Despite the ongoing absence of a surgical treatise, references spread throughout the cuneiform corpus suggests significant skills and techniques in the handicraft of healing. The most famous law collection of Mesopotamia, the so-called Code of Hammurapi (from the early second millennium BCE), contains data on healing with "hand-work" techniques.
§ 215 If a physician (asûm) makes a serious wound with a bronze lancet (ina karzilli siparrim) upon a person and thus heals the person, or opens (petûm) a person's temple (nakkaptum) with a bronze lancet (ina karzilli siparrim) and thus heals the person's eye, he shall take 10 shekels of silver (as his fee). § 218 If a physician (asûm) makes a serious wound with a bronze lancet (ina karzilli siparrim) upon a person and thus causes the person's death, or opens (petûm) a person's temple (nakkaptum) with a bronze lancet (ina karzilli siparrim), and thus blinds the person's eye, they shall cut off his hand. (modified after Roth 1995)
This makes clear that the patient had to pay the healer for treatment. People with low incomes might struggle to afford this healthcare. On top of this, a fee had to be offered to the healing goddess Gula, as mentioned in medical incantations. In this respect, most of the textual evidence we possess originates from the upper classes of society. Most medical treatments we encounter in cuneiform were reserved for the rich.
The hazards of surgery are easy to guess from the Code of Hammurapi. Incantations preserved in the Nineveh Medical Encyclopedia show that improving a medical problem before undertaking surgery was the preferred option, as it is generally today. This is especially true in the case of fragile body parts such as the eyes:
Incantation: "O, you eyes are porous blood vessels! Why have you picked up chaff, pebbles, fibres, algae of the river, clods from the streets (and) twigs from the rubbish heaps? Why have you carried (them) along (with you)? Rain down like (a shooting) star, drop down like a meteor (lit. flame), before Gula's flint-razor and scalpel (ṣurru naglabu) manage to reach you (i.e. the eyes). An irreversible incantation, the incantation of Asalluhi and Marduk, the incantation of Ningirimma, mistress of incantations, and Gula, mistress of the medical skill; she casts (the spell) and I (the healer) carry (it) out." Incantation formula. (K.2573, r ii 34-39, modified after http://oracc.org/asbp/ninmed/P394523)
The medical knife, perhaps similar to the one Gula is holding in the drawing above, is the instrument for the surgical intervention. Intriguingly, more than a thousand years after the Code of Hammurapi (cited above), this therapy was still in use, and its progress recorded in the Nineveh Medical Encyclopedia, in the second tablet of the first treatise on the Head.
For (the case): a man's temple constantly hurts him. You prick (his temple) with a bronze knife (ina siparri) once, twice (or) three times until blood starts flowing (Then) you anoint him with nikiptu-plant in oil. (BAM 482 i 64', modified after http://oracc.org/asbp/ninmed/P365744)
Knives and razors were used to cut through skin, but ointment must have been applied by hand. In order to avoid confusion, medical texts specify exactly when only a finger is needed:
You pound separately alluharu-mineral, white plant, emesallu-salt, fat, tuškû-mineral, black cumin and exudation of copper. You take in equal amounts, stir them together. You pour them into a huliam-vessel, which you have earlier rinsed. You knead it in ghee and šumēnu-mineral, then you open the upper lied (lit. head) of his eyes with a finger (ina ŠU.SI) and you put the medication into his eyes. He keeps his eyes closed while you rub his eyes (i.e. the eyelids and surroundings) and continuously do this for nine days. (BAM 513 o ii 34'-37', modified after http://oracc.org/asbp/ninmed/P394520)Fingers were essential for applying ointments. They can be wrapped with a cloth and then coated with the relevant drug. In the case below, salt is used.
If paralysis seizes a man, so that he cannot let anything come down (i.e. eat and drink): you shall heat up premium beer in a tangussu-vessel. You put salt in it, and you pour (the mixture) into his anus. Then, you (= the healer) wrap your finger (ŠU.SI-ka) in linen, you coat it with salt, you rub his anus, (and) you put pubic hair from an old woman in the middle of his mouth; (then) he will get better. (BAM 575 r i 47-48, modified after http://oracc.org/asbp/ninmed/P393743)
The role of the finger was to rub the salt into the flesh of the anus. This must have been uncomfortable at best. Then the pubic hair from an old woman was stuck inside the patient's mouth. This must have been unpleasant too. Perhaps the idea was that the patient would smell ammonia, releasing adrenalin and triggering a response in the paralyzed sufferer. This prescription clearly combines disgusting treatments with the hope to revive the patient from the paralyses. A second example follows different steps:
If a man's internal organs continually have cramps: he shall drink beer from a flask on an empty stomach. You heat up vinegar, you put mint and emesallu-salt in it, you drip oil into it, and you pour (the mixture) into the middle of the anus (lit. vessel). You anoint him in his (anal) entirety with oil, using your left finger (ina ŠU.SI GUB₃-ka). (BAM 575 o ii 24-25, modified after http://oracc.org/asbp/ninmed/P393743)
Left and right extremities had symbolic implications, as well as practical differences. Thus, when necessary, it was specified exactly which hand or finger should be used.
A third example, although not fully clear, shows a remarkable treatment from the field of surgery. The "hand-work" is performed with a finger, and the incision with an unnamed razor.
If a man"s scalp holds fluid: you touch the place where it holds fluid with your big finger (ina ŠU.SI-ka GAL-ti). If its UZU.GIŠ smells bad, (and) the fluid of his skull has descended, you open it up, and you incise his skull, (so) you can remove? the fluid of his skull. (BAM 480 r i 55-57, modified after http://oracc.org/asbp/ninmed/P365742)
Actual examples of an injured skull with such incision marks have survived from Mesopotamia. The example from Tell Biʾa demonstrates that a person had experienced a severe blow to the skull with a hard object (Figure 2). The injury was consequently scraped and incised in order to improve the patient's condition. Remarkably, the patient survived the partial trepanation. This skull might be the result of a therapy similar to what is described above.
Geller, M. J and S. V. Panayotov. 2020. Mesopotamian Eyes Disease Texts: The Nineveh Treatise. Die babylonisch-assyrische Medizin in Texten und Untersuchungen 10. Berlin-Boston: Walter de Gruyter.
Roth, M. T. 1995. Law Collections from Mesopotamia and Asia Minor. Writings from the Ancient World 6. Atlanta, Georgia: Scholars Press.
Wolska, W. 1994. "Zwei Fälle von Trepanation aus der altbabylonische Zeit Syriens", in Mitteilungen der Deutschen Orient Gesellschaft 126: 37-50.
Strahil V. Panayotov
Strahil V. Panayotov, 'Information from texts', 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/surgery/informationfromtexts/]