Can No Physician Be Found?: The Influence of Religion on Medical Pluralism in Ancient Egypt, Mesopotamia and Israel 9781463202484, 2013045203, 1463202482

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Can No Physician Be Found?

Gorgias Studies in the Ancient Near East

6

This series of monographs and edited volumes explores the societies, material cultures, technologies, religions and languages that emerged from the Levant, Mesopotamia, and Egypt.

Can No Physician Be Found?

The Influence of Religion on Medical Pluralism in Ancient Egypt, Mesopotamia and Israel

Second Edition

Laura Marie Zucconi

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34 2013

Gorgias Press LLC, 954 River Road, Piscataway, NJ, 08854, USA www.gorgiaspress.com Copyright © 2013 by Gorgias Press LLC

All rights reserved under International and Pan-American Copyright Conventions. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning or otherwise without the prior written permission of Gorgias Press LLC. 2013

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ISBN 978-1-4632-0248-4

Library of Congress Cataloging-in-Publication Data Zucconi, Laura M., author. Can no physician be found? : the influence of religion on medical pluralism in ancient Egypt, Mesopotamia and Israel / by Laura Zucconi. -- Second edition. p. ; cm. -- (Gorgias studies in the ancient Near East ; 6) Includes bibliographical references and index. ISBN 978-1-4632-0248-4 I. Title. II. Series: Gorgias studies in the ancient Near East ; 6. [DNLM: 1. Bible. Old Testament. 2. History of Medicine--Ancient Lands. 3. History of Medicine--Egypt. 4. History of Medicine--Israel. 5. Cross-Cultural Comparison--Ancient Lands. 6. Cross-Cultural Comparison--Egypt. 7. Cross-Cultural Comparison--Israel. 8. Health Knowledge, Attitudes, Practice--Ancient Lands. 9. Health Knowledge, Attitudes, Practice--Egypt. 10. Health Knowledge, Attitudes, Practice--Israel. 11. History, Ancient--Ancient Lands. 12. History, Ancient--Egypt. 13. History, Ancient--Israel. 14. Physicians--history--Ancient Lands. 15. Physicians--history--Egypt. 16. Physicians--history--Israel. 17. Religion and Medicine--Ancient Lands. 18. Religion and Medicine--Egypt. 19. Religion and Medicine--Israel. WZ 51] R127.5 610.932--dc23 2013045203

Printed in the United States of America

TABLE OF CONTENTS Table of Contents ..................................................................................... v Acknowledgments .................................................................................. vii Abbreviations ........................................................................................... ix Introduction .............................................................................................. 1 Egyptian Healing .................................................................................... 15 Egyptian World System ................................................................ 18 Egyptian Healers............................................................................ 36 Conclusion ...................................................................................... 52 Mesopotamian Healing .......................................................................... 55 Mesopotamian World System...................................................... 59 Mesopotamian Healers ................................................................. 82 Conclusion ...................................................................................... 93 Healing in the Hebrew Bible ................................................................ 95 World System in the Hebrew Bible ............................................ 97 Healers in the Hebrew Bible ......................................................113 Conclusion ....................................................................................126 Ancient Near Eastern Supra- and Subcultures ................................129 Bibliography ..........................................................................................139 Index .......................................................................................................155

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ACKNOWLEDGMENTS This present volume is a continuation of the work I began eight years ago on the role of physicians in the ancient Near East. I have shifted focus away from Kleinman’s criteria of patient-practitioner interaction in order to emphasize the world system of the healers and how they communicated among its various elements. This work was conducted at the Richard Stockton College of New Jersey. I am indebted to my colleagues in the history and philosophy departments, especially Lisa Rosner and Rodger Jackson, for their help and expertise. I also owe thanks to Beth Olsen and Ann Edmonds from the Grants Office for assisting in funding for this research as well as Mary Ann Trail, Carolyn Gutierrez, and Susan Bucikowski of the library staff for tracking down rather obscure documents. Rachel Magdalene and Anke Dorman were instrumental in the presentation of my preliminary findings at several meetings of the International Society of Biblical Literature that allowed me to fine tune my argument. Bradley Root read early drafts of the manuscript and introduced me to Gorgias Press. Under the wonderful guidance of the editors Steve Wiggens and George Kiraz, I am able to bring this project to fruition and for that I give my gratitude. There are many whose friendship over the years has given me the encouragement (and at times a much needed break) to complete this work. To this list I humbly add the great composers that provided the soundtrack: Tomaso Albinoni, J. S. Bach, Kate Bush, Georg Händel, Joseph Haydn and Wolfgang Mozart. Most of all I would like to thank my family. My father George taught me to view the beauty of the world with curiosity. My brothers Christopher and John always urged me to do my best and never take “no” for an answer. It is to my Mom that I owe the greatest thanks; no words can justly describe the love, generosity, vii

