Ancient Babylonian Medicine

Medical Incantations

We can readily appreciate why incantations would be used with magical rituals, since they are essentially dramatic affairs intended to impress the patient with elaborate and powerfully moving spectacles: fumigations, peeling onions and wiping the patient with flour, massage, scapegoat rituals, drum-beating, and other kinds of rituals (which we might consider as hocus-pocus). Medicine was, on the whole, much more subdued: the patient was treated with potions, suppositories, oiled reeds inserted into his penis, bandages, and amulet stones hung around his neck, as well as the occasional incantation. There is, however, a grey area between these two spheres of influence, consisting of incantations exclusively applied to Babylonian therapeutic prescriptions.

Incantations within medical recipes form a genre of their own. There is little point in trying to deduce worthy medical information from the incantations themselves, as if medical incantations had some particular role to play within diagnoses and treatment (Collins 1999: 64–122; Geller 2007a: 390, 396). On the contrary, the incantations within the medical corpus tend to be rather jejeune and simplistic, many with abracadabra-type formulae, more akin to nursery rhymes than sophisticated magic.

Several incantations are situated within medical prescriptions for eye disease to treat cloudy vision, filmy eyes, eyes filled with blood, and so forth. One incantation within this corpus alludes to the dangers of surgery:

Incantation. Eyes with the porous blood-vessel, why have you been blurred by chaff,
thorns, šuršurru-fruit, or river algae (var. algae tossed up by the river)?
Why have you been blurred by clods in the streets or twigs in recesses? Rain down here like a star,
keep falling here like a meteor, before the flint(-knife) and scalpel of Gula reach you.

An irreversible incantation, the incantation of Asalluhi-Marduk and the incantation of Ningirimma, master of spells,
and Gula, master of healing arts, has cast (it) and I have taken (it) up. Incantation spell.

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Incantation for removing chaff, twigs and whatever from the eyes.
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(BAM 510 174–80)

The point of this incantation is that blurred vision can be caused by various types of foreign objects in the eye, such as algae from the river, debris of plants, or dirt from the street. “Raining down” is probably a reference to tears washing out the intrusive objects, and the spell makes a threat: the foreign matter must leave the eye as soon as possible, with the speed of a falling star, or else the patient will be subjected to the surgeon’s scalpel. The actual phrase used, “scalpel of Gula,” is meant as an oblique warning that the sick eye had better heal itself before it requires the doctor’s intervention. Since Gula was the patron goddess of asûtu (see Figure 4.1), we can guess that a physician’s scalpel is alluded to in this incantation, although we have no independent evidence to confirm that the asû acted as a surgeon.

The healing goddess Gula and her son Damu make frequent appearances in medical incantations, but often in a rather practical mode. The following incantation occurs within the same collection:

Incantation. The open eye is open, the open eye is open, the angry eye is angry, the open eye is angry, the look is crouching, the look is evil, thick eyes, cloudy eyes,
porous [in (its) veins], the eye pissing blood like the sacrifice of a male sheep. (The eye) is (affected by) “shadow-disease” like the water floating with the swamp and seaweed, like the vinegar floating in the jug.

A mud-wall is built between them (the eyes), Nergal entered and his seat¹²⁵ is placed in between,
because of this “seat” within that one, preventing breathing

freely. The incantation is not mine, it (belongs to) Ea and Asalluhi, the incantation (belongs to) Damu and Gula, the incantation (belongs to) Ningirimma, mistress of incantations. O Gula – heal and receive your fee.

Incantation spell. (BAM 510 84–90)

images/Chapter4_image_5_5.jpg — **Figure 4.1** Healing goddess Gula with her dog, holding a scalpel in her right hand and a tablet in her left hand (Collon 1987: No. 793; photo courtesy D. Collon)

It is the last line which engages our interest, since it repeats a phrase found frequently in medical incantations, asking Gula to heal the patient and to take her fee. The fact that this is a “fee” rather than a “gift” (as usually translated) can be seen from a late Uruk incantation which spells it out unmistakably. In this text the healer tells the patient that he deserves to be healed since “you have given a fee to the exorcist” (von Weiher 1983: No. 22, 113), and the patient afterwards declares before the god Šamaš, “I gave a fee to your servant, the mašmaššu-exorcist, in front of you.”¹²⁶ Since the exorcist was an active priest in the temple, such a gift for services rendered makes good sense, and what we have here is a polite reminder that healing costs money.

The following brief incantation from the same text is a mixture of simple Sumerian logograms and Akkadian phrases, with some levels of meaning which we cannot fully comprehend, comparing the eye ailments to a storm:

Incantation. The open eye looks, the open eye sees, the cloudy eye is clouded, the open eye is clouded.

The two eyes are sisters in between which a mountain is put across, above them a knot is tied, below them a clay wall is built.

Which is their wind, which is not their wind?

Which is the onset of their wind, which is not the onset of their wind?

The storm ahead is dark, the surface of the pupil [of the eye is dark]. (BAM 510 121–6)

The image is clear: the two eyes are sisters, and the nose and mouth are described as a mountain and clay wall, from which wind emanates; these images may be based upon a doll or figurine. “Wind” is often a disease agent in medical texts, either as a draught or flatulence. The poem otherwise tells us little about the disease itself or its causes, but there may be a teleological image referring back to creation, judging by another incantation from the same eye-disease text:

Incantation. In the beginning before creation, the “water-carrier” (alalu) came down to earth,
the seeder-plow bore the furrow and the furrow
the shoot, the shoot the seedling, the seedling the node, the node the ear of barley, the ear of barley
the stye (in the eye). Šamaš gleaned and Sin gathered, and while Šamaš was gleaning and Sin gathering,
the stye entered the lad’s eye. Attend, Šamaš and Sin, and let the stye go out. [Incantation spell].

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Incantation for removing a stye from the eyes.
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(BAM 510 181–6)

Eye disease, in this case caused by an insect or something very small, originates from time immemorial when agriculture was first established (see Collins 1999: 95f.; Foster 1993: ii 854). According to the ontology of this incantation, agriculture led to disease in humans, and even beneficial activities such as sowing and reaping had harmful results, but no specific information given is relevant to actual diagnosis or treatment.

One very short incantation in this group poses the simple question asked by every patient: “Why me?”

