Episode 32. András Bácskay: Fever!: Transcript

0:14 JT

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.

0:32 JT

This episode we look at medicine in ancient Iraq. People then obviously suffered from many of the same problems as we do today. But they understood the human body, disease, and the world around them differently. It can be very difficult to recognise the diseases we know from the descriptions found in the ancient texts.

0:57 JT

The cures suggested in ancient medical texts can look strange to us. Just as disease was partly natural and partly supernatural in origin, so cures rely on what we would call medical and magical remedies. Some ingredients can be seen to follow a rationale. Others look more mysterious. Some look simply disgusting. But things are not always what they might seem.

1:27 JT

Our guest is an expert in Mesopotamian medicine. He has worked extensively on texts that treat symptoms featuring heat in some way—what we might call ‘fevers’ of various kinds. More recently he has been working on scribal remarks in the medical texts, which reveal evidence for alternative treatments, different local traditions, or other ways of integrating different ways of doing things.

1:55 JT

So get yourself a cup of tea, make yourself comfortable, and let’s meet today’s guest.

2:08 JT

Hello, and welcome to Thin End of the Wedge. Thank you for joining us.

2:13 AB

Hello, Jon. I am happy to hear you.

2:17 JT

Could you tell us please: who are you, and what do you do?

2:20 AB

I am András Bácskay. And I’m an assyriologist and ancient historiker (= historian), and a faculty member of the Department of Ancient History at the Pázmány Péter Catholic University in Budapest. I hold lectures and seminars for students of history and culture of the ancient near east. And my research focuses mainly on the Mesopotamian medicine and magic. And recently I am dealing with glosses in cuneiform medical texts.

2:28 JT

Could you set the scene for us please: what do we need to know, and what sources do you use in your research?

2:58 AB

I think that the most important fact that one of the largest text groups dealing with the medical topics in the ancient world originates from Babylonia and Assyria. With their two millennium-long tradition, the medical texts written in cuneiform attest the healing activity of one of the oldest literate cultures. These texts preserve numerous disease names, symptoms, treatment descriptions, and they also document the use of several hundred plants, stones, minerals, as healing material; diagnosis, prognosis pharmacological, and therapy feature equally in the Mesopotamian sources, which did not form a hermetically closed tradition, but made an important contribution to the healing activity of the later Near Eastern and more likely Greek and Roman antiquity. And I’m sure that the significance of Babylonian medicine cannot be overestimated with regard to the history of medicine, or the history of science in general.

4:06 AB

The first cuneiform medical texts are from the late third millennium, but the most sources can be related to the first millennium BC. Cuneiform medical texts originate from tablet collections of royal palaces, temples, as well as private persons. The most widely known were found as a part of neo- Assyrian royal libraries in Nineveh kept in British Museum, as well as in library of an incantation priest’s family in Ashur. Moreover, huge amount of cuneiform medical texts came to light in temple and private libraries in the first millennium Babylonia. Medical texts are known especially from tablet collections originating from Uruk, Borsippa, Nippur, and Babylon. A comprehensive investigation of the Babylonian medical sources still remains a desideratum of the research. But we have to emphasize that the Neo- and Late Babylonian medical texts fall outside of the scope of the more published or mainstream medical corpus, known to us from the Neo-Assyrian medical tablets. And they represent a local healing tradition.

5:19 JT

You’ve worked a lot on fever, When the Babylonian medical texts talk about fever, what do they mean by that?

5:28 AB

First of all, we have to emphasize that fever or terms for fever mainly occurs as a type of suffering in a list of symptoms description of the medical prescription, but various terms related to fever also appear individually as a name of disease. In medical texts, patients’ high temperature can be described using different Sumerian and Akkadian lexemes. The verbal and nominal form of the lexeme “to be warm” or “to be hot” is Akkadian ememu or ummu. The nominal form is the most commonly used term, which refer generally to the entire body or to specific parts of the human body. This term is not a specific medical phrase for the heat sensed on the human body, but it also related to the various topics or non-medical sources.

6:27 AB

Besides the general use of heat or fever, several specific names of illness were constructed using this term, such as “strong heat”–ummu dannu; “flaring of heat”–tsirihti ummi; “intense” or “not intense heat”–ummi hahhash or la hahhash; “chronic heat”–ummu lazzu; “constant heat”–ummu kayyamanu; “even” or “uneven heat”–ummu mithar or la mithar. All of these terms can be associated with the empirical experiences of change of temperature in strength or intensity or its duration. Further Mesopotamian lexemes associated with fever, are terms for burning pain or burning sensation–in Akkadian, hamatu and tsarahu–which can be attested on the patient’s internal or external body parts, like on stomach, or on skin.