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and wisdom she has shown me. I hope this work stands as a small repayment for all her efforts. There are too many people to mention all by name that have helped me in writing this book. Its mistakes, however, are all my own.

ABBREVIATIONS Aph. AfO AJSL AMT ANET BA BAM

Hippocrates, Aphorisms Archiv für Orientforschung American Journal of Semitic Languages and Literature R. C. Thompson, Assyrian Medical Texts J. B. Pritchard, Ancient Near Eastern Texts Biblical Archaeologist F. Köcher, Die babylonisch-assyrische Medizin in Texten und Untersuchungen BASOR Bulletin of the American Schools of Oriental Research BM tablets in the collections of the British Museum BMS L. W. King, Babylonian Magic and Sorcery BR Bible Review BRM Babylonian Records in the Library of J. Pierpont Morgan CAD The Assyrian Dictionary of the Oriental Institute of the University of Chicago CH Code of Hammurabi CHI C. G. Helman, Culture, Health, and Illness COS W. W. Hallo and K. L. Younger, The Context of Scripture CT Cuneiform Texts from Babylonian Tablets DN divine name JAOS Journal of the American Oriental Society JEA Journal of Egyptian Archaeology JBL Journal of Biblical Literature JPS Jewish Publication Society JNES Journal of Near Eastern Studies ix

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tablets in the Kouyunjik collection of the British Museum KAR Keilschrifttexte aus Assur religiösen Inhalts LXX The Septuagint NBC tablets in the Babylonian Collection, Yale University Library Or Orientalia RA Revue d’Assyriologi et d’Archéologie Orientale SAA S. Parpola, Letters from the Assyrian Scholars to the Kings Esarhaddon and Assurbanipal SA.GIG Sumerian title for series of omen tablets STT O. R. Gurney and J. J. Finkelstein, The Sultantepe Tablets TDP R. Labat, Traité akkadien de diagnostics et pronostics médicaux VAT tablets in the collections of the Staatliche Museen, Berlin VT Vetus Testamentum YBC tablets in the Babylonian Collection, Yale University Library ZA Zeitschrift für Assyriologie

INTRODUCTION If one wishes to stop back pain there are a variety of remedies available from analgesics to magnetic bracelets. The choice of remedy depends upon whether the person focuses on blocking pain receptors or manipulating the body’s naturally occurring electricity to ease muscle spasms. But there is more to this phenomenon than just a simple understanding of human biology. The use of remedies derives from a confluence of factors. One’s knowledge of physiology is just a part of the puzzle. Other factors include an understanding of what constitutes illness, based upon: the function of the body within the world, who is recognized as an authority in health matters, and what it means to be healed within a world system that integrates body and community in a universal view. Studies centered on how people explain episodes of illness and the role of healers are not in short supply for modern society. But this type of investigation has been lacking in the study of ancient medicine. Just as many may dismiss the fellow wearing a magnetic bracelet, there is an assumption that ancient people vacillated between uncanny modern scientific medical knowledge, as exhibited in the Egyptian Edwin Smith Papyrus and unenlightened hocus-pocus found in the Leiden Papyrus1 and Akkadian omen James Henry Breasted, The Edwin Smith Papyrus (Chicago: University of Chicago Press, 1930), 4–5; John Nunn, Ancient Egyptian Medicine (Norman: University of Oklahoma Press, 1996), 96; Warren R. Dawson, “The Egyptian Medical Papyri,” in Diseases in Antiquity, ed. Don R. Brothwell and A.T. Sandison (Springfield: Bannerstone House, 1967), 98– 111. 1

