Medicine and healing: curing the body, calming the spirits

Even mighty kings fall ill. When any of the Assyrian royal family took sick, specialist healing scholars were called in to diagnose and treat the patient and to report back to the king on their progress. Spiritual, mental, and physical wellbeing were understood holistically, as an indicator of favour or disfavour with the gods. Thus as well as medication to alleviate distressing symptoms, healers were likely to prescribe purification rituals as part of the cure. Once evil was expelled and normal communication with the divine world restored, the patient was considered to be on the road to recovery.

What did they suffer from?

Childbirth was a serious threat to the health of both mother and baby. This protective bronze plaque depicts the evil demon Lamaštu travelling on a boat through the Underworld as she prepares to snatch away a newborn. The mother in labour is surrounded by fish-cloaked scholars, protective genies, and Lamaštu's nemesis Pazuzu, who pokes his head up over the back. AO 22205, photo (c) Musée du Louvre. View image on the Louvre website.

In a letter to king Esarhaddon, chief physician TT Urad-Nanaya PGP quotes the king's words back to him: "Why do you not diagnose the nature of this illness of mine?" (SAA 10: 315). Modern scholars have as much difficulty with this task as Urad-Nanaya did. The problems are complex. As modern medicine now understands it, a disease may exist independently of its host - for instance the common cold virus, or chickenpox - or it may be a manifestation of a malfunctioning of the body itself - most cancers, or dementia, for example. Even in modern medicine neither the patient's own description of their symptoms, nor even the professional's observations of the surface of the patient's body, are sufficient to achieve an accurate diagnosis. With ancient records the difficulties are even more acute: we cannot suppose that they are based on the same cultural norms as today; neither can we be sure that technical terms were used consistently; nor can we always identify those terms' range of meaning. But even if we did have access to full, accurate, and consistent accounts, within any patient group symptoms manifest differently in different individuals, dependent on age, health, diet, climate, and many other factors. Modern medicine depends on a variety of sophisticated interventions, from x-rays to DNA analysis, to provide accurate diagnoses, but even these are prone to error: diseases can be identified when none are present (false positives); equally can be overlooked or mis-identified (false negatives). New disease entities come into being (AIDS, avian flu); others decline or disappear (bubonic plague, cholera); most are constantly mutating (the common cold). Thus without direct access to ancient bodies to investigate their pathology, the modern historian of medicine cannot hope to make a confident retrospective diagnosis based on descriptions of symptoms by either healer or sufferer.

But those obstacles to disease identification do not render the study of ancient medicine redundant. However, they do shift the emphasis from diseases as objective entities to illnesses as subjective experiences. How did members of the Assyrian royal family experience disease? How did they express their suffering and what did they expect their scholarly entourage to do about it? How, in turn, did the healing professionals respond to those demands and how did they manage their royal patients? Of course it would be satisfying to know exactly what was wrong with Esarhaddon, but given that it is far too late to cure him ourselves then in many ways it no longer matters. The fact that he did consider himself ill, though, has major historical implications. On the one hand, his illness had profound effects on the course of Assyrian history; on the other, his medical needs must have stimulated innovation in healing theory and practice as scholars in the royal entourage competed to make him well.

Medicine in theory

Assyrian jewellery was not simply pretty adorment. Coloured stones (and glass) were considered to have beneficial properties: they warded off evil and protected against harm. Healers often prescribed protective necklaces to be worn during times of illness or stress. BM ANE 127228, photo by Eleanor Robson. View large image.

Assurbanipal's Library contained many different genres of writing on the subject of medicine and healing: medical recipes, often collected according to the body part affected; lists of medical herbs, plants, and stones; incantations TT and rituals TT against illness; and a canonical TT series of omens TT drawn from observations of the patient and their surroundings, known in Assyrian times as sakikku 'Symptoms' and intended to help determine a prognosis. Most text types are quoted in the scholars' letters. Urad-Nanaya gives several recipes for tampons TT to cure nose-bleeds (SAA 10: 321), which involve the preparation of medical ingredients, from plant seeds to "dust from the crossroads", over which an incantation should be recited. SAA 10: 327 is a fragmentary list of remedies by the same scholar. Marduk-šakin-šumi PGP quotes a ritual against "the evil demon TT and epilepsy TT " (one of the few cases in which we are confident of the identity of the ancient disease) (SAA 10: 238) and Nabu-naṣir PGP describes rites "To keep ma[laria] TT , plague and pestilence away from a man's home" (SAA 10: 296). The prognostic omen series 'Symptoms', however, is not mentioned in any of the extant letters (although prognoses are given: e.g., SAA 10: 319).