7:31 AB

Besides lexemes with general meaning for the high temperature and burning sensation, the Mesopotamian medical terminology used two original expressions to indicate specific disease associated with fever. One of them the term is li’bu, which doesn’t mean fever in itself, but it stands together with terms for fever such as fever, burning fever, or strong fever. Moreover in one prescription li’bu in fact is the synonym of strong heat or strong fever, and further texts mentioned strong li’bu, which could also be interpreted as association of strong heat. Another specific fever-like medical term is Akkadian tsetum, which derives from the verb “to come out” and literally means “what is coming out”. In medical texts, this variation refers of two different medical problems: one of them is skin disease; and the other one heat radiance related to the sun. Maybe it is the sunstroke.

8:37 AB

Finally, it is important to note that the various medical terms for high temperature or inflamed status of the patient’s body cannot be interpreted as a fever in the sense of the modern medical diagnosis, because the Mesopotamians had no physiological knowledge about the evolution of fever and have no specific tools for measure of temperature of the body. Lacking the real information about the anatomy and physiology of the human body, empirical experience of Mesopotamian diagnosis was limited to the external surface of the patient’s body. And we also have to know that the references to the mentioned lexemes can be found in all types of medical texts. But we can observe differences between the terminology and the context of the references. For example, the so-called “vade mecum” text, which contains healing plants and disease names, do not mention any lexemes of fever or heat, which is the most frequent frequent term for the high temperature in therapeutic effects. On the other hand, the use of different terms may not always indicate different meaning.

9:52 JT

How did you get one of these fevers?

9:55 AB

The Babylonian medical texts do not describe precisely the physical reason of the disease. And the theoretical basis of the Babylonian medicine was primarily influenced by religious- magical view. From this point of view, diseases were caused by the effect of evil demons or they are punishment of the gods. We can observe the appearing of disease including a fever-like disease, were described as the seizure of the patient or patient’s body part, which can be associated with the personalisation of the supernatural forces. In the case of fever, at least three demons can be mentioned. In the symptom prescription for medical prescription Mukil resh lemutti demon caused fever in patient’s body. Another one is a female demon Lamashtu, whose destruction powers connected to the fever. Furthermore, the male demon Asakku is related to fever-like disease, and this demon can be associated with feverish stadium of the disease malaria. Moreover, the use of amulets against fever demonstrate clearly the close connection between fever and supernatural forces.

11:11 AB

On the other hand, our sources rarely mention direct connection between the specific medical problems and fever. In a letter written by Nabu-nasir, a court exorcist of Ashurbanipal, you can read about the cause and effect of teething problems and fever: “As to what the king my lord wrote to me, write me truthfully. I’m speaking the truth to the king, my lord. The burning wherewith his head, arms, and feet were burned, was because of his teeth. His teeth were trying to come out. Because of that, he felt burned and transfer it to his innards. Now he is very well and has fully recovered”. In this letter, the court incantation priest explains to the king that the inflamed status or the fever status of the patient’s body connected directly to the teething problems.

12:08 JT

How would they cure the fevers?

12:11 AB

Yeah, we have a lot of different medical terms for fever. And we have a lot of medical prescriptions to cure the fever. The most frequent healing procedures are the ointments, bandages, lotions, and finally the potions. The consistency and the method of these treatment depends mainly on the part of the body where the medical treatments are applied. Generally, for external problems they use bandages or ointments, and for internal treatments, mainly potions and enemas. It means that fever, for example, at a person’s head was cured mainly by external procedures like ointment and bandages.

12:55 AB

Formally different types of therapeutic procedures can be distinguished. One part of the treatment consists of only a single drug, but the majority of the procedures use several healing substances. In most cases, the drugs were used in dry form, and after crushing they were mixed or boiled in liquids– mostly in oil or beer–and applied directly on patients body part. Although the direct mention of cooling the patient is rare in our sources, we can observe that the application of liquid or semi-liquid medicine is written in therapeutic prescriptions. The scientific background of this praxis against fever could be based most probably on the opposition with hot and cold or dry and wet.

13:45 AB

Here I would like to present treatments to demonstrate the different types of healing procedures. The first presented prescription is a simplicium, which means that the recipe uses only a single drug. And this prescription is preserved on a cuneiform tablet from the library of Kisir-assur. I quote the text: “If somebody has been seized by heat, you mix first class wine from the country of Pizala with olive oil, then wrap him continually and he will recover”. The peculiarity of this prescription is the mention of the specific type of wine serving here as materia medica. The therapies and ointment in the text do not mention any specific body part. Therefore, we can suggest that the whole body of the patient was salved.

14:39 AB

The next station includes more recipes for the same disease. This prescription is preserved in a four-column tablet which originated from the same library as the previous one. “If somebody has been seized by fever, you wrap repeatedly kukku-plant, and burashu-juniper mixed in oil”. And the next recipes use coral and rub it repeatedly mixed in oil. The next one uses azallu-plant and something which is broken and you rub it repeatedly mixed in oil. And the last one–box-vine is a plant against heat.

15:18 AB

In this case, the text includes at least five different procedures. Each of them is ointment using different healing plants. All healing plants are very common. And they were also used against further disease. We can interpret the different procedures as an alternate, which was probably copied from different original tablets. Unfortunately, we do not have an information how was choosing the suitable procedure. The Babylonian doctor applied these therapies parallel. All of the mentioned procedures use single or maximum two healing substances. But the medicines against fever can be made much more drugs. We know one prescription which listed 79 drugs, including plants, trees, minerals, and stones. The popularity of this prescription among the Mesopotamian healers, could testify that the process is known from three different cuneiform tablets. And one of them the same Assyrian library than the previous two tablets, another one from the Late Babylonian archives.

16:30 AB

A further group of the treatments against fever consists of various magical procedures. One of these procedures described applying of phylacteries, which was sometimes also followed by ointments. A phylactery means the healing drugs were wrapped in leather or wool and it was placed around patient’s neck. Here I present again a citation of this type of cures. “If somebody has been seized by heat, you can use hair of the man’s skull, something broken, place it on his neck and salve him with antimitu-plant, and he will recover”. Second, “if ditto, which means that if somebody has been received by fever, use bone of mankind, ata’ishu or ninu-plant, harmunu-plant and salve him. If ditto again, living fly-catching spider and you wrap it in a tuft of wool”. The next one–“if ditto, black hair from the leg of donkey, leather worker fungus, you rub them on to leather”. Next one–“if ditto, the scale of snake, mother scorpion, bone of mankind, soiled rag, black frit, musu-stone, tsattsuntu– plant, you wrap them on the leather”. Next one–, “if ditto, you wrap hulu-mouse, plant of Lamashtu in a tuft of wool and place it around his neck”. And the last one–“if ditto, nuhhurtu– plant, cobweb, something broken, lizard from the steppe, you rub them mixed with oil on the leather”.

18:12 AB

This quoted text preserves one treatment in each line. The drugs are different, but the method is always the same: to place the phylactery around the patient’s neck. In other references, similar procedures were applied by incantations, which ensure the affectivity of these treatments.

18:34 AB

Another part of magical procedures against fever describes making and applying of cylinder-shaped amulets. Here I quote again: “If one day the fever seized him, on another day left him, you mix caal clay in canal water and wipe the ill man’s body. Take hair from the right part of the donkey and the hair from the left part of the donkey. Mix them in the clay and make a cylinder seal. Put the remaining animal hair on the cylinder seal, something broken, and repeat the incantation ‘Lamashtu, daughter of Anu, who was named her name by the gods Ardat-lili etc. etc.’ This is the incantation formula. You write this incantation on it”.

19:21 AB

As we see, the amulet was made of canal clay and canal water mixed with donkey hair from both sides of the animal. The magical medical impact of his amulet is based on two components: the inherent magic character of the material, and the magical quality of the incantation written on it. The magical background of the materials related to the canal can be explained by the purifying aspect of the water courses, which can carry the patient sin and illnesses from the human sphere into the netherworld. The hair from the left and right side of the donkey was used as an ingredient of an amulet in two such rituals against Lamashtu, who was one of the demons who can cause fever. And the procedure’s connection to Lamashtu supports the incantation written on the cylinder amulet. It is important to note that this amulet inscribed with the incantation has been also archaeologically discovered in a Persian grave in Ugarit. Now, as we’ve seen, there’s a lot of different procedures. One of them use only healing drugs. Another used healing drugs, minerals, and various drugs. And the third one is clearly magical procedures. We suppose that Babylonian doctors can use all types of these treatments. But I repeat again, we do not know how choose the Babylonian doctor which procedure will be fit to the patient.

20:29 JT

You offered an explanation for the use of some of the ingredients. A remarkable ingredient that caught my eye is lizards. Do we know why some recipes talk about putting a lizard in a pot with the drugs boiling it up and then removing it before giving the potion to the patient?

21:15 AB

The lizard was used as a pharmacopoeia of ointments in at least two or three prescriptions. And additionally, it was also applied as an amulet in the same prescription against fever. The explanation–maybe the Mesopotamian thought that the ectotherm animal took the patient’s heat upon itself. It’s important to know the sympathetic aspect of the lizard attested also in the Hittite medical texts, and also clearly mentioned a green lizard enclosed in a vessel and used as an amulet against fever. And we also know the frog was used in a similar method in Babylonian medicine.

22:03 JT

Other ingredients include bodily fluids and waste products. Are these ingredients always what they seem to be?

22:11 AB

The medical texts sometimes mention several drug names originated from animals or humans. And it seems to be that these drug names served as a Deckname or secret name of real healing plants. For example, “human semen” means the seed of amilianu– plant. Or the “pig bristle” is a Deckname of the elikulla-plant. Another type of this Deckname is associated with the names of gods or demons. “Plant of Shamash” seems to be an alias of shagiru-plant. But we also know that sometimes one Deckname can be connected to more than one healing plant. And finally, the use of the Deckname or the secret name in medical texts can be explained maybe that this text belongs to the secret knowledge owned by the families of healers and incantation priests.

23:12 JT

You mentioned that more recently you’ve been working on glosses. What is a gloss, actually?

23:19 AB

Yeah, formally, glosses are scribal remarks between the lines of cuneiform texts and glosses were written usually with smaller and sometimes lower contrast cuneiform signs. We can identify different types. The most frequent type is interlinear glosses, which has two sub-types: superscript or subscript. Another one is the so called embedded variants or embedded glosses. Finally, the last type is text written in blank lines. And functionally, the glosses may serve mainly an explanatory remarks. Making glosses can be associated with the copying and editorial activities of the ancient scholars. And we can also assume that this type of scribal remarks preserved oral comments or explanations similarly to those contained in the commentary texts.

24:25 JT

Could you tell us what different types you found and what the broader significance of each type is, please?

24:32 AB

Yeah, sure. The vast majority of glosses in medical texts are written in subscript. And I think the high number of subscript glosses suggests that this type was most widely used in medical texts. But it is very important to note that, for example, the embedded variants or embedded glosses are much more common in other text types. For example, in omen incantation series. The function of the embedded variants is always the same. That’s to provide alternative terms, mostly for drugs, or an alternative way of treatment. The function of glosses–it’s complicated. There’s a group of pronounciation glosses that center around Sumerian logograms or syllabic signs, Akkadian terms. On the other hand, the majority of the glosses are the so-called interlinear variants, which provide mostly alternative drugs, or technical terms. Alternative drugs may represent, I suppose, a suggestion for cheaper or more upmarket ingredients, or simply it’s representative of different healing tradition. Most of the glosses and embedded variants represent semantic variants, which seems were considered equal from the therapeutic point of view. In addition, different cuneiform signs with the same meanings can be identified as another possible semantic link between the variants and the gloss. Finally, orthographic variants also indicated with the help of glosses.

26:13 JT

When will your book appear?

26:16 AB

Hopefully it will appear in this year. I will be very happy. But the draft is ready for publishing now. And hopefully it will publish in the series of Dubsar.

26:32 JT

And how can we follow your work more generally?

26:35 AB

My papers, articles and small scientific writings can be followed on Academia and ResearchGate. But I have also a lot of information on the website of my university.

26:48 JT

Well, thank you very much.

26:49 AB

You’re welcome.

26:50 JT

I’d also like to thank our patrons: Tyler Russell, Enrique Jimenez, Jana Matuszak, Nancy Highcock, Jay C, Rune Rattenborg, Woodthrush, Elisa Rossberger, Mark Weeden, Jordi Mon Companys, Thomas Bolin, Joan Porter MacIver, John MacGinnis, Andrew George, Yelena Rakic, Michael Katsevman, Mend Mariwany, Kathryn Topper, Zach Rubin, Sabina Franke, Sophus Helle, Shai Gordin, Aaron Macks, Jonathan Stökl, Maarja Seire, Jaafar Jotheri, Morgan Hite, Chikako Watanabe, Mark McElwaine, Heather Baker, Sukanya Ramanujan, Laura Battini, Jonathan Blanchard Smith, Vanessa Richards, as well as those who prefer to remain anonymous.

27:45 JT

I really appreciate your support. It makes a big difference. Every penny received has contributed towards translations. Thanks of course to the lovely people who have worked on the translations on a voluntary basis or for well below the market rate. For Arabic, thanks in particular to Zainab Mizyidawi, as well as Lina Meerchyad and May Al-Aseel. For Turkish, thank you to Pinar Durgun and Nesrin Akan. TEW is still young, but I want to reach a sustainable level, where translators are given proper compensation for their hard work.

28:25 JT

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