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texts.2 This has often led to translations of titles for healers that fall along the lines of either a physician or a magical practitioner. The Egyptian swnw and the Akkadian asû are commonly designated as “physician” whereas the wʿb priest and zɜw from Egypt are “magicians” as well as the āšipu from Mesopotamia. Similarly, the Hebrew Bible is thought to depict a society that relies only on God for miraculous healing through the prophets 3 thus obscuring any information we might gain concerning the health practices of ancient Israel and in particular the role of the priest. More recent scholarship looks to amend this view of ancient medical practices by seeing ancient healers as active participants in a system incorporating religious beliefs. Ritner describes the Egyptian healer as “mediating between the ideal and real worlds of health… and his many divine patrons.”4 The use of “ideal” and “real worlds” indicates that his analysis of Egyptian healing still is grounded in a science-magic dichotomy rather than a comprehensive system that would explain all health phenomena to a person in the ancient world. In the field of Assyriology, Scurlock attempts to clarify the roles of different healers by describing the asû as a technician akin to a pharmacist and the āšipu as a diagnostician.5 This

Edith K. Ritter, “Magical-Expert (Āšipu) and Physician (Asû): Notes on Two Complementary Professions in Babylonian Medicine,” in Studies in Honor of Benno Landsberger, University of Chicago and Benno Landsberger (Chicago: University of Chicago, 1965), 299–321; Jean Bottéro, “Magic and Medicine,” in Everyday Life in Ancient Mesopotamia, ed. Jean Bottero, trans. Antonia Nevill (Baltimore: Johns Hopkins University Press, 1992), 174–75. 3 Klaus Seybold and U.B. Mueller, Sickness and Healing, trans. Douglas W. Scott (Nashville: Abingdon, 1978), 35; Jacob Milgrom, Leviticus 1–16: A New Translation with Introduction and Commentary, Anchor Bible Commentaries (New York: Doubleday, 1991), 817; Julius Preuss, Biblical and Talmudic Medicine, ed. and trans. Fred Rosner (New York: Sanhedrin Press, 1978). 4 Robert K. Ritner, “Magic: An Overview,” in The Oxford Encyclopedia of Ancient Egypt (New York: Oxford University Press, 2001), 321. 5 JoAnn Scurlock, “Physician, Exorcist, Conjurer, Magician: A Tale of Two Healing Professions,” in Mesopotamian Magic: Textual, Historical and 2

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solution inadvertently places the two healers in a hierarchical relationship while obscuring the religious nature of healing in ancient Mesopotamia. Likewise, Avalos re-examines the position that the Israelites had no recourse to medical treatment by looking at a hierarchy of remedies and the role of priests and prophets. 6 His conclusions, though, only reinforce the idea that instrumental (i.e. scientific) healing was distinct from miraculous healing by describing the average person’s use of balms for simple ailments and how the priests at the Jerusalem Temple did not heal but rather only guarded against impurities leaving the more seriously afflicted to find some other recourse (most likely prophets). This also creates a false sense of tension between folk healers and professional health care that may lead research into a blind alley of attempting to determine if the prophet was a folk or professional healer and that one group was possibly lax in taking care of the community. There are a number of ways in which individuals may seek help when feeling ill. They may rest and/or take a home remedy; ask a friend, relative or neighbor for help; or consult a priest, healer or “wise person.” Any of these avenues may be followed by the sick person and in any order; their availability depends upon the size and complexity of the society.7 Therapeutic options can be found in any of the three sectors of health care: the popular, the folk, and the professional.8 All three of these may exist simultaneously in any one society. The existence of various therapeutic options within one society is medical pluralism. In modern societies, one health care system, including its healers, is deemed official, elevated above the other medical systems and categorized as the professional sector.9 Healers act in a capacity beyond simple healing; they may reassert a society’s values, exert a measure of social conInterpretative Perspectives, ed. Tzvi Abusch and Karel van der Toorn (Groningen: Styx Publications, 1999), 78. 6 Hector Avalos, “Ancient Medicine: In Case of Emergency, Contact Your Local Prophet,” BR, no. 11 (1995): 27–35, 48. 7 Cecil G. Helman, Culture, Health and Illness (Boston: Butterworth Heinemann, 2000), 50. 8 Helman, CHI, 49–70. 9 Helman, CHI, 50.

