A discussion about disease

A discussion about disease invariably turns into discourse about health, which is generally defined in terms of the ‘scientific’ theories of contemporary cultures. Hence, notions about ‘health’ and ‘disease’ tend to be cultural constructs, dependent on the collective attitudes of a certain society within a certain period of history. As cultures evolve over time, influenced by political, economic and social factors, ideas about ‘health’ and ‘disease’ also change.

The existing ideas themselves influence ideas about ‘the body’, and vice versa; both of which have an influence on the way disease is treated. Galenic notions of disease, for example, regard an imbalance of bodily ‘humours’ as the origin of illness. Treatment of such illness requires a restoration of the balance. In contrast, Mesopotamians attributed illness (or any misfortune, in fact) to the wrath of a god; in this case, rituals would be performed to appease the said god, or solicit the assistance of a personal god. In this essay, I intend to explore the Mesopotamian notions of ‘disease’, how they changed, and their influences with respect to social and cultural factors.

It is a common notion that ‘disease’ is a condition that is deviant from the social and cultural norm of ‘health’; in effect, health and illness are seen as mutually exclusive opposites in the human state of being. Mesopotamians also believed in this dichotomy: perfect health constituted the protection of a personal god, good omens within the local environment, and avoidance of the wrath of any “witchcraft, spells, magic, or other evil incantations of men” (Kinnier Wilson, 1967b). A reversal of any of these conditions was believed to incur illness and disease. Divinity played a large role in Mesopotamian medicine and healthcare simply because divinity was a significant part of all aspects of Mesopotamian culture.

During difficult times, such as war or famine, Mesopotamian people would seek divine intervention to provide help. Each person believed they had a personal god, who was rarely in possession of vigorous ‘magical’ powers, but acted as a messenger and protector in communication between the individual and a higher power. Each aspect of Mesopotamian culture had a representative god, to whom pleas and enquiries were directed. In fact, one can gauge the significance of any aspect of Mesopotamian life according to the importance placed upon each divine patron. For example, Ea, the patron of wisdom – who had influence over all the crafts, including ‘magic’ and ‘medical science’ – and Gula, Sumerian goddess of healing, feature frequently in the archaeological evidence uncovered from the Ancient Mesopotamian period.

This implies that Mesopotamians considered ‘magic’, ‘medical science’ and healing as major elements of their lifestyle and culture. In contrast, the role of the as (a type of medical practitioner) is considered neither lucrative nor endowed with any special status by the Middle Babylonian period, because it lacks a special divine patron for its profession (Oppenheim, 1977). Evidently, Mesopotamian society did not deem the as as important enough to Mesopotamian culture for such an honour to be bestowed.

Also, since the Old Babylonian period, ass had traditionally been associated with the symptomatic relief of illness and disease, which was generally a more basic role than the ipu, who employed the use of incantation, divination and conjuration along with the application of medicine in the restoration of health. As divinity was an important part of society, and thepu was a necessary link between the divine patron and health, a�ipus had a higher status, with more lucrative careers. This highlights culture-conditioned behaviour towards medical practitioners in any civilisation.

Our ideas of the ‘magical’ and ‘rational’ elements to Mesopotamian health and disease are also cultural constructs; they are modern categories which western presumptions often – ignorantly – distinguish ‘scientific’ from ‘non-scientific’ attitudes (Heessel, 2004). While, Kinnier Wilson describes the Mesopotamian line between disease and health as ‘wrong’ (Kinner Wilson, 1967a), the emphasis should not be on where Mesopotamians demarcated the difference between health and disease, but on why the demarcation existed where it did. Our notion of disease as a localized pathology cannot be compared with the Mesopotamian notion of disease as ‘magical’ in origin.

In fact, we should not even use the term ‘magical’ and ‘scientific’ as categories within the realm of Mesopotamian medicine because they distort the cultural relevance of ideas of health and illness at the time. Mesopotamians did not differentiate between the medical and non-medical; the services of both as� and a�ipu were required for recovery from disease, and these services were not mutually exclusive. In Thrapeutique msopotamienne, Herrero makes the assertion that the difference between the curative techniques of an aspu depends on the way the nature of the illness is understood (Sarlock, 1999). If we impose our current understanding of illness upon the sources we interpret, we misrepresent the Mesopotamian construction of disease.