[Incantation.] The veiled eyes, the confused eyes (with) porous blood vessels, [the] two (eyes) cry towards their mother Mami:

“Why (does it happen) to us and (why) did you saddle us with ašû-disease, blood, and wind?” Incantation spell. (BAM 510 163–5)

One distinction between magic and medicine is how each approach deals with the patient’s personal trauma. The question “Why me?” is not likely to be answered by the asû, and the patient would probably be advised to go and ask the exorcist.

As mentioned, one of the main features of formal magical incantations is a bilingual Sumerian-Akkadian format, usually referring to a dialogue between Marduk and his father Ea. One incantation within the same group of eye-disease medical recipes is a bilingual Sumerian-Akkadian medical incantation, which resembles (in form at least) incantations from the realm of magic, as if borrowed from a mašmaššu-colleague:

Incantation. The wind was blowing in heaven and a sore settled in a man’s eye.

It blew in from the distant heavens (Sum. and a sore settled in a man’s eye.)

A sore was found in the sick eyes.

The eyes of that man are troubled, his eyes are blurred, and when by himself that man cries bitterly.

Nammu (var. Nāru) noticed that man’s illness:

“Take crushed (var. cooked) kasû, recite the Eridu incantation, bind the eye of that man.”

When Nammu (var. Nāru) touches the man’s eye with her pure hand, may the wind which is swept into a man’s eye be removed from his eye. (BAM 510 151–61)

This incantation has some hallmarks of a formal bilingual incantation of a mašmaššu-exorcist. Instead of a dialogue, however, between Marduk and Ea, the protagonist is the goddess Nammu, Ea’s mother, who appears in other incantations as patron goddess of the Apsû, the subterranean sweet waters. In this role, Nammu acts like Marduk: she “notices” the man’s illness and has to decide what is to be done, although she has no one to whom to turn for advice. These conventions are quite rigid and cannot be easily altered by whoever composed the incantation.

There is an anomaly here, since an earlier version of this incantation from Sultantepe¹²⁷ has the river god Nāru appearing in place of Nammu in later versions. The river god Nāru was elsewhere invoked in namburbî incantations to counteract evil portents because the river carries off the bad magic which had been tossed away (Maul 1994: 85–9). Nāru also appears in hemerologies, schedules of lucky and unlucky days in the month; if you asked Nāru the river god a question on a certain day of the year, he would answer you with “news” (Labat 1939: 98f.). But mostly Nāru is associated with the River Ordeal, in which the innocent man is thrown into the river and survives but the guilty is drowned, with his recovered body covered with sores and bleeding from his orifices; it is the god Nāru who does the judging, one presumes, but our information is far from abundant (see Lambert 1965: 6, 9). In any case, the older variant from Sultantepe with the river god Nāru does not conform to the usual tropes of exorcistic incantations,¹²⁸ and the later version of the incantation makes the goddess Nammu (rather than Nāru) protagonist, perhaps because the incantation places the spell within the city of Eridu, Nammu’s residence and gateway to the Apsû. Nammu notices the patient’s sore eyes and takes some remedial action, and that is about it. This medical incantation appears to have been altered to look like standard exorcism, but in fact it is far less elaborate than conventional incantations emanating from the exorcist’s workshop.¹²⁹ Moreover, these medical incantations are not overly theological in trying to pin the cause of disease on sin and transgression (see van der Toorn 1985: 76). According to them, disease just happens.

There are some exceptions to this pattern. Medical texts dealing with childbirth contain rather more elaborate incantations, comparing the fetus to a boat on the water and the mother giving birth to the Cow of Sin, the moon god (Stol 2000: 64–70). We also find the familiar formal dialogue between Marduk and Ea, suggesting that these incantations were composed by an exorcist, rather than as an afterthought of an asû-physician. These childbirth incantations within the medical corpus are exceptional, but childbirth is exceptional, for several good reasons. Childbirth is not a disease, it concerns women not men, and it can need serious magic to help it along. In some sense, childbirth medical texts may be considered as more conservative than other types of medical texts, but, if so, Babylonia is not alone in this. Within the Hippocratic corpus, the treatise dealing with diseases of women is also considered to be more conservative than other treatises, containing more elaborate pharmacological recipes and exotic ingredients (Nutton 2004: 98).

An incantation is primarily an encounter between forces which try either to harm or to protect mankind. Malevolent forces can be anything from an evil demon to an evil or angry god, witchcraft, bad omens, envy (described as an evil eye or evil tongue), negative effects of violating a taboo, or just plain bad luck, and divine powers can be marshaled to help, as we know. The real subject of the incantation is usually the human victim. Is it the same in medicine? The simple answer is “No.” The Diagnostic Handbook consists of long lists of symptoms drawn from patients, organized from head to foot, drawn from all kinds of diseases and affecting every part of the body – but we have no idea how many patients were behind each symptom. Ten? A hundred? The least likely possibility is that each symptom represents an individual case from a single patient. The same is true of the therapeutic medical recipes, which never refer to any specific patient by name or otherwise, and it seems obvious that these are not case histories. Recipes are aimed at a disease or diseases of any number of patients which share the same symptoms and signs.

This may ultimately explain why the medical corpus includes simple incantations, to give the impression that gods also maintain an active interest in the patient’s well-being and health. Introducing incantations into medical texts may have been an attempt to make the medicine somewhat more personal. On the other hand, the last thing a physician wants is to be confused with an exorcist.

Therapeutic Prescriptions as Genre

A typical feature of medical texts shows duplication most often occurring with individual recipes, drawn from different contexts, rather than whole compositions being duplicated. In fact, the process of duplicating passages within Babylonian therapeutic texts is unique, when compared to other types of cuneiform literature. The usual pattern, outside of medicine, is for a composition to exist in various manuscripts, which are mostly the same or similar. Incantations are a good example. Entire tablets and compositions appear in multiple copies, normally with variants among manuscripts. Not so with medical texts; often a single line of text, representing a single recipe, may be duplicated between one text and another, but within completely different medical contexts. We will see how this works.

Therapeutic texts are normally constructed from individual recipes or prescriptions, and each individual medical recipe therefore had a semi-autonomous status and could be cited freely between different genres of therapeutic texts. We do not understand the system behind these citations, but texts dealing with one medical condition might quote a recipe designated for a different ailment altogether.