Both Marduk-šakin-šumi and Nabu-naṣir carried the title āšipu, often translated "exorcist" TT , while Urad-Nanaya was an asû, usually translated "physician" TT . Ancient library catalogues distinguished clearly between the knowledge associated with each profession: the omen series 'Symptoms' and the rituals and incantations all belonged to the domain of āšipūtu "the office of the exorcist", while medical recipes and lists of ingredients comprised asûtu "the office of the physician". Some historians have wanted to see the asû as a "rational" practitioner in physical remedies and the āšipu as a worker in (superstitious) "magic". But how useful is this distinction? It is certainly true that the 24 letters from Urad-Nanaya and his fellow physicians are primarily concerned with alleviating symptoms, while the 129 letters from Marduk-šakin-šumi and the other exorcists mostly concern ritual purification TT (about 40% of the time in medical contexts). However, the boundaries between the two professions could become rather blurred. In SAA 10: 315, for instance, Urad-Nanaya gives instructions on the proper application of ṣilbānu poultices TT but also proffers a necklace of protective stones TT ; Marduk-šakin-šumi advises on exactly the same matters in SAA 10: 241. Urad-Nanaya suggests auspicious days TT for treatments in SAA 10: 325, although that was nominally the preserve of the exorcist. The disgraced exorcist Urad-Gula PGP had begun his career as a junior physician under king Sennacherib PGP . Urad-Nanaya and the exorcist Nabu-naṣir write jointly to Esarhaddon to announce his mother's recovery (SAA 10: 297).

Perhaps a more fundamental critique of the historians' distinction between rationality and magic is that no such division existed (so far as we can tell) in the minds of the scholars themselves. As the medical ritual "against evil demons and epilepsy" suggests, and the rest of the Assyrian medical corpus also demonstrates, no distinction was made between supernatural and natural causes of illness, the illness itself, and the symptoms it produced. In theory the ultimate cause of illness was divine displeasure, whether the immediate agent of the sickness was a deity, a demon, a witch TT , or an ill-wishing human. Thus the ultimate means of healing was to make amends with the angered gods and/or to expel evil from the patient's body. Meanwhile, the patient's suffering should be alleviated as much as possible, with soothing words and physical therapies. The interplay between theory, experience, and a good bedside manner are exemplified in a letter from the exorcist Marduk-šakin-šumi to Esarhaddon, who is laid low with a cold. The scholar assures him that "the gods of the k[ing] will quickly cure it, and we shall do whatever is relevant to the matter. [It is] a seasonal illness; the king, my lord, should not [wor]ry" (SAA 10: 236).

Healing in practice

Assyrian palace gateways were flanked by protective winged bulls and humanoid genies to drive away illness-carrying demons. The bulls guarding the main entrance to Assurnasipal's Northwest palace at Kalhu (c.860 BC) also wore fish-crowns in honour of the great sages from before the Flood. Photo by Eleanor Robson. View large image.

But what did scholarly healers actually do? We have already seen that Esarhaddon expected Urad-Nanaya to diagnose his illness (SAA 10: 315). In that same letter Urad-Nanaya proposes that his diagnosis be the subject of an extispicy query to confirm its correctness. He encloses lotions, salves TT , and healing stones for the king to apply himself, and gives instructions for the correct performance of a medical procedure. The healers often had to give such directions to the royal family's domestic staff, and it was a matter of some irritation when they were not carried out properly - as for instance when Urad-Nanaya's anti-nosebleed tampons were inserted incorrectly into the nostrils of a royal patient (SAA 10: 322). Having explained how and why the procedure has gone wrong, he suggests that he enter the palace itself to instruct the domestics face-to-face. Practical experience and manual dexterity were clearly as important as book-learning for the practicing physician.

Empathy, encouragement, and even assertiveness were also valuable skills, especially during the king's bouts of depression. When Esarhaddon had eaten nothing for two days running, the senior exorcist Adad-šumu-uṣur PGP sent him a cajoling letter, ending firmly: "G[ood ad]vice is to be heeded: restlessness, not eating and not drinking disturbs the mind and adds to illness. In this matter the king should listen to [his se]rvant" (SAA 10: 196). But the healers did not only communicate with the king at a distance. Their letters refer to formal audiences with the king (e.g., SAA 10: 315, 328) and to sitting up all night with their patients to nurse them (e.g., SAA 10: 329). Therapeutic and preventative rituals could take many days to prepare for and perform (SAA 10: 255). "Keeping the watch of the king" could be a wearing and demanding business: Adad-šumu-uṣur is expected to be in two places at once (SAA 10: 222), while Urad-Nanaya becomes so exhausted that he begs the king for a month off work (SAA 10: 320).

We now know that diseases are either self-limiting (they go away on their own or one learns to live with them) or terminal (they kill), so that most healers in most pre-modern societies more often than not made little objective impact on the course of a disease. But there is more to healing than that. The royal family must have been enormously grateful for the confident and sympathetic advice and support that the senior scholars offered in times of crisis, even when events ran beyond their control. When Adad-šumu-uṣur counsels Esarhaddon,

As to what the king, my lord, wrote to me: "I am feeling very sad; how did we act that I have become so depressed for this little one of mine?" - had it been curable, you would have given away half of your kingdom to have it cured! But what can we do? O king, my lord, it is something that cannot be done. (SAA 10: 187)

it is impossible not to feel the emotion, even two and a half thousand years later.

Medicine and healing: curing the body, calming the spirits

What did they suffer from?

Medicine in theory

Healing in practice

Further reading