The sources from which we gather our evidence are themselves cultural constructs. We depend upon cuneiform tablets, specifically a rich corpus of medically related texts, to provide valuable insights into the nosology of the area (CDLI, 2003). Our interpretations aside, there are many ways in which these cuneiform tablets record the Mesopotamian notion of disease and health. Firstly, we should note that – as with any archaeological text – there are vested interests behind the production of a document containing a ‘standardised’ body of knowledge. Certainly in the Old Babylonian period, there was a royal obligation to manage the well being of a kingdom and its people.

The variety of professionals (for example, as�s and a�ipus) involved in healthcare included scholars who informed their opinion and practice of healthcare from medical literary texts. Further observations, amendments or novel ideas within the realm of medicine would be recorded onto cuneiform tablets and, depending on royal patronage, slowly incorporated within influential collections of medical works. These scholars would often be a�ipus, who were known to be literate and frequently acted as scribes. According to the interests of the royal patron, these texts would be copied and amended; that which was considered important to the culture of the time was dutifully included and emphasised. For this reason, cuneiform tablets do not necessarily reflect the general consensus on disease and healthcare, but instead depict the notions of a subset of that contemporary culture.

Secondly, Oppenheim comments on the remoteness of cuneiform as a writing style from the realities of everyday life (Oppenheim, 1977) and I am inclined to agree. Although we have few other sources to make such comparisons, it seems unlikely that the Mesopotamian culture interacted in the poetic storytelling fashion of cuneiform tablets. It seems more likely that information was recorded in this way as a rhetorical style, not a realistic depiction of everyday relations and occurrences.

At the same time, these tablets represent the ideas, activities and even culture of a localised region or kingdom, to be learnt from in later centuries. Any diseases recorded would be analysed by later generations, and this information was built upon, to the extent that it is difficult to know which notions of disease are specific to which cultures across the time span of many centuries. Also, as there was no requirement for health practitioners to be literate, nor base their activities upon a standardised corpus of medical knowledge, the treatment and concepts of disease may easily have differed in practice compared to the ‘theory’ of medicine we discover in cuneiform.

If disease is taken as a cultural construct, then we have to be aware of the wide array of influences upon that culture and its ideas. For example, Mesopotamia was an active area of the world, ardently involved in trade within the separate kingdoms and also to more distant countries. The dynamics of such a large exchange in goods provided the basis for an exchange of ideas. The link between trade and knowledge is most clearly demonstrated by the exchange of medical practitioners as prestige items in international diplomacy; practitioners that were particularly effective in their treatment of disease (generally, apus had royal patronage) were occasionally sent by their king to give assistance to rulers of foreign countries.

In this way, the king’s prestige was increased, by impressing his peers with the skills of his court practitioner. During his time there (the could be male or female, but an a�ipu, especially one sent on a long arduous journey, tended to be male (CDLI, 2003)), the court practitioner could influence and be influenced by the ideas of other court practitioners, who might have had more experience with the treatment of disease. Hence, the greater the trade links, the more likely there was also an exchange of ideas (particularly those relating to healthcare) in Ancient Mesopotamia. In contrast, wars and famines could have a detrimental effect on the local economy. As there is no evidence of a state healthcare system, it is likely that all  and  services required payment, with the  regularly charging more than the by the time of the Neo-Babylonian period and their increased status.

The combination of these two ideas suggest that during times of financial struggle, the Mesopotamian public would be more likely to ask for the assistance of an as�, whose notions of disease were only partially influenced by divinity. During these times, the  greater influence amongst everyday notions of disease, but not necessarily in the courts nor amongst the intellectual elite. Conversely, a dependence on gods and goddesses was so deeply interwoven into Mesopotamian culture, that an u might also have greater influence, with his strong links to divinity. Consequently, the socio-economic status of an ancient culture may also influence widespread concepts of disease.

Any information on how Mesopotamians conceptualised disease gives us important information on Mesopotamian culture. The importance of a divine origin to disease, the method of payment for its treatment, and the diagnostic warning signs an might consider, all provide interesting and rare openings to the Mesopotamian culture across two millennia. Our notions of disease belong to our contemporary culture and reflect our current beliefs; imposing ideas from the twenty-first century upon a culture that began four thousand years ago, is hardly sensible for scholarly research. If we cannot separate ipu, it is probably because we are looking for binary opposites where there are none (Sarlock, 1999). Even the Mesopotamian anatomical and disease terminology also belong to the culture from which they originate; by using them when we talk about Mesopotamian medicine, allows us to explore the links between language and lifestyle, thereby revealing even more about Mesopotamian culture.

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