Babylonian Medicine
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Bloodaxe's Realm     The Medieval World  

 

The Babylonians
 

      Figure 1. The stele of Hammurabi
      The importance of medicine and surgery in Western Asia before 2000 BCE was revealed by the presence of a legally established tariff for the services of both the physician and the surgeon embodied in the Code of Hammurabi (1800 BCE). These legal regulations of medical and surgical practice toward the beginning of the 2nd millennium BCE would indicate that medicine in ancient Babylon was already centuries old at that time, and that the beginning of medical knowledge must therefore reach back well toward 3000 BCE, perhaps into the Sumerian civilization. In fact, the famous Code of Hammurabi appears to be a systematic rewrite of much older Sumerian laws. The Code carried with it some rather harsh penalties for therapeutic failure.* Whether any were actually carried out is not clear.

       

      It has been suggested that certain parts of the Code clearly allude to the procedure of lens couching for cataract -- something not described in Greek literature until the Alexandrian School in 300 BCE [1,2] The evidence for this supposition is not decisive nor is the translation of the pertinent parts of the Code without controversy (see Figure 2). What is intriguing is that the Aryans, who conquered the Indus valley, came from this area and there is a possibility that they may have brought couching with them. It is strange, however, that such a technique did not pass over into Egyptian medicine and it is probably not a coincidence that the Greeks first described the procedure at the time of Alexander's conquest of India. That these ancient people performed surgery is not in doubt, however, and the invention of couching may well lay with them.

      At that time a reasonably complete anatomical vocabulary was in use and ophthalmology as well as other specialties practiced. As to ametropia and/or spectacles, Figure 3 is intriguing.

      Figure 2. Section indicated is under discussion
      Unfortunately the actual tablets upon which were recorded the medical literature of ancient Babylonia and which obviously must have existed in Hammurabi's day have practically all vanished . The treatises which have survived to us are copies made in the Assyrian Empire (7th century BCE). These copies, furthermore, are themselves in a very incomplete and fragmentary state. We may derive from them, nevertheless, an impression of the range and character of medical writings in Western Asia for probably some 2,000 years before the Christian Era. They cover a wide range of ailments grouped roughly according to the part of the body chiefly affected. The leading treatises deal with ailments of the head, including mental troubles, infections, baldness, and affections of the eyes, ears, and temples; ailments of the respiratory and digestive organs, and of the muscles and ligaments. There were, besides, specialized works on pregnancy, child-birth, obstetrics, and diseases of the genital organs.

      Figure 3. Lens (?) excavated at Nineveh
      ca 800 BC.

      The materia medica employed in treatment of these ailments includes a long list of vegetable, mineral and animal substances (including excreta), most of which are impossible to identify. A frequent method of use, after special preparation, was by direct application to the affected part, or by binding it on. The commonest method of administering was by mouth, and occasionally by the use of a rectal suppository.

      There is no clear indication that the physician knew anything of the real nature of the ailment encountered or, except in the more obvious cases, the function of the organs affected. Among the long list of available remedies, a few, like oil for stiff limbs, or milk for stomach troubles, salt peter and crushed ostrich shell for kidney stones, may have been beneficial, but some of the remedies employed seem to be entirely valueless. This may even have been realized at the time as indicated by the seeming indifference with which the physician moved through a long list of medications, shifting from one to another for the same disease.

      Therefore, while these tablets have revealed a wide range of observed diseases and an extensive list of herbs and minerals in the physician's pharmacopoeia, there was no systematic fund of knowledge of the human body; neither was there any rational consideration of disease. The causes of disease and the operation of remedies, as conceived by the physician, were so intertwined with belief in supernatural forces, that a rational understanding of the organs and functions of the human body, sick or well, or of the operation of remedies when applied, was not likely or even possible. It is evident that primitive folk medicine, with all its superstitions, completely dominated the medical teaching of the ancient Babylonians, just as such superstitions suffused their general outlook on the natural world.

      Ancient Babylonian knowledge of anatomy, physiology, and pathology was therefore limited, and under these circumstances the contributions of Babylonian medicine to later medical science can not be said to have been important. There is, in addition, little or no evidence of cultural crossover into other civilizations -- except, perhaps, that of India. Our own knowledge of Babylonian attainments, unfortunately, is limited by the fact that not a single Babylonian tablet on surgery has descended to us. We cannot, however, doubt the existence of such treatises in early Babylonia in view of the legally recognized and regulated position of the surgeon in Babylonian society of the 20th century BCE already mentioned. Recent examinations of some of the tablets have revealed, in addition, that as revealed in the Egyptian Smith Papyrus, some physicians in Mesopotamia --as their fellows in Egypt -- practiced without recourse to the temple. Whether they operated for cataract or not -- the answer is: maybe .

 

      * Considering the litigious atmosphere in which medicine is practiced today, we seem to have come full circle.