CHAPTER I The Evolution of Modern Medicine | ||
ASSYRIAN AND BABYLONIAN MEDICINE
OF equally great importance in the evolution of medicine was the practically contemporary civilization in Mesopotamia. Science here reached a much higher stage then in the valley of the Nile. An elaborate scheme of the universe was devised, a system growing out of the Divine Will, and a recognition for the first time of a law guiding and controlling heaven and earth alike. Here, too, we find medicine ancillary to religion. Disease was due to evil spirits or demons. "These `demons'—invisible to the naked eye were the precursors of the modern `germs' and `microbes,' while the incantations recited by the priests are the early equivalents of the physician's prescriptions. There were different incantations for different diseases; and they were as mysterious to the masses as are the mystic formulas of the modern physician to the bewildered, yet trusting, patient. Indeed, their mysterious character added to the power supposed to reside in the incantations for driving the demons away. Medicinal remedies
Three points of interest may be referred to in connection with Babylonian medicine. Our first recorded observations on anatomy are in connection with the art of divination—the study of the future by the interpretation of certain signs. The student recognized two divisions of divination—the involuntary, dealing with the interpretation of signs forced upon our attention, such as the phenomena of the heavens, dreams, etc., and voluntary divination, the seeking of signs, more particularly through the inspection of sacrificial animals. This method reached an extraordinary development among the Babylonians, and the cult spread to the Etruscans, Hebrews, and later to the Greeks and Romans.
Of all the organs inspected in a sacrificial animal the liver, from its size, position and richness in blood, impressed the early observers as the most important of the body. Probably on account of the richness in blood it came to be regarded as the seat of life—indeed, the seat of the soul. From this important position the liver was not dislodged for many centuries, and in the Galenic physiology it shared with the heart and the brain in the triple control of the natural, animal and vital spirits. Many expressions in literature indicate how persistent was this belief. Among the Babylonians, the word "liver" was used in hymns and other compositions precisely as we use the word "heart," and Jastrow gives a number of illustrations from Hebrew, Greek and Latin sources illustrating this usage.
The belief arose that through the inspection of this important organ in the sacrificial animal the course of future events could be predicted. "The life or soul, as the seat of life, in the sacrificial animal is, therefore, the divine element in the animal, and the god in accepting the
Hepatoscopy thus became, among the Babylonians, of extraordinary complexity, and the organ of the sheep was studied and figured as early as 3000 B. C. In the divination rites, the lobes, the gall-bladder, the appendages of the upper lobe and the markings were all inspected with unusual care. The earliest known anatomical model, which is here shown, is the clay model of a sheep's liver with the divination text dating from about 2000 B. C., from which Jastrow has worked out the modern anatomical equivalents of the Babylonian terms. (Fig. 7.) To reach a decision on any point, the phenomena of the inspection of the liver were carefully recorded, and the interpretations rested on a more or less natural and original association of ideas. Thus, if the gall-bladder were swollen on the right side, it pointed to an increase in the strength of the King's army, and was favorable; if on the left side, it indicated rather success of the enemy, and was unfavorable. If the bile duct was long, it pointed to a long life. Gallstones are not infrequently mentioned in the divination texts and might be favorable, or unfavorable. Various interpretations were gathered by the scribes in the reference note-books which serve as guides for the interpretation of the omens and for text-books of instructions in the temple schools (Jastrow).
The art of divination spread widely among the neighboring nations. There are many references in the Bible to the practice. The
way and looked in the liver. Hepatoscopy was also practiced by the Etruscans, and from them it passed to the Greeks and the Romans, among whom it degenerated into a more or less meaningless form. But Jastrow states that in Babylonia and Assyria, where for
In Roman times, Philostratus gives an account of the trial of Apollonius of Tyana,[16] accused of human hepatoscopy by sacrificing a boy in the practice of magic arts against the Emperor. "The liver, which the experts say is the very tripod of their art, does not consist of pure blood; for the heart retains all the uncontaminated blood, and irrigates the whole body with it by the conduits of the arteries; whereas the gall, which is situated next the liver, is stimulated by anger and depressed by fear into the hollows of the liver."
We have seen how early and how widespread was the belief in amulets and charms against the occult powers of darkness. One that has persisted with extraordinary tenacity is the belief in the Evil Eye the power of certain individuals to injure with a look. Of general belief in the older civilizations, and referred to in several places in the Bible, it passed to Greece and Rome, and today is still held fervently in many parts of Europe. The sign of "le corna,"—the first and fourth fingers extended, the others turned down and the thumb closed over them,—still used against the Evil Eye in Italy, was a mystic sign used by the Romans in the festival of Lemuralia. And we meet with the belief also in this country. A child with hemiplegia, at the Infirmary for Diseases of the Nervous System, Philadelphia, from the central part of Pennsylvania, was believed by its parents to have had the Evil Eye cast upon it.
The second contribution of Babylonia and Assyria to medicine— one that affected mankind profoundly—relates to the supposed influence of the heavenly bodies upon man's welfare. A belief that the stars in their courses fought for or against him arose early in their civilizations, and directly out of their studies on astrology and mathematics. The Macrocosm, the heavens that "declare the glory of God," reflect, as in a mirror, the Microcosm, the daily life of man on earth. The first step was the identification of the sun, moon and stars with the gods of the pantheon. Assyrian astronomical observations show an extraordinary development of practical knowledge. The movements of the sun and moon and of the planets were studied;
With the rationalizing influence of the Persians the hold of astrology weakened, and according to Jastrow it was this, in combination with Hebrew and Greek modes of thought, that led the priests in the three centuries following the Persian occupation, to exchange their profession of diviners for that of astronomers; and this, he says, marks the beginning of the conflict between religion and science. At first an expression of primitive "science," astrology became a superstition, from which the human mind has not yet escaped. In contrast to divination, astrology does not seem to have made much impression on the Hebrews and definite references in the Bible are scanty. From Babylonia it passed to Greece (without, however, exerting any particular influence upon Greek medicine). Our own language is rich in words of astral significance derived from the Greek, e.g., disaster.