Let us look at a typical example. The following text is from seventh century BC Assur, from the private house of exorcists, which contained a considerable medical library as well as texts relevant to magic and exorcism (Maul 2004: 81f.), and it has duplicates from the Nineveh state library founded by Assurbanipal.

1 [If a man] suffers [from discharge], crush together kukru, ata’išu,

2 myrrh, and alum,

3 and he drinks it in strong wine on an empty stomach.
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4 If ditto, “silver-lustre”-plant, puquttu seed,

5 pallišu-plant/stone, sāpinu, (var. azallû-seed), baluhhu-resin,

6 [“donkey]-vulva”(-shell), shell of ostrich-egg,

7 myrrh, coral; (total) 9 drugs

8 for discharge, checked, he keeps drinking it in wine.
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9 If ditto, “pure”-plant, “mole-cricket,” kukru, šunû,

10 madder, myrrh, baluhhu-resin,

11 šunû seed, taramuš seed, umlalu,

12 fat, and almond(wood); [crush] together these 11 drugs

13 and boil them in ghee, his thighs

14 (and) his buttocks [……………

Reverce

1′–2′ .……………

3′ put [.…………] into it and pour it into his penis.
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4′ If ditto, urnû, ditto, ditto, ditto.
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5′ [If di]tto, crush fox-vine, ditto, ditto, ditto.

6′ pea, myrrh, and horned alkali,

7′ coral, alum; 5 drugs.

8′ If a man repeatedly rises 130 because of his urine,
9′ he keeps drinking (the drugs) either in beer or in wine or water.
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10′ Crush together imhur-lim, myrrh, ostrich-egg shell,
11′ black frit, for 3 days in fish brine,
12′ for 2 days in drawn wine, and for 3 days in
13′ pomegranate-juice, and he keeps drinking it
14′ [for a] stricture of midday.
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15′ Hurriedly excerpted for his [lecture] (colophon). (BAM 7 7)

images/Chapter4_image_11_5.jpg — **Figure 4.2** Assur recipes *BAM* 116 and duplicate recipes (*Babylonisch-assyrische Medizin*)

The recipe concerns kidney ailments. Other texts duplicate no more than a single recipe from this composition, consisting of only a few lines. Two of the partial duplicates from Assur are lists of medicinal plants which include a section of drugs specifically for kidney disease. As for the materia medica it is likely that the medical recipe and lists drew upon some common source.

The great Nineveh library provides another example of a kidney disease text (see Figure 4.3), but only two lines of the Nineveh text duplicate the Assur text above (BAM 116):

Its ritual (dù.dù.bi): Crush together imhur-lim, myrrh, ostrich-egg shell, black frit, for 3 days in fish brine,
for 3 days in drawn wine, and for 3 days in pomegranate-juice, he keeps drinking it and he will improve. (BAM 7 2 ii 19–20)

What is unusual is that the Nineveh text writes dù.dù.bi “its ritual,” to introduce these two lines; this type of dù.dù.bi rubric usually introduces an exorcistic ritual which follows an incantation (Herrero 1984: 26), and in fact these two lines immediately follow an incantation in the Nineveh tablet (BAM 7 2 ii 18). In other words, the same therapeutic recipe in an Assur tablet is employed as a “ritual” and follows an incantation in a Nineveh tablet.

images/Chapter4_image_12_1.jpg — **Figure 4.3** Duplicate recipes (*Babylonisch-assyrische Medizin*)

If we compare the contexts of these two tablets, we can see that both recipes from Assur and Nineveh were used within medical compositions to combat kidney disease. The Assur tablet is a single-column tablet and its contents, according to the colophon, were “hastily excerpted,” either for a lecture or for application. The tablet contains various recipes which could have been drawn from a longer composition, while the Nineveh tablet is a multi-column library composition with many recipes against kidney ailments. We have two completely different genres of texts, one from Nineveh being a major compendium of medicine, the second from Assur being a teaching tool in which a few important or typical recipes have been excerpted and compiled. There is little otherwise in common between these tablets. Are these the same literary genre? I think not, because a library reference work is quite different from a textbook or digest of texts for pedagogic purposes. Tablets could be excerpted for a variety of reasons. For instance, another Assur tablet composed by the well-known Assur exorcist Ki images ir-Nabû introduces a recipe for making an ointment for the anus and claims to have excerpted the recipe from many different sources and collected the information together into a single tablet; the colophon explains that this excerpt was made hastily for the purposes of performing a specific medical treatment (BAM 7 42); the tablet is excerpted ana abat epēši, “for use.” This kind of tablet should also be differentiated from a standard library reference work.¹³¹

Another example of two different genres of medical texts which share common recipes occurs in recipes for a diseased anus, which also contain prescriptions employed in tablets dealing with “cough” (suālu). The precise medical connection between rectal ailments and “cough” (which could include diphtheria or pneumonia) is unclear. The following text is a case in point.

−1 If a man’s limbs are poured out, his chest and shoulders hurt him,
0 his arms, shins [and knees] hurt him, his testicle, either on the right side or on the left,
1′ bothers him, and he shows blood in his urethra, that man
2′ suffers from stricture of the anus. To cure him, you heat in an oven (l. 9) taramuš, imhur-lim,
3′ kukru, […………], juniper, suādu,
4′ sweet reed, ballukku, šimeššalû,
5′ cedar, šupuhru-cedar, šunû,
6′ urnû, hašû, nuhurtu,
7′ nīnû, dates, malt-flour, beer,
8′ wine-drops, …-barley.
9′ You pour (it) into the anus.
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10′ [If a man] suffers from rectal disease and his anus stings him,
11′ mix [together] juniper, kukru, umlalû, [and .….]
12′ [pour] kanaktu and a clump of malt in oil and beer into his anus.
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13′ If a man suffers from a sore anus and has piercing pain
14′ and his belly cannot take in food and fluids (and) pours out mucous from his anus,
15′ to cure him: pour hašû (and) urnû in kasû-juice
16′ into his anus.
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17′ If a man’s bowels are bloated, his intestines
18′ make a lot of noise like (that) of an išqippu-bird,
19′ that man suffers from flatulence and “sun-fever”.
20′ His condition is of long duration, (it is) the Hand of the Ghost; in order to cure him, heat in premium beer (l. 24) nīnû,
21′ “mountain”-plant (azupīru), hašû, nuhurtu,
22′ juniper, kukru, umlalû, ballukku,
23′ cuttings of aromatics, field-clod, – 11 plants,
24′ filter and cool them, add oil into the (mixture),
25′ pour it into his anus and he will recover. (BAM 88 = BAM 7 27)

