Tuesday, November 20, 2012

3000-900 B.C.: Asthmatic boy in Babylon

So as soon as we get back from Ancient Egypt our time machine is ready for another journey, and we're asked to quickly board so we don't upset the time space equilibrium, whatever that is.  After a few shakes and quakes the ride is rather pleasant.  I'm thankful I already tucked my rescue inhaler into my pocket.

When we arrive we are amid ten people, a family I assume, each with long black hair tied with a ribbon, and all squatting -- all but one boy that is -- around a large bowl, eating slop with their fingers.  The sun is setting in the east and the air feels cool yet comfortable, stained with the aroma of whatever was dinner and the fire (the smoke of which is making my lungs feel tight). The men and women wear woollen cloaks, making us feel out of place in our 21st century sweatshirts and jeans.  (Sigerist page 400)

No, they don't see us, as we are merely observers. Yet as an asthmatic I can't help but to notice the teenager slumped in the corner, leaning against a flat rock.  The others seem to ignore him, and he makes no effort to seek help either.  I find this odd.  Although our guide states this isn't odd, because the boy doesn't want sympathy.  While we may surmise he has asthma, these folks have no concept of asthma.  The symptom was the disease as primitive man had no concept of nosological entities, that is, of disease.  The young man, if he doesn't recover, is a burden; a hindrance.  He wants no sympathy.

Likewise, our guide states, we must understand that a disease is a curse and illness was a punishment of something you did wrong.  The boy may simply not know what he did wrong, and maybe he didn't do anything at all.  Yet that won't stop his family from assuming he was a bad boy.  Because he had no idea what he did so wrong to feel so bad, he was resigned.  So it was easier for the boy to hide, or pretend to be fine.

Our guide says we must be somewhere around 1500 B.C. in Babylonia.  We also learn from our guide that a variety of primitive societies lived in Mesopotamia -- the land between two rivers (Tigris and Euphrates) for thousands of years, and united to manage the rivers.  They dug canals that filled when the rivers rose to prevent floods from wiping out villages and cities.  After the floods the canals were drained to irrigate the land.  (Sigerist page 378)

Each primitive society had it's own gods and demons, and as the people united a variety of city states formed that adapted some of these gods and demons and created some of their own.  At the center of each city-state is a hill with pyramidal structure with a flat top used to worship the gods.  The first ones appeared around 3,000 B.C.and this is considered the beginning of the Sumerian civilization.  It's greatest city-state may have been Ur, which sat on the Tigris close to the sea.  Even after Ur fell, Sumeria lasted until around 2400 B.C., and had a resurgence later that lasted until 2004 B.C.

While the Sumerians created the first civilization in Mesopotamia, they're customs and culture continued to influence people for thousands of years.  One city-state, Babylon, grew to be the largest city in the world, partly due to the influence of Hammurabi. He was a great ruler who created what we refer to as the Code of Hammurabi, which was a code of strict punishments for wrong doings.  It was an eye for an eye, a tooth for a tooth, a limb for a limb.  It lasted from about 1830-1531 B.C.

Another city-state along the Tigris grew into a national state of Assyria, that lasted from about 2400-612 B.C. Nineveh would later become the new capital of the empire that flourished from 750-612 B.C.  The Book of Genesis mentions Ur as the birthplace of Abraham, and Niveveh also has a Biblical impact, mainly having to do with its demise and destruction. 

Unlike the Ancient Egypt society, which was also growing at this time, the Mesopotamians aren't concerned with the After Life.  What they are concerned about, as most primitive societies were, are all the demons that surrounded them.  They carried amulets and charms, and cited incantations and prayers to prevent and treat diseases that were caused by these demons.  Yes, these demons were everywhere, like the bacteria and viruses we have to live with today. 

Yet as we don't live in fear of bacteria and viruses, they don't live in fear of demons.  They have learned through years of experience, and constant reminders by the priests, what needs to be done to keep the positive balance between the demons, the spirits, the dead, and the living.  Disease in this way can both be prevented and treated.

