Hello, and welcome to the Thin End of the Wedge. The podcast where experts from around the world share new and interesting stories about life in the ancient Middle East. My name is Jon. Each episode, I talk to friends and colleagues, and get them to explain their work in a way we can all understand.
Health is a universal human concern. It will come as no surprise then, that it was a concern in the ancient Middle East. The sources have a lot to tell us about health and wellbeing. Healthcare, on the other hand, is something that varies widely. While we may all have more or less the same body, how cultures understand that body differs. And what we do to that body, therefore also differs.
Cuneiform medical texts have been known since the beginnings of assyriology. But they’ve never enjoyed the attention that, say, ancient literature has. This pre-modern medicine seemed to have little to offer. At first glance, it looks like hocus pocus. The texts of course have special vocabulary, so they’ve often been left to one side as being too difficult to understand. In recent years, however, Mesopotamian medicine has been the subject of ever increasing interest.
Our guest today is an expert in cuneiform medical texts. He introduces us to the ancient doctors and how they worked, with a focus on his recent work on eye medicine. He explains the challenges we face in interpreting the material, and our prospects for progress. One of our most important sources is a remarkable collection of texts known as the Nineveh Medical Encyclopaedia, a highly structured compendium from the seventh century BC. It’s newly reconstructed, and still only partly translated.
So get yourself a cup of tea. Make yourself comfortable. And let’s meet today’s guest
Hello, and welcome to Thin End of the Wedge. Thank you for joining us.
Can you tell us please: who are you, and what do you do?
My name is Strahil Panayotov. And I’m ancient historian or assyriologist. And in the last years I was working in the field of Mesopotamian medicine.
Could you start by telling us something about the doctors please?
The doctors in Mesopotamia, what we see from the cuneiform record is that we have two professions that are connected with healing functions. So as we understand–the doctor, or medical practitioner. We have one doctor that is called ashipu in Akkadian. And this is a medical practitioner that dealt mostly with physo-therapeutic methods, but was also involved in, let’s say, more magical stuff like treating ghost inflictions. And we have another doctor, that is more the magician, so to say. But these categories are modern. So we have two healing professionals that have their own specialisation. It’s a topic that was always discussed in assyriology. And if you ask assyriologists, every assyriologist will give you a slightly different explanation about these two healing professions.
How did these doctors work then? Did they work as individuals or in groups? Were they private or institutional? And where did they work actually?
Let’s start with if they work in groups. What we can see also in ancient depictions in imaginary, for instance, on amulet, that mostly there are two healing professionals around the bed of a sick person, for instance. So it seems also from the ancient texts that sometimes these two healing professions work together, but they also work separately. We have private doctors. Their workplace was mostly, I suppose, in the house of the sick person. This is what many texts are telling us. At the other hand, we have doctors that work at the royal court, for instance, so they were bound to institutions. And from the written record, it is obvious that also some temples were connected with healing. We certainly had doctors working there. But the written record is not crystal clear. So there are some interpretations. But for sure we have private doctors, we have institutional doctors, and we have doctors working in groups, and working individually. So it’s not that different from what is happening nowadays. What is really different is we are not informed about hospitals. So we don’t have any clue if there were hospitals in ancient Mesopotamia.
What kind of work did they do?
We can imagine the following scenario: a doctor would go to a house of a sick person. He will examine, or they will examine, the sick person. They might prepare a medication based on plants and minerals. They may anoint the patient with this medication, or give him some mixture to drink or some preparation to eat. But for instance, they could also fumigate the patient. It’s like in Thailand, so you go there and then he lit some candles, and burn some substances over fire burner. And this smoke magically heals the patient. We have ointments, we have potions that are drunk, some massaging, and another important treatment that people forget about, it is incantations. So there is psychological healing as well.
Do we know how effective the doctors would have been?
