A Peculiar Late Babylonian Recipe For Fumigation Against Epilepsy

Strahil V. Panayotov, BabMed Project, Free University Berlin.

Fumigation is a term for healing through the power of smoke. It is a wide-spread therapy in many traditional healing systems and it was also used in Ancient Mesopotamia.

Through fumigation the Babylonian medical practitioner could heal different illnesses: depression, epilepsy, troubles with the ears and the eyes, or even hemorrhoids. A solution of potent drugs produced the smoke. To produce each blend, different substances were mixed with plant’s sap and/or oil in special vessels [fig. 1].

Panayotov Fig 1
Image drawn by Ann Searight. Walker, C.B.F. 1980. Some Mesopotamian Inscribed Vessels. IRAQ 42: 84-86.

Then, in order to produce the smoke, the medical practitioner poured out this mixture over hot cinders. Afterwards the sick body parts were exposed to the smoke. Fumigation has a quick-acting physical effect, especially when the smoke is inhaled. This is due to the swift way of administering drugs that is much faster then internal medication. Furthermore, using aromatics for fumigation (Babylonian medical practitioners often mentioned conifers, and especially their pleasant smell) most likely induced psychological effects, which are comparable to aromatherapy.

Well, this is only one kind of fumigation. Yet, when a demon had to be expelled stinky and pungent fumigants came into play, as it is the case for the translated recipe below. It dates to the time around or shortly after the death of Alexander the Great, at the end of the 4th century BC. The cuneiform tablet was found in ancient Uruk – nowadays in South Iraq. The fumigatory mixture is extraordinarily interesting. It was prepared to cure epilepsy as well as the demonic attacks causing it. The main ingredient consists of parts of the head of a dead young male goat. The whole ritual process could be reconstructed as follows: the medical practitioner recited a spell ‘O, evil, evil’ in the both ears of a young male goat. Perhaps, in this way the flesh of the young male goat was magically activated to produce the potent substance, needed to fumigate out the demonic presence. Then the practitioner slaughtered the young male goat. He took different parts of the head of the young male goat mixed them with naphtha, saps of plants, oils and plants. He prepared a solution, which he first gave to the patient to drink and eat. Then, with that very same mixture, the body of the patient was anointed and at the end he was fumigated [fig 2].

Thureau-Dangin, TCL 6 no. 34 (photo courtesy of the author).
Thureau-Dangin, TCL 6 no. 34 (photo courtesy of the author).

TRANSCRIPTION:
If [ep]ilepsy, Lugalurra-epilepsy-demon, Hand of God, Hand of Goddess befall a man: in order to remove it – it’s ritual: you take a young male goat, you recite [in] its right and left [e]ar the incantation ‘Oh, evil, evil’, (and) you slaughter (it). You take blood of the eye, the pupil of the eye, the covering-tissue of the depressions of the head and the neck, the dark fluid of his two eyes, naphtha, fish oil, cedar blood, maštakal[1]-plant, seed of maštakal-plant, owl blood, skin of a qiššû-cucumber,[2] tendril of qiššû-cucumber – pure fumigants, taramuš-lupine plant, imhur-līm[3]-plant, imhur-ešrā[4]-plant, [you (crush and?) m]ix [(them) together.] He shall eat it (and) drink it, you anoint him and fumigate him over cinders, and then he will get better. [14 drugs for] fumigation with a young male goat.

The peculiar substances mentioned in this recipe have certainly also symbolic significance, which, we may assume, sometimes go along with the chemical usefulness of the substances, since Babylonian traditional medicine was based on empirical experiments that had lasted for thousands of years. Some of the substances, such as ‘owl blood,’ were alternative names for drugs and some were not. We know this because some passages of the text were discussed in ancient commentary, which helped healers understand the extraordinary substances better.

Further reading:
Frahm, E. 2011. Babylonian and Assyrian Text Commentaries, Origins of Interpretation. Münster: Ugarit.

Geller, M. 2010. Ancient Babylonian Medicine, Theory and Practice. Chichester (GB) & Malden, Mass: Wiley-Blackwell.

Labat, R. 1961. A propos de la fumigation dans la médecine assyrienne. Revue d’assyrologie et d’archéologie orientale 55: 152-153.

Stol, M. 1993. Epilepsy in Babylonia. Groningen: Styx.

Thureau-Dangin, F. 1922. Textes Cunéiformes VI. Tablettes d’Uruk. (TCL 6) Paris: Paul Geuthner.

Walker, C.B.F. 1980. Some Mesopotamian Inscribed Vessels. IRAQ 42: 84-86.


[1] Unknown plant used often for purification. Scholars often translate it as soapwort, which is not certain at all.

[2] Qiššû-cucumber, written dKu-ši ‘God Kušu’ is most probably syllabic secret writing of kuš8 =qiššû-cucumber. Suggestion is courtesy of Prof. Andrew George. Furthermore, the reading makes very good sense in the light of the fact that tillatu ‘tendril’ of dKu-ši was used. On the on hand, it is possible that the qiššû-cucumber could be deified; on the other the god Kušu could be symbolically represented by the qiššû-cucumber.

[3] The name means ‘it resists thousand (ailments)’.

[4] The name means ‘it resists twenty (ailments)’.

I smell a rat! Fumigation in Mesopotamian and Hippocratic recipes for women’s ailments – Part 2

By Ulrike Steinert

In this post, I will introduce Hippocratic prescriptions for fumigation from below and compare the uses of this treatment form in Mesopotamian and Hippocratic gynaecology. Some Hippocratic recipes — like the Akkadian BAM 237 discussed in Part 1 —  just list the ingredients, which have to be thrown into the fire, adding a short instruction for application. Other Greek recipes describe a procedure very similar to the Babylonian text K.8678+ (see Part 1), especially the instruction to dig a hole in the ground as a receptacle for the fumigant:

Diseases of Women (DW) 2.195, L 8.376 (Totelin 2009, 253):
Another fumigation: it is necessary to dig a hole and to roast grape stones, in the amount of two Attic choinikes; let him throw some of this ash in the hole, continuously dropping sweet-smelling wine. Seating herself around <the hole> and taking her legs apart, let her be fumigated.

A few Hippocratic recipes state that the woman should be completely covered with clothing during treatment, so that none of the fumes would escape around her. We find the same instruction in a Mesopotamian recipe (12th cent. BCE) for releasing postpartum blood and “fluids” that are “blocked” in the womb:

(If) a woman gives birth and subsequently she has intestinal trouble, her excrement? […], her intestines are blocked, her fluids and [her] blood are (b)locked [in her belly?], to make her release (it): kukru-aromatic, juniper, atā’išu-plant, ṣumlalû-aromatic, “sweet reed”, ballukku-aromatic, myrrh, ṭūru-aromatic, abukattu resin, baluḫḫu-aromatic resin, root of atā’išu-plant. These eleven drugs you mix together. You gather charcoals of ašāgu-thorn into a kirru-vessel, you throw these drugs into it, you have that woman sit down above it, you wrap her with cloth(s).(W.G. Lambert, “A Middle Assyrian Medical Text”, in: Iraq 31 (1969), 28-39 obv. 1-9)

In some Hippocratic passages we notice the desire to make the procedure more comfortable for the woman by using a chair with a hole in it placed above the fire on which she could sit during the treatment (DW 2.114, L 8.246). Several instructions warn to take care not to burn the patient (e.g. DW 1.75, L 8.164). It is probable that the Babylonian healers also used such a chair, but this is never explicitly stated, and it is likewise possible that the patient had to squat above the fumigation apparatus as shown in the illustration.

An African woman is fumigated during delivery. From: Gustave J. Witkowski, Histoire des accouchments chez toys les peubles, 1887, fig. 282. Source: http://ihm.nlm.nih.gov/images/A30263
An African woman is fumigated during delivery. From: Gustave J. Witkowski, Histoire des accouchments chez tous les peuples, 1887, fig. 282. Source: http://ihm.nlm.nih.gov/images/A30263

Both Babylonian and the Greek recipes leave us with unanswered questions. How did the Hippocratics and the Babylonian healers explain the effect of the treatment in view of the contrasting symptoms for which they applied fumigations? How was it possible that fumigation of the genitalia could at the same time stop bleeding and release fluids locked in the womb?

The Hippocratics apparently attributed a drying effect to some fumigations, since they explain in one prescription for stopping fluxes that the ingredients should be mixed only with a little vinegar, in order not to moisten the womb too much.[i]

Likewise in Akkadian, the choice of “human bone” as fumigant for bleeding (in BAM 237) can be explained on the basis of its dryness: blood is contrasted with bone as “wet” with “dry”, and at the same time entails a colour contrast. Thus, the name of the drug “human bone” could have referred to the drying effect of the substance.

On the other hand, in the Hippocratic recipes the effect of fumigations to induce bleeding is sometimes described as “expulsive” (e.g. DW 1.78, L 8.186), and DW 2.133 explains that when the womb attaches itself to the hip joint, with the result that the womb becomes twisted sideways and closed, a fomentation is able to fill the womb with air, straighten and open it. Missing similar explanations for our second Babylonian example K. 8678+, it is hard to say whether the fumigation was supposed to open the womb (remove blockages) or to irritate it.

Some of the fumigations in the Hippocratic corpus were certainly quite irritating to the nose! A common treatment in Hippocratic gynaecology when the womb had moved upward in the body was to apply fragrant, sweet-smelling substances to the vagina (by fumigation or pessary), while foul-smelling substances like animal excrements or hair had to be inhaled by the patient in order to lure the uterus back downwards.[ii] This principle does not hold for fumigations with a different therapeutic purpose. Thus, beside recipes using fragrant substances such as myrrh, ingredients as stag horn and cow dung are recommended for a fumigation to stop fluxes (DW 2.195, L 8.376), and wolf’s turds and donkey hair are burned to help conception. We have likewise encountered similar materia medica as Dreckapotheke in one Mesopotamian prescription, and in both traditions their application entails symbolic meanings. But in contrast to Hippocratic medicine, in Mesopotamia such substances were not restricted to the treatment of women.[iii]

But beware! It is known that in Mesopotamian medicine some ingredients like “dog turds” and “wolf fat” were secret names (Decknamen) for medicinal plants, and often should not be taken literally! Thus, in a plant compendium, “human bone” is a secret name for the (unidentified) plant “shepherd’s staff”, and it is possible that the scribe of BAM 237 consciously used this code to keep his knowledge secret from the uninitiated, making a fool of a 21st century interpreter… The debate about the actual use of Dreckapotheke in Mesopotamian medicine is still going on, and it could reshape our perspective on ancient medical practice!


[i] DW 2.114, L 8.246; cf. DW 2.195, L 8.376 for recipes which apply dry and astringent ingredients such as horn, roasted flour/grain, dry cypress, gallnuts and astringent dark wine.

[ii] E.g. DW 2.123, L 8.266; DW 2.127, L 8.272.

[iii] For ingredients such as excrement in Hippocratic gynaecology see e.g. von Staden 1992.

References:

L = Littré, Émile (1962) Œuvres completes d’Hippocrate. Tome Huitième, Amsterdam.

von Staden, Heinrich (1992) “Women and Dirt”, in: Helios 19, 7-30.

Totelin, Laurence (2009) Hippocratic Recipes. Oral and Written Transmission of Pharmacological Knowledge in Fifth- and Fourth-Century Greece. Leiden, Boston.

I smell a rat! Fumigation in Mesopotamian and Hippocratic recipes for women’s ailments – Part 1

By Ulrike Steinert

In my first post on the blog, I described some of the difficulties in studying Mesopotamian medical texts from 2nd and 1st millennium BCE Babylonia and Assyria. In the following two contributions, I would like to discuss similarities between Babylonian and Hippocratic recipes applying “fumigation from below” as a therapy for gynaecological disorders. In this part I will present the recipes themselves with some comments on fumigation in general. In the next post I will compare Mesopotamian and Hippocratic concepts of women’s ailments and their treatment gleaned from the fumigation recipes.

The specific treatment form of fumigation from below is so far attested only a few times within the Mesopotamian gynaecological corpus, but fumigation of the (whole body of the) patient or of specific body parts (e.g. the ears) is more commonly found as a treatment type in other areas of Mesopotamian therapy. Surprisingly, the situation is reversed in the Hippocratic texts: most attestations within the Hippocratic corpus are found in the gynaecological treatises, while fumigation is otherwise rare (Goltz 1974, 232). Here, I would like to point out some similarities and differences between the Babylonian and Hippocratic sources with regard to the therapeutic procedure itself, and with regard to the female ailments treated by fumigation from below in each tradition.

Before comparing the recipes, the term “fumigation” should be clarified. In fumigation, hot and dry vapours or smoke are led to a body part, while in the cognate procedure of “fomentation”, hot water vapours are used to lead medicinal substances to a body part (Totelin 2009, 52; Goltz 1974). The differentiation between both techniques was not very strict in Greek medicine, except in the gynaecological treatises (Goltz 1974, 235). The main difference between both procedures is the apparatus: in fomentation, a vessel containing the drugs and some water is heated over a fire and the vapours are led to a body opening through a reed, while in fumigation substances are directly thrown into the fire or onto glowing charcoals or ashes. In Mesopotamian medical texts, fumigation consists of burning aromatic substances on a fire or on charcoals (usually a brazier is used), exposing the patient (or specific body parts) to the fumes (Goltz 1974).

It may come as a surprise that in both Mesopotamian and Hippocratic gynaecology fumigation from below was applied for some identical purposes and ailments. In Hippocratic gynaecology, fumigation was used to treat infertility, with the incentive to open or soften the uterus for conception.[i] Interestingly, fumigation was regarded as a patent method both to stop fluxes and to expel retained fluids from the womb.[ii] More often however, fumigation was applied to return the womb to its correct position, if it had moved elsewhere in the body.[iii]

By contrast, the theory that the womb could move within the body and cause illness is unknown to Mesopotamian medicine. But one prescription applies fumigation from below to stop bleeding during pregnancy (naḫšātu), comparable to the Hippocratic use of fumigation for fluxes. Further, both in Hippocratic and Mesopotamian gynaecology fumigation from below was prescribed when fluids were retained or blocked in the womb. While the Hippocratic texts speak of blocked menstrual or postpartum blood (lochia), the Babylonian texts describe a similar condition called “(b)locked fluids” (lit. “water”). Because this condition is sometimes mentioned in the context of postpartum complications, it is possible that the word “fluids” here refers to the lochia, but this is far from certain, since the word “fluids” can stand for several things in different contexts, e.g. for the amniotic fluid or for vaginal discharge other than blood. Yet, Mesopotamian texts describe very similar symptoms in connection with the condition “(b)locked fluids” as the Hippocratic texts do in connection with disease conditions caused by retained menses (see Steinert 2013 for discussion). Should the Akkadian expression “(b)locked fluids” be a euphemistic term for the retained menses?

BAM 237 (VAT 8577+), a collection of gynaecological recipes from Assur. Source: Cuneiform Digital Library Initiative (http://cdli.ucla.edu/dl/ photo/P285323.jpg)
BAM 237 (VAT 8577+), a collection of gynaecological recipes from Assur. Source: Cuneiform Digital Library Initiative (http://cdli.ucla.edu/dl/photo/P285323.jpg)

One of the prescriptions for fumigation from below is contained in a Neo-Assyrian text from Assur (ca. 7th cent. BCE), devoted to treating bleeding during pregnancy:

BAM 237 i 26’-27’:
“You scatter “human bone” over charcoal, you let the woman sit down above it. If (the haemorrhage) does not stop, you repeat (it), and let her sit down (again), ditto (i.e. and it will stop).”

From a second, contemporary recipe on a Babylonian tablet found in the palace library of the Assyrian king Ashurbanipal at Nineveh, we learn a few more details about the procedure:

K. 8678+ rev. 9’-12’:
“If ditto (i.e. a woman is (b)locked regarding the fluids): you dig a hole, you make it two fingers [deep], […],
[…] you cover (it). You throw flour? into it, one tenth of a litre of ka[mūnu-spice?],
[…] solid pieces? of resin, one thirtieth of a litre of ṭūru-aromatic […],
[…] you spread on coals; you make the woman sit down above it.”

Although the text is fragmentary and presents difficulties, the procedure is quite clear and bears similarities to a few Hippocratic recipes for fumigation of the womb (presented in Part 2 of this post). The apparatus is simply a hole in the ground, which functions as a receptacle for burning charcoal and the fumigants. The woman’s pubic region is exposed to the fumes.

 


[i] E.g. Diseases of Women 1.75, L 8.164; cf. Diseases of Women 2.154, L 8.330; Sterile Women 230, L 8.438ff. describes a fomentation with a gourd for the same purpose.

[ii]DW 2.114, L 8.246; DW 2.195, L 8.376; DW 1.78, L 8.186.

[iii] For discussion see King 1998; e.g. Diseases of Women 2.123, L 8.266 movement to the head; DW 2.126, L 8.272 womb attaches itself to the hypochondria; DW 2.127, L 8.272 movement to the liver; DW 2.133, L 8.284-6 fomentations when the womb moves to the hip joint; DW 2.203, L 8.390 womb fixes itself to the loins. Sometimes, the patient is described to suffer from more than one symptom at the same time, e.g. in Diseases of Women 2.154, L 8.330 the womb is “irritated”, the menses are blocked and the woman does not conceive.

References:

Goltz, Dietlinde (1974) Studien zur altorientalischen und griechischen Heilkunde. Therapie-Arzneibereitung-Rezeptstruktur, Wiesbaden.

King, Helen (1998) Hippocrates’ Woman. Reading the Female Body in Ancient Greece, London/New York.

L = Littré, Émile (1962) Œuvres completes d’Hippocrate. Tome Huitième, Amsterdam.

Steinert, Ulrike (2013) “Fluids, rivers, and vessels: metaphors and body concepts in Mesopotamian gynaecological texts”, in: Journal des Médecines Cuneiformes 22, 1-23. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3791376/

Totelin, Laurence (2009) Hippocratic Recipes. Oral and Written Transmission of Pharmacological Knowledge in Fifth- and Fourth-Century Greece. Leiden, Boston.