Plus if you lived during this time in this society, you probably worked all day, as the people we see did all day, a day that exceeded 110 degrees Fahrenheit (which I find stunning considering how cool it is).  So the Sumerians, and later the Babylonians, don't have time to worry about the transcendental, other than the rituals, incantations, and prayers.  They arduously manage their crops, the river, or fight wars, and have little time to fear the unseen.

Yet as an asthmatic myself, one who yearned for my inhaler, I know that young lad had no such inhaler to help him.  He had no rescue medicine to give him instant relief.  So what would he do if his breath didn't come back?  I know from my own personal experience with this disease he can only pretend to be fine, to hide, so long.  So what are the options for the young asthmatic in Babylon?

As we sadly watch the lad huff and puff, our guide explains that both the Sumerians and the Babylonians knew little of anatomy.  They did not dissect humans or perform autopsies, and they did not mummify the dead as the Egyptians did.  They did, however, dissect some animals in search of omens.  They examined the entrails, especially the liver, for signs of good and evil.  Yet they had no concept that diseases were caused by these organs, nor that they were essential for life.  So they rarely thought to dissect them to learn what was inside.   (Sigerest 455)

He explained there were three types of priests. This knowledge didn't interest me at first, because how was a priest going to help an asthmatic boy.  Yet then as I listed, I realised the priest was the best help for the boy aside from waiting it out. The three types of priests were:  Seers, Exorcists, and physicians.  Seers are experts in omens, exorcists drive out evil spirits, and physicians treat illness and wounds.  All options are viable to the boy, who finally gives up and seeks the help of his father as he finishes licking his chops. 

Another option for the boy is what Herodotus observed when he traveled to Mesopotamia to learn how they lived.  He observed the ill being set in a public square, and everyone passing by was encouraged to ask what symptoms he was suffering from.  Anyone with knowledge of the symptom and remedies was encouraged to speak up.  (Withington, page 34)

I watch as the family huddles around the suffering boy.  A lady, the mother perhaps, places her hand on the boy's head and says what I believe is an incantation.  He touches an amulet on the boy's chest, a small bone I think, and says another incantation.  Soon the entire family is singing a song, or perhaps it's an incantation or prayer.  I wonder if this has happened before, and the family is doing what a priest suggested to ward off whatever evil spirit is causing the dyspnea. 

The father leaves the courtyard.  The mother stays with the boy, as if trying to comfort him.  The rest of the family enters the home.  Nothing changes for several hours, until the father returns with an elderly man well garnished with necklaces and earrings. He's also carrying a satchel. This, I assume is a priest.  What kind of priest is he? I wonder. 

The priest approaches the boy, who's now sitting on the ground with his mother rubbing his brow with a damp cloth.  The priest kneels so he's at the height of the boy and touches his brow. He utters some words, and then the mother rushes into the home and comes out with a pot.  He sets it between the boy and the priest, which I realize is a physician as soon as he pulls various herbs or drugs from his satchel and tosses them into the pot.  He inserts a reed tube into the pot, seals it with wheaten dough, and places it onto the fire.

Once the pot is steaming the boy places his mouth around the reed tube and inhales.  The boy appears to get little if any relief from this.  Yet he smiles as he walks with his parents inside, we assume with the hope of falling asleep.  The physician leaves.  Darkness ensues. 

I attempt to follow the physician to learn more, but am shoved back into the time machine just as the door shuts.  I'm forced to return to the modern world with no knowledge of how the boy fared.

Back in my office I wonder about the boy.  Surely the physician had access to rational medicine to help the asthmatic?  Right?  What I  learned was quite interesting.

As my guide suggested, the gods of ancint Mesopotamia were all powerful, and they were the cause of all diseases, and they were the only means of a cure. However, the best method of treating sickness and injuries was to prevent them altogether. Each city-state had its own gods to worship, and huge temples were built for these gods to live.  The priests performed rituals where they offered prayers, incantations, and sacrifices to appease them.  Smaller temples were built where average citiens could offer sacrifices too. 