It depends on the perspective, and what do you consider being effective. This is the first thing to start with. With Mark Geller, we published a book on eye disease texts. And we worked closely with Dr. Annie Attia. She is French ophthalmologist. And she has excellent knowledge of cuneiform texts. She’s always saying that two thirds of the problems heal by itself. The human body can cope with a lot of the problems. So this means that if the treatment is not that effective, and if the treatment is not worsening the situation, the perspective of being effective is quite high. So I think the ancient doctors were quite effective.
And we see this in the cuneiform texts, because the medicine was written down for 1000s of years, the texts were transmitted. And we know that, for instance, there are tested cures. In Akkadian, this is the bultu latku. And the tested cures were transmitted sometimes for … we can trace maybe 1000 years transmission of a single prescription. Which means that some prescriptions and some medicines that were done by ancient healers work quite, quite effective. And we even have legends in cuneiform, that, for instance, this treatment or this medicine, for instance, the eye ointment of the king Hammurabi which lived in, let’s say 1800 BCE. And 1000 years later, we meet texts that tell about these ancient cures, which suggests that ancient Mesopotamian medicine was extremely effective for the ancient people. Of course, it depends on the perspective. And of course, modern medicine is technologically much more advanced, and some things look foolish. But on the other hand, the ancient doctor did quite well.
What kind of eye problems did they have?
First, every ancient society has different taxonomy. This is true for ancient versus modern medicine. So it’s quite difficult to say exactly what kind of problems ancient people had. But we can summarise and we can say that, for instance, ancient people experienced often eye dryness, something that is very common. We can frame the stuff with more general descriptions. For instance, we are certain they had trachoma. But we cannot really say what was this in Akkadian. For instance, problems like eye barley were common infection, different infections of the eyes, eye ailments that were connected with food, for instance. We have very interesting prescriptions that describe treatment of night blindness with animal liver. And as many people pointed out, this makes sense, because in the animal liver, you have vitamin Bs, that are helping against night blindness and so on, so that we have many things that we can generally describe and understand. But if modern ophthalmologists look[s] at the text, they see only general descriptions. And one of the most common general descriptions in the text is, in fact, when the eyes of a person or a patient are sick. So it’s extremely general. The descriptions are hard to be equalised with modern taxonomies of sickness.
What treatments did they use for these problems?
The treatments, we have a lot of treatments. Maybe it will be nice just to read a treatment. If a man’s eyes suffer from dryness, the patient should chop onion and drink it in beer. Then you, the practitioner, sprinkle sesame oil into his eyes, and he should get better. This is a very short prescription. So this is hard to understand. Everything seems okay. But if you start asking, okay, the eye dryness is something quite common. Every person has experienced eye dryness in his life. But we don’t know what’s really the cause for it. It seems that like chopping onion makes sense, because everybody also knows that if you chop onion then tears flow. But then if drinking it in beer will really help, this is another question. Sprinkling sesame oil into the eyes. Yeah, this might counteract the eye dryness. But was it really effective? And was it pleasant? I’m not sure about it. So we have many, many open questions about ancient treatment. But I think these texts are extremely important, because they contain original information from the ancient world. It’s not like Graeco-Roman medicine, where everything was transmitted, translated, and written down, edited and copied later on. The information that we have from the cuneiform sources is genuine, even though it was transmitted in cuneiform sources, it’s still the same culture. And this makes it quite important.
The taxonomy of anatomy and medical materials are also difficult, aren’t they?
It’s a big issue. It’s always a big issue. And it’s very rare that people pay attention to taxonomy. About anatomy, I say it’s a bit easier. Why? Because every human has the same human body more or less. We can identify the visible body parts with Sumero-Akkadian words. The therapeutic texts often mention eyes. So this is the word that they use for a problem, is “if the eyes are sick”. But then from the logical point of view, and especially this question was raised by Dr. Annie Attia: it makes no sense, and it will be extremely unhelpful and damaging treatment, if you rub, let’s say mixture from oil and minerals into the eyes. So we can imagine that this was rubbed at the outer part of the eyes. And again, this is a problem of taxonomy. In Akkadian, many words were used in more general sense than we would expect nowadays. So an eye might refer to the eyeball, might refer to the eyelid. We just don’t really know.