These lines come from a single-column tablet (provenance unknown) dealing with rectal problems. The prescriptions in this tablet were known both in Assur and Nineveh, since they occur in no less than seven other manuscripts representing three different genres of medical texts. Let us describe a few of the other manuscripts. Two tablets (BAM 52 and 168) belong to the same prolific Assur scribe, Ki images ir-Nabû, and both probably come from the Exorcists’ House in Assur. The colophons of both tablets explain that these manuscripts consisted of excerpts hastily made for treatment or pedagogic purposes (see Hunger 1968: No. 212); the colophon of one of the tablets, mostly devoted to diseases caused by cough (suālu), specifies that the tablet was a “sixth excerpt of a collection of (medical) recipes, based upon a wax tablet from Assur, the original being from Uruk, written and checked” (BAM 52). Another tablet owned by the scholar Ki images ir-Nabû contains recipes from diseases caused by the Hand of the Ghost (a common cause of illnesses), as well as kidney and anal disease recipes (BAM 7 34). A third duplicate comes from Nineveh, a four-column library tablet devoted mostly to diseases also caused by the Hand of a Ghost (BAM 471). All of these texts have different orientations and purposes within their own specific contexts.

One manuscript mentioned above deserves a closer look, and we offer below a selection of recipes from this prescription (BAM 168):

18 If a man suffers from “sun-fever,” flatulence, paralysis, lameness, šaššaudisease,
19 Hand of the Ghost(-disease), Hand of the Oath, disease of the rectum, (or) any disease, in order to cure him,
20 10 shekels of “health”-plant, 10 shekels of tiātu, 10 shekels of ata’išu,
21 10 shekels of hašû, 10 shekels of nuhurtu, 10 shekels nīnû,
22 10 shekels of urnû, 10 shekels of clump of salt, 10 shekels of azupīru,
23 10 shekels of šibburratu, 10 shekels of “white” plant, 10 shekels of alum,
24 10 shekels of juniper, 10 shekels of kukru, 10 shekels of aktam, 10 shekels of salt,
25 10 shekels of madder seed, 10 shekels of umlalû, 10 shekels of suādu,
26 10 shekels of baluhhu, 10 shekels of cedar, 10 shekels of myrrh,
27 10 shekels of “sweet reed,” 5 shekels of sihu, 5 shekels of argannu,
28 5 shekels of barīrātu, 5 shekels of “sun”-plant: pound and sieve these 25 drugs
29 and aromatics together. Take premium beer, kasû-juice
30 and strong vinegar, add this powder (of ground up ingredients) to it,
31 heat (it) in an oven, take it out in the morning, cool (it), add honey and pressed oil to it,
32 pour (it) once, twice, and three times into his anus.
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45 If a man suffers from stricture of bladder, 2 shekels of myrrh, 2 shekels of baluhhu-resin,
46 juice of hašû, juice of nuhurtu, salt-water, the juice of all of these aromatics:
47 take a half sila of each of these juices, pound them together, boil (it),
48 you filter (it), cool (it), mix a half (sila) of oil with them. Crush 7 grains of “health”-plant,
49 add (it) into (the mixture), divide the fluids into 3 parts and
50 pour (it) into his anus once, twice, and three times, to relieve his constipation (lit. to cause the stopping up of his bowel to pass through).
51 If uršu-sores are smashed (or) if the hemorrhoids are plucked off,
52 the illness will be relieved, his anus will be widened; this lotion
53 (is) for releasing from an oath (and) for all kinds of disease.
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66 If a man’s bowels need to relieve constipation (lit. cause a stoppage to pass) or crush sores and pluck out hemorrhoids,
67 weigh out juniper, kukru, nuhurtu, horned alkali, “health”-plant,
68 in equal measure, boil (them) in beer or vinegar, you filter it,
69 cool it, put oil into it (var. honey or oil), pour (it) into his anus.
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70 If a man’s groin hurts him at an inappropriate time, and his shins
71 cause him a stinging pain (var. he stretches out his feet), he is weak in his thighs and his knees (var. shins) gnaw at him with pain (var. are cold for him),
72 that man suffers in the rectum (already) during his youth. To cure him:
73 crush in equal amounts black kamūnu, nīnû, kanaktu, “health”-plant,
74 kasû, mix them in fat and make a suppository,
75 sprinkle (on it) cypress oil, insert it into his anus and he will improve.
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76 If ditto, bat guano, nīnû, baluhhu-resin, “white” plant,
77 dates (var. of Dilmun), gourmet-salt, ox fat, these 7 (var. 6) drugs for a powerful suppository.
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78 You dry out Dilmun dates, horned alkali, fat of the kidney of a male sheep,
79 kukru, juniper, umlalû, baluhhu-resin,
80 abukkatu-resin – 8 drugs – insert a suppository
81 into his anus to stop flatulence; a proven remedy (var. a proven suppository which stops wind).
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82 Kiir-Nabû son of Šamaš-ibni hastily excerpted (this) for application. (BAM 7 34)

Here we see a text covering a variety of different medical problems, and the colophon explains that these recipes have been hastily extracted for treatment (ana abat epēši, “for use”).¹³² One of the recipes gives amounts of drugs (either five- or ten-shekel amounts) for general conditions: fever, flatulence, rectal disease, several kinds of paralysis, and two categories of disease known by theoretical causes (Hand of the Ghost and Hand of the Oath¹³³ diseases), or simply used as a panacea (“any disease”). Another recipe in this collection describes an elaborate enema for bladder ailments (stricture). Further recipes refer generally to bowel problems and hemorrhoids, and some of these prescriptions are older and already attested at Sultantepe, an eighth-century library found in modern Turkey. Every recipe in this Ki images ir-Nabû excerpt tablet has a duplicate from some other manuscript, which is not always the case with medical texts.¹³⁴

