History of Iran: History of ancient Medicine in Mesopotamia & Iran We use cookies to understand how you use our site and to improve your experience. This includes personalizing content and advertising. By continuing to use our site, you accept our use of cookies. To learn more, click here. Yes, I agreeWe use cookies to understand how you use our site and to improve your experience. This includes personalizing content and advertising. By continuing to use our site, you accept our use of cookies. To learn more, click here. Yes, I agree Home|Art & Culture|History|Iran's Guide|Society Friday, December 23, 2022 ×search History of Iran History of ancient Medicine in Mesopotamia & Iran By: Massoume Price, October 2001 Science including medicine has a long history in Middle and Near East and goes back to the ancient Mesopotamian period (Beginning with Sumer 3000BC). There are many cuneiform tablets from cities as ancient as Uruk (2500 BC). The bulk of the tablets that do mention medical practices have survived from the library of Asshurbanipal at Nineveh (668BC) Assyria. So far 660 medical tablets from this library and 420 tablets from the library of a medical practitioner from Neo-Assyrian period, as well as Middle Assyrian and Middle Babylonian texts have been published. The vast majority of these tablets are prescriptions, but there are a few series of tablets that have been labeled "treatises". One of the oldest and the largest collections is known as "Treatise of Medical Diagnosis and Prognoses." The text consists of 40 tablets collected and studied by the French scholar R. Labat. Although the oldest surviving copy of this treatise dates to around 1600 BC, the information contained in the text is an amalgamation of several centuries of Mesopotamian medical knowledge. The diagnostic treatise is organized in head to toe order with separate subsections covering convulsive disorders, gynecology and pediatrics. To the non-specialist they sound like magic and sorcery. However, the descriptions of diseases demonstrate accurate observation skills. Virtually all expected diseases exist, they are described and cover neurology, fevers, worms and flukes, venereal disease and skin lesions. The medical texts are essentially rational, and some of the treatments, (such as excessive bleeding) are essentially the same as modern treatments for the same condition. Mesopotamian diseases are often blamed on pre-existing spirits: gods, ghosts, etc., and each spirit was held responsible for only one disease in any one part of the body. Ancient mythologies tell stories of diseases that were put in the world by supernatural forces. One such figure was Lamashtu the daughter of the supreme god Anu, a terrible she-demon of disease and death. It was also recognized that various organs could simply malfunction, causing illness. Medicinal remedies used as cures were specifically used to treat the symptoms of the disease, and are clearly distinguished from mixes or plants used as offerings to such spirits. There were two distinct types of professional medical practitioners in ancient Mesopotamia. The first type of practitioner is called ashipu, who in older texts is identified as a sorcerer or the witch doctor. One of the most important roles of the ashipu was to diagnose the ailment. In the case of internal diseases or difficult cases the ashipu determined which god or demon was causing the illness. He also attempted to determine if the disease was the result of some error or sin on the part of the patient. He prescribed charms and spells that were designed to drive out the spirit causing the disease. The ashipu could also refer the patient to a different type of healer called an asu. He was a specialist in herbal remedies, and in texts is frequently called "physician" because he dealt with empirical applications of medication. For example in case of wounds the asu applied washing, bandaging, and making plasters. The knowledge of the asu in making plasters is of particular interest. Many of the ancient plasters (a mixture of medicinal ingredients applied to a wound often held on by a bandage) seem to have had some helpful benefits. For instance, some of the more complicated plasters called for the heating of plant resin or animal fat with alkali. This particular mixture when heated yields soap which would have helped to ward off bacterial infection. The two practitioners worked together and at times could function in both capacities. Another textual source of evidence concerning the skills of Mesopotamian physicians comes from the Law Code of Hammurabi (1700 BC). There are several texts showing the liability of physicians who performed surgery. These laws state that a doctor was to be held responsible for surgical errors and failures. Since the laws only mention liability in connection with "the use of a knife," it can be assumed that doctors were not liable for any non-surgical mistakes or failed attempts to cure an ailment. According to these