Illness as a practical and a spiritual problem
In Mesopotamia, which covers ancient Iraq and neighbouring regions, illness could be understood in several ways at once. A fever or a wound might have a visible cause, such as injury, diet or exposure, and it might also be linked to the displeasure of a god, the action of a demon, a curse or an act of witchcraft. Healers did not treat these ideas as exclusive. A single case could involve a drug applied to the body and a ritual meant to remove an unseen cause.
Our knowledge comes from cuneiform tablets, written in Sumerian and Akkadian over many centuries. Many of the best-known medical texts come from the libraries of the kings of the Assyrian Empire, especially at Nineveh in the first millennium BCE, though they often copy older material. The writing system itself, cuneiform writing, made it possible to record long lists of symptoms and treatments, and the collections that survive are large.
Two specialists: the asu and the ashipu
Texts name several kinds of healers. Two are most prominent, and they are usually identified by their Akkadian titles.
The asu, often translated “physician”, worked mainly with the body. He examined the patient, prepared and applied medicines, bandaged wounds and carried out simple procedures. His therapies included plant, animal and mineral ingredients, used as ointments, poultices, washes, potions and similar preparations.
The ashipu, often translated “exorcist” or “incantation priest”, dealt with the supernatural and ritual side of illness. He diagnosed whether a sickness had been caused by a god, a demon or a human act, and used incantations, purification and ritual actions to address it. His training included wide knowledge of ritual literature.
It is tempting to see the asu as “practical” and the ashipu as “magical”, but that division is too neat. Texts from the exorcist’s tradition contain real observations of symptoms, and the physician’s texts contain incantations. The two specialists could be consulted in sequence, and some scholars think they sometimes cooperated.
Diagnosis and the role of omens
The best-known diagnostic collection is the series usually called the Diagnostic Handbook. It lists signs observed on the patient’s body, such as colour, temperature, sweating and behaviour, and gives a prognosis. Other texts relate the omens met by the healer on the way to the sick person’s house, or the circumstances of the illness, to the likely outcome. This habit of reading signs is related to the wider omen literature of the region, including the traditions behind Babylonian omens, where the world was read as a system of messages.
Diagnosis in this sense was both clinical and interpretive. The healer looked at the body, and he also interpreted what the illness might mean.
Treatments and ingredients
Therapeutic texts give recipes with plant, mineral and animal ingredients, sometimes accompanied by instructions on preparation and application. The identity of many ingredients is hard to establish, because the names are not always clear and may not match any modern term. Beer and oil were often used as bases, and some treatments instruct the healer to apply a remedy together with the recitation of a particular spell.
Because the evidence is textual, it can be hard to know how widely a recipe was used or whether it worked. Some ingredients may have had real effects, others none, and it is not possible to judge them mechanically. The texts also show that healers recognised a range of conditions, including eye, skin and digestive problems, injuries and fevers.
Training and status
Training seems to have been passed within families or through scribal schools, and the written tradition shows that healing was taught through texts and apprenticeship. Healers often worked in connection with temples and the royal court, and some served kings. The Assyrian rulers, for instance, kept physicians and exorcists in their entourage, and letters from these specialists to the king survive.
Healing could also be a matter of law. Provisions in the laws of Hammurabi set out fees for successful surgeries and punishments for surgeons whose patients died or lost limbs, depending on the patient’s social rank. These rules suggest that surgery was practised and regulated, though we do not know how strictly they were enforced.
Midwives, lay healers and everyday care
Much of ordinary care, like much of Mesopotamian daily life, probably took place at home, with family members, midwives and neighbours. Because writing was done by a literate elite, these practitioners are largely invisible in the sources. Women played a significant role in childbirth and childcare, but the extent of their medical authority is difficult to reconstruct.
Influence beyond Mesopotamia
Mesopotamian medicine had a wide regional impact. Its texts and practices were known in neighbouring regions, and it is often discussed as part of the background of later Greek medical thought, along with Egyptian medical knowledge. The details of any transmission are debated, and it would be wrong to assume direct borrowing in each case. Still, the evidence shows a mature tradition of observation, recipe collection and ritual that stretches back at least to the second millennium BCE, and in some respects earlier.