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trol by labeling and punishing socially deviant behavior, or facilitate the (re)integration of individuals into the community. 10 The question remains as to why there are multiple titles for healers within one society and the relationship between these healers. One may think that this medical pluralism in a society indicates competition between the various healers since such competition did exist in ancient Greece between the cults of Asclepius and Hippocratic medicine.11 This study, though, will bear out that for both Egypt and Mesopotamia the existence of various titles for healers is not an indication that they were competing with one another or that they were placed in a set hierarchy. Rather, the multiple healers within one society worked as equal complements to one another. The practices of the various healers tended to overlap in the use of instrumental healing, such as poultices, and the more readily-recognizable ritualistic forms, like incantations, thus showing that for the ancient world there was no clear distinction between science and magic. The real differences between the healers appears to have been in their mode of communication both in terms of how they came to understand the meaning of illness and to whom they communicated it in order to restore health. The message inherent in illness could be discerned through mechanisms like unsolicited omens and mediumistic divination. Restoration of health could be achieved by communicating either vertically or horizontally; some healers focused on vertical forms of communication while others concentrated on the horizontal. Vertical communication was directed at the gods, demons, and/or spirits therefore appearing as ritual forms. Horizontal is often mistaken for scientific since it uses instrumental forms of healing when addressing the body as a message to the surrounding community of humans. In as much as both horizontal and vertical modes convey a message, in effect these types of healers are actually forms of diviners. Although the classification of all ancient Near Eastern healers as religious functionaries is not particularly radical, or the elimination of a science-magic dichotomy, the body and especially healing as a Helman, CHI, 6. G. E. R. Lloyd, In the Grip of Disease: Studies in the Greek Imagination (Oxford: Oxford University Press, 2003), 40. 10 11

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communicative tool integrating various communities has not been closely analyzed. A similar difference in the mode of communication can be found in the healing practices of the Hebrew Bible. Although priest and prophet are not distinct titles for healers like the swnw and asû, their activities place them in the role of healer. On first appearances, both can communicate horizontally as well as vertically. But their practices in effecting such communication do differ. The priest relies on precise formulaic actions, sacrifice, to communicate vertically with God. He also must follow a prescribed course when declaring a person’s purity status, a form of horizontal communication, with the covenantal community. In contrast, the prophet uses ecstatic methods to receive the message from the supernatural realm. Similarly, his healing techniques appear to “occur to him” even though they may use ritual action, such as bathing in the Jordan. It is through these healing strategies that the prophet communicates horizontally with the covenantal community. But further analysis of biblical healing shows that priestly activity tends toward the horizontal mode of communication while the prophets are more concerned with vertical communication. As described in Leviticus 12–15, the priest understands the message from God by a close inspection of the body, the outward sign to the covenantal community. Yet, in many cases, he does not declare what exactly the afflicted had done to acquire the impurity.12 By overlooking these explanations, there is an implicit understanding that the priest is not so much concerned with the afflicted’s relation with God as on his status within the community and how that affects community well-being. Although the fate of the community depends upon their relation with God, the priest’s primary objective is community cohesion, a prerequisite to the relationship with God. The priestly role in community cohesion is also exhibited in the sacrifices performed after the afflicted is declared clean. The sacrifice acts as a form of ritual healing that reintegrates a person with the covenantal community.

12 In the case of childbirth and some instances of discharges the cause is rather obvious.

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The prophet does not physically inspect the afflicted and makes no declaration to the covenantal community. Instead, the prophet declares, to the afflicted, God’s judgment concerning the afflicted’s status with God. Through this action, we can discern that the prophet’s focus is not on the covenantal community but the relationship between God and Israel. This form of community maintains its cohesion through vertical forms of communication. The instrumental healing of the prophet is a sign of that vertical communication. The afflicted’s use of a poultice signifies his willingness to submit to God while the healing itself is a sign that God accepts the relationship. The difference between horizontal and vertical communication does not necessitate that the priest and prophet were conflicting healing practitioners. Like Egyptian and Mesopotamian healers, the Israelite priest and prophet may complement each other. These ancient societies functioned with the understanding that people existed in a balance between the natural and supernatural worlds. It is only logical that their healing strategies would likewise balance these two realms. Unlike Egypt and Mesopotamia, though, there is a recorded tension between the Israelite prophet and priesthood. 13 But it must be remembered that these prophetic admonishments are aimed at abuses and not the office of priest itself. The scholarly preoccupation with the strife between priests and prophets, especially in the political realm, and the centralization of the priesthood at the Jerusalem Temple to some extent, obscure how both priest and prophet functioned in Israelite health care. Although Avalos tries to integrate the idea of religion and healing, he focuses his work on the centralization of the Yahwistic cult at the Jerusalem Temple and then compares this not only with Mesopotamia but also with Greek medical practices within temples. As a result, Avalos’ study better depicts the culture of health care in the Persian (539–334 BCE) and Hellenistic (334 BCE–70 CE) periods