laws, both the successful surgeon's compensation and the failed surgeon's liability were determined by the status of his patient. Therefore, if a surgeon operated and saved the life of a person of high status, the patient was to pay a lot more as compared to saving the life of a slave. However, if a person of high status died as a result of surgery, the surgeon risked having his hand cut off. If a slave died the surgeon only had to pay enough to replace the slave. At least four clay tablets have survived that describe a specific surgical procedure. Three are readable, one seems to describe a procedure in which the asu cuts into the chest of the patient in order to drain pus from the pleura. The other two surgical texts belong to the collection of tablets entitled "Prescriptions for Diseases of the Head." One of these texts mentions the knife of the asu scraping the skull of the patient. The final surgical tablet mentions the postoperative care of a surgical wound. This tablet recommends the application of a dressing consisting mainly of sesame oil, which acted as an anti-bacterial agent. It is hard to identify some of the drugs mentioned in the tablets. Often the asu used metaphorical names for common drugs, such as "lion's fat" (much as we use the terms "tiger Lilly" or "baby's breath"). Of the drugs that have been identified, most were plant extracts, resins, or spices. Many of the plants incorporated into the asu medicinal repertoire had antibiotic properties, while several resins and many spices have some antiseptic value, and would mask the smell of a malodorous wound. Beyond these benefits, it is important to keep in mind that both the pharmaceuticals and the actions of the ancient physicians must have carried a strong placebo effect. Patients undoubtedly believed that the doctors were capable of healing them. Therefore, visiting the doctor psychologically could reinforce the notion of health and wellness. Temples belonging to gods and goddesses of healing were also used for health care. Gula was one of the more significant gods of healing. The excavations of such temples do not show signs that patients were housed at the temple while they were treated (as was the case with the later temples of Asclepius in Greece). However these temples were sites for the diagnosis of illness and contained libraries that held many useful medical texts. The primary center for health care was the home. The majority of health care was provided at the patient's own house, with the family acting as care givers. Outside of the home, other important sites for religious healing were nearby rivers. These people believed that the rivers had the power to care away evil substances and forces that were causing the illness. Sometimes a small hut was set up either near the home or the river to aid the patient and their families. While many of the basic tenants of medicine, such as bandaging and the collection of medical texts, began in Mesopotamia, other cultures developed these practices independently. In Mesopotamia many of the ancient techniques became extinct after surviving for thousands of years. It was Egyptian medicine that seems to have had the most lasting influence on the later development of medicine, through the medium of the Greeks. In the fifth century BC the Greek historian and traveler Herodotus commented on current medical practices in Egypt; "the art of healing is with them divided up, so that each physician treats one ailment and no more. Egypt is full of physicians, some treating diseases of the eyes, others the head, others the teeth, others the stomach and others unspecified diseases". The ancient Egyptian texts of the Old Kingdom (2635-2155 BC) contain at least 50 physicians, mainly from their names on tombs. The later periods also give detailed information about physicians and their practice. Though most physicians were men, female physicians existed as well. The title ‘Lady Director of Lady Physicians’ proves the existence of a group of women who practised as doctors. Physicians were literate, some were scribes and others were priests at the same time. Most inherited the profession from their fathers but needed to be trained in the field. The profession was organised hierarchically with the Chief Physician at the top and lesser titles following, such as Master of Physicians, Director of Physicians, Inspector of Physicians, Plain Physicians and auxiliaries such as Bandage personnel etc. Texts deal with diagnosis, treatments and prescriptions. Surgery and mummification processes used by ancient Egyptians still amazes the modern experts. All major and expected diseases are known and treated, ailments are attributed to spirits, ghosts and revenge by gods and goddesses. Texts dealing with gynaecology cover fertility, sterility, pregnancy, contraception and abortion. Women were tested to decide whether they could conceive or not. However the Egyptians were behind Babylonian doctors who had gone further and designed the