Thursday, October 09, 2014

2000 B.C.: Assyrian physicians will treat your dyspnea

Of course there is no evidence of asthma in ancient Mesopotamia, although there is evidence the ancient Mesopotamian civilizations had knowledge of the lungs, and were aware that some symptoms,-- excessive sputum, cough, shortness of breath, etc., were caused by "poisons" inside the lungs. There is also evidence of remedies for the various lung ailments that were known, and even something that might be considered the first man made inhaler.  

Now, at what point the knowledge was obtained we can only speculate. Early on in human history asthma-like symptoms must have been observed, and over time someone must have speculated these symptoms were due to the lungs.  A basic anatomy of the lungs must have been known, because mankind had been cutting open animals for food since the beginning of time. And surely accidents occurred where a person was badly mangled, and his lungs were observed.  Surely this opened the door to pondering, and at some point the link was made between shortness of breath and the lungs. 

Somewhere in the course of time herbs were tossed into a fire and inhaled.  Now, when this happened for the first time your guess is as good as mine.  Since it was also known in ancient Egypt that inhaling herbal remedies was the best way to provide breathing relief, it's highly probable this knowledge was obtained at an early time, and then shared among the various tribes or families. However, the techniques used to inhale respiratory medicine in Mesopotamia were different than what was used in Egypt.  So this may be evidence the discoveries were isolated, although we may never know for sure. 

So let's say it's the year 2000 B.C., you live in ancient Assyria, and you are short of breath.  Your first thought may be: "What god is mad at me?" or "What did I do wrong?"  At first you just deal with it, because you don't want to be a burden, although as your shortness of breath continues, you finally decide to seek help.

A baru is sent to your home, and it is his job to diagnose you. He comes adorned with several necklaces made of precious stones, and they rattle as he dances around the fire.  He sings incantations while inspecting your body, makes occasional gestures, and then he closes his eyes and presses his hands together as if in prayer. He stands up and notifies your family that it is now time to interpret the omens.  Since you do not own much, you choose not to sacrifice one of your animals to allow the baru to inspect the liver.

When your brother fell sick years ago a baru visited him, and he wanted your parents to sacrifice one of your sheep.  However, your parents opted to go with the cheaper option, and the baru walked to a nearby pond and placed a few drops of oil on the water and watched how the oil reacted.  The oracle did not give a good sign for your brother, and he died a few days later. Once you saw a baru place a stick in the fire, and he determined by the way the flame continued in the gentle breeze your mother would live another year or so after injuries she obtained when she fell off a horse.

He also used this method to determine that there would be a drought, and the drought would last a long time.   Once there was no water nearby, so he placed the oil in to a cup.  While you were sitting with the baru later that night, you read what he wrote: (10, page 455)
If I drop oil on water, and the oil sinks and rises again.. it means bad luck for a sick man.
If a ring forms from the oil in eastern direction and remains thus it means: for a campaign that I shall undertake it and shall make plenty of booty; for a sick it means that he will recover.
If two rings develop from teh oil, one large, teh other small, the wife of the man will give birth to a boy; for a sick it means that he will recover
If the oil disperses and covers the cup, the sick will die; the army will be destroyed.
If the oil bubble moves in Eastern direction, the sick will die.  (10, page 463)
This time, however, the baru finds a sign from the gods right away.  While inspecting your home for signs of the wishes and voices of the gods, he observed birds flying over the right side of the home, and he determined that this is a good omen, one that means the gods wish you well and will allow you to live.  This is a sign that it is okay to treat you. (10, pages 453-454, 484)

Henry E. Sigerist, in his 1951 history of medicine, explains that descriptions of lung disorders are common in Mesopotamia.  He wrote:
'A man is affected in his lung passage' or 'suffers from teh "pipe of the lungs,"' means that the patient has a disease of the bronchi or upper respirtory organs.  An Assyrian tablet published by Labat and Tournay gives a good description of bronchitis: If the patient suffers from hissing cough, if his windpipe 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 480-481)
Sigerist continues:
In the tables dealing with diseases of the chest, we have a number of diagnoses although they don not go beyond naming the organ affected. 'If a man's breast hurts him, his epigastrum burns him, his stomach (is inflamed (swolen)... that man has lung trouble.' (10, page 481)
If it is determined that the ailment plaguing you is pneumonia, "the treatment recommended in this case was very sensible. The chest was formented with water in which fennel had been boiled, after which balsamic poultices were applied.  this remained the treatment of pleurisy and pneumonia for several thousand years," writes Sigerist. (10, page 480)

He describes other symptoms of lung diseases, such as: (10, page 480)
  • A man "coughs dry, ejecting no saliva"
  • The "lungs cough up pus and the inward parts"
  • "A man is affected in his lungs and they vomit exceedingly"
  • '"f a man's lungs pant with his work"
  • "When the breath of a man's mouth is difficult"
  • "A man is affected in his lung passage"
  • "Suffers from the 'pipe of the lungs"
Sigerest says we can interpret these however  we like.  The use of "panting" and "difficult" may refer to shortness of breath, or dyspnea.  "Pus" and "inward parts" may be excessive sputum, or perhaps it means bleeding, hemorrhage. Although most of these passages must refer to "diseases of the bronchi or upper respiratory organs." (10, page 480)

So now an asu comes to your home carrying with him pottery jars.  He says, "The hands of a ghost are upon you." He chants an incantation, and says, "Your breathing is ailing because of 'restriction of breath.'  We will work with you to remove the ghost the baru says is possible to extricate.  I cannot promise you anything, yet what I offer is the best option for you." (10, page 420)

