Our ideas of the ‘magical’ and ‘rational’ elements to Mesopotamian health and disease are also cultural constructs; they are modern categories which western presumptions often – ignorantly – distinguish ‘scientific’ from ‘non-scientific’ attitudes (Heessel, 2004). While, Kinnier Wilson describes the Mesopotamian line between disease and health as ‘wrong’ (Kinner Wilson, 1967a), the emphasis should not be on where Mesopotamians demarcated the difference between health and disease, but on why the demarcation existed where it did. Our notion of disease as a localized pathology cannot be compared with the Mesopotamian notion of disease as ‘magical’ in origin. In fact, we should not even use the term ‘magical’ and ‘scientific’ as categories within the realm of Mesopotamian medicine because they distort the cultural relevance of ideas of health and illness at the time. Mesopotamians did not differentiate between the medical and non-medical; the services of both asû and āšipu were required for recovery from disease, and these services were not mutually exclusive. In Thérapeutique mésopotamienne, Herrero makes the assertion that the difference between the curative techniques of an asû and āšipu depends on the way the nature of the illness is understood (Sarlock, 1999). If we impose our current understanding of illness upon the sources we interpret, we misrepresent the Mesopotamian construction of disease.
The sources from which we gather our evidence are themselves cultural constructs. We depend upon cuneiform tablets, specifically a rich corpus of medically related texts, to provide valuable insights into the nosology of the area (CDLI, 2003). Our interpretations aside, there are many ways in which these cuneiform tablets record the Mesopotamian notion of disease and health. Firstly, we should note that – as with any archaeological text – there are vested interests behind the production of a document containing a ‘standardised’ body of knowledge. Certainly in the Old Babylonian period, there was a royal obligation to manage the well being of a kingdom and its people. The variety of professionals (for example, asûs and āšipus) involved in healthcare included scholars who informed their opinion and practice of healthcare from medical literary texts. Further observations, amendments or novel ideas within the realm of medicine would be recorded onto cuneiform tablets and, depending on royal patronage, slowly incorporated within influential collections of medical works. These scholars would often be āšipus, who were known to be literate and frequently acted as scribes. According to the interests of the royal patron, these texts would be copied and amended; that which was considered important to the culture of the time was dutifully included and emphasised. For this reason, cuneiform tablets do not necessarily reflect the general consensus on disease and healthcare, but instead depict the notions of a subset of that contemporary culture.
Secondly, Oppenheim comments on the remoteness of cuneiform as a writing style from the realities of everyday life (Oppenheim, 1977) and I am inclined to agree. Although we have few other sources to make such comparisons, it seems unlikely that the Mesopotamian culture interacted in the poetic storytelling fashion of cuneiform tablets. It seems more likely that information was recorded in this way as a rhetorical style, not a realistic depiction of everyday relations and occurrences. At the same time, these tablets represent the ideas, activities and even culture of a localised region or kingdom, to be learnt from in later centuries. Any diseases recorded would be analysed by later generations, and this information was built upon, to the extent that it is difficult to know which notions of disease are specific to which cultures across the time span of many centuries. Also, as there was no requirement for health practitioners to be literate, nor base their activities upon a standardised corpus of medical knowledge, the treatment and concepts of disease may easily have differed in practice compared to the ‘theory’ of medicine we discover in cuneiform.
If disease is taken as a cultural construct, then we have to be aware of the wide array of influences upon that culture and its ideas. For example, Mesopotamia was an active area of the world, ardently involved in trade within the separate kingdoms and also to more distant countries. The dynamics of such a large exchange in goods provided the basis for an exchange of ideas. The link between trade and knowledge is most clearly demonstrated by the exchange of medical practitioners as prestige items in international diplomacy; practitioners that were particularly effective in their treatment of disease (generally, āšipus had royal patronage) were occasionally sent by their king to give assistance to rulers of foreign countries. In this way, the king’s prestige was increased, by impressing his peers with the skills of his court practitioner. During his time there (the asû could be male or female, but an āšipu, especially one sent on a long arduous journey, tended to be male (CDLI, 2003)), the court practitioner could influence and be influenced by the ideas of other court practitioners, who might have had more experience with the treatment of disease. Hence, the greater the trade links, the more likely there was also an exchange of ideas (particularly those relating to healthcare) in Ancient Mesopotamia. In contrast, wars and famines could have a detrimental effect on the local economy. As there is no evidence of a state healthcare system, it is likely that all asû and āšipu services required payment, with the āšipu regularly charging more than the asû by the time of the Neo-Babylonian period and their increased status. The combination of these two ideas suggest that during times of financial struggle, the Mesopotamian public would be more likely to ask for the assistance of an asû, whose notions of disease were only partially influenced by divinity. During these times, the asû had greater influence amongst everyday notions of disease, but not necessarily in the courts nor amongst the intellectual elite. Conversely, a dependence on gods and goddesses was so deeply interwoven into Mesopotamian culture, that an āšipu might also have greater influence, with his strong links to divinity. Consequently, the socio-economic status of an ancient culture may also influence widespread concepts of disease.
Any information on how Mesopotamians conceptualised disease gives us important information on Mesopotamian culture. The importance of a divine origin to disease, the method of payment for its treatment, and the diagnostic warning signs an asû or āšipu might consider, all provide interesting and rare openings to the Mesopotamian culture across two millennia. Our notions of disease belong to our contemporary culture and reflect our current beliefs; imposing ideas from the twenty-first century upon a culture that began four thousand years ago, is hardly sensible for scholarly research. If we cannot separate asû from āšipu, it is probably because we are looking for binary opposites where there are none (Sarlock, 1999). Even the Mesopotamian anatomical and disease terminology also belong to the culture from which they originate; by using them when we talk about Mesopotamian medicine, allows us to explore the links between language and lifestyle, thereby revealing even more about Mesopotamian culture.
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