Mesopotamia, the land between the Tigris and Euphrates Rivers, was the arena of the growth and decay of many civilizations, including those known as Sumerian, Chaldean, Assyrian, and Babylonian. Although Egyptian civilization is better known, we will begin our survey of ancient civilizations with Sumer to emphasize the point that other, less familiar areas also became urban and literate at a very remote date.

Sumer flourished some four thousand to five thousand years ago, but by the first century, its language had vanished and its writings, in the form of cuneiform characters inscribed on clay tablets, were indecipherable. Scholars believe that the wedge-shaped symbols evolved from pictures used in an early accounting system into abstract signs that represented sounds of speech. Most Sumerian tablets dealt with mundane economic and administrative transactions, but thousands of others record myths, fables, and ideas about science, mathematics, and medicine. Scholars have even discovered cuneiform tablets containing recipes, which provide intriguing clues to eating, drinking, and the role of cults and feasting in the ancient world. Other traces of the extent and complexity of ancient Mesopotamian civilization have recently been revealed by surveillance satellites. These photographs reveal traces of previously unknown settlements and networks of roads long buried under the sands of the Middle East. Some of the roads were probably constructed four thousand to five thousand years ago to link the cities of Mesopotamia to neighboring settlements and distant farmlands.

In Sumer, the mastery of agricultural techniques led to dramatic changes in population density and the establishment of the bureaucratic apparatus needed for planning, storage, and redistribution of crops. The great mass of people lived as peasants, but their productivity supported a small urban elite of priests, warriors, and noblemen. Because law and medicine were ascribed to divine origins, the priests also assumed the roles of judges, lawyers, and physicians.

The cuneiform texts pertaining to medicine can be divided into three categories: therapeutic or ''medical texts,'' omen collections or ''symptom texts,'' and miscellaneous texts that incidentally provide information on diseases and medical practices. After analyzing numerous texts, scholars divided the medical traditions of Sumer into two categories, which have been called the ''scientific'' and the ''practical'' schools. According to this scheme, the ''scientific practitioners'' were the authors and users of the symptom texts. In contrast, members of the practical school concentrated on empirical medical practices and were the authors and users of the medical texts.

The medical texts of the practical school followed a formal arrangement typical of Mesopotamian scribal practice. Each text contained a series of units or cases following the same general format: ''If a man is sick (and has the following symptoms)..." or ''If a man suffers from (such and such) pain in (wherever it was)..." The description of the list of symptoms was followed by instructions for the medicines needed, their preparation, the timing and means of administration. The healer ''discovered'' the significant symptoms by listening to the patient's account of the illness, not by performing a direct physical examination of the patient's body. Although most units conclude with the comforting promise that the patient would get well, certain symptoms presaged a fatal outcome.

In contrast, the ''conjurer,'' ''diviner,'' or ''priest-healer'' looked at the patient's symptoms and circumstances as omens that identified the disorder and predicted the outcome of the disease. Unlike his ''practical'' counterpart, the diviner performed a direct physical examination in order to discover signs and omens. Clearly the gods were at work if a snake fell onto the sick man's bed, because this omen indicated that the prognosis was favorable. But wine-colored urine was a portent of progressive, debilitating illness and pain. If the priest could not wrest sufficient information from his direct examination of the patient, he could find signs in the viscera of sacrificial animals. Omens provided by animal livers were applied to the patient, whose liver was inaccessible.

Although there are many uncertainties in interpreting ancient texts, tentative diagnoses of some of the disorders discussed in the cuneiform tablets are sometimes possible. Mesopotamian physicians were probably familiar with a wide range of diseases, including schistoso-miasis, dysentery, pneumonia, and epilepsy. Malnutrition would obviously correlate with the periodic famines alluded to in various texts, but even when food supplies were adequate in quantity, the daily diet was probably monotonous and unbalanced. Descriptions of eye disorders, paralysis, swollen bellies, and the ''stinking disease'' are consistent with various vitamin deficiency diseases. A combination of poor quality foods and chronic infestation with various parasites would amplify the problem of malnutrition and retard the growth of children.