Sometimes we find a tablet containing unique medical prescriptions (i.e. no duplicates found as yet), but the tablet will also include a recipe which appears in many other manuscripts. For example, one Assur text with relatively few duplicated passages (BAM 104) has one line (l. 34) which occurs in three other manuscripts. One of these duplicates (BAM 152) is a four-column tablet containing recipes for ailments of the head, feet, and rectum. A second duplicate (BAM 95) is written in a “landscape” format (with the longer side being its width rather than height), and may represent an older text tradition, while the third duplicate from Sultantepe¹³⁵ certainly goes back to an older eighth-century text tradition (see Figure 4.4).¹³⁶

Let us return to the question of why the same drugs would be used within two different genres of medical texts, having entirely different medical uses and aims, for entirely different parts of the human body or organs. Two possibilities come to mind. One, recipes were associated with each other as literary compositions and learned as such, and hence recipes which were thematically related (e.g. referring to diseases of the rectum) would often be copied together in the same sequence in different tablets. For example consider the following three recipes:

If a man’s limbs are flaccid (lit. poured out), his chest and shoulders hurt him,
his arms, shins [and knees] hurt him, his testicle, either on the right side or on the left,
bothers him, and he shows blood in his urethra, that man suffers from stricture of the anus.

To cure him, you heat in an oven (l. 7) taramuš, imhur-lim, juniper, suādu, sweet reed, ballukku, šimeššalû, [cedar], šupuhru-cedar, šunû, urnû, hašû,
nuhurtu, nīnû, dates, malt-flour, beer, wine-drops(?), and …-barley, and you pour (it) into the anus.

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If a man suffers from rectal disease and his anus stings him and his bowels are cramped and he is constipated, boil vinegar and premium beer, cool it and pour it into his anus.
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[If a man] suffers from rectal disease (and) it stings him: mix together juniper, kukru, umlalû, [.….
<boil> kanaktu (and) clump of malt in oil and beer and [pour it] into his anus. (BAM 7 32 1–11)

images/Chapter4_image_17_4.jpg — **Figure 4.4** *BAM* 104 and duplicates (*Babylonisch-assyrische Medizin*)

images/Chapter4_image_18_1.jpg — **Figure 4.5** *AMT* 56,1 and duplicates *(Assyrian Medical Texts* and *Babylonischassyrische Medizin)*

The recipes above come from a Nineveh manuscript (AMT 56,1), a single-column tablet (hence probably not a library tablet), written in Babylonian script,¹³⁷ which has recipes for rectal disease on the obverse and recipes for stiffness in hips and groin on the reverse. This Nineveh text has several duplicates for these lines, two of which are from Assur, both dealing with rectal disease (BAM 88 and BAM 182).

The Assur recipes duplicate the Nineveh recipe in the same sequence, but with one important difference: another two-line recipe intervenes (see Figure 4.5).

If a man is ill in the rectum and his anus stings him and his innards are bloated, he suffers from constipation; boil vinegar and premium beer, cool (it) and pour it into his anus. (BAM 7 32 8–9)

It is difficult to discover whether any literary scheme lies behind these complex arrangements.

This pattern repeats itself throughout Babylonian therapeutic medical literature, with one important exception: eye-disease texts. The British Museum houses a collection of three lengthy Nineveh tablets devoted to eye disease, and these tablets are unusual in being three complete manuscripts of the same therapeutic text (BAM 510, 513, and 514). It is not easy to know why eye texts were copied as complete manuscripts while other recipe collections were not, but, nevertheless, the composition is in fact more complicated. These Nineveh tablets contain only a couple of individual recipes also attested elsewhere, but these same few duplicated lines appear in no less than three other Assur tablets.¹³⁸ When we finally find a duplicated eye recipe, it turns out to be popular, also known in Assur. An exceptional text from mid-first-millennium BC Sippar provides excerpts from a variety of medical texts dealing with many different conditions, but two lines of this text also duplicate a single recipe in the Nineveh eyedisease manuscripts (see Heeßel and al-Rawi 2003: ii 15–19). It is strange that this is the same recipe duplicated in Assur. Hence, a single three-line recipe in a large Nineveh medical eye-disease text appears in various Assur medical sources and a Sippar school compendium, but few other duplicated passages are to be found. It is difficult to explain this pattern.

A different scenario appears in another Assur tablet from the Louvre dealing with ear disease (Geller 2007b), copied by an apprentice of Urad-Nanaya, the senior court physician at Assur. Many of its lines are also duplicated on the same Sippar extract tablet mentioned above (Heeßel and al-Rawi 2003), as well as duplicated recipes in other Assur tablets and tablets from Nineveh, Babylon, Uruk, and Nimrud, showing how widely popular individual recipes might be. It should not be surprising that prescriptions for ear symptoms employ the same recipes as tablets devoted to the disease caused by the Hand of the Ghost, since the disease was often thought to be caused by a ghost whispering into the patient’s ear (Scurlock 2006: 14). This kind of association of ideas can partially explain how similar recipes can appear in different medical contexts. However, recipes may have been copied in several manuscripts with more regard to literary composition than to medical efficacy. Recipes often (but not always) occur in the same general sequence, even if another recipe intervenes.

The literary character of recipes can also be seen within the listing of materia medica, since plants and stones are often given in standard sequences, which were learned by the medical scribes (Tavernier 2008: 193f.). It is unlikely that we will find a medical reason for materia medica to be listed in a fixed sequence within recipes, other than that scribes found it easier to remember ingredients in this way.

Poetry Within Therapeutic Prescriptions

The idea that medical recipes could be composed in poetic form rather than prose might seem alien to a modern reader, but such texts were well known in the classical world. A second-century BC priest of Apollo and physician from Claros in Asia Minor, one Nicander, composed a lengthy Greek remedy in 958 lines of hexameter verse against venomous creatures and their bites. His work was called Theriaka, the name later given to a recipe popular in the Roman world as an antidote and later general panacea (Watson 1966: 13 f.).

Despite the lack of evidence for poetic recipes in Babylonian therapy, medical texts are not entirely devoid of poetry. Incantations serve as the poetic component of therapeutic texts. Medical incantations are poetic and often revolve around literary themes which have little specific application to the recipes. The passage below, for instance, shows recipes phrased in the second person in the form of instructions for treatment, while the interspersed incantations are in the first person singular, as abbreviated passages containing allusions to more cosmic motifs. The medical incantations themselves provide a literary structure which aims to define the role of the practitioner as a powerful figure, well connected with the powers governing heaven and earth.

