When the Greek historian Herodotus visited Babylonia in the fifth century b.c.e., he reached the remarkable conclusion that the Babylonians had no doctors. The sick, he said, were taken to the marketplace to seek advice from those who had experienced similar illnesses. This story proves only that we should not take the tales told by tourists too seriously. As we have seen, Mesopotamia had a complex medical tradition. Both the empirical and the magical approach to healing were well established, but eventually the balance of power apparently tilted in favor of the magician. Evidence about the various kinds of healers who practiced the art in the region can be extracted from the most complete account of Babylonian law, the Code of Hammurabi. Today, Hammurabi (fl. 1792-1750 b.c.e), Babylonia's most famous king, is of more interest for the code of laws bearing his name than for his military and political triumphs.
Hammurabi founded the Babylonian empire that unified and ruled southern Mesopotamia (Sumer and Akkad) for almost two centuries. The Babylonian empire was eventually destroyed and, in 538 b.c.e., the last of the Babylonian kings surrendered to the Persian ruler Cyrus the Great and Babylonia became part of the Persian Empire. Toward the end of his reign, Hammurabi commissioned the creation of a great stele portraying the king receiving the insignia of kingship and justice from the gods. Below this portrait were inscribed the 282 clauses or case laws now referred to as the Code of Hammurabi. According to the inscription, the gods who had made Babylon a great and everlasting kingdom called upon Hammurabi to ''bring about the rule of righteousness in the land, to destroy the wicked and the evil-doers; so that the strong should not harm the weak.'' In an epilogue to the Code, Hammurabi called himself the ''wise king,'' who had taught his people righteous laws and pious statutes, and established order in his kingdom.
The code governs criminal and civil matters such as the administration of justice, ownership of property, trade and commerce, family relations, labor, personal injuries, and professional conduct. Replete with harsh punishments, the Code of Hammurabi reveals the relationships that governed Babylonia's priests, landowners, merchants, peasants, artisans, and slaves. The penalty for many infractions, such as theft or harboring a runaway slave, was death, but many other crimes were punished by amputations. Various clauses refer to illness, adoption, prostitution, wet nursing, pregnancy, miscarriages, and malpractice by doctors and veterinarians. Some laws actually did promote Hammurabi's promise that the laws would protect the weak. For example, a man could take a second wife if his first wife became ill, but he had to support his sick wife and allow her to remain in his house.
Criminal penalties were based on the principle of lex talionis, literally, the ''law of the claw,'' that is, an eye for an eye, a tooth for a tooth. Retribution or punishment was designed to fit the crime: amputation of the hand that struck the father, or blinding the eye used to pry into secrets. Such punishments are generally referred to as ''judicial mutilation.'' Given the number of clauses that specify amputations as punishment for various offenses, one could imagine a fairly lively business for specialists in judicial mutilation. The penalties specified by the laws fell with different degrees of severity on the three classes that made up Babylonian society: gentlemen, or seigniors; commoners, or plebeians; and slaves, whose lowly status was indicated by a physical mark. Slaves apparently carried a 30-day warranty against certain disorders. For example, if a slave was attacked by epilepsy within one month of purchase, the seller had to reclaim that slave and return the purchase price.
The laws of special interest to the history of medicine—those pertaining to surgeons, veterinarians, midwives, and wet nurses—follow the laws dealing with assault. Nine paragraphs are devoted to the regulation of medical fees and specifications concerning the relationship between the status of the patient and the appropriate fees and penalties. The severe penalties set forth for failures suggest that practitioners would be very cautious in accepting clients and would shun those that looked hopeless or litigious. The laws also reflect a profound distinction between medicine and surgery. The physicians, who dealt with problems that would today be called ''internal medicine,'' were of the priestly class and their professional conduct was not governed by the criminal laws pertaining to assault and malpractice.
Because internal disorders were caused by supernatural agents, those who wrestled with such diseases were accountable to the gods. Wounds were due to direct human error or aggression. Therefore, those who wielded the ''bronze knife'' were accountable to earthly authorities. Fees and penalties for surgical operations were substantial. If a doctor performed a major operation and saved the life or the eyesight of a seignior, his fee was 10 shekels of silver. The fee was reduced by half for operating on a commoner, and was only two shekels when the patient was a slave. However, if the surgeon performed such an operation and caused the death of a seignior, or destroyed his eye, the doctor's hand should be cut off. If the physician caused the death of a slave, he had to provide a replacement. If he destroyed the eye of a slave, he had to pay the owner one-half his value in silver.
Just what operation was involved in ''opening the eye-socket'' or ''curing'' the eye is a matter of some dispute. The operation could have been the couching of a cataract (destruction of a lens that had become opaque) or merely lancing an abscess of the tear duct. While such an abscess causes intense pain, it does not affect vision, whereas cataracts lead to blindness. Probing or lancing might help in the case of an abscess, but if poorly done such interventions could cause blindness. Presumably eye surgery was only twice as difficult as setting a broken bone, or healing a sprain, because the fee for such services was five shekels of silver for a seignior, three for a commoner, and two for a slave. The veterinarian, also called the ''doctor of an ox or an ass,'' carried out various surgical operations, including castration of domesticated animals.
Women served as midwives, surgeons, and even palace physicians in Mesopotamia, but the Code of Hammurabi does not specifically mention female doctors. The laws did, however, refer to women who served as wet nurses (women who provided breast milk for the infants of other women). If a seignior gave his son to a wet nurse and the child died, her breasts could be cut off if she had taken in other infants without informing the parents. Obviously, such a woman would never commit that offense again.
In excavating the remains of ancient Mesopotamian cities, archaeologists continue to unearth thousands of cuneiform tablets. Most refer to mundane business transactions and political matters, but as new texts are painstakingly deciphered our picture of Mesopotamian civilizations may well undergo profound changes.
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