first pregnancy tests known in history. This test involved placing in the women’s vagina a tampon impregnated with the juice of various plants in a solution of alum. This was left in position either overnight or for three days. Pregnancy or non-pregnancy was indicated by colour changes between red and green. The test used the pH value of the woman’s secretions in vagina to determine pregnancy. Rational thinking and sound medical observation were used alongside magic and sorcery. Magic was based on the assumption that an object with certain qualities, or an action of a certain kind, could be used to create sympathetic action (healing) or to repel something evil. Magical elements were included in medical texts and were added to the prescriptions and medicines appropriate for treatment of diseases. Some conditions like sterility and impotence in men used magic extensively while other easier ailments relied mainly on medicinal treatments. Heart was extensively studied with arteries however it is not clear if they fully understood the circulation of blood. In fact heart was considered to be the organ of reason instead of the brain though this later organ was extensively studied as well. Anatomy was well understood and dissection was a common procedure. There are many medical papyri providing detailed descriptions of surgical procedures and other topics related to medicine. The collections are massive and medical knowledge is organised and detailed. Such organisation of knowledge is a prerequisite for major advances in science. Indeed Greeks made extensive use of Egyptian science and medicine and created their own school of medicine that dominated the ancient civilisations for centuries to come. By the time Hippocrates began his scientific medicine in his native city Cos, the city was already the headquarters of the Asclepiadae, a professional association of physicians under the patronage of Asclepius, the god of healing. They were all familiar with Mesopotamian and Egyptian medical knowledge and used such texts extensively. However the Greeks based medicine on empirical knowledge and separated the supernatural from the scientific information. The first major Iranian dynasty Achaemenid (550 BC) promoted the development of culture and science extensively. The great scholars such as the philosopher Heraclitus of Ephesus, the Babylonian astronomer Kidinnu and even the historian Herodotus were Persian subjects. The ancient cultures of the Egyptians, Babylonians, Elamites, and others continued to exist and develop. Babylonian Physicians were all over the territories and served all people including Persians. Xenophon relates that when the Greek soldiers who served under Cyrus the younger passed through the territory of Babylonia, they found sufficient number of Physicians even in the villages to treat the wounded warriors. Texts describe how physicians used medicine, prayers and magic, they would often model images of evil spirits out of clay and shatter them, in order to restore the invalid to health. Achaemenid made Babylon one of their major capitals and extensively used the texts at the temple libraries. The library and museum at the Persepolis was build to rival the Babylonian archives famous in the ancient world. Greek and Egyptian physicians were invited to join the Achaemenid court and served the royal household. Persians also adopted the tradition of paying the physicians according to the rank and gender. The archives at Persepolis indicate that physicians and midwives who delivered boys were paid double the amount they got when the baby delivered was a girl. The records do not indicate severe punishments if the sick person died, as was the case under Hammurabi. Texts also show lists of plants, herbs and other substances used for medicinal purposes. Drugs are taken internally; mercury, antimony, arsenic, sulfur and animal fats are also prescribed. All are basically the same as Babylonian medicine and prescriptions. At one point Darius orders a representative to return to Egypt in order to restore the department of the ruined house of life dealing with medicine; " While his majesty was in Elam he ordered me (Udjahorresne) to return to Egypt. I gave them every useful thing and all their instruments indicated by the writings, as they had been before. His majesty did this because he knew the virtue of this art to make every sick man recover". The subsequent Seleucid and Parthian dynasties followed the same trends with more Greek influence science and art due to massive presence of Greeks in the area. However the flourishing of science and technology happened in the Sassanian period with major centers of learning and the famous university Jundaishapur. The Sassanian king, Khosrow Anoshirvan is mentioned by many historians and biographers to have been a major promoter of all sciences including philosophy and medicine. In a Pahlavi text (Karnamag) he is quoted the following; "We have made inquiries about the rules of the