In the world's first cities 4,000 years ago, people came to doctors for help with much the same problems they do today--everything from impotence, depression, tuberculosis and cancer to gluten hypersensitivity, hemorrhoids, narcolepsy and migraines.
The treatment they received in ancient Mesopotamia is also familiar in many respects, with medical specialists writing prescriptions for pills, potions and patches that patients would take to a pharmacist.
Studying medical texts inscribed in cuneiform, the first system of writing, Chicago researchers JoAnn Scurlock and Burton Andersen found the physicians of the earliest civilizations were delivering surprisingly sophisticated, knowledgeable and effective health care 2,000 years before Christ lived.
In fact, citizens received treatment superior to what Americans got in George Washington's time, according to the researchers. The first president died in 1799 after doctors bled him in an effort to rectify the "imbalance" of his bodily "humors."
Scurlock and Andersen describe their findings in a newly published scholarly tome titled "Diagnoses in Assyrian and Babylonian Medicine." At 900 pages and $150 a copy, it is not a likely bestseller.
But the book may well upend conventional wisdom about the history of medicine, which has always given a hallowed place to ancient Greek physicians and dismissed medicine in ancient Mesopotamia as primitive superstition.
Mesopotamian treatments evolved through hundreds of years of careful experimentation and observation, the authors say. Some are still in use, such as surgically draining the pus that sometimes develops between the lungs and chest wall of pneumonia patients. Their precise instructions to "make an opening in the fourth rib [with] a flint knife" to insert a lead drainage tube pretty well match present-day procedures.
The ancient Greeks, by contrast, subscribed to the idea that the body is composed of four "humors"--yellow bile, black bile, water and phlegm. The Greek model of medicine persisted in Europe and America as late as the 1850s.
"Their best known treatments were bleeding, purging with laxatives, puking and starving," said Andersen, a retired professor and chief of infectious diseases at the University of Illinois at Chicago. "We now know, of course, all four of those are injurious and very seldom helpful in any circumstance."
"The Greeks are our intellectual ancestors, but these Mesopotamians are the true ancestors of modern medicine," said Scurlock, a professor of ancient history at Elmhurst College.
In fact, their medicine appears so good that the authors hope to discover overlooked treatments that could be useful in tackling difficult conditions today. "That is the hope," said Andersen. "It's not likely, perhaps, but it is possible."
Scurlock and Andersen's new book, published late this summer by the University of Illinois Press, is based on their studies of nearly 1,000 clay tablets found in modern-day Iraq and covering a period roughly from 2000 B.C. to 150 B.C. Key among them were remnants of a standard diagnostic handbook used for hundreds of years to train and inform doctors. Researchers have been able to reconstruct about half the estimated 3,000 entries it once contained.
If injured or ill, citizens of a city/state like Nineveh or Uruk would seek out a doctor, called an ashipu. Often the physicians were specialists in areas like pediatrics, obstetrics, gynecology, neurology, infectious diseases, dentistry, vision and even veterinary medicine.
The doctors were religious figures and worked in temples. They and their patients usually viewed diseases as punishments from various gods, ghosts or demons. In the handbook and other texts, diseases are rarely named; instead they are described and attributed to the "hand" of the god responsible.
One tablet, describing severe arthritis, states: "If he has been sick for five, ten, fifteen [and then] twenty days ... the digits of his hands and his feet are immobilized and so stiff that he cannot open [them] or stand [on them], `hand' of Istar."
Without timepieces, doctors measured pulse by comparing a patient's to their own or to an assistant's. They noted body temperature by feel. Some of their diagnostic procedures continue to be used today, including using metal hammers to tap just below the knee to test reflexes.
As a cure, the doctors prescribed offerings to placate the offending gods and spirits. The offerings, however, took the form of medicinal treatments using plant, animal and mineral material. Treatments were administered with nearly every delivery system used today except for needle injections into the blood system, a method apparently unknown to them.
There were pills and potions, rectal and vaginal suppositories, enemas, medicinally saturated ear tampons and transdermal patches--salves spread on bandages that were bound to the skin. They were careful to keep surgical wounds clean with bandages treated with antiseptics like cedar and ginger.
