Ancient Medicine

From Mesopotamia to Rome

Laura M. Zucconi

• Publisher: Eerdmans
• Year: 2019
• Print ISBN: 9780802869838
• eBook ISBN: 9781467457514
• Topic: Medicine
• Subtopic: Ancient History

This book by Laura Zucconi is an accessible introductory text to the practice and theory of medicine in the ancient world. In contrast to other works that focus heavily on Greece and Rome, Zucconi's  Ancient Medicine covers a broader geographical and chronological range. The world of medicine in antiquity consisted of a lot more than Hippocrates and Galen.

Zucconi applies historical and anthropological methods to examine the medical cultures of not only Mesopotamia, Egypt, Greece, and Rome but also the Levant, the Anatolian Peninsula, and the Iranian Plateau. Devoting special attention to the fundamental relationship between medicine and theology, Zucconi's one-volume introduction brings the physicians, patients, procedures, medicines, and ideas of the past to light.

1. Introduction

Roy Porter’s The Greatest Benefit to Mankind, a seminal work on the history of medicine, devotes only six of the nearly seven hundred pages to medical practice that predates classical Greece.¹ He devotes thirty pages to Greco-Roman medicine. Porter includes a chapter on faith and medicine but limits it to the Judeo-Christian-Islamic religions. Other popular books simply begin their history with Hippocrates.² These works essentially ignore the rich history of medical practices across the ancient Near East and Mediterranean as well as the fundamental relationship between medicine and the theological concepts of the regions’ different cultures. This work seeks to fill the gap not only by examining more in depth the medical culture of Mesopotamia, Egypt, Greece, and Rome but also by expanding the analyses to the Levant, the Anatolian Peninsula, and the Iranian Plateau. Numerous studies on ancient medicine exist but treat each area in isolation rather than showing how a given area represents a local manifestation of a wider ancient medical culture.

MEDICAL ANTHROPOLOGY

Another problem with the studies on the history of medicine is the tendency to highlight those practices that directly led to modern techniques and theories as an inevitable evolution of the field. When briefly addressing the ancient world, practices that became an “evolutionary dead end,” so to speak, are mentioned more as a curiosity about how far the discipline has come or an example of nonscientific thinking. The reason for this lies in the prominence of reduction and causation ideologies in medicine itself.

Causation tries to determine the single entity that created the disease, whether a germ or a gene. Once the cause is known, treatments can target it to stop the disease and promote healing. Closely tied to this is the reductionist view, which separates the pathogen from the patient; the bacteria or virus is the problem, not the person. Even genetic disorders are isolated as a particular gene causing difficulty. This aids in the targeting approach to therapy. Attention is then focused on the disease agent; the patient becomes secondary.

Since the clinical practice of medicine relies on reduction/causation, the history of the field has reflected and supported that process. The key figures in that history, besides the disease itself, are the ones who have correctly identified a cause and reduced it to develop targeted treatments. Yet this method ignores another important player in the history of medicine, the patient. Additionally, reduction/causation makes medicine synonymous with only the natural world, subject to investigation by the scientific method. Any medical system making use of the supernatural was dismissed. Yet more recent studies on the history of medicine now investigate the relationship between the disease, the patient, and the healer, with a focus on how the patient and healer function within a cultural context. This anthropological approach allows scholars to understand the way people view health and illness as connected to the supernatural world as well as the natural one. The history of medicine is no longer only a narrow, natural-world point of view but a wider, integrated perspective on human interaction.

This present study attempts to incorporate key concepts of medical anthropology to highlight the rational thought process behind ancient medical practices that reconcile natural phenomena with cosmological perspectives; particular attention is paid to how ancient societies understood the role of humans in that cosmology. This is not a unique approach for studies focusing more exclusively on ancient cultures, such as the work of JoAnn Scurlock on Mesopotamia.³ But it has not been applied to a more comprehensive study of ancient medicine across cultures.

Health

Central to medical anthropology is the concept of health, which at first seems rather simple and intuitive; all know when they are healthy as opposed to when they feel sick. Yet the actual definition of health can vary. The standard medical explanation is the ability to function optimally in terms of physiology, psychology, or culture.⁴ More anthropological definitions see health as a balance between people, nature, and the supernatural,⁵ while some keep it simply to “the absence of disease.”⁶ The common element in all of these definitions is their reliance on cultural norms. This is true even for the apparent scientific “absence of disease,” since disease itself is culturally defined. Modern Western clinical medicine uses numerical measurements to define the norm, such as the ratio of height to weight, blood pressure, or hemoglobin count. Health then is how well one fits into a statistical range in a variety of categories. But this focuses on just the biochemical factors. Norms can be applied in psychodynamic, behavioral, and social models, as found in the practice of psychiatry.

