Bryn Mawr Classical Review

Reviewed by L. R. Siddall, School of Oriental and African Studies, University of London (luis.siddall@gmail.com)

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[Disclaimer: The reviewer would like to acknowledge that he previously studied Sumerian language and Akkadian medical texts under Professor Markham J. Geller.]

Babylonian medicine presents a number of difficulties for Assyriologists and scholars of the history of medicine. Many textual sources are still being analyzed and others have not yet been properly edited or remain unpublished, and our understanding of the medical terms and the therapies used still requires much research. However, Professor Markham J. Geller's book Ancient Babylonia Medicine: Theory and Practice provides an authoritative and thought provoking assessment of the topic, which shines a light on some of the murky areas of the discipline. The study concentrates on the theory and practice of Babylonian medicine in its final forms during the first millennium BCE and sets out to elucidate a number of problems that Babylonian medicine presents, such as what constituted medicine in ancient Babylonia, how it was practiced and by whom, who in society had access to medical treatment, where 'medical' knowledge fitted into Babylonian epistemology, and how the practitioners were trained. These topics are often discussed with reference to Greco-Roman and Medieval medicine, which provides both historical and historiographical contexts for Geller's findings. Geller also presents editions and translations of hitherto unpublished texts and new translations for out-dated material.

In the first chapter (pp.11-42), Geller offers some models for measuring the scientific nature of Babylonian medicine. The first model is concerned with the presence of theory in Babylonian epistemology. He argues that there are three "preconceptions" for theory: imagination (the process of clarifying the randomness found in nature), deductive logic (finding logical, causal relationships), and observation (a formalized and calibrated set of data). The second model for determining the scientific nature of Babylonian scholarship is that the more mathematical a discipline, the more scientific is was. Geller then examines different aspects of Babylonian medical practice in accordance with the two models, namely material medica, (the lack of) knowledge of human anatomy, medical predictions and prescriptions, therapeutic texts, understanding of psychosomatic illnesses and divination.

The question of who practiced medicine and on whom it was performed is taken up in the second chapter (pp.43-55). The discussion concentrates on the exorcist and the physician, but also considers the evidence for the diviners. Geller begins by examining the terminology used in medical and lexical texts for exorcists and physicians. While the terminology for physician is consistently asû, there are two mutually exclusive terms for exorcist, mašmaššu and āšipu. Through analysis of the lexical lists and the context in which these terms were used Geller concludes that the two terms do not mean the same thing, but are synonyms. āšipu was a more prestigious term used in scholarship and literature while mašmaššu was a term used more generally. Importantly, Geller also argues that our translation of āšipu and mašmaššu as "exorcist" is far too narrow for the "exorcist" performed a wide variety of rituals of which exorcism was a just one.

The textual evidence reveals some differences between the activities of exorcists and physicians. It seems the exorcist was responsible for the magical prevention of disease (warding off demons, angry gods, and witchcraft), visited the sick and made prognoses, and held priestly responsibilities at the temple. The physician, however, seems to have been involved in treating existing symptoms (insect bites, kidney stones, etc.) and preparing medical recipes for sale and apothecary. These differences in practice can be somewhat understood in the light of their place of occupation. The exorcist was a member of the temple administration while the physician seems largely to have been independent, probably operating a street stall. The exorcist received temple prebends (of which we have records) while the physician was an entrepreneur who could travel from land to land. Geller points out that working conditions of the diviner (Akkadian bārû) was closer to the physician than the exorcist.

Geller also considers the question of quacks and quacksalvers in ancient Babylonia. While there were no formal qualifications for physicians in ancient Mesopotamia, nor was there a word for "quack(salver)" in Akkadian (like Classical Greek), there was an awareness of the possibility that a quacksalver may impersonate physicians. Geller suggests that this might have been a reason for the presence of Dreckapotheke in medical recipes; and point out that the quack is a recurring character in Babylonian comedy.

The third chapter (pp. 56-88) is temporally and geographically broader than other chapters for it considers the relationship between politics and medicine in ancient Mesopotamia (Babylonia, Mari and Assyria) from the second and first millennia BCE. Geller surveys five instances where one can observe the interaction of politics and medicine. The first instance is the regulation of physicians (asû) and barbers (gallābu) in Hammurabi's Laws from the Old Babylonian period. The Babylonian king regulated what physicians could charge patients of the different social classes and what the penalties were for both physicians and barbers who committed malpractice. Noteworthy is the absence of exorcists from Hammurabi's Laws. Geller suggests that the prominence of the physician in the laws reflects the text's focus on civil law and hence its interest in surgery. The second instance is in the letters discovered at the city of Mari from the Old Babylonian period. The letters from the time of Yasmah-Addu and later show that there were staff physicians at the royal court. However, it is clear that the kings preferred the service of foreign physicians over the local staff. The prominence of the physician in the Old Babylonian courts is mirrored in the medical texts from the period, for the medical texts do not contain magical elements, rather they typically comprise medical prescriptions with a prognosis.