13 Jer 6, 8, 13, 14; Isa 28, 56–66; Ezek 22; Micah 3; Zeph 3; Hos 6; and Neh 13.

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than for the pre-exilic (1200–586 BCE).14 Such conflation between time periods and cultures is not new. Julius Preuss, a late 19th/early 20th century German physician who also studied Hebrew literature, remains the most influential figure in the study of biblical medicine through his text BiblischTalmudische Medizin.15 The layout of the book is much like a basic medical text with sections divided according to systems and their organs. Each section attempts to identify specific diseases and their treatments. Preuss does not make a clear distinction between the cultures, at least in terms of medicine, of the biblical and Talmudic writers and often relies heavily on Talmudic sources to depict ancient concepts and practices. To further illuminate biblical medicine, Preuss draws upon Galen and Josephus. Again, there is no distinction between medical practices of the Greco-Roman world and Israel of the First and Second Temple periods. This present study examines the ancient Near East in a broad time frame but does not conflate epochs that embody vastly different world views. The terminus post quem is set at the earliest possible point for written evidence attesting to the titles of healers. The Egyptian swnw is attested in tomb inscriptions from the 4th Dynasty (2600–2500 BCE) while the Akkadian title asû dates as far back Old Akkadian (c. 2500 BCE). The destruction of the first Jerusalem Temple in 586 BCE marks the terminus ad quem, since the ancient Near East in the 6th c. BCE and following witnessed considerable changes under Persian political domination. Although particular medical practices may have undergone shifts during the intervening two thousand years, the basic principles governing the concepts of illness and effective healing appears to have remained the same. This characterization of the underlying concepts influencing medical practices should leave room for future detailed analysis of how certain titles for healers may have enjoyed periods of vogue deAvalos acknowledges that most of his sources come from the Second Temple period and Qumran. Additionally, he dates P to the postexilic era; see Hector Avalos, Illness and Health Care in the Ancient Near East: The Role of the Temple in Greece, Mesopotamia and Israel (Atlanta: Scholar’s Press, 1995), 235 and 300. 15 Preuss, Biblical and Talmudic Medicine. 14

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pending on the socio-religious context of a more specific time frame. Aside from the problems inherent in comparing medical practices across incompatible time frames, many of the studies on ancient medicine fall victim to the methodology still prevalent in the practice of medicine itself, that is the Reductionist/Causation view, which limits the manner in which medicine can be used to analyze the function of health care within a culture. The Reductionist approach to medicine attempts to define a disease in empirical terms; to separate a pathogen from the patient. By doing this, the medical community can analyze the disease solely in the context of natural science. “The existence of a disease as specific entity is a fundamental aspect of its intellectual and moral legitimacy.”16 In conjunction with this is the use of Causation which attempts to identify the pathogen per se. Once the mysterious micro-organism or gene is identified then the disease can be treated and the patient will be healed. But the Reductionist/Causation view prevents an understanding of diseases in their social context. Illness is not seen as an integral part of the patient or culture. Because of the Reductionist/Causation view, analyses of the ancient texts tend to separate naturalistic medicine from the supernatural and remove the socioreligious significance of the symptoms and diseases within the ancient world. An empirical medical approach can elucidate the physical environment of the Bronze and Iron Age. Analysis of the physiological data is necessary. Diseases and their frequency do effect the development of culture. Therefore, knowledge of specific diseases in a given time and region help us to understand the process of cultural change in response to fluctuations of morbidity and mortality. On occasion, the clarification of certain terms in the Hebrew Bible also benefit from the osteoarchaeological record. The common translation of ṣaraʿat as leprosy came under dispute as to whether the term refers to Hansen’s Disease or simply a general classification of dermatological disorders. According to current 16 Charles Rosenberg, “Framing Disease: Illness, Society and History,” in Framing Disease: Studies in Cultural History (New Brunswick: Rutgers University Press, 1992), xvi.