Taxonomy of inner body parts is much more complicated. And there we don’t have a lot of clues. Plants, medical ingredients, are a big problem, and especially identification of ancient plants. Since the birth of assyriology, so to say, people are trying to identify ancient plants, based on etymology, and based on descriptions. But all these methods are absolutely uncertain. And for most of the plants, we don’t have any clue what these ancient names refer to. And it’s quite disappointing. But that’s the state of the art so far. For ancient minerals, from stones, we’re much better informed, because sometimes we see inscriptions on stones that bear the name of the stone, which gives a positive identification for the stone.
For the medical ingredients, there is some hope, because we have some vessels that are inscribed in cuneiform, with ancient drugs and with medical preparations. From ancient drugs. If laboratory analyses these vessels, for instance, with organic residue analysis, we might have a positive identification. But so far, I can see this is the only methodology that will bring certainty. All other discussions and interpretations are by far uncertain.
When and where do our sources come from?
I touched a bit two minutes ago upon this topic. I think everybody who deals with Mesopotamian medicine, shall be first very proud of this fact, because that person is working with original texts from the ancient time. And this is very important, because this is not edited or re-edited later on in time. We always have to bear in mind that we’re working with spotlights. So we have periods with plenty of information, and we have periods with no or less information. And this is of course, due to the fact that some sites were excavated, not everything was excavated, so we are dealing with fragmentary material. The material that we know of starts in the late third millennium, BCE. We have cuneiform texts written in Sumerian dealing with different ailments, also eye disease. Later on in the second millennium, we see that like with every other genre of cuneiform texts, medical texts were edited and transmitted. So the big bulk of production starts. Like with every other cuneiform texts, the first millennium is really the period where we see many medical texts. What is important is that these medical texts are witness of older traditions, they were transmitted from older times.
Roughly how many texts do we have?
I would guess for around more than 2000 texts. So we have plenty of material. This material that I’m talking, these are not, you know, the same texts. Some tablets are big, some tablets are small. We have many, many hundreds of small fragments that can be joined to bigger tablets. And this is quite a big corpus, especially the so called Nineveh Medical Encyclopaedia.
Can we talk in more detail about the Encyclopaedia, please. So what actually is the Nineveh Medical Encyclopaedia?
This is a collection of material that was edited from earlier texts. And this material was gathered in Nineveh in the seventh century BCE, under the patronage of King Ashurbanipal. In these days, Assyria was the richest country in the world. And so they had all the resources to gather information. So a lot of information from different cities was compiled, and re-edited in Nineveh in order to build up one of the first and most important libraries in the human history. And so this compilation comes from Nineveh. What we can reconstruct so far is that this compilation had 50 large tablets that are divided in, we believe, 12 treatises. So you can imagine something like Encyclopaedia with 12 books, and each book had different chapters. It’s much larger than other ancient collections in those days. The 12 different books address 12 different body parts. The whole Encyclopaedia is extremely logically structured, much more structured than the Hippocratic corpus or Egyptian material.
So it’s structured from head to toenails. And it starts with head problems, general head problems. Then goes down to eye problems and continues with ears, nose, neck, dental medicine problems. Then it goes down to bronchial infection, nasal infection, goes down to lungs, respiratory problems, goes down to stomach problems, then kidney–kidney is a big topic–anus problem, everything with haemorrhoids, and so on, and then finishes with leg problems. Oddly, hands seem to be excluded from the problems, but hands also do get injured. They might have fallen under the leg, but it’s quite fragmentary, so we’re not sure so far. Within each book, so to say, there were sections with thematically different problems and different treatments, but they were ordered, so to say, in groups.
There are other areas that seem to be missing as well aren’t there? It’s quite noticeable, for example, that there doesn’t seem to be anything in there about gynaecology.