Because health relies upon one’s ability to fit into culturally defined categories, we can analyze health within two spheres, the personal and the communal. The personal sphere is how an individual perceives his or her own status, while the communal sphere is how other people perceive someone’s status. Many take a dualistic approach to the personal sphere, dividing it between the mind and the body, although this minimizes or completely disregards the intimate connection between the two. A person’s interaction with work, family, and religion comprises the communal sphere. Although these spheres allow for an ease of analysis, they should not be used as exclusive categories but recognized as intertwining at certain points. The exact form of blending the personal and communal spheres can vary by culture. Modern Western bio-medicine values the personal bodily sphere, whereas the biblical world of Job gives priority to the communal religious sphere.

Disease and Illness

A corollary to health is disease or illness. But this concept also has a variety of definitions dependent on cultural norms. Most people, like clinical physicians, use the terms disease and illness interchangeably. Medical anthropologists work with separate definitions for disease and illness. Disease means a deviation from an official norm, such as physiochemical parameters as declared by an accepted authority, such as a board-certified physician. Illness, in contrast, is the perception of a disruption in the personal or communal sphere, or even both, linked to a somatic symptom. This may also need to be recognized by an accepted authority such as a physician but can also be done by other types of authorities, such as a priest or even a parent. (“You’re too sick to go to school today.”)

The actual presence of a physical ailment is less a concern in medical anthropology. The issue is how one perceives him- or herself and the extent to which the community agrees with that perception. When the communal and personal spheres agree, a person can assume the sick role.⁷ Assuming the sick role allows a person to avoid obligations within the communal sphere. The sick role also has certain responsibilities, mainly seeking out help and the restoration of health from an accepted authority. The sick role is ideally a temporary state. The disruption to the communal sphere, and possibly the personal sphere, will eventually be removed, thus reintegrating the person into society and reestablishing community cohesion. Even without the removal of the physical disruption, restoration can occur by shifting the sick role to a new categorization, such as “disabled,” that allows one to reintegrate with the community in a different fashion. Such restoration of health depends upon the patient and the healer agreeing to an explanatory model of illness.

Explanatory Model of Illness or Cultural Concepts

In medical anthropology, an explanatory model of illness is not simply disease etiology, but the conjunction of physiology, disease etiology, and therapeutic measures. One model does not explain every case of illness. It cannot, since the disease etiology itself may vary, whether it is bacteria, virus, gene, allergen, an imbalance of humors, or even a god or ancestral spirit. In modern Western bio-medicine, the somatic aspect is emphasized, so the disease agent’s impact on the accepted understanding of proper physiology guides the types of treatments used to alleviate physical symptoms. The more the body is returned to proper physiological function, the better the cure. In the ancient Near East and Mediterranean, the focus is on community cohesion both among people and within the supernatural realm. Physiology reflects those relationships, so treatments target their restoration, with the success of cures depending on the person’s reintegration within the human and supernatural communities.

Physiology plays an important role in the explanatory model of illness, but that term tends to conjure a rather clinical image of the body, as used in Western bio-medicine. The importance of physiology for the history of medicine really is how a person conceptualizes the structure of the body, that is to say its anatomy, as well as its function. Collectively, this is better known in medical anthropology as body image. A part of this body image is an understanding of the boundaries of the physical body and how it interacts with the environment. For many people, their body image is formed by various elements of culture, such as the media, socio-economic status, and religion. As we shall see, ancient cultures often had the belief that their anatomical parts could form distinct relationships on the basis of their religious understanding of the formation of humans. Symbolic anatomy is a common form of conceptualizing the structure of the body. It links body parts to cosmological forces, such as the gods, as a way of understanding how various relationships affect the body and health. For some cultures, the anatomy’s ability to form such relationships makes it more a case of symbiotic rather than symbolic anatomy; organs such as eyes are not fully under control of the individual but exist as independent entities that tacitly agree, symbiotically, to work with the individual.