Sigerist also provides a description of a Mesopotamian remedy for lung disorders, and this may be ideal for your respiratory distress, and it may be that this is what the asu was thinking, and why he brought the two jars :
...If a man is affected in the lungs, thou shalt spread powder of tar over a thornfiore, let the smoke enter his anus... his mouth and nostrils, it shall make him cough (?): thou shalt bathe him with water of vitex: thou shalt anoint the whole of his body with curd: thou shalt bray linseed either in milk (?)..., bind on him for three days, and let his tongue hold honey and refined oil... (11)
Sigerist also writes about an ancient Mesopotamian inhaler:
Like their egyptian colleagues, the Assyrian doctors possessed an apparatus for inhalations.  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.' 
The baru had many other natural remedies he could prescribe, including a variety of fruits and vegetables, resins, gums, trees, shrubs, and minerals.  Like the ancient Egyptians, they also used a variety of stuff taken from animals, such as fat, blood and liver. Just about any animal's parts could be found useful, including cattle, sheep, goat, pig, donkey, dog, lion, wolf, fox, gazelle, mouse, frog, chicken, pigeon, raven, stork, swan, owl, falcon, and even vulture, according to Sigerist.  Vehicles used were "wines, beers, fats, oils, honey, wax and milk."(10, page 485-6)

Some drugs that they had access to that would some day benefit an asthmatic -- if it didn't happen already -- were hemp and opium.  (10, page 485)

During the course of the next few days you get better, and now your sister is sick.  The baru has a different diagnosis for her, and the asu a different treatment.  She is not prescribed a herbal remedy, only an incantation to site: (10, 464-465)
O! Ninlil, lady of teh gods, I have turned unto thee
To spare and to show favour thou knowest. thy mantle I have taken hold of
A heavy sin (?) I carry, I knkow not to bear it
Because of (my) transgression knkown and unknown I have become weak.
Because of the evil I have done and have not done I perish, O! lady,
(because) of the sin which since the time of my youth I have carried
And which the apostle of god has known or not known I suffer greatly
daily (?), O! my lady, may my evil be expelled.
May thy good breath blow and the darkness be brightened.
 From trouble and calamity that distress take thou my hand,
May not my offender prosper who exults over me
May I live, may I prosper and the greatness of thy great divinity ever shall I cherish
Later on you witnessed a 'a man sick with cough," and in this case the asu recommended the following:
Ground lolium, pounded roses, as mixture thou shalt mix, let him eat it in oil and honey; let him drink soup of pig's meat; when he goes to stool thou shalt light a fire before him, he shall direct it to his anus, and shall recover.
Sometimes people recovered after seen by the baru and asu, and sometimes not.  When they do it's due to the magic of the baru and the asu. When they don't it's because of the will of the gods.

Plus as in modern times, "drugs must have been prescribed occasionally merely because the patient expected something to be done," explains Sigerist.  So perhaps that inhaler the bure prescribed for you merely made you feel better by providing you with hope.

References here are for this post and all posts regarding ancient Mesopotamian medicine:  
  1. Wilder, Alexander, "History of Medicine: a brief outline of medical history and sects of physicians, from the earliest historic period; with an extended account of the new schools of the healing art in the nineteenth century, and especially a history of the american Eclectic practice of medicine, never before published," 1901, Maine, New England Eclectic Publishing Co.
  2. Baas, Joh Herman, "Outlines in the history of medicine and the medical profession," translated by H.F. Handerson, 1889, New York, J.H. Vail and Co. 
  3. Garrison, Fielding Hudson, "An introduction to the history of medicine, with medical chronology, suggestions for study, and bibliographic data," 3rd edition, 1922, Philadelphia and London, W.B. Saunders Company
  4. Roberts, J.M., "The illustrated history of the world: Volume 1: Prehistory and the first civilizations," 1998, New York, Oxford University Press
  5. "The Assiatic Journal, for British adn foreign India, China and Australia," volume VIII, New Series, May-August, 1832, London, Parbury, Allen and Co.
  6. Bradford, Thomas Lindsey, "Quiz questions on the history of medicine from the lectures of Thomas Lindsey Bradford," edited by Ray Roth, 1898, Philadelphia, John Joseph McVey
  7. Osler, William, "The evolution of the history of medicine: a series of lectures delivered at Yale University on the Silliman Foundation in April, 1913," 1922, New Haven, Yale University Press
  8. Gill, N.S., "Babylonian gods and goddesses," About.com, http://ancienthistory.about.com/cs/egypt/a/babygodsindex.htm, accessed 4/11/13
  9. Biggs, Robert G., "Medicine, surgery, and public health in ancient Mesopotamia," Civilization of the ancient Near East, edited by Jack M. Sasson, 1995, New York, Charles Scribner's Sons
  10. Sigerist, E. Henry, "A History of Medicine: Primitive and Archaic Medicine," volume 1, New York, Oxford University Press
  11. Sigerist, E. Henry, ibid, page 488, reference used by Sigerist: Thompson, Rev. Assyr.,1934, 31:18
  12. Martell, Hazel Mary, "Kingfisher Book of The Ancient World: from the ice age to the fall of Rome," 1995, New York, Larousse Kingfisher Chambers Inc. 
  13. Hopper, Anthony, "Five Important Phoenician Contributions to Western Medicine," Yahoo.com, http://voices.yahoo.com/five-important-phoenician-contributions-western-11972417.html, accessed 4/13/2013
  14. Foster, Leila Merrell, "The Sumerians," 1990, New York, London, Toronto, Sydney, 
  15. Morris, Jastrow, "The Civilization of Babylonia and Assyria," 1915, Philadelphia and London, J.B. Lippincott Company 

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