If a man suffers from maškadu, he must keep drinking (from a potion) gourd, e’ru-seed, and kazallu, [crush] “field-clod”-plant, “scorpion”-plant. (Then) mix flour in premium beer, and when you make a concoction, [he will improve].

_________________________________
.……………….
_________________________________

Incantation. I impregnate myself, I impregnate my body, just as a dog and bitch or pig and sow

have had sex in the steppe; just as a plough has seeded the earth and the earth has received its [seed],

so I cast the spell that I receive (it) in myself and in my body, and impregnate himself (and) [his] body and [cause the evil to depart].

_________________________________

Incantation for maškadu.
_________________________________

(BAM 7 31: 11′ 13′; 18′–21′)

A somewhat different view of medical incantations is provided by an Assur text, KAR 73, now BAM 7 9–10 (see Böck 2008: 307f.). This single-column tablet contains two poetic incantations, with one medical extract between them sufficient to show that the context is medicine, not magic. The format of the tablet is unusual, since the incantation on the obverse is ruled while that on the reverse is not.139 We give the reverse here only, since the obverse, although an incantation, is essentially a hymn to the healing goddess, Gula.

1 When (it is the case): if a man (suffers from) either pardannu or sahhihudisease,
2 discharge or stricture or a rectal disease,
3 he constantly has dripping urine,
4 as if being struck down by a weapon – like a (menstruating) woman –
5 or whatever other illness which is not recognized,
6–7 its remedy (lit. ritual): you sprinkle pure juices of juniper in front of Gula, you set up a small altar, on a roof, the place of ritual preparation,
8 (on which) you sprinkle dates and sasqû-flour, you place mirsu-cakes of honey and butter,
9 you set up an adagurru-vessel (and) you either make a pure offering or a prayer.
10 You set (on the altar) the shoulder, the fatty meat and the roast-meat,
11 crush together hašû, ata’išu, sweet-plant, “single”-plant, šumuttu, sahlû,
12 and put (them) into premium beer, and place it before Gula.
13 Have the patient kneel and you fumigate your hand over him,
14 you withdraw and that patient raises up in [his] hand the premium beer which you set out and he recites thus:
_________________________________
15′ Incantation. I beheld your face, [O Gula], august healer,
16′ [.………], you are supreme and pre-eminent (var. the pure one),
17′ I beheld this drug which I hold up before you.
18′ On this very day, (the patient) has either pardannu or šahhihu-diseases,
19′ either discharge (var. or stricture) or rectal disease or loin disease, or dribbling of urine, or one is struck by a weapon like a (menstruating) woman, or whatever illness with which I am sick,
20′ and you know what I do not know: am I to drink this drug?
21′ With these drugs let me be healthy, let me be well, let me be happy,
22′ so that I may praise your great divinity! [Incantation spell.]
23′ “In every corner let them bless Gula,
24′ who is supreme in spells and healing,
25′ great is her medicine, Gula heals those who revere her.
26′ By the command of Baba I will praise and call her name to everyone,
27′ when I go before her.” Three times you will have him recite it (the incantation and he will bow down,
28′ he will drink this drug and bow down, and recite thusly:
29′ “I drank this healing drug of my goddess,
30′ [..] and I was cured.” He says this three times and bows down.
31′ [.…….] he keeps drinking this drug and he will recover.

images/Chapter4_image_22_10.jpg — **Figure 4.6** Healing goddess Gula with her dog, seated before the god Latarak (R. Ellis, Fs. J. J. Finkelstein, figure no. 3; drawing F. A. M. Wiggermann)

Again we note the characteristic first-person-singular orientation of the incantations, expressing the healer’s special relationship with the goddess of healing arts, Gula, while the therapeutic recipe takes the usual form of second-person instructions for treating the patient. Within the incantation, the patient is referred to in the third person, as if a character in a drama, while the incantation priest asks rhetorical questions about the effectiveness of the cure (but always anticipating a positive reply).

This is not to suggest that medical incantations have a fixed format or structure, since there is a great variety of themes expressed within them. In a Nineveh medical text which is partially duplicated in Uruk, one incantation is devoted to būšānu-disease, which affects the nose and mouth:

Incantation. Būšānu, strong is his grip, it seized the uvula like a lion, it has seized soft tissue like a wolf, it has seized the tender part, it has seized the tongue,

its “seat”140 is positioned in the windpipe(s). Go out, būšānu, not to be seized by you,

like death which shows the way [a one-way voyage], or a stillborn child which cannot seize its mother’s breast (var. milk),

you must not return to what was seized by you. The incantation is not mine, it belongs to Ea and Asalluhi,

the incantation of Damu and Gula, of Ningirimma, mistress of incantations, Gula, life-giving mistress,

Gula who makes life secure, take your “gift” (i.e. fee). Incantation-spell. (Hunger 1976: Nos. 52 and 54, 55–61)

This incantation ends with the conventional formulaic lines explaining that the incantation belongs to the gods, not to the credit of the healer himself, since it would have been considered hubris for the healer to claim that the healing power comes from his own personal charisma. The healer himself was an instrument of the magic, but not the power behind it. The incantation itself provides some interesting and even important information, but within a magical framework which has little relevance to the therapies employed. The significant point is that the illness, in this case būšānu, has a “seat” or “topos” within the windpipe, which is the organ associated with the disease. The theoretical notion of the “seat” of a disease is expressed within the incantation because there is little scope for a therapeutic recipe to explain the thinking or theoretical basis behind the medicine. Medical incantations provided a mechanism for expressing more general ideas about the nature of healing and disease.

