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Antiquity, Plants and Herbs, Remedies, Series: Women's Health

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

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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.

Antiquity, Remedies, Series: Fertility, Series: Women's Health

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

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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.

Antiquity, Medical Practitioners, Records, Documents and Notes, Remedies, Series: Women's Health

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

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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).