It seems that this is part of other collections. We know that gynaecology existed. But I think gynaecology is something special. It is always something different. Also nowadays. You know, there are also other medical fields outside the Encyclopaedia. For sure, we had treatments of wounds, and surgery, we had many collections with different incantations that address for instance, ghosts and demons. This was also part of the ancient healing system. And everything falls under the umbrella of medicine. But it was not part of the Nineveh Medical Encyclopaedia, although we see some surgical interventions mentioned here and there in the different treatises. But the corpus of gynaecology is a distinct corpus, and this makes sense.
Do we know how it was used?
Yes, and no. Of course, we don’t have precise instructions. Nobody will write it down, because the people knew how to use it. What we can see, for instance, is that the royal court of Nineveh, seventh century BC, we have the royal epistolary evidence from communications between the king and his scholars. Some of the scholars were medical practitioners. And there we see hints that point towards the fact that these specialised healers–these were the top doctors of ancient Mesopotamia–they were consulting medical works. And the most explicit medical works in Nineveh is the Encyclopaedia. So this Encyclopaedia was certainly used by medical personnel that lived in Nineveh.
Of course, it’s a big question, if precisely this precious collection of material could be used from doctors from other cities, but the material that is in the Encyclopaedia, the same prescriptions appear also on different tablets from different cities. So the material generally, so to speak, was in use by the medical doctors throughout Mesopotamia. We see this because the material from the Nineveh Medical Encyclopaedia comes first from older times. And some of the prescriptions and treatments are known from other ancient cities from Iraq, for instance, like Assur, or Sippar, or Babylon. But they’re also known from places like Sultantepe or Hattusa, which are sites in Turkey, or Ugarit, which is near Latakia in Syria. So, no, there is a broad geographical spectrum, where the certain spots, we see spotlights which resemble quite closely the Nineveh Medical Encyclopaedia, which is the ultimate collection of material in the seventh century BC.
The reconstruction of the Encyclopaedia is a relatively recent thing, isn’t it? Could you tell us something about how it was reconstructed, please?
Many assyriologists knew that in Nineveh, of course, there is a collection of medical writings, but they were not sure how to order them. So there was a big chaos in the information. And the reconstruction of the Encyclopaedia was, so to say, done in the late years, because I think because Mark Geller got a grant from the ERC and gathered different people that were interested in Babylonian medicine in Berlin. So I was part of the so called BabMed team. He had the idea to work on an ancient catalogue coming from the city of Assur. This ancient catalogue was not really published in those days, but many people worked upon it. He just wanted that we all studied the catalogue together. Slowly it turned out that many texts from Nineveh have the same order or similar order to the order of the catalogue. It was like playing with a puzzle in those days.
So it was obvious that, let’s say, the catalogue lists works in a certain order. And then if you check the works–with works I mean these are ancient tablets that are designated. And each tablet has a name. The way that the tablets are ordered is that every first line of the tablet, this is the name of the tablet. It’s an ancient methodology to order texts that’s known also from other cultures. And each tablet has a name and the following tablet has a name as well. And so at the end of the first tablet, you have something that is called a catchline. And this catchline is, in fact, the name of the next tablet. And in this way, the ancient scholars ordered their works. When they ordered them in a shelf, they had to be in a certain sequence. Otherwise, nobody could find anything in this big amount of information. And by pulling the pieces together from the catalogue, and from the tablets, we were able to establish the sequence. By proving many times the sequence, we arrived to the conclusion that this belongs to one work.
But the work for the reconstruction started more than 100 years ago with scholars like Campbell Thompson, working in the UK, also the British Museum. This is a work done by generations. It’s not that it’s done by several people; it’s done by a lot of people. But we could finally piece the pieces of the puzzle together.
How can we follow your work?
I upload from time to time things at Academia. I hope maybe to do more podcasts like this, because I’m hearing to podcasts, and I think this is something nice that you started really.
Thank you very much.
Okay, welcome, Jon.
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