An obvious classification of medical texts differentiates between single recipes or prescriptions, usually on single-column or small tablets, and multi-column tablets containing numerous recipes, rubrics, and incantations. One assumes that the difference denotes individual prescriptions written out by the physician himself for the patient, as opposed to textbook or reference works in which many recipes are collected and recorded, perhaps taken from tablets containing a single recipe. As for single-column tablets containing relatively simple texts, late examples from Achaemenid Babylon exhibit a consistent alternating pattern of medical recipes and incantations being written in either vertical or horizontal (i.e. portrait or landscape) formats; tablets with a portrait (vertical) orientation tend to be asûtu while those with a landscape (horizontal) orientation are āšipūtu (Finkel 2000: 146). This shows clear distinctions being made within late scribal schools between the physical shape of tablets dealing with medicine (asûtu) and those dealing with magical arts (āšipūtu). Scribes had to learn to write both. Nevertheless, it is not possible to prove that these single tablets were collected and copied into larger compositions.

A clear distinction can also be seen between medical recipes which give the amounts of each ingredient to be used, and those which do not. This is distinct from dosage, which is rarely specified. It may be that weights of materia medica (typically one or two shekels of each ingredient, or fractions thereof), reflect a more precise genre of medical practice, which attempts to calibrate the amount of each ingredient (see Finkel 2000: 146 f.). The argument against this assumption is that, in most cases, the amounts given are standardized, so that the same amount (e.g. one shekel) of each drug is prescribed, which makes little sense in reality. One would hardly expect this in either a cooking or medical recipe, since the values and effects of individual ingredients are very different from each other.¹⁴¹

It is more likely, however, that recipes are schematic. Some weights and measures might be mentioned in order to give the recipe more authority, or to distinguish a medical recipe from a list of commonplace foodstuffs. We find this difference in later systems of medicine, such as in Maimonides’ Regimen for Health, in which he lists foods which people ought to eat to maintain good health, but when Maimonides lists similar ingredients to be used as a drug, he usually specifies the precise amount of each ingredient to be used in the recipe. There are clearly different genres here: recipes without amounts and those with amounts.

The following treatment for kidney disease is an example of a recipe with weights of materia medica (BAM 7 9; Böck 2008: 311ff.). The recipe consists of a long list of 33 drugs, each beginning with the amount of 2 shekels, in three columns:¹⁴²

2 shekels of puquttu, 2 shekels of azallu, 2 shekels of “dog’s-tongue” plant

2 shekels of fox-vine, 2 shekels of raisins, 2 shekels of šibburatu-plant

2 shekels of cucumber, 2 shekels of gherkin, 2 shekels of .…

2 shekels of madder, 2 shekels of aktam, 2 shekels of nuhurtu-plant seeds,

2 shekels of root of male mandrake, 2 shekels of pig-fat plant,¹⁴³ 2 shekels of kukru,

2 shekels of juniper, 2 shekels of umlalû-plant, 2 shekels of šimeššalû,¹⁴⁴

2 shekels of abukkatu-plant resin, 2 shekels of suādu, 2 shekels of myrrh,

2 shekels of male nikiptu, 2 shekels of female nikiptu, 2 shekels of .…

2 shekels of azupīru, 2 shekels of šumuttu, 2 shekels of.…

2 shekels of samīdu, 2 shekels of “detox” plant,¹⁴⁵ 2 shekels of .…

2 shekels of nitku, 2 shekels of .….

2 shekels of peas, 2 shekels of lentils, 2 shekels of .….

2 shekels of madder, 2 shekels of pomegranate, 2 shekels of …

2 shekels of e’ru-wood, 2 shekels of .… 2 shekels of .….

2 shekels of šunû, 2 shekels of alamâ,¹⁴⁶ 2 shekels of kamantu,

2 shekels of coral, 2 shekels of sea-pebble, 2 shekels of sea-.…,

2 shekels of sea-stylus, 2 shekels of “donkey-vulva” shell, 2 shekels of yellow ochre,

2 shekels of kalgukku, 2 shekels of muu-stone, 2 shekels of loadstone,

2 shekels of zalaqu-stone, 2 shekels of frit, 2 shekels of black frit,

2 shekels of umlalû, 2 shekels of pallišu-stone, 2 shekels of sāpinu-stone,

2 shekels of alluharu, 2 shekels of qitmu, 2 shekels of alum,

2 shekels of pumice, 2 shekels of kak.na₄ , 2 shekels of ostrich-egg shell,

2 shekels of block salt, 2 shekels of red salt, 2 shekels of steamed salt, variant: half a shekel of each of the salts.

Total of 9[4] drugs soaked for “stricture.”

There are two other drug-inventory tablets from Nineveh, probably from the same archive, which give the same listing of drugs and have the same rubric, “in all: 94 drugs, these to be soaked.”¹⁴⁷ In the Nineveh inventories, only the drugs used against kidney-disease are listed with their two-shekel weights (as in the text above); no other drugs in the lengthy inventories have associated measures.

What do we make of a list of ingredients duplicated in very different texts (one a medical recipe and the other an inventory of medicinal plants), but both extracts having the same format? Can we call this a literary convention (“two shekels” plus drug) or is there something special about this particular group of drugs used against kidney ailments? Variant readings within texts can also point to readings based upon literary rather than medical considerations. The final line of a kidney-disease recipe reads, “½ shekel of block salt, ½ shekel of red salt, ½ shekel of steamed salt” (BAM 7 11: 34′). This line relates to a final phrase in a similar recipe which reads, “2 shekels of block salt, 2 shekels of red salt, 2 shekels of steamed salt, variant: ½ shekel [of each of] the salts” (BAM 7 9 32f.). It is likely that the latter scribe was working from two sources, and that the variant was more literary than medical.

Occasionally medical texts give listed weights in fractions of a shekel, such as “handfuls” (BAM 7 16). Other texts have various weights of ingredients, as one might expect, as in the following extract from what can be considered an ancient Physician’s Desk Reference text:¹⁴⁸

1 Two shekels kukru, two shekels …

2 two shekels ballukku, half shekel juniper,

3 two shekels fine reed, one shekel [drawn] vine,

4 half shekel ata’išu, one shekel raisin,

5 half shekel mint,

6 half shekel būšānu-plant

7 one shekel imhur-lim-plant, one shekel imhur-ešra-plant

8 two shekels cucumber, (all of which) you heat in beer.

9 You (then) put oil and honey into it, [knead it] into a powder.

10–12 This lotion is effective and tested against jaundice and hepatitis.

13 Lotion of oils (for) “sun-fever.” (BAM 186)

The colophon of the tablet tells us that this tablet belongs to Mr Ki images ir-Assur, exorcist (mašmaššu) of Assur, and that the recipe was “hastily extracted for a use in a treatment.”