The introduction of astrology into Europe has a passing interest. Apparently the Greeks had made important advances in astronomy before coming in contact with the Babylonians,—who, in all probability,
It is surprising to learn that, previous to their contact with the Greeks, astrology as relating to the individual—that is to say, the reading of the stars to determine the conditions under which the individual was born—had no place in the cult of the Babylonians and Assyrians. The individualistic spirit led the Greek to make his gods take note of every action in his life, and his preordained fate might be read in the stars.—"A connecting link between the individual and the movements in the heavens was found in an element which they shared in common. Both man and stars moved in obedience to forces from which there was no escape. An inexorable law controlling the planets corresponded to an equally inexorable fate ordained for every individual from his birth. Man was a part of nature and subject to its laws. The thought could therefore arise that, if the conditions in the heavens were studied under which a man was born, that man's future could be determined in accord with the beliefs associated with the position of the planets rising or visible at the time of birth or, according to other views, at the time of conception. These views take us back directly to the system of astrology developed by Babylonian bârû priests. The basis on which the modified Greek system rests is likewise the same that we have observed in Babylonia—a correspondence between heaven and earth, but with this important difference, that instead of the caprice of the gods we have the unalterable fate controlling the entire universe—the movements of the heavens and the life of the individual alike" (Jastrow). [19]
From this time on until the Renaissance, like a shadow, astrology follows astronomy. Regarded as two aspects of the same subject, the one, natural astrology, the equivalent of astronomy, was concerned with the study of the heavens, the other, judicial astrology, was concerned with the casting of horoscopes, and reading in the stars the fate of the individual.
As I mentioned, Greek science in its palmy days seems to have been very free from the bad features of astrology. Gilbert Murray
us the things that shall be. If some things fall out differently from what was foretold, that is due to the deceit of men that speak what they know not: calling into contempt a science to which past and present alike bear a glorious testimony" (Ann. vi, 22).
Cato waged war on the Greek physicians and forbade "his uilicus all resort to haruspicem, augurem, hariolum Chaldæum," but in vain; so widespread became the belief that the great philosopher, Panætius (who died about 111 B. C.), and two of his friends alone among the stoics, rejected the claims of astrology as a science (Garrod). So closely related was the subject of mathematics that it, too, fell into disfavor, and in the Theodosian code sentence of death was passed upon mathematicians. Long into the Middle Ages, the same unholy alliance with astrology and divination caused mathematics to be regarded with suspicion, and even Abelard calls it a nefarious study.
The third important feature in Babylonian medicine is the evidence afforded by the famous Hammurabi Code (circa 2000 B. C ).— a body of laws, civil and religious, many of which relate to the medical profession. This extraordinary document (Fig. 9) is a black diorite block 8 feet high, once containing 21 columns on the obverse, 16 and 28 columns on the reverse, with 2540 lines of writing of which now 1114 remain, and surmounted by the figure of the king receiving the law from the Sun-god. Copies of this were set up in Babylon "that anyone oppressed or injured, who had a tale of woe to tell, might come and stand before his image, that of a king of righteousness, and there read the priceless orders of the King, and from the written monument solve his problem" (Jastrow). From the enactments of the code we gather that the medical profession must have been in a highly organized state, for not only was practice regulated in detail, but a scale of fees was laid down, and penalties exacted for malpraxis. Operations were performed, and the veterinary art was recognized. An interesting feature, from which it is lucky that we have in these days escaped, is the application of the "lex talionis"—an eye for an eye, bone for a bone, and tooth for a tooth, which is a striking feature of the code.
Some of the laws of the code may be quoted:
Paragraph 215. If a doctor has treated a gentleman for a severe wound with a bronze lances and has cured the man, or has opened an abscess of the eye
218. If the doctor has treated a gentleman for a severe wound with a lances of bronze and has caused the gentleman to die, or has opened an abscess of the eye for a gentleman and has caused the loss of the gentleman's eye, one shall cut off his hands.
219. If a doctor has treated the severe wound of a slave of a poor man with a bronze lances and has caused his death, he shall render slave for slave.
220. If he has opened his abscess with a bronze lances and has made him lose his eye, he shall pay money, half his price.
221. If a doctor has cured the shattered limb of a gentleman, or has cured the diseased bowel, the patient shall give five shekels of silver to the doctor.
224. If a cow doctor or a sheep doctor has treated a cow or a sheep for a severe wound and cured it, the owner of the cow or sheep shall give one-sixth of a shekel of silver to the doctor as his fee. [22]
Morris Jastrow: The Liver in Antiquity and the Beginnings of Anatomy. Transactions College of Physicians, Philadelphia, 1907, 3. s., XXIX, 117-138.
Philostratus: Apollonius of Tyana, Bk. VIII, Chap. VII, Phillimore's transl., Oxford, 1912, II, 233. See, also, Justin: Apologies, edited by Louis Pautigny, Paris, 1904, p. 39.
M. Jastrow: Aspects of Religious Belief and Practice in Babylonia and Assyria, New York, 1911, p. 210.
CHAPTER I The Evolution of Modern Medicine | ||