Bronze-Medal Medicine

Eric Lis

Last week, I wrote about perceptions of psychiatry and neurology in ancient Babylon. Although I’m very biased in that I think mental disorders tend to be much more interesting and thought-provoking than physical ones, physical illness and the treatments for it probably plays a much bigger role in most games. Here are a scattering of tidbits from some different publications to give you a taste of what the Babylonian approach to physical medicine was like. I’m not going to put up a full list of the eight or so papers and books I drew from, but anyone so inclined could find all the same papers I did through Pubmed and Google Scholar. You will, however, need some sort of institutional access to read most of what you find.

Babylon had, not only fairly advanced medicine, but also advanced medical law. The famous Code of Hammurabi contains a surprising number of rules regarding the practice of medicine. The code established what fees a healer could charge for different procedures and services, and these fees were required to be on a sliding scale, depending on what the customer could afford. Slave owners were required tom cover the medical bills of their slaves. Patients’ rights were clearly set, and physicians’ right to advertise their services were regulated. Perhaps most interesting, Hammurabi actually ordered physicians to perform regular quality assurance; they had to track the outcomes of their patients in a standardized fashion, and the government had the right to determine that a healer wasn’t meeting proper standards of care. Considering that this sort of legislation vanished with the fall of Babylon and didn’t reappear until well into the modern era, it’s really quite astonishing. It should be remembered, of course, that Hammurabi’s name roughly translates as “kinsman of a healer,” so he may have been influenced by important people in his life.

Incidentally, the fee which the Code establishes for medical services was impressively high. A surgeon who performed a single successful operation might earn enough to rent a middle-class home for one year. Suffice it to say that I don’t get paid that well.

Babylonian healers were a combination of diagnosticians and pharmacists. Like the healers in medieval Europe, they held both knowledge and their own medications. Their medical texts reflect this; the texts that have reached us tend to be a lengthy description of some set of symptoms, followed by multiple recipes for medicines to cure the illness. Such recipes tended to involve brewing various herbs in wine or beer which subsequently entered the patient via one of several possible holes. We can see a degree of empiricism and pragmatism to these recipes, in so far as many texts suggest a remedy, then says something along the lines of “hopefully the patient will get better, but if not, next, try this.” Although they had some apparently advanced surgical techniques, very few healers practiced surgery. According to the Code of Hammurabi, a surgeon who made an error that killed a patient could be punished by having his hand cut off, ensuring both that he never practiced again and also that he didn’t simply move to another town and kill someone else. This may go a long way to explaining why most Babylonian healers didn’t practice surgery.

Babylonian texts extensively cover such topics as urology, gastroenterology, ophthalmology (the Code of Hammurabi repeatedly makes special reference to eye surgery), hepatology, respirology (especially tuberculosis), and pregnancy. Flesh diseases were especially well described, although little treatment, if any, was available for things like gangrene. The treatments may not have been fantastically effective, but the detailed descriptions of the illnesses are such that we can read them today and tell, with fairly high accuracy, what our modern diagnosis would be. Importantly, although the Babylonians described pathology, many (if not most) of their diseases were still blamed on gods and demons. Leprosy in particular, much as in the Dark Ages, was clearly attributed to a man being “rejected by his god” and therefore “he is to be rejected by men.”

Many surviving Babylonian medical texts include incantations which seem to have been meant to facilitate healing. Many were only meant to be used together with other treatments, but some stand alone. In particular, several incantations relating to pregnancy and birth have been recovered and translated. Such incantations typically evoke deities such as Inanna and Ninhursag, both fertility goddesses (among other things, including war gods). Aside from helping the mother survive giving birth, the incantations appear to have been meant to assign a sex to the child, helping the parents have a girl or boy, as they preferred.

Interestingly, despite common beliefs about the ancient world, Babylonian medicine probably made little to no use of bloodletting. Bloodletting was widely used in the Arabic regions during this period, but the Persian peoples seem to have resisted its use, although it was clearly known. We can only speculate as to why they never adopted it when it would go on to become one of the dominant forms of “healing” in much of the world.

One area of Babylonian medicine that deserves special mention – because you’ll be able to use it to freak your players out – is their view of birth defects. Babylonian medicine comes at birth malformations from two distinct angles. On the one hand, they closely observed malformations and even linked some birth defects to certain risk factors, like a mother’s exposure to certain poisons during pregnancy. On the other hand, they also practiced “teratomancy,” meaning that they used dead babies to predict the future. Because birth defects were seen as being symbols sent by the gods, there was a whole art to recovering the body of a (usually stillborn) baby born with visible malformations and deducing, from the shape, what the gods were foretelling. This extended to observing live children as they grew; the birth of a mentally disabled child portended one fate, while the birth of a child with dwarfism predicted another. An unusually large baby was felt to mean that the father was a sinful man, and the birth of an albino child predicted that the whole household would soon suffer. Interestingly, a deaf child predicted that a family would prosper, but only if they left the city and moved elsewhere. Just imagine the looks on your players’ faces if the next time they want to consult an oracle, they find the oracle sifting through a pile of stillborn fetuses. 

More than four years ago, Dr. Eris Lis, M.D., began writing a series of brilliant and informative posts on RPGs through the eyes of a medical professional, and this is the one that appeared here on May 2, 2015. Lis is a physician, gamer, and author of the Skirmisher Publishing LLC OGL sourcebook Insults & Injuries, which is also available for the Pathfinder RPG system