Читать книгу The Greatest Benefit to Mankind: A Medical History of Humanity - Roy Porter - Страница 19

By around 3000 BC the warm and fertile region in the Middle East watered by the Tigris and the Euphrates was cradling some of the world’s first great civilizations: Ur on the Euphrates, founded by the Sumerians, a hundred miles upriver from the Persian Gulf; Babylon, farther up the Euphrates; Assyria, centred on Assur, and later Nineveh on the Tigris, near Mosul in modern Iraq. Assyria destroyed Babylon; Nineveh reached its height under its kings Sennacherib (r. 705–681 BC) and Assurbanipal (r. 668–627 BC); its fall to the Persians in 608 BC is celebrated in the Bible.

All these Mesopotamian (‘land between the rivers’) kingdoms have left magnificent remains, archaeological and written, which permit reconstruction of their dynasties and deities, and the agrarian and bureaucratic infrastructures that sustained them. Their healing practices remain cloudy, but among the 30,000 or so surviving clay tablets covered with cuneiform writing there are about a thousand from the library of Assurbanipal on medicine, containing diagnoses and prognostications, remedies and their ingredients. These date from the seventh century BC, though the Sumerian/Assyrian healing traditions they record go back much further.

The chief text, called ‘The Treatise of Medical Diagnosis and Prognosis’, comprises some three thousand entries on forty tablets. It is basically a fist of ailments, and some are identifiable today: ‘the patient coughs continually. What he coughs up is thick and frequently bloody. His breathing sounds like a flute. His hand is cold, his feet are warm. He sweats easily, and his heart activity is disturbed’ – this sounds like tuberculosis. Eye disorders are prominent, and mention of ‘stinking disease’ and distended bellies suggests the vitamin-deficiency diseases symptomatic of the new grain-growing economies.

The framework for disease interpretation was largely omen-based, using divination based on inspection of the livers of sacrificed animals (hepatoscopy), because the liver was regarded as the seat of life. Prognostication may also have involved techniques like observing a flickering flame. Medical practice mixed religious rites and empirical treatments. Mention is made of three types of healers, presumably cooperating with one another: a seer (bârû), specializing in divination; a priest (âshipu), who performed incantations and exorcisms; and a physician (âsû), who employed drugs and did bandaging and surgery. An official head physician presided, and court doctors were expected to take an oath of office and allegiance.

The sixth king of the first dynasty of Babylon, Hammurabi (17 28–1686 BC) was a mighty ruler who made Babylon feared. Alongside the mathematical treatises, dictionaries, astrological, magical writings and other forms of learning that gave lustre to his reign, his greatest work was a legal code, whose 282 laws deal with the regulation of society, family life and occupations. The Code of Hammurabi, engraved on a two-metre-high stele found in 1901 at Susa in Iran and preserved in the Louvre, includes medical instructions for physicians. Its rules set out fees for treatment, with a sliding scale adjusting rewards according to the patient’s rank (nobleman, commoner or slave), together with terrifying draconian fines for incompetence or failure. ‘If a physician has performed a major operation on a lord with a bronze lancet and has saved the lord’s life … he shall receive ten shekels of silver’ (more than a craftsman’s annual pay); but if he caused the death of such a notable, his hand would be chopped off. A doctor causing the death of a slave would have to replace him.

The Mesopotamian peoples saw the hand of the gods in everything: disease was caused by spirit invasion, sorcery, malice or the breaking of taboos; sickness was both judgment and punishment. An Assyrian text of around 650 BC describes epileptic symptoms within a demonological framework:

If at the time of his possession, while he is sitting down, his left eye moves to the side, a lip puckers, saliva flows from his mouth, and his hand, leg and trunk on the left side jerk like a slaughtered sheep, it is migtu. If at the time of possession his mind is awake, the demon can be driven out; if at the time of his possession his mind is not so aware, the demon cannot be driven out.

Headaches, neck pain, intestinal ailments and impotence were read as omens, and remedies involved identifying the demons responsible and expelling them by spells or incantation, though when maladies were the work of a god they might be a portent of death. Sicknesses were also ascribed to cold, dust and dryness, putrefaction, malnutrition, venereal infection and other natural causes.

Physical symptoms might be treated with empirical remedies. The Babylonians drew on an extensive materia medica – some 120 mineral drugs and twice that number of vegetable items are listed in the tablets. Alongside various fats, oils, honey, wax and milk, active ingredients included mustard, oleander and hellebore; colocynth, senna and castor oil were used as laxatives; while wound dressings were compounded with dried wine dregs, salt, oil, beer, juniper, mud or fat, blended with alkali and herbs. They had discovered distillation, and made essence of cedar and other volatile oils. Use of dog dung seems to smack of Dreckapothecary treatments, faecal ingredients designed to drive off demons.

Such empirical remedies accompanied a prognostic bent reflecting Babylonian preoccupations with astrology, the casting of horoscopes and soothsaying through examination of animal entrails (haruspicy). Viewing disease as largely supernatural, Mesopotamian medicine might be regarded as sorcery systematized. Parallels to this are offered by Egyptian medicine, which developed at the same time and presents comparable healing practices involving prayers, magic, spells and sacrifices, together with practical drug treatments and surgery.