inhabitants of the Roman Empire and the Indian states. We have never rejected anybody because of their different religion or origin. We have not jealously kept away from them what we affirm. And at the same time we have not disdained to learn what they stand for. For it is a fact that to have knowledge of the truth and of sciences and to study them is the highest thing with which a king can adorn himself. And the most disgraceful thing for kings is to disdain learning and be ashamed of exploring the sciences. He who does not learn is not wise". Greek Philosophers Syriac speaking Christians and Nestorian Christians fleeing persecution by Byzantine rulers were received by Anoshirvan and were commissioned to translate Greek and Syriac texts into Pahlavi. Paul the Persian dedicated Works of logic to the king. The Greek philosopher Priscianus Lydus wrote a book in response to the king’s questions on a number of subjects in Aristotelian physics, theory of the soul, meteorology and biology. The Sassanian religious text, Dinkard shows familiarity with all these topics, especially Aristotelian physics. It is apparent from the text that Aristotle’s famous article ‘On Coming to be and Passing away’ was well known by the compilers of Dinkard. Becoming, decay and transformation the three fundamental concepts in the article are mentioned and discussed. Pahlavi texts also indicate that the doctors were paid according to the rank of the patient. Books in medicine, astronomy, Almagest (by Ptolemy), Aristotle’s Organon and a number of texts in crafts and skills were translated from Greek. Syrian Christians in particular played a significant part in communicating Greek sciences and knowledge to the Persians. The famous university and the hospital at Jundaishapur built earlier reached its peak at Anoshirvan’s time. The Muslim historian Qifiti (12/13th century AD) in his book ‘History of Learned Men’ quotes the following; "In the twentieth year of the reign of Khosrow II (Anoshirvan) the physicians of Jundaishapur assembled for a scientific symposium by order of the king. Their debates were recorded. This memorable session took place under the presidency of Jibril Durustabad, the physician in ordinary to Khosrow, in the presence of Sufista’i and his colleagues, together with Yuhanna and a large number of other medical men". It is likely that the medical teaching resembled those at Alexandria with some influence from Antioch. This hospital and the medical center were to become the model on which all-later Islamic Medical Schools and hospitals were to be built. Earlier Muslim historians such as Maqdisi (10th century) mention the medical school in Khuzistan and name it’s famous associates and practitioners. The famous writer and translator, Burzoy who translated the Indian book of fables the Panchatantra (later, Kalila wa-Dimna) for Anoshirvan was also a well-known physician from Nishapur. The first recorded Muslim Physician Harith bin Kalada had studied at Jundaishapur Medical School. In Jundaishapur Greek, Indian and Persian scientific traditions were assimilated. Indian scientific material in astronomy, astrology, mathematics and medicine were also translated into Pahlavi along with Chinese Herbal medicine and religion. The books were kept at the university and the royal libraries and Greek medicine based on works by Hippocrates and Galen dominated the discipline. The later Muslim historians refer to the Sassanian Imperial library as the House of Knowledge (Bayt al Hikmat). The library functioned as both a place where accounts of Iranian history and literature were transcribed and preserved. At the same time it was a place where qualified hired translators, bookbinders and others worked to preserve, purchase, copy, illustrate, write and translate books. It was such texts that made their way into the Islamic period. Many books in sciences and philosophy were translated by the Persians, Greeks, Syriac and Aramaic-speaking scholars into Arabic and eventually made their way into Muslim Spain and Western Europe. Persia and Byzantium dominated the area before Islam. The later was a continuation of the Eastern Roman Empire and the seat of Greco-Roman art, culture and civilization. Alexandria and Constantinople were major centers of intellectual activities with theaters, libraries and universities. In addition to Major cities like Alexandria Constantinople and Jerusalem, intellectuals and scientists moved and carried ideas from Edessa in the west, through Nisbis and Mosul (Iraq) to Marv and Jundaishapur in Western Persia. The conquest of Islam in 7th century united east and west, improved trade and boasted book publishing by introducing advanced paper making techniques from China. However major cities and libraries were destroyed, Arabic eventually became the universal language of the empire and forced conversions into Islam threatened national identities and local cultures. The Imperial library at C… truncated (13,576 more characters in archive)