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paleopathological research the earliest skeletal remains exhibiting signs of Hansen’s Disease do not occur until 200 BCE in Egypt.17 Combining this information with the assessments from textual analysis leads to the conclusion that biblical leprosy cannot be synonymous with Hansen’s Disease but rather ṣaraʿat refers to a general description of skin ailments. Many sources for medical practices are mediated tales rather than clinical assessments of cases. Lawrence Conrad’s work on the Philistine plague in 1 Samuel 5–6 is an example of how scholars can integrate cultural and medical approaches to understand ancient tales of illness.18 Conrad starts with an analysis of the literary tradition and transmission of the passage in question and acknowledges that the plague account is a literary topos. Next, there is an attempt to arrive at a precise translation of key terms, ʿafalim as “boils” or “piles” and ʿaḵbar as “mouse” or “rat,” since these differences are significant in terms of diagnosing a specific disease. To determine the proper translation, a comparative analysis is done with Deut 28:27. Only when these problems have been sufficiently solved are the symptoms in 1 Samuel 5 then matched with symptoms of a known disease such as the bubonic plague or dysentery. Conrad concludes that the plague could not be bubonic and the evidence for dysentery is also suspect. The present account is an amalgam of “possibly historically accurate themes — pestilence, rodent infestation and some kind of swelling disorder — into a single narrative” but a specific disease cannot be identified.19 The Deuteronomistic Historian (Dtr) uses plague symptoms to convey and emphasize particular historical and theological points rather than an accurate description of medical cases thus explaining its later appeal as a literary motif. How the cultures of Egypt, Mesopotamia, and Israel understood illness depended on the religious ideology of each particular Joseph Zias, “Death and Disease in Ancient Israel,” BA 54 (1991): 147–59. 18 Lawrence Conrad, “Biblical Tradition for the Plague of the Philistines,” JAOS 104 (1984): 281–87. 19 Conrad, “Biblical Tradition for the Plague of the Philistines,” 286– 87. 17

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region. These religious ideologies found expression in fundamental principles governing the overall operation of the world: Egyptian mɜʿt, the Mesopotamian hierarchy of wills, and Israelite covenantal monotheism. Yet similarities existed across all three cultures. They understood the body and illness as a message from the supernatural realm and the act of healing involved forms of horizontal and vertical communication between the supernatural and natural worlds. The types of messages conveyed and the forms of horizontal and vertical communication varied depending on their particular world view. This common ancient Near Eastern medical culture, despite regional variations in practices, could have allowed for trafficking of medical knowledge. Just as Braudel and the Annales school looked at the intersection of time junctures, this study opens the possibility of cultural junctures as an avenue for study as people navigated between their particular region and the wider ancient Near East. Comparative analysis always runs the danger of relying too heavily on a neighboring culture for answers.20 But by investigating the juxtaposition of broad ancient Near Eastern medical culture with the particular details specific to Israel, Egypt, and Mesopotamia, we can better understand not only how ancient peoples interacted but also improve techniques for comparative studies. Weber proposed that the interaction of class, status group, and party determines the political process. Applying this concept to health care in the ancient world, groups can be divided not on political-economic lines but upon one’s power to affect the environment. Hence, this study works with the three basic groups or communities of the divine, spirit, and human. Power sets them in a hierarchy. Interactions among the power hierarchy were exhibited by illness and healing.

20 Blenkinsopp notes the difficulties in looking at any pre-industrial society and even problems encountered in using other ancient Near Eastern civilizations. See Joseph Blenkinsopp, Sage, Priest, Prophet: Religious and Intellectual Leadership in Ancient Israel, Library of Ancient Israel (Louisville: Westminster John Knox, 1995), 6–7.

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Similarities in health care across ancient Near Eastern cultures exhibited a consensus on how the various power groups interacted. The higher power, such as a deity, sent messages through illness to a lesser power, i.e. a human. Human action in response to illness took on the form of physical and oral rites to access and affect power thus communicating to the higher group such ideas as obedience. Individual cultures within the ancient Near East may have had variations as to which illness served as an appropriate vehicle for the message and which rites were an equally appropriate response. The story of Naaman’s skin affliction exemplifies these cultural variations between the Israelites and the Canaanites. When analyzing such a world system, questions arise as to how legitimate authority and community membership are established.21 Not only are the communities of the divine, spirit, and human set in a hierarchy, but nestled within each community is another hