></ul>
  4. 4. Mesopotamia <ul><li>The name means &quot;the land between the rivers&quot;. </li></ul><ul><li>Refers to the geographic region which lies near the Tigris and Euphrates Rivers. </li></ul><ul><li>Many civilizations developed, collapsed, and were replaced. </li></ul>
  5. 5. Cradle of civilizations <ul><li>The region is made fertile by the flooding of the Tigris and Euphrates Rivers. </li></ul><ul><li>The floods aided agriculture by adding rich silt to the soil. </li></ul><ul><li>Tremendous amount of human labor was needed to irrigate the land and to protect the young plants from the flood. </li></ul>
  6. 6. Cradle of civilizations <ul><li>Given the combination of fertile soil and the need for organized human labor, it is not surprising that the first civilization developed in Mesopotamia. </li></ul>
  7. 7. Features of Mesopotamian civilizations <ul><li>Agriculture. </li></ul><ul><li>Towns grew to be cities. </li></ul><ul><li>Cuneiform writing was used. </li></ul><ul><li>Metal working had begun. </li></ul><ul><li>Temples were built on a monumental scale. </li></ul>The Ur Ziggurat.  In it's day, it was taller.  There was a temple built atop of this structure.  Ishtar gate in Babylon
  8. 8. Cuneiform writing <ul><li>A system of writing established by the Sumerians (c.3100 BC), which required the use of a stylus in order to make wedge-shaped marks on wet clay tablets. </li></ul><ul><li>Once the tablets were dry they could be stored, transported, etc. </li></ul><ul><li>Became the dominant system of writing in Mesopotamia for over 2000 years. </li></ul><ul><li>Even after Sumerian became extinct as a spoken language, many other cultures continued to write using cuneiform. </li></ul><ul><li>As a result of its extensive use of several centuries, many cuneiform tablets have survived. </li></ul>Stylus found in Kish revealing the method used in cuneiform signs
  9. 9. Cuneiform tablets <ul><li>Provided historians with the opportunity to study the culture of the ancient Mesopotamian civilizations. </li></ul>Tablet commemorating the construction of Sîn-kšid‘s palace Uruk
  10. 10. Mesopotamian concepts of disease and healing <ul><li>Spirits were blamed. </li></ul><ul><li>Each spirit or god was held responsible for only one disease. </li></ul><ul><li>Specific offerings were made to a particular god or ghost when it was considered to be a causative factor, but these offerings are not indicated in the medical texts. </li></ul><ul><li>It was recognized that various organs could malfunction, causing illness. </li></ul><ul><li>The plants used in treatment were to treat the symptoms of the disease, and were not given for magical purposes. </li></ul>Sumerian gods
  11. 11. Mesopotamian concepts of disease and healing Assyrian palace gateways were flanked by protective winged bulls to drive away illness carrying demons.
  12. 12. Mesopotamian concepts of disease and healing <ul><li>The interplay between spiritual and rational concepts are exemplified in a letter from the priest healer Marduk-šakin-šumi to Esarhaddon, who is laid low with a cold. </li></ul><ul><li>&quot;the gods of the king will quickly cure it, and we shall do whatever is relevant to the matter. [It is] a seasonal illness; the king, my lord, should not worry”. </li></ul>
  13. 13. Mesopotamian medical practitioners <ul><li>Two distinct types of professional medical practitioners: Ashipu and Asu. </li></ul><ul><li>Ashipu </li></ul><ul><li>Also accounted as &quot;sorcerer“ or exorcist. </li></ul><ul><li>Diagnose the ailment, this meant which god or demon was causing the illness. </li></ul><ul><li>Determine if the disease was the result of some error or sin of the patient. </li></ul><ul><li>Attempt to cure the patient by means of charms and spells that were designed to drive out the spirit causing the disease. </li></ul><ul><li>Could also refer the patient to a different type of healer called an asu. </li></ul>Marduk-šakin-šumi and Nabu-naṣir carried the title āšipu, often translated &quot;exorcist”, while Urad-Nanaya was an asû, usually translated &quot;physician”.
  14. 14. Mesopotamian medical practitioners <ul><li>Asu </li></ul><ul><li>Also accounted as &quot;physician“. </li></ul><ul><li>Specialist in herbal remedies. </li></ul><ul><li>Dealt with empirical applications of medication. For example, when treating wounds the asu generally relied on washing, bandaging, and making plasters (a mixture of medicinal ingredients applied to a wound and held on by a bandage). </li></ul>Seal of a Babylonian Asu with 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-Lugaledina the physician is your servant.
  15. 15. The relationship between Ashipu and Asu <ul><li>The relationship between the ashipu and the asu is not entirely clear. </li></ul><ul><li>The two kinds of healers seemed to have worked together. </li></ul><ul><li>The wealthiest patients probably sought medical attention from both. </li></ul><ul><li>Sometimes there is some overlap between the skills of the two types of healers: an asu might occasionally cast a spell and an ashipu might prescribe drugs. </li></ul>
  16. 16. Other health providers <ul><li>Temple of Gula (a goddess of healing): </li></ul><ul><ul><li>Patients were not housed at the temples dedicated to Gula while they were treated. </li></ul></ul><ul><li>The majority of health care was provided at the patient's own house by the family. </li></ul>The goddess Gula with her dog. Detail from a boundary stone dated to the reign of Babylonian king Nabu-mukin-apli, 978-943 BCE.
  17. 17. Other health providers <ul><li>The Mesopotamians believed that the rivers had the power to expel evil substances. A small hut was set up for the patient near the river. </li></ul>A healing ritual taking place in a reed hut. The healing goddess's dog on the roof. The sick person is stretched out on a bed, two priests carry out the rite. Cylinder seal from Tel Halaf. Dated to the first half of the first millennium BCE. Reed hut
  18. 18. Other health providers <ul><li>Gallabu (barbers): marking and unmarking of slaves and performing dental surgery. </li></ul><ul><li>Baru: </li></ul><ul><ul><li>Practiced hepatoscopy to predict, believing that the liver was the seat of the soul. </li></ul></ul><ul><ul><li>Used individual markings or overall shape of a sheep liver. </li></ul></ul><ul><ul><li>Diagnosis and prognosis were made by consulting a coded model of a sheep's liver. </li></ul></ul>Clay model of a sheep’s liver. Babylonian, about 1900-1600 BC. Sippar, southern Iraq. The model was used to teach students. 1-right lobe 2-left lobe 3-caudate lobe 4-quadrate lobe 5-porta hepatis 6-lymph nodes 7-gallbladder
  19. 19. Sources of Mesopotamian medicine <ul><li>Most of the information comes from cuneiform tablets. </li></ul><ul><li>Unfortunately, while an abundance of cuneiform tablets have survived from ancient Mesopotamia, relatively few are concerned with medical issues. </li></ul><ul><li>Tablets that mention medical practices: </li></ul><ul><ul><li>Library of Ashurbanipal. </li></ul></ul><ul><ul><li>Medical texts (420 tablets) were found at the library of a medical practitioner from Ashur. </li></ul></ul><ul><ul><li>Prescription tablets. </li></ul></ul><ul><ul><li>&quot;Treatise of Medical Diagnosis and Prognoses“ </li></ul></ul><ul><li>Code of Hammurabi. </li></ul>Sumerian medical tablet (2400 BC), ancient city of Nippur. Lists 15 prescriptions used by a pharmacist.
  20. 20. The library of Ashurbanipal <ul><li>Last great king of Assyria. </li></ul><ul><li>Tablets were housed in the king's palace at Nineveh. </li></ul><ul><li>When the palace was burned by invaders, around 20,000 clay tablets were baked (and thereby preserved). </li></ul><ul><li>660 medical tablets from the library of Ashurbanipal were published. </li></ul>Ashurbanipal 669-627 B.C. - ruled and expanded Assyria to include Babylonia, Persia, Egypt, and Syria. Ashurbanipal describes himself as a literate person in an account written by himself on his life and education.
  21. 21. &quot;Treatise of Medical Diagnosis and Prognoses“ <ul><li>40 tablets related to each other. </li></ul><ul><li>Dates to around 1600 BC. </li></ul><ul><li>Organized in head to toe order with separate subsections covering convulsive disorders, gynecology and pediatrics. </li></ul><ul><li>The descriptions of diseases demonstrate a keen ability to observe and are usually clever. </li></ul><ul><li>All expected diseases can be found described when those parts of the tablets are fully preserved, as they are for neurology, fevers, worms, VD and skin lesions. </li></ul><ul><li>The medical texts are rational. </li></ul><ul><li>Some of the treatments are essentially the same as modern treatments for the same condition. </li></ul>
  22. 22. Law Code of Hammurabi <ul><li>A collection of legal decisions made by Babylonian king Hammurabi (c. 1700 BCE). </li></ul><ul><li>Of the 282 edicts, 15 mentioned physicians, veterinarians, barbers or midwives. </li></ul><ul><li>A doctor was to be held responsible for surgical errors and failures &quot;the use of a knife”. </li></ul>Code of Hammurabi, large block of polished diorite. Louvre Museum in Paris Hammurabi receiving his laws from Babylon's sun god and god of justice, Shamash
  23. 23. Law Code of Hammurabi <ul><li>Both the successful surgeon's compensation and the failed surgeon's liability were determined by the status of his patient: </li></ul><ul><ul><li>If a surgeon saved the life of a person of high status, the patient was to pay ten shekels of silver. </li></ul></ul><ul><ul><li>If the surgeon saved the life of a slave, he only received two shekels. </li></ul></ul>
  24. 24. Law Code of Hammurabi <ul><li>If a person of high status died as a result of surgery, the surgeon risked having his hand cut off. </li></ul><ul><li>If a slave died from receiving surgical treatment, the surgeon only had to pay to replace the slave. </li></ul><ul><li>The severe punishment for negligence supposedly weeded out physicians incapable of delivering adequate care </li></ul>A physician testifies and defends himself in a trial concerning a malpractice complaint by his patient Hammurabi strictly enforced compliance through severe penalties. If they were not satisfied, patients could seek justice from a legal system
  25. 25. Spiritual methods of treatment <ul><li>Charm: Healers often prescribed protective necklaces to be worn during times of illness or stress. </li></ul>Assyrian jewellery was not simply pretty adornment. Coloured stones (and glass) were considered to have beneficial properties: they warded off evil and protected against harm.
  26. 26. Spiritual methods of treatment <ul><li>Spells. </li></ul><ul><li>Rituals. </li></ul><ul><li>Sacrifices. </li></ul>Preparing a ram for sacrificial divination; detail of the stone decoration of Assurnasirpal's Northwest Palace in Nimrud, c.860 BC 
  27. 27. Empirical methods of treatment <ul><li>Surgery. </li></ul><ul><li>Treating fractures. </li></ul><ul><li>Pharmaceuticals. </li></ul><ul><li>Delivery. </li></ul><ul><li>Empathy and encouragement. </li></ul>Medical instruments from Mesopotamia Medical instruments included bronze lancets, metal tubes to blow remedies into bodily orifices, and spatulas.
  28. 28. Surgery <ul><li>Law Code of Hammurabi infers that surgery was widely practiced. </li></ul><ul><li>One legal text may refer to cesarean section performed on a dead woman. </li></ul><ul><li>Clay tablets describe some surgical procedures: </li></ul><ul><ul><li>A procedure in which the asu cuts into the chest of the patient in order to drain pus from the pleura. </li></ul></ul><ul><ul><li>Postoperative care of a surgical wound recommending the application of a dressing consisting mainly of sesame oil (which acted as an anti-bacterial agent). </li></ul></ul>
  29. 29. Pharmaceuticals <ul><li>More than 250 medicinal plants (extracts, resins, or spices), 120 mineral substances and 180 other drugs were combined with alcoholic beverages, fats, honey, milk in various forms, oils, wax and parts and products of animals. </li></ul><ul><li>Many of the drugs mentioned in the tablets are difficult to identify: often the asu used metaphorical names for common drugs, such as &quot;lion's fat“. </li></ul><ul><li>Many of the plants incorporated into the asu prescriptions had antibiotic properties, while several resins and many spices have some antiseptic value, and would mask the smell of a malodorous wound </li></ul><ul><li>Medications were ground and filtered for ointments or plasters to spread on a piece of thin leather to apply. </li></ul><ul><li>Prescriptions specified enemas, laxatives, ointments,, pills, powders, and suppositories. </li></ul><ul><li>There was no extra charge for medications. </li></ul>
  30. 30. Delivery <ul><li>Childbirth was a serious threat to the health of both mother and baby. </li></ul>Protective bronze plaque depicts the evil demon Lamaštu travelling on a boat through the Underworld as she prepares to snatch away a newborn. The mother in labour is surrounded by fish-cloaked scholars, protective genies, and Lamaštu's nemesis Pazuzu, who pokes his head up over the back. Musée du Louvre.
  31. 31. Empathy and encouragement <ul><li>When Esarhaddon had eaten nothing for two days because of depression, the senior exorcist Adad-šumu-uṣur sent him a letter: </li></ul><ul><li>“ Good advice is to be heeded: restlessness, not eating and not drinking disturbs the mind and adds to illness. In this matter the king should listen to his servant” </li></ul>Berlin Museum Replica of a stele depicting Esarhaddon Assyrian King 7th century BC.