Ancient healthcare fit for a king

You might have heard that doctors swear the 'Hippocratic oath' – named after the ancient Greek healer Hippocrates (around 460–370 BC) who is celebrated as the 'father of medicine' – when they promise to uphold ethical standards in their medical practice. However, very few people know how sophisticated medicine was before Hippocrates' time.

In the ancient world, Egyptian medicine enjoyed a status of respect and prominence. The famous historian Herodotus seems to have appreciated that different parts of the body required different treatments and medical specialists. Each physician was trained to deal with diseases of one specific part of the human body, such as the eyes, the teeth or the stomach.

But how did the achievements of doctors living in other parts of the ancient world compare? What about physicians in the great cities of Assyria and Babylonia, in ancient Iraq? Herodotus says medicine is one of their wisest customs. According to him, the Mesopotamian way of dealing with diseases included bringing the sick to the marketplace. There, people who had already recovered from a similar illness passed on their experience to those still suffering. But healthcare in ancient Iraq was far more advanced than that – let's dig a little deeper.

The early roots of medicine

In Mesopotamia, medicine mostly involved plant-based remedies – plants individually or in combination were applied externally as bandages or salves, and taken internally in the form of healing potions or enemas. By around 2000 BC, healers had already begun to record medical practice in writing, using a wedge-shaped writing system called cuneiform. With the help of a stylus, they impressed small cuneiform signs into the moist surface of clay tablets, which were the main medium for writing in Mesopotamia. The stone relief below is from the palace of Sennacherib, and depicts an Assyrian scribe in the background, with a stylus and a writing-board (an often-used alternative to clay tablets), taking notes of soldiers who are being rewarded for their military achievements.

Putting one tiny wedge after the other, these early healers detail what is already a complex and sophisticated array of treatments that mostly included conventional medical practices like bandages and balms. Occasionally, we find other forms of therapy, for example, healers dealt with the supernatural origin of the disease by invoking magic and performing rituals. They summoned the help of specific deities, such as the healing goddess Gula. This goddess was also associated with dogs, and healers used her symbolic animal to fashion golden amulets like the one below that would protect against diseases.

The early medical texts were reused, extended and elaborated on by later generations. This long tradition culminated in the 7th century BC, with a large collection of medical records containing thousands of disease and symptom descriptions, together with the corresponding therapeutic prescriptions.

At that time, there was only one place where it was possible to compose such an elaborate medical handbook – in the library of the Assyrian king, Ashurbanipal . Fascinated by all kinds of scholarly activity, Ashurbanipal wanted to create a library to contain all knowledge. He commissioned specialists to collect texts concerned with medicine from around the empire and bring this material to his capital Nineveh. There, scribes would produce something that far exceeded everything that came before it. This medical dictionary, today called the 'Nineveh Medical Encyclopaedia' (which we'll call the Encyclopaedia here for ease), represents the world's first standardised, structured and systematised handbook on therapeutic medicine.

The Nineveh Medical Encyclopaedia

The Encyclopaedia is a highly structured account of medical and therapeutic knowledge made up of 12 sections. It moves from head to toe, with each section focusing on the diseases affecting an individual part of the human body. The body parts and their illnesses, as well as the corresponding treatments, are discussed in great detail. Almost all 12 sections consist of more than one 'tablet' – the ancient equivalent of our book chapters – and in total there are 50 tablets.

The first section deals with diseases of the head. Its five tablets include therapies for a great variety of illnesses affecting either the head in general or a particular part of it, such as the scalp, eyes, ears and nose. Next come treatises discussing how to treat problems with specific parts of the head in more detail: eyes (four tablets), ears (one tablet), neck (six tablets), nose (one tablet), and teeth (two tablets). After the head, the Encyclopaedia turns to the remaining parts of the body, moving down through the torso, legs and feet. More on some of the treatments and therapies shortly.

The Encyclopaedia was huge – each tablet contained at least 250 lines, making a total of more than 10,000 lines of text. At the end of each tablet was a scribal remark explaining its proper place in the series. Such a comprehensive collection of medical theory and practice can add hugely to our knowledge of ancient medicine. With its help, we gain a deeper understanding of how people in ancient times perceived and classified diseases, and what they thought were the best ways to treat them.

But what about the practical side of Mesopotamian healthcare? The Encyclopaedia can also tell us about the types of activities and practices carried out by a healer, especially when combined with other texts and visual imagery. There were two main types of specialists. One of them called the asû ('physician') functioned like doctors today. They treated the physical symptoms with the help of healing plants and liquids. The other type of specialist, the āšipu ('exorcist' or 'incantation priest'), can be best described in modern terms as an 'alternative healer'. They used magical spells and rituals to end the supernatural influence behind the physical manifestation of the ailment. There were no official clinics, and treatments probably took place in patient's homes.