"A couple of tablets describe night blindness when a patient can see in daylight but is blind at night," Andersen said. "They talk about cutting off a piece of liver and having the patient eat it. Night blindness, we now know, is caused by Vitamin A deficiency, and liver is loaded with Vitamin A."
The doctors had a system of putting plant material to burn on a hooded brazier, then telling the patient to stick his head under the hood to inhale the smoke. Scurlock said she is certain they used medical marijuana in that way.
"It seems to have been used to relieve pain, as an antidepressant and nausea," she said. "It seems also to have been used to treat impotence, but they recognized that it was a double-edged sword. It could create desire, but too much could be the cause of impotence."
What they couldn't treat, they were honest about, giving the patient and family the sad but inevitable prognosis.
The diagnostic handbook is almost poetic in its description of the sad hopelessness for a patient with dementia: "his [mind] is continually altered, his words are unintelligible, and he forgets whatever he says, a wind from behind afflicts him; he will die alone like a stranger."
A strong ethical code prohibited doctors from prescribing expensive treatments and magic rituals for patients who were obviously dying, Scurlock said. Instead, doctors were bound to do what they could to ease the patient's suffering, saving families from false hope and unnecessary expense.
The researchers say some diseases appear to be deadlier then than now, such as herpes, which apparently could cover people's bodies with sores and kill them. Some of the described diseases seem to have no modern counterparts.
"Humans since these texts were written have had thousands of years to develop disease immunities," Andersen said. "We may have evolved defense mechanisms that make herpes less serious now than it was then. There may be old diseases we have never seen because we developed immunities that long ago rendered them extinct."
Scurlock and Andersen's book deals mostly with the diagnoses and prognoses of disease by the early physicians, leaving treatments and therapies as the subject for a second volume still being researched.
The first book is so exhaustive and specialized that other scholars have barely begun to refer to it. Gary Beckman, a University of Michigan professor of Near Eastern studies, said his sampling of the contents has been enough to convince him the book will be invaluable to other cuneiform scholars--and also to question some findings.
"Most of these texts were known before, but most have never been available in transliteration before and gathered in one place," Beckman said. "Now it will be easier for others to approach these texts.
"It's difficult to know in fact if their conclusions are correct. Certainly they show there was more to this than mere magical belief. To say it is like scientific medicine might be difficult for others to accept."
The authors said it will prove impossible to figure out the contents of most Mesopotamian medicines because so many were plant-based. Scholars have identified about 200 to 300 Mesopotamian plant names, but that does not tell us what present-day plants they represent.
Without pictures or written descriptions of most of the plants, experts can only try to deduce what the plants are by deciphering the context in which they were used. By that means, Scurlock is fairly certain the Mesopotamians used henna, best known today as a hair dye, in many medicines.
"They didn't get everything," she said. "But it's amazing what they did find. ... It makes you proud to see what human intelligence could do back then without all the machines and computers we have now."
- Ancient name: Sagkidibbu ("affliction of the temples")
Modern condition: Headache
Modern treatment: Salicylic acid (aspirin)
Ancient treatment: "[You crush] together [and sift] adaru-poplar seed [poplar trees contain salicin], aktam, kamantu seed, amharu, kasu, huratu seed and kirban eqli. You decoct it in drawn wine. You scatter roasted grain [flour] and emmer flour on it. [You massage it into leather]. You shave his [head]. If you bandage him with it, he should recover."
- Ancient name: Nahshatu
Modern condition: Abnormal uterine bleeding
Modern treatment: Estrogen
Ancient treatment: "You char and grind date kernels [which contain estrogens], wrap it in a tuft of wool and insert it into her vagina."
- Ancient name: Kuraru
Modern condition: Ringworm
Modern treatment: Topical therapy with antifungal agents
Ancient treatment: "You plaster his head with cow urine. You wash it with uhhulu qarnqanu infusion [liquid soap] and kasu juice. You shave his head. You dry, crush and sift [these] 11 plants: shunu seed, pillu seed, qutru seed, kamantu [probably henna, a potent fungicide experimentally proven to be effective for ringworm], uriyanu [leaves], [...], rushrushshu, tsatsumtu, kurkanu, tigilu, mirishmaru and kalbanu. You mix it with first quality beer and vinegar. You bandage his head with it and do not take it off for three days."
Source: Dr. Richard H Beal, HittiteDictionary Project, Oriental Institute