How the body actually functions can take a variety of forms as well, but two of the most ubiquitous are the balance and plumbing models. The balance model explains that the body properly functions as long as certain substances or forces within it are kept in balance. Treatment measures then aim to restore the balance. The plumbing model sees the uninterrupted flow of substances/forces through the body as the basis of health. Restoration of health revolves around unblocking that movement. The ideas of symbolic anatomy, balance, and plumbing can easily work in conjunction in a single explanatory model of illness.

Although a general principle such as community cohesion underlies the explanatory model of illness, one must keep in mind that the exact form of expression for community cohesion will vary when analyzing the medical practices across a spectrum of cultures. Because the ancient documents relating to medical practices frequently, but not exclusively, mention the gods and other supernatural entities as key to disease etiology and treatment, this study looks at the prominent theology for each culture as a way to understand their particular forms of an explanatory model of illness.

As the chapters examine the different cultural concepts governing issues of physiology and anatomy, a pattern can be discerned as the ancient Near East and Mediterranean transform into a Hellenistic worldview. Guiding principles such as community cohesion now must integrate with a growing sense of individualism. This can be traced to the popularity of later Roman works such as Galen’s De Locis Affectis. Modern scholarship such as Medicine and Space analyzes this swinging pendulum, with essays on the tendency in late antiquity through the Middle Ages, to look at physiology as simply understanding form following function, while the early modern period begins to redevelop theories of organs and systems working together.⁸

Healers

Most societies have a multiplicity of healers from which patients can choose; this is known as medical pluralism. Different factors such as economics, location, and especially an explanatory model of illness can determine the types of healers consulted. Yet patients experiencing one episode of illness may seek aid from more than one type of healer. A friend may be consulted at the onset of symptoms, but their persistence can lead to seeking out a more powerful or authoritarian healer, what anthropologists term the hierarchy of resort. Each “rung” on the hierarchy may have a different explanatory model of illness or concentrate on a particular aspect within a culturally dominant explanatory model.

Typically, scholars divide the hierarchy of resort into three broad categories of Professional, Popular, and Folk, based on not only the explanatory model of illness but also factors such as remuneration and education. The professional healer is sanctioned by other authority structures in society, religious and political ones being the most frequent. The professional healer may even be a part of one of these, such as a priest. Often, there is an internal hierarchy of specialists within this professional category. These healers tend to concentrate in urban centers, near the other power structures.

In contrast, the popular healer is a nonprofessional and nonspecialist, such as a family member, and usually the first to be consulted. The patient recognizes the healer’s authority in health matters as drawing from naturally accruing wisdom and experience. The folk healer is a nonprofessional specialist with ties to religious structures that are not part of the dominant culture. This term is often a catch-all in studies where the popular and professional labels do not easily apply. It also betrays a colonial perspective that marginalizes authority not directly linked to preferred power structures. The overlap of these different categorizations for healers, especially as they cross cultural boundaries, has recently undergone more nuanced studies, at least in terms of Greco-Roman medicine.⁹

The classification of ancient healers into these categories is difficult. Most textual sources come from an elite class that attest to what could be called the professional healer. Some archaeological evidence may indicate popular or even folk medicine, but we lack the necessary type of evidence to make a discernment. Additionally, a clear division between folk and professional itself is questionable and only serves to replicate a distinction between a secular biomedical system, favored by Western powers over what is considered “ethnomedicine” in colonized areas.¹⁰ To avoid these anachronistic complications, this study does not strictly delineate a specific hierarchy of resort for the different ancient Near Eastern and Mediterranean cultures. The terms for healers in their original languages are retained as much as possible, eschewing the typical translations such as “magician” and “physician.” Exceptions to this rule occur when the texts use a term for a magician/sorcerer that is commonly understood as such in a no...

Table of contents

• Title Page
• Copyright
• Dedication
• Contents
• Foreword by Candida Moss
• Acknowledgments
• Abbreviations
• 1. Introduction
• 2. Mesopotamian Medicine
• 3. Egyptian Medicine
• 4. Canaanite Medicine
• 5. Hittite Medicine
• 6. Classical Greek Medicine
• 7. Hellenism and Hellenistic Medicine: A Brief Introduction
• 8. Ptolemaic Egyptian Medicine
• 9. Etruscan and Roman Medicine
• 10. Second Temple and Early Rabbinic Medicine
• 11. Persian Medicine
• Bibliography
• Index of Authors
• Index of Subjects
• Index of Scripture and Other Ancient Texts