The Encyclopaedia is one of Assyria's best kept secrets. Ashurbanipal's tablets were smashed to pieces when Nineveh was ransacked in 612 BC. The laborious task of piecing them back together still occupies specialists, 170 years after their discovery. Both cuneiform writing and the Akkadian language fell out of use 2,000 years ago, and as only a handful of people can reconstruct these tablets and translate them, much of the Encyclopaedia remains unknown even to specialists.

However, as a result of the ongoing work to translate the Encyclopaedia into plain English, we're now able to share just some of the weird and wonderful therapies popular in the 7th century BC.

Rash creams

As in ancient Iraq, bandages and salves are still the most common methods of therapy in dermatology today. The Encyclopaedia contains dozens of medical recipes for the skin, which were used – apparently successfully – to treat patients almost 3,000 years ago. The physician typically made a dough-like substance by boiling or kneading healing plants in some kind of liquid:

If a man's head has been seized by sāmānu, it itches, but then it diminishes [and] calms down, [only to] increase again afterwards: you pound seed from 'dog's tongue' plant, sesame powder, powder [taken] from the dead wood of a thornbush, malt powder, dried excrement of a dove [that lives] on a gurummaru-tree [and] seed from 'lone' plant, you knead them in warm tamarind sap, you shave [and] cool down his head, [and then] you bandage him [with the mixture].

One of the main advantages of treating skin disorders is that physicians can study the medical problem and make a relatively reliable diagnosis. Using only their sight and their patient's complaints, ancient physicians were able to describe and classify more than a hundred skin conditions – with sāmānu most probably referring to some kind of rash. As is the case in alternative medicine nowadays, the affected area of the head was equipped with a bandage that probably worked as a cooling and numbing agent.

Release the whirlwind

Sometimes it was very difficult to make a reliable diagnosis. In Mesopotamia, this was mainly true for diseases affecting the inside of the body. Surgery was non-existent, so physicians had to guess what might have been going on. They developed theories based on analogies taken from their surroundings. In a medical spell used against some kind of constriction in the gastro-intestinal tract, there is talk of minute creatures. The physician sends these creatures to the 'canal inspector' living in the patient's stomach, tasking them with opening up the blocked pathways, just as a labourer would dig a canal clear.

What are your entrails filled with? What are your entrails filled with? [. . .] your entrails. Whom shall I send to the canal inspector of your entrails? May they bear shovels of silver [and] spades of gold! May they open up the waterways! May they open up the canals, so that his excrement can escape and come out, so that the whirlwind in his innards can come out and see the sun

A bellyful of treatments

Spells played an important role in Mesopotamian medicine – physicians recited them during healing rituals with the aim of enhancing the healing powers of the remedy. They're important to the modern reader, too, because they explain what an ancient specialist wanted to achieve while performing the act of healing, and how it would work. In the case of the gastro-intestinal tract, the lack of anatomical knowledge sometimes led to the application of multiple treatments at once. In the example below, this included having the patient consume healing potions, take an enema, and wear a bandage.

If someone's belly is sick, and more specifically it has piercing pains, he eats bread [and] drinks beer, [but then] he voids it through his anus, he vomits [and] swallows' saliva in a meadow: you pound asafoetida* [and] he drinks it in water. You boil down white plant in oil [and] you pour it into his anus. He drinks pressed wine. You boil down juniper [and] the aromatic kukru [. . .] in a small copper pot, you smear [the mixture] on a piece of fabric [and] you bandage him.

*Asafoetida is a dried resin obtained from the root of Ferula plants, with strong sulphurous odour, used for medicinal and culinary purposes.

Want to know more?

With the support of the Wellcome Trust, we are reconstructing the Nineveh Medical Encyclopaedia as far as is possible, and translating it into plain English, free for all to read.

'Introducing Assyrian medicine: healthcare fit for a king' provides experts and non-experts alike with meaningful access to the rich body of Assyrian medicine preserved in the Nineveh Medical Encyclopaedia. Our open access translations will be made available on our project website.

Our digital Assyrian medical library will also allow us to compile a pharmacopeia: an index all the plants and substances used, together with the procedures for applying them. This will allow researchers to understand the underlying theory of Mesopotamian medicine. We hope to gain a greater knowledge of a medical system that had been in existence long before the starting point of 'modern' medicine, commonly associated with the writing of the first Greek medical texts. Through this exciting project, we hope the contribution of Assyria to the history of medicine will be made clear for the first time.

Visitors can explore highlights of Ashurbanipal's library in Room 55. If you look closely, you might even discover parts of the Nineveh Medical Encyclopaedia on the shelves.

Supported by the Wellcome Trust