To make the job more difficult these gods had the ability to make demons, and they could either be good or evil depending on the wishes of the god. These demons, or monsters, appeared in a variety of forms, such as animals, birds, or both. 

Herodotus was a historian who lived in Ancient Greece from 484-425 B.C.  He traveled the world so he could write about it. He dismissed Ancient Mesopotamian medicine because he believed they had no doctors.  However, modern historians know from excavated cuneiform tablets that various types of physicians existed in Ancient Mesopotamia from an early time, just as in Ancient Egypt.

The Mesopotamian physician is among the most educated in this society; he or she is literate (a member of the literate), familiar with tradition, and well trained. (Sigerist, page 432). He will give the boy hope, and hope alone has psychological benefits that should help the boy cope until his breath comes back. 

Edward Withington, in his 1894 book "Medical history from the earliest times," explains that "If a Persian wished to practice medicine, he must first practice upon unbelievers; should three of these die under his hands he is forever incapable; should he cure three, he is qualified to act as a physician... for ever and ever..." (Withington, page 36)

From Henry Sigerist, in his 1955 book, "A History of Medicine," we learn that the physician probably did have knowledge of lung diseases, and he did -- as I saw on my journey, have access to an inhaler of sorts.  Yet there was no knowledge of asthma, only the symptoms of dyspnea, cough, excess sputum, chest pain, and anxiety.  Each was a disease, and the one that was most prevalent -- the dyspnea in the boy's case, was the diagnosis. 

Yes, he probably did know about dyspnea.  Some examples are mentioned by Sigerist:
"A man 'coughs dry, ejecting no saliva,' or the 'lungs cough up pus and the inward parts,' or 'a man is affected in his lungs and they vomit exceedingly.'"
Surely  this isn't asthma, yet it's a lung ailment.  Sigerist also writes: 
"Dyspnea is probably referred to in several passages which say:  'if a man's lungs pant with his work,' although the translation is not certain.  'When the breath of a man's mouth is difficult,' is probably also a reference to dyspnea."
Also, "'A man is affected in his lung passage' or 'suffers from the 'pipe of the lungs,'' means that the patient has a disease of the bronchi or upper respiratory organs.  You hear no specific descriptions of that make you think asthma, although bronchitis, or at least bronchitis symptoms, are known. 

Sigerist mentions a passage from an Assyrian tablet:
"If the patient suffers from hissing cough, if his wind-pipe is full of murmurs, if he coughs, if he has coughing fits, if he has phlegm: bray together roses and mustard, in purified oil drop it on his tongue, fill, moreover, a tube with it and blow it into his nostrils.  Thereafter he shall drink several times beer of the first quality; thus he will recover."  (Sigerist, page 480-81)
Other than incantations and prayer, or simply toughing it out, some physicians might provide the asthmatic with what you would consider among the first inhalers, similar to the Egyptian method of heating dried herbs on stone and inhaling the smoke.  The Mesopotamian inhaler is described by Sigerist as such:
"A decoction of various drugs was placed into a pot, which was sealed with wheaten dough after a reed-tube had been inserted into it.  The pot was placed on fire and then: 'thou shalt put it (the tube) into his mouth, let him draw the steam up by the reed-tube into his mouth... it shall strike his lungs: for nine days thou shalt do this.'"
Ah, and this is so stunningly accurate to what I saw.  Amazing! 

Yet there is little knowledge that the drugs placed into the pot, when inhaled, did any good to relieve the boy's dyspnea, whether it was caused by asthma, bronchitis or pneumonia.  Yet at least it proved to be a somewhat more rational (rational acording to our modern definition anyway) approach to treatment of respiratory conditions, as compared with prayer, incantation, and hope alone. We can only wonder how the boy fared.

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