The division between magic and medicine seems to have continued into the Middle Babylonian period as evidenced in an archive of letters from Nippur. Many of the letters in the archive were written by a medic, Šumu-libši, and his colleagues who worked in a temple. Unfortunately, Šumu-libši does not refer to his title so it cannot be determined whether he was a physician in the temple or if he was an exorcist with a good understanding of medicine. Geller points out that Šumu-libši used non-magical therapies for patients. Thus, in the second millennium, there was little overlap of magic and medicine in therapy.

Geller turns his discussion to the Neo-Assyrian (first millennium) court, in particular the reigns of Esarhaddon and Ashurbanipal (681-c. 630 BCE), to further examine the relationship between politics and medicine. Four scholars at the court are the focus: Marduk-šāpik-zēri, Urad-Gula, Urad-Nanaya, and Adad-šumu-usur. In each case, Geller demonstrates the advantages the king's favor brought these individuals and how, in turn, their advice influenced the decisions the kings made. These letters indicate that there was a shift in the first millennium court personnel from physician to exorcist and diviner. Further, there is a greater overlap in the medical practices of the exorcists in the Neo-Assyrian period, for they undertake both pharmaceutical and magical practices.

The forth and fifth chapters examine the place of Babylonian medicine in wider scholarly activities in Babylonia and Greece. The fourth chapter considers the place of medical texts in literature (pp. 89-117). Medical texts, like literary texts, were consistently copied throughout the second and first millennia and as a result there are duplicates of most medical texts. However, unlike literary texts, the medical corpus is unique in two aspects. First, medical compositions were rarely copied in whole, but rather a medical text comprised selections from numerous texts to create unique edition. Thus, the individual prescriptions and recipes of a medical text were semi-autonomous and duplicates can be found in very different contexts, such as in either large medical compendia or in a small prescription. Geller illustrates this process well in figures 4.2 to 4.5 which show examples of duplicates in various tablets. Second, medical texts, particularly those of the first millennium, contain both prose (recipes and prescriptions) and poetry (incantations). Geller also outlines three different genres of medical texts: (1) the Diagnostic Handbook which is not a collection of case histories, but a description of diseases in the form of diagnostic omens; (2) lists of material medica or diseases; and (3) therapeutic texts which combine recipes, material medica, incantations. Interestingly, there is little information about illness in the medical incantations, and they place the cause of medical problems not with the gods, sin or transgression. Rather illness merely occurs.

The fifth chapter examines medicine and philosophy (pp. 118-129). After comparing the similarities and differences between Babylonian medicine with that of Pre-Hippocratic and Hippocratic medicine, Geller looks at what the Greeks considered the role of philosophy was in medicine and whether there was similar thought in Babylonia. For the Greeks, the physician healed the body, and wisdom the mind. There is a vague parallel in Babylonian medicine with the asû tending to symptoms of disease and the exorcist treated the psyche. However, in Mesopotamian thought wisdom and was the domain of the gods and humans were merely capable of possessing knowledge. While 'philosophy' might not have been the domain of the Babylonians, change and innovation did occur, most drastically in the second half of the first millennium. This was a period when astrology came to influence scholarship more broadly and in medicine, and there were even attempts to place the cause of disease within the body, rather than ascribing it to supernatural forces. This transition occurred in a period when the exorcist came to dominate the sources and physician disappeared altogether. While this phenomenon might reflect the temple context of the archives, Geller plausibly suggests that it might actually reflect the functioning of the Persian court, which gave preference to foreign physicians (usually Greek) and the magii who fulfilled very similar functions to the exorcists. In doing so, the Persian system marginalized the Babylonian asû.

The sixth and seventh chapters turn to consider the way ancient scholars were trained and what evidence there is for professional development and scholarly practice. Chapter six (pp. 130-140) looks at the scribes' titles and the terminology used for tablet copying to reconstruct how a scribal school functioned. Geller shows that the scribal titles provide clues to some form of hierarchy, but no overall picture emerges of how scribes could progress. Particularly interesting is the analysis of the terminology in colophons which indicate the purpose of the tablet. Much attention is paid to the phrase ana tāmarti, literally "for viewing," but often understood to mean "for reading." Geller makes a convincing argument that ana tāmarti had a more specific meaning, which was "reading for academic scrutiny."

Chapter seven (pp. 141-160) returns to assessing the evidence for theory in Babylonian scholarly practice. The late Uruk medical commentaries provide information about what the 'professors' (ummânu) taught their students. While the commentaries are not full treatises, Geller shows that they are evidence that the Hellenistic Babylonian schools were reinterpreting and explaining the received medical texts. Such evidence strongly suggests that theory was part of the teaching and learning procedures in the scribal schools of this period. The commentaries, and the archives in which they were found, indicate that the division between medicine and magic was gone, and that exorcists in particular studied all areas of Babylonian science. In this way, the Uruk commentaries provide an insight into one reason the exorcists were more prominent than the physicians in later Babylonian history.

The book closes with the eighth chapter, "Medicine and Magic as Independent Approaches to Healing" (pp. 161-167), which largely summarizes the findings and states the conclusions. Chapter eight is followed by an appendix that comprises a new edition of a medical commentary by the fourth century Babylonian scribe, Iqīšâ (pp. 168-176).

In sum, Geller has written a remarkably useful and thoughtful volume on what is an elusive topic. Assyriologists and historians of medicine will gain much from reading this work and it will certainly become required reading for the discipline.