Other examples of Babylonian recipes list minute amounts of drug weights, such as eye salve prescriptions giving amounts as an eighth of a shekel (bitqu), 15 “grains” (= a twelfth of a shekel), and a twenty-fourth of a shekel (von Weiher 1983: No. 50).

Such Akkadian recipes have equivalents from the Greco-Roman world, such as a recipe for the “windpipe” recorded by the Roman physician Celsus in the first century AD:

4 grams each of Cassia, iris, cinnamon, nard, myrrh, frankincense

1 gram of saffron,

30 peppercorns boiled in 1½ liters of raisin wine until the consistency of honey. (Celsus [Loeb], 2 5 25)

Note how the major ingredients all share the same amounts (4 grams). Compare this with a Greek recipe against gout and sciatica, attributed to Proclus, which looks altogether too schematic:

9 ounces of germander

8 ounces of centaury

7 ounces of birth-wort

6 ounces of geniat

5 ounces of huperikon

4 ounces of Macedonian parsley

3 ounces of meon

2 ounces of agarikon

1 ounce of phou

2 kotylae of Attic honey. (Tecusan 2004: 623)

The question is whether these amounts were real or imaginary, in all our ancient medical sources.

The Babylonian Background to Greco-Roman Pharmacology

In 66 BC the Roman world was transformed by the news of the defeat of King Mithridates of Pontus, but the effects of this victory were further reaching than could have been anticipated. According to accounts preserved by both Pliny and Galen, Mithridates had perfected an antidote against poison, and it proved to be so effective that he was unable to poison himself after his defeat but had to be killed by a soldier. The Romans found an entire library with recipes, and the Roman Lenaeus was ordered by Pompey to translate and copy the recipes for Rome. Although Lenaeus’ work does not survive, there are reports that the Mithridates antidote or theriac caused a sensation in Rome because, as Pliny remarks, plants had not been studied by Roman physicians. Although not the first recipe of its kind, the Mithridates antidote was widely quoted as a compound recipe against venoms (a theriac) and poisons, and even as a general panacea; it became popular among drug-sellers throughout the Empire (Watson 1966: 81).

The question is why the Mithridates antidote became so popular in Rome, since similar preparations had been known to Greco-Roman medicine for centuries. Antiochus III of Mesopotamia, for instance, was reported to have developed a theriac against venoms already in the second century BC, which consisted entirely of herbs and may have relied upon more ancient Babylonian sources; other theriacs were known from further west (Watson 1966: 13). There are several factors, however, which may have influenced the reputation of the Mithridates antidote. One is that we are not told in which language the recipes were written, although scholars assume them to have been composed in Greek. Nevertheless, Pontus was located in the Orient, in Asia Minor, and the recipes may have been based upon a much older tradition of medicine (in the local language?) than that preserved in Greek, similar to the theriac of Antiochus III. Another factor is the information that Mithridates had first tried out his antidote on criminals; records of such experimentation are rare.149 Finally, the Mithridates antidote became famous as a panacea partly because it was a compound recipe consisting of some 90 ingredients, while in Greco-Roman medicine it was often the practice to rely upon pharmaka or “simple” drugs, i.e. single drugs employed against single conditions.

A famous example of a theriac was recorded by the first-century AD Roman Celsus, ascribed to Mithridates. The recipe reads as follows:

1.66 grams of costmary

20 grams of sweet flag

8 grams each of hypericum, gum, sagapenum, acacia juice, Illyrian iris, cardamom

12 grams of anise

16 grams each of Gallic nard, gentian root, dried rose leaves etc. (Celsus [Loeb], 2 5 23; see Watson 1966: 5–6)

We see in this compound recipe that although some ingredients appear in various amounts, other ingredients with identical measured amounts are grouped together. The same pattern can be seen in Babylonian medical texts specifying amounts of ingredients (see above).

As to why the Mithridates antidote became so popular, we need to examine the state of healing arts within the broader reaches of the Roman Empire as well as among its immediate neighbors, particularly in Mesopotamia, to gauge the proper medical context of theriacs and antidotes. In order to do this effectively, it is necessary to consider systems of medicine in the ancient world, rather than writings of individual physicians. We propose some general comparisons between so-called Hippocratic medicine and Babylonian medicine, although recognizing many sub-divisions within these two general categories of approaches to healing.¹⁵⁰ Essentially, Babylonian medicine was an extremely conservative system of healing, already well-established by the early second millennium BC, consisting of recipes and drugs used to treat diseases which were identified by careful examination and documentation of all external bodily symptoms as well as urine and other indicators of bodily functions. Disease was considered to be the result of external attack on the body, either by demons, or from natural causes such as bites, draughts, or poisoned food. The earliest phases of healing arts in Greece were probably very similar, as can be seen from early treatises within the Hippocratic corpus, which relied upon careful scrutiny of external symptoms. As in Babylonia, early Greek medicine expressed prognosis in the form of signs and omens, as indications of whether the patient was likely to live or die or survive for a limited time. Like Babylonian medicine, pre-Hippocratic medicine (referred to by the Hippocratics as hoi archaoi – the “ancients”) considered disease to be the result of demonic attack, which often called for magical means to counteract it. Finally, like Babylonian physicians, Hippocratic physicians had only a rather vague idea of internal anatomy because few physicians conducted autopsies on human corpses (see von Staden 1998).

Hippocratic medicine as a general system departed from traditional Babylonian medicine in the fifth century BC by developing a new approach to both diagnosis and therapy. The primary notion of external attack by demons was replaced by the theory of humors or internal balance/imbalance within the human body, which had to be corrected through the use of diet, purgatives, and eventually minor surgery in the form of venesection. Writers usually consider Greek medicine to be more “scientific” than its Babylonian counterpart, in the same way that Greek mathematics improved upon that of its predecessors. In a comparable way, once a theory of humors was developed to explain all manner of disease, the practitioner could dispense with a cumbersome system of preparing prescriptions which had to be tailored to each individual condition and ailment. In other words, the simple rule replaces the exhaustive database. Although not necessarily more effective for the patient, the new Hippocratic methodology took its place among other emerging disciplines in Greek science, as begun by Thales and his contemporaries.¹⁵¹