Practitioners usually continued treating the crushed active ingredients by mixing (balālu, summuhu), soaking (ramāku), softening (mahāhu), stirring (mahāṣu), putting (nadû), steeping (rasānu) or kneading (lâšu) them in liquid or semi-liquid carrier substances. The aim was to extract as much healing properties from these substances as possible and in order to achieve this goal, practitioners could turn to several different procedures. Some procedures involved treating mixtures with heat, while others only required that the active ingredients spent a longer period of time in contact with a liquid carrier. There was no established nomenclature of these different procedures in the Akkadian language -- medical recipes employed, instead, sets of instructions to inform practitioners about the required manufacturing process.
Maceration means to keep drugs in liquids at room temperature for a longer period of time, so they can soften or dissolve. In therapeutic texts, the usual way of describing this process is with the phrase "you let (the mixture) stand overnight under the stars" (ina kakkabi tušbât), which combined the practical knowledge about maceration with a more symbolic aspect -- harnessing stellar energy to make the medication more effective. The latter motivation becomes apparent in those instances, where medical recipes specify which star constellation was meant by this statement. In a prescription for bile disease, we find the following statement:
In order to heal him, you wash roasted errû ("colocynth") from the north side (of the garden) in water, you split up baluhhu (an aromatic), you select some nuhurtu ("asafoetida"), (and then) you soak these three drugs in high-quality beer in proportion to equal amounts, you place them under the Goat star, you draw a circle around them, in the morning you filter those (ingredients), he drinks them on an empty stomach (. . .) (Stomach 3, BAM 578+ i 38-41)
The Goat star corresponds to the constellation Lyra, and it was thought in antiquity to be the star of the healing goddess Gula. In our passage, the nightly exposure to Gula's star was further enhanced by a circle that was probably scratched on the ground, and which may have served to focus the stellar power of the healing goddess even more on the medicament.
When heat is introduced into the manufacturing process, decoction is one of the methods employed to extract the healing properties of drugs. In this case, active ingredients are placed in cold liquid carriers, and then the mixture is brought to the boil using an open container. Digestion is a method where drugs are kept in a closed container and heated for a longer period of time at a lower temperature. In connection with decocting or digesting ingredients, medical recipes say nothing about the regulation of heat input but use a wide range of expressions, including general verbs for "to boil", "to heat up" and "to warm" (bašālu, salāqu, buhhuru, emēmu), as well as more detailed instructions like "you heat (the mixture) in an oven" (ina tinūri tesekker) or "you heat (the mixture) over fire" (ina išāti tušahhan). Sometimes practitioners aimed at making more concentrated decoctions, so they kept mixtures simmering for a longer period of time to allow them to reduce to the desired amount. Such technical details are rare, however, and occur mostly in the Late Babylonian era, by which time exact measurements became more consistently indicated in the medical texts.
You put two litres of vinegar into four litres of water, you add three shekels of uḫūlu ("alkali"), three shekels of salt (and) three shekels of nīnû (a kind of mint) to it, (and then) you boil (the mixture) until it is reduced to two litres. (Excerpt from a Late Babylonian prescription for skin disease)
After solid ingredients were combined with liquid or semi-liquid carrier substances, practitioners could continue with other procedures. If the medicament was heat-treated, for instance, the next step was to remove it from the heat source (elû) and apply it while it was hot (bahrussu), or to let it stand for a while until it cooled (kuṣṣû). Sometimes practitioners also filtered (šaḫālu) the mixture and added further drugs, including honey, oil, crushed plant bits and flour that were sprinkled (salāḫu, šulputu) or poured (šapāku, nadû) over the medicament.
Krisztian Simko
Krisztian Simko, 'Combining active ingredients with carrier substances', The Nineveh Medical Project, The Nineveh Medical Project, Department of the Middle East, The British Museum, Great Russell Street, London WC1B 3DG, 2022 [http://oracc.museum.upenn.edu/asbp/NinMed/medicaltechniques/combiningingredients/]