Because illness was regarded as a divine punishment for sins committed by the patient, healing required the spiritual and physical catharsis obtained by combining confession and exorcism with purgative drugs. Sumerian prescriptions include about 250 vegetable and 120 mineral drugs, as well as alcoholic beverages, fats and oils, parts and products of animals, honey, wax, and various kinds of milk thought to have medical virtues. Medical texts, like almost all Mesopotamian tablets, were anonymous. But some medical tablets provide enthusiastic personal endorsements and testimonials for particular remedies. Medications are said to have been tested or discovered by unimpeachable authorities, such as sages and experts. Some remedies were praised for their antiquity or exclusivity. Of special interest is a small cuneiform tablet containing about a dozen recipes recorded by a Sumerian physician about four thousand years ago. This tablet appears to be the oldest written collection of prescriptions.

The separation of magical and empirical aspects of medicine is a very recent development. Thus, it should not be surprising that Mesopotamian patients considered it prudent to attack disease with a combination of magic and medicine. A healer who was both priest and physician could increase the efficacy of drugs by reciting appropriate incantations. Although the healer needed some knowledge of anatomy and drug lore, precise knowledge of magical rituals was more important because errors in this department could alienate the gods.

Hordes of demons and devils were thought to cause diseases and misfortune; each evil spirit tended to cause particular disorders. As in the case of folk medicine and so-called-primitive medicine, Mesopotamian healers also attempted to rid their patients of disease-causing demons by the administration of noxious remedies. Enveloped in the aroma of burning feathers, and liberally dosed with dog dung and pig's gall, the patient hardly seemed an inviting abode for demons and devils. The magician might also try to transfer the demon into a surrogate victim, such as an animal or a magical figure. Sometimes healers engaged disease-causing demons in a formal dialogue, as in a conversation between the priest and the ''tooth worm'' recorded about 2250 b.c.e. While an incantation entitled ''The Worm and the Toothache'' hardly sounds like a major epic, this dialogue is a rich source of cosmological concepts and creation myths.

Mesopotamian pharmaceutical texts reflect familiarity with fairly elaborate chemical operations for the purification of crude plant, animal, and mineral components. Plants and herbs were so important to ancient medicine that the terms for ''medicine'' and ''herbs'' were essentially equivalent. Drugs made from seeds, bark, and other parts of plants were dissolved in beer or milk and administered by mouth, or mixed with wine, honey, and fats and applied externally. In retrospect, it is logical to assume that the wine used in wound dressings provided some benefit as an antiseptic. Whether red or white, wine is a better antiseptic than 10 percent alcohol, but red wine seems to be the beverage of choice for fighting infection.

According to the Mesopotamian legend known as the Gilgamesh Epic, human beings lost possession of the most powerful, life-giving herb in creation through the carelessness of Gilgamesh, a powerful hero-king who was two-thirds god and one-third human (by what genetic mechanism these ratios were generated is not clear). The hero of the ancient epic was apparently based on the exploits of a real king who ruled Babylonia about 2700 b.c.e. Some six hundred years after his death, legends about the life of Gilgamesh were collected in the form of an epic poem. Thus, The Epic of Gilgamesh provides insights into the lives and beliefs of the people who lived in the land between the Tigris and Euphrates rivers in the second and third millenniums b.c.e.

Despite his god-like qualities, Gilgamesh learns that he, like all human beings, must inevitably succumb to illness and death. When his friend Enkidu was stricken with a serious illness, Gilgamesh swore that he would never give up hope of saving him ''until a worm fell out of his nose'' (a striking omen of impending death). After many trials and tribulations, and an awesome journey through the realm of darkness, Gilgamesh learned the secret of the herb of life and swam to the bottom of the waters where the marvelous plant grew. Before he could take the herb of health and healing back to Uruk, the exhausted hero stopped to rest. While Gilgamesh slept, a mysterious serpent slithered out of his hiding place and ate the herb of life. As a result, the snake shed its old skin and was instantly rejuvenated while Gilgamesh wept for himself and all of suffering mankind. According to the epic, when Gilgamesh returned from his journey, he engraved the story of all his adventures and the wonders of the city of Uruk on a clay tablet for the instruction of posterity. Thus, ever since the time of Gilgamesh, each time a snake sheds its old skin its rebirth reminds human beings that they must grow old and die. Nevertheless, the epic tells us, even though great heroes may die they become immortalized in the written record of their great deeds.

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