Kidney and Urinary Tract Disease in Ancient Babylonia, with Translations of the Cuneiform Sources
Total Page：16
File Type：pdf, Size：1020Kb
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Kidney International, Vol. 47(1995), pp. 1811—1815 HISTORICAL ARCHIVES Kidney and urinary tract disease in ancient Babylonia, with translations of the cuneiform sources MARKHAM J. GELLER and SIMoN L. COHEN Departments of Hebrew and Jewish Studies and Medicine, University College, London, England, United Kingdom Kidney and urinary tract disease in ancient Babylonia, with transla-procedures. There is little evidence of surgery in Babylonian tions of the cuneiform sources. The large corpus of Babylonian medical medical literature [4]. texts is much less known to medical history than the contemporary medical papyri from Egypt, but offer a rich new source of information regarding Another collection of cuneiform tablets which is basic to the ancient diagnosis and treatment of disease. The Babylonian physicians study of Babylonian medicine has become known as the 'diagnos- systematically noted systems related to kidney and urinary tract diseases. tic handbook.' These tablets, dating from the first millennium Pharmacological prescriptions tended to consist of plant and mineralB.C., comprise a long list of diseases organized from head to foot, substances administered either orally in drinks, or were inserted directly into the urethra through a tube. in which all symptoms from any diseases which affected the head were listed with of head symptoms, then eye symptoms, mouth, neck, and so forth. The symptom lists were actually used by the incantation-priest (ãfipu) rather than the physician (asâ) [5], There are numerous Babylonian medical texts written on clayjudging by the opening line of the composition which states, 'when tablets which have survived from Mesopotamia, covering allthe a.iipu goes to the house of the sick man' [6]. It seems likely that aspects of ancient medicine. The oldest medical tablet dates fromit was the incantation-priest who visited the patient to offer a the early second millennium B.C., and contains no incantations ordiagnosis, while the physician/pharmacist was the technician who magic [1]. The rest of the corpus comes down to us in a ratheractually made up the recipes. different form, primarily in Akkadian (the Semitic language of Finally, a third type of medical texts consisted of long lists of Mesopotamia), from archives dated from the late second millen-plants and minerals with descriptions, such as milky sap, red spots nium (from Assur), and many more from the first millennium B.C.on the leaves, etc. No systematic work has appeared on these [2]. These later Akkadian medical texts, dating from the eighth toimportant lists of materia medica since 1949 [7]. seventh centuries B.C., come mainly from the Library of Assur- We cannot assume that an ancient Babylonian physician ap- banipal which was previously in Nineveh but now resides in theproached the patient with today's method of history, examination, British Museum. Other cities in Iraq, such as Babylon, Borsippa,investigation, and treatment. There is no evidence that any Uruk, and Sippar, have also contributed cuneiform medicalBabylonian doctor took history into account when diagnosing archives dating from the Neo-Babylonian, Persian, and Seleucidkidney disease, although occasionally family histories are men- periods (sixth to first centuries B.C.). tioned in anecdotes in the Talmud [8]. The most common type of Babylonian medical text consists of As for kidney prescriptions themselves, the present selections of prescriptions in which descriptions of symptoms are immediatelysymptoms have been culled from the medical tablets themselves, followed by extensive recipes. There are some incantations withinextracted from the prescriptions written by trained physicians. the medical corpus, but these are of relatively minor importanceThe i3abylonian medical texts were intended for professional use, in relation to the recipes, which embody the main purpose of theeither by the diagnostician when visiting the patient or for training medical texts. The texts were probably written by the asa,theof physicians [9]. The following selection is an attempt to identify so-called 'physician' whose function was closer to that of acertain manifestations of renal disease and related symptoms in pharmacist [3]. The prescriptions consisted of many differentcuneiform tablets, based upon the evidence of Babylonian diag- plant and mineral ingredients, often boiled or distilled in wine ornOstic observation. The cuneiform texts have been translated by beer, which were ingested through the mouth or rectum in theM.J. Geller. Words in parentheses have been inserted for the form of potions, pills, or suppositories. These texts form the majorpurpose of clarity of meaning, and italics are used for words which part of the ancient medical corpus, reflecting the actual diagnosescannot be translated. and treatments of illnesses, but we do not know who actually administered the drugs to the patient or performed any medical "If a man is made prone(?) from fafituna-disease, and constantly has an erection [101, and his bladder swells up [that is, an obstruction preventing emptying of the Received for publication March 4,1994 bladder], that man is overcome by sdtu-disease [11]. In and in revised form December 7, 1994 order to cure him, bray together 'dog's tongue', seed of Accepted for publication December 29, 1994 tamarisk, seed of puquttu, myrrh, resin of balukkatu, © 1995 by the International Society of Nephrology whether in wine or in milk or in best beer; he must not 1811 1812 Gellerand Cohen: Ancient Babylonian kidney disease Fig. 1. Neo-Assyrian medical tablet dealing with disorders of the kidney and gall bladder (K fl + 2449+, photograph courtesy of the Trustees of the British Museum). administer it gradually over 3 days, but have him drink it "[If (the patient) is a man] who drinks water and in one day [12]. 'greatly rises' (that is, gets an erection), eventually he will get better. If a man's urine constantly drips and he is not able to [If a] man urinates in bed, (it is the work of the hold it back, his bladder swells and he is full of wind, his urine duct is full of blisters; in order to cure him, bray goddess) Bëlet-ili, he will [get better] [18]." puquttu, crush it in pressed oil, and [blow] it into his In some cases, however, we can really see which disease is being penis through a bronze tube [13]. treated quite clearly. Kidney stone, for instance, is easily identi- If a man's urinary tract is blocked and his urine, whether fled: of fluid [or...] does not come out, on that day [ [14]. "[If a mani suffers from a stone, which does not [come out2 j [19] If a man suffers from 'stricture of the bladder'. .. .[15] If a man's pelvic region is affected either when he walks [....]during3 days, he has a stone in the urethra, that or in bed, [. him, burns him, and hits him after man must drink beer and [the stone] will be passable. If . .] stings that man doesn't drink beer but drinks a lot of water, he he passes urine, .[.. .] [16]." will be assigned to his fate [20]." These manifestations of urethritis cannot really assist in iden- tifying the diseases [17], but at least they provide some notion of Other urinary problems result from urethritis, as in the follow- symptom observations, which are occasionally quite simplistic: ing prescriptions: Gel/er and Cohen: Ancient Babylonian kidney disease 1813 "If a man has pain in the 'flesh' of his kidney, his hips (or If his urine is like beer dregs, that man suffers from groin) are affected and his urine is white like donkey- discharge (musd) disease. urine, and later on his urine contains blood, that man If his urine is like wine dregs, that man suffers from suffers from 'discharge' (mu-disease), you boil to- discharge (muü) disease. gether 2 shekels of myrrh, 2 shekels of baluhhu, 2 If his urine is like clear paint, that man suffers from sila-measures of grapejuice in a jug; cool it and mix it (in discharge (mua) disease. two parts) equally in pressed oil. You pour half of (the If his urine is like kasi2(beet)-juice [28], that man suffers mixture) into his urethra through a bronze tube; the from sëtu-disease [29]. other half mix in best beer and let it sit out [overnight] If his urine is yellow, that man [suffers] from stricture of and give it to him to drink on an empty stomach and he the loins. will get better [21]." If his urine is white and thick, that man [suffers] from Here one can see three stages of good medical practice, namely kidney stone. observation of pain in the kidney, investigation of the color of the If his urine is like duhfu-stone, that man [suffers] from a urine, and noting that it contains blood, followed by treatment. stone. The reference to 'discharge' or muâ-disease in this extract could If his urine is as normal, his loins and epigastrium are reflect a urine infection from stone or pyelonephritis. 'Discharge' [....];thatman suffers from stricture of the rectum is a common term of kidney disease texts, and although we cannot [30]." be sure what kind of discharge is being described [22]. Notice thatHere the physician is noting the color and texture of the urine, the drugs are administered by being poured directly into hisprobably looking for frothy urine, but the investigation also urethra through a bronze tube, or orally, as in the followingincludes the possiblity that the urine is normal. example: Another 'kidney disease' text calls for the physician to use his "If a man's penis stings him when he passes urine (and) finger during the investigation of the patient. As is so often the his semen is discharged [23], he is 'seized' [in] his 'heart' case, the crucial second half of the line is broken, but one cannot and is 'bound up' [that is, cannot get erect] when he has help but wonder whether the physician was inserting his finger sex with a woman, and pus (farku) constantly flows from into the patient's rectum [31]; it is unclear whether the Babyloni- ans could have known about the prostate, especially since the his penis, [that man] suffers from 'discharge' (mus.â disease).