Like an alien in a strange old world – Reading Mesopotamian medical texts on women’s healthcare

By Ulrike Steinert

Decoding medical cuneiform texts often makes you feel a bit like a detective who has entered a mysterious, foreign world of words and ideas. Not few of my Assyriologist colleagues would probably favour other topics, rather than studying Mesopotamian medical texts, because they are hard to understand, full of strange disease names and unknown drugs, and because these texts have a reputation of being technical, monotonous and boring.

Not surprisingly then, Mesopotamian medical texts remain a poorly known corpus, and few scholars have worked on the subject or published books for a general audience.[i] Although the majority of the texts are still unavailable in proper editions and translations, the situation is steadily improving. Beside a growing number of publications every year, cuneiform medicine is becoming an increasingly recognised topic, and a few research projects are currently investigating these texts, preserved on thousands of fragments of clay tablets and scattered in various museums.[ii] The fragmentary nature of the corpus, consisting of diagnostic and therapeutic texts as well as handbooks on materia medica, written during the 2nd and 1st millennium BCE, and the difficulty of decoding them connected with the cuneiform writing system and the genre (especially the use of many multivalent logograms) have contributed to the lagging behind of research in this field, compared e.g. to Egyptological research on medical papyri.

Let me describe some of the difficulties posed by the Mesopotamian medical texts, specifically those concerned with treating women, to a modern reader. These difficulties result to a considerable degree from cultural differences e.g. between ancient and modern concepts of physiology, disease and therapy.

One problem for the modern scholar is to grasp ancient disease concepts and ideas of physiology from symptom descriptions. The gynaecological texts form a small sub-corpus among the majority of medical tablets devoted to diseases which are normally not gender-specific and which use the male body as a general model. Thus, while the latter diagnostic and therapeutic texts begin with the formula “If a man (suffers from ailment X/symptoms X, Y, Z)”, the gynaecological texts begin with “If a woman …”. The gynaecological corpus, not unlike the modern medical discipline, focuses on female reproduction: (in)fertility, complications occurring during pregnancy, birth, and in childbed, but also includes treatments for abnormal vaginal bleeding and other fluxes, as well as renal, rectal and gastro-intestinal ailments in women. Yet, because the perspective of gynaecological texts was restricted to the diagnosis and treatment of abnormal phenomena, they do not contain descriptions and explanations of normal physiological functions, such as menstruation, which have to be inferred from the sparse information gleaned from the medical texts or other text genres.

A Babylonian tablet with medical prescriptions for women, ca. 7th cent. BCE. Source: Cuneiform Digital Library Initiative (http://cdli.ucla.edu/dl/ photo/P238756.jpg)
A Babylonian tablet with medical prescriptions for women, ca. 7th cent. BCE. Source: Cuneiform Digital Library Initiative (http://cdli.ucla.edu/dl/photo/P238756.jpg)

For instance, Babylonian healers collected treatments “to stop a woman’s blood” in case “a woman’s blood flows and does not stop”, leaving us at loss to decide whether this refers to unusually heavy menstrual bleeding or to abnormal haemorrhage due to other causes. Beside blood, the texts also treat discharge of “fluids” (literally “water”) from the vagina, which depending on the context, refers to phenomena which modern medicine has come to differentiate, like amniotic fluid (premature rupture of the membranes) and vaginal discharge due for instance to leucorrhea. It becomes clear that the Babylonian healers do not share our differentiations of symptoms and diseases, and that progress with the texts will only be made by investigating their system of ideas about what goes wrong in the body when disease occurs.

This undertaking is somewhat hampered by another characteristic of Mesopotamian medical texts, namely that the writers (Babylonian and Assyrian healers and scholars) rarely recorded their theories (e.g. discussions which took place in the classroom and in scholarly discourse). Yet, some of their concepts of the body, health and disease emerge, often implicitly, from disease aetiologies, names, and from metaphors found especially in the incantations that accompanied medical treatments. These characteristic traits of Mesopotamian medical texts form a contrast to Greek and Roman medical writers who often speculated in writing about physiological processes such as menstruation, conception and the nature of female illnesses based on humoral theory.

Another challenge arising from Babylonian medical texts is to understand the “logic” of ancient medical treatments and recipes even though the majority of the drugs are unidentified, and to reconstruct the cultural context in which the texts were used, e.g. how medical consultation and application of treatments actually took place. Thus, it is still debated whether Babylonian (male) healers actually examined women (and applied the prescribed remedies like tampons), or whether the symptom descriptions in the texts stem from what the patients observed themselves and told the doctor. In upcoming posts on fumigation in Mesopotamian and Hippocratic gynaecology, I will illustrate an approach to discover principles of coherence between the use of particular materia medica and specific complaints.


[i] A real primer presenting a comprehensive overview of Mesopotamian medicine is Markham J. Geller’s Ancient Babylonian Medicine. Theory and Practice. Malden / Oxford, 2010.

[ii] The most ambitious of these projects in terms of scope is “BabMed”, a project at Freie Universität Berlin, consisting of a small research team led by Markham Geller. An overview of publications about Mesopotamian medicine can be found in the regularly updated bibliographies in Le Journal des Médecines Cunéiformes (http://www.ames.cam.ac.uk/jmc/de.html).

Cold, dry and bald

By Laurence Totelin

A few months ago, I read with fascination – and surprise – a post by Jennifer Evans on the treatment of baldness in the early modern period. According to one of her sources (William Drage, a physician and apothecary from Hitchin) anything drying, and in particular sexual intercourse, would be detrimental to he who is thinning on top; women and eunuchs, for their part, rarely went bald because of their moist nature.

I was fascinated to find that the early-modern recipes and remedies listed by Jennifer were very similar to those preserved in texts from Graeco-Roman antiquity. Thus recommendations to cut the hair short; to use a laudanum unguent; to anoint the head with juice of onions/leeks, or with radish oil are all to be found in one of the earliest medical treatises preserved in Greek: the Hippocratic Diseases of Women 2 (chapter 189, 8.370 Littré). Some early modern treatments of baldness that presented, such as Mary Glover’s recipe involving cow’s piss and stinking old shoes, were rather unsavoury, but they pale in comparison with pigeon dung (also listed in Diseases of Women 2.189) or the following recipe, excerpted from Cleopatra’s Cosmetics by Galen:

Deer hunt on a fourth-century BCE mosaic from Pella. Source: Wikipedia
Deer hunt on a fourth-century BCE mosaic from Pella. Source: Wikipedia

Another [remedy against alopecia]. The power of this [remedy] is better than that of all the others, as it works also against falling hair and, mixed with oil or perfume, against incipient baldness and baldness of the crown; and it works wonders. One part of burnt domestic mice, one part of burnt remnants of vine, one part of burnt horse teeth, one part of bear fat, one part of deer marrow, one part of reed bark. Pound them dry, then add a sufficient amount of honey until the thickness of the honey is convenient, and then dissolve the fat and the marrow, knead and mix them. Place the remedy in a copper box. Rub the alopecia until new hair grows back. Similarly, falling hair should be anointed everyday. [Galen, Composition of Medicines according to Places 1.2, 12.404 Kühn]

So how is this supposed to work? Ancient recipes do not come with explanation as to their functioning. One must turn to more theoretical texts to find out more. The philosopher Aristotle devoted a long passage of his treatise Generation of Animals to baldness, stating that this affliction is linked to sexual intercourse:

The reason is that the effect of sexual intercourse is to cool, as it is the excretion of some of the pure, natural heat, and the brain is by its nature the coldest part of the body; thus, as we should expect, it is the first part to feel the effect. [Aristotle, Generation of Animals 5.3, 734b. Translation: A.L. Peck]

He went on to explain that children and women do not go bold because they are incapable of producing seminal secretion. Thus, for Aristotle, the cause of baldness is a loss of vital heat through sexual intercourse. Galen, for his part, sees dryness as the cause of the affliction, explaining that women and eunuchs have moist heads, while bald people have dry ones [Galen, Commentary on Hippocrates’ Sixth Book of Epidemies, 17b.5  Kühn]. The physician’s explanation is closer to that found in early-modern treatises: it is through loss of moisture that the hair thins on top.

Wounded bear. Mosaic from Pompeii. Source: Wikipedia
Wounded bear. Mosaic from Pompeii. Source: Wikipedia

Where do remedies fit within shifting systems of explanation? The burnt ingredients in the Cleopatra remedy could be interpreted as both warming and drying, while deer marrow and bear fat would have been emollient (moistening). But I would argue that these explanations are too simplistic. One needs to go further and look at what brings cold, dry and baldness together.

In ancient humoural theory, cold and dry were associated with the Autumn season. (Clearly the theory was not devised in the UK!) It is in the Autumn of life that man loses his hair. There is no real solution to the problem, but ‘fertilising’ ingredients such as ashes could perhaps help. Fats from animals born in the spring and hunted in the autumn might also add to the efficacy of the remedy.

Sounds too far-fetched and less ‘rational’ than humoural explanations? Consider the following: Aristotle himself compared hair loss to shedding of leaves, and poets sometimes drew an analogy between lush greenery and animal hair (see for instance Columella, On Agriculture 10.71).  Ancient recipes can always be read in many different ways!

Distilling the Essence of Heaven: How Alcohol Could Defeat the Antichrist

by Tillmann Taape

In my last post, I introduced Hieronymus Brunschwig’s Small book of distillation and considered how it presented medical knowledge. Here, I explore how Brunschwig’s reading of alchemical ideas shaped his concept of distilled remedies.

Like anyone living in medieval or early modern times, Brunschwig knew that the world was strictly divided into two separate realms: heaven and earth. While the celestial spheres were perfect and unchanging, revolving in harmonious circles with clockwork precision, the sublunar world was rather different.  All earthly matter was made up of the four elements: fire, air, earth, and water. Unless their qualities were perfectly balanced, they were volatile, prone to haphazard permutations. This was why everything in nature was thought to be constantly changing or decomposing, posing a major health threat to the human body which was also made of earthly matter. In fact, it was governed by bodily humours which corresponded to the four elements, and were just as difficult to balance.

Seeking to keep physical corruption at bay, it is not surprising that Brunschwig turned to alchemy, especially distillation. As he wrote in his Small book, this was a powerful way of transforming and purifying matter (see, for example, Jonathan Cey’s post on alchemy and fecal matter). While Brunschwig did not get much more specific in this particular work, we can look to the Large book of distillation which he published in 1512 for more detailed insights into his alchemical worldview. Numerous references and quotations suggest that the fourteenth-century alchemical writings of the Franciscan John of Rupescissa had a particularly important influence on his concept of distillation.

Haunted by apocalyptic visions, Rupescissa was convinced that the coming of Antichrist was near. In order to prevail in the final battle, evangelical men needed to search for the panacea, a universal medicine which cures all illnesses by adjusting any imbalance of the four humours. According to Rupescissa, the only substance fitting the bill was “quintessence of wine”– alcohol distilled many times over, the stronger the better.

This marvellous liquid was not, like all other earthly things, imbued with the qualities of the four sublunar elements and thus doomed to decay. Instead, it was perfectly balanced, much like the fifth element which made up the heavenly spheres, and therefore incorruptible. Rupescissa also called it “man’s heaven”, indicating that while it did not actually amount to a swig of celestial matter, it could confer the incorruptibility of the heavenly spheres to the human body to keep it healthy. This miraculous substance was hard-won through demanding alchemical processes. Multiple distillation at different carefully-regulated temperatures was followed by “circulation” of the substance in specially made glass vessels to remove any remaining traces of the corruptible elemental qualities. Distillation thus emerges as a process capable of profoundly changing physical matter.

From the many quotations in Brunschwig’s Large book, we can see that Rupescissa’s ideas about distillation and quintessence were central to Brunschwig’s medicine-making. Bearing this in mind, the distilled remedies in the Small book appear in a new light. Like Rupescissa, Brunschwig thought of distillation as a process with some cosmological significance which made sublunary matter “incorruptible” and more “like a heavenly thing” [1].

It is important to note though, that he never referred to the remedies described in the Small book as “quintessences”, and the techniques for their production were mostly quite straightforward. They certainly didn’t appear to be geared towards anything as complex and esoteric as Rupescissa’s celestial panacea. They did not remove all elemental qualities from Brunschwig’s distilled waters, although they did separate the plant’s healing virtues from its material dross, and thus produced more standardised remedies with a predictable effect on the human body and its humours.

Far from Rupescissa’s ideal of incorruptibility, the shelf life of Brunschwig’s waters was clearly limited, and most of them went off after three years. Even before their use-by date, the power of distilled remedies declined over time. This, however, occurred at a highly predictable rate: some, like water of mandrake or water lily, were initially so powerful that they should only be applied externally, but after one year their power was tempered sufficiently to be taken internally. This suggests that, although Brunschwig’s Small book aimed considerably lower than “man’s heaven”, Rupescissa’s concept of distillation was at work here. It did not go all the way to yield the perfect balance and incorruptibility of heaven, but it channelled some of heaven’s clockwork regularity and thus made Brunschwig’s remedies more reliable. The remedies would have a well-defined effect on the patient’s humoural balance, and even though their power would decay over time, it did so at a predictable rate, allowing the practitioner to keep track of its current state.

[1] “unzerstörlichen” and “gleich dem hymelischen”. Hieronymus Brunschwig, Liber de arte distillandi de simplicibus (Strasbourg: Johann Grüninger, 1509).

Medicinal Compounds, Efficacious in Every Case

By Lisa Smith

Perhaps the most famous cure-all of all time is Lydia E. Pinkham’s Vegetable Compound, immortalized in song as “Lily the Pink” (or “The Ballad of Lydia Pinkham”).* Although the original vegetable compound aimed to treat women’s ailments, the song suggests—tongue in cheek–that it might have much wider, rather miraculous applications. The boy with sticky out ears learns how to fly; the man who thought himself Julius Caesar becomes emperor of Rome.

Ridiculous. How, after all, could one drug cure so many ailments? In the modern world, cure-alls just don’t make sense.

But they did at one time. In early modern Europe, cure-all medicines were as likely to be sold by elite physicians as by “quacks” and were often made domestically. These treatments made sense. In a humoral body, with its properties of cold, hot, wet and dry, many seemingly different problems might have the same underlying cause.

Bridget Hyde’s book, late seventeenth century. Wellcome Library, MS 2990, f. 52v. Image Credit: Wellcome Library.

“Dr Stevens’ Water” was a common remedy in English remedy collections kept by well-to-do families. Authors sometimes provided lists of a treatment’s “virtues”, which usefully explain the underlying rationale. Bridget Hyde, for example, described Dr. Stevens’ Water as good for the vital spirits, inward colds, palsy, dropsy, gout, bladder stones, weak sinews, barrenness, worms, tooth-ache, stomach, and “rayns of ye back”. (Reins of the back refers to a urinary or genital discharge.)

An even more impressive and random list than Lydia Pinkham’s Vegetable Compound! What all of these illnesses had in common, however, was that they were caused by cold and wet humours. Looking up each ingredient in herbals and pharmacopoeias reveals that herbs like nutmegs, cloves, mace, aniseeds, lavender and rosemary (for example) had warming and drying properties.  Rosemary was ruled by the Sun and Aries; given its warming and comforting properties, it was commonly prescribed for any problems caused by cold humours. Mace, ruled by Venus, was chiefly used for treating problems of the womb.

Sometimes the connections are surprising. “Pertes de sang” (or blood loss) in French collections could refer to general losses of blood, excessive menstruation or uterine bleeding, miscarriage – or diarrhoea.  For example, one remedy for fluxes of blood in Mme Lievain’s book (Wellcome Library MS 3258, f. 132) also specified its use in diarrhoea. The main herb, cinquefoil, was commonly used for stomach problems as well as fluxes of all kinds, with a cooling property to sweeten the blood.

Most cure-alls did not try to treat everything, but had a clear rationale and focused on a group of closely-related ailments.

That said, not all cure-alls were created equal — and there were some weird ones out there. Lionel Lockyear, for example, claimed that his pills had the extract of the sun in them. Even better than Lily the Pink, then…

Broadsheet advertising L.Lockyer’s patent medicine. Image Credit: Wellcome Library.

*A rather entertaining song, though it needs an ear worm alert.

This has been cross-posted at the Cliopatra award-winning Wonders & Marvels, a fun group blog that focuses on odd stories and interesting historical tidbits. 

More on multi-purpose remedies can be found in my article, “Imagining Women’s Fertility before Technology”, Journal of Medical Humanities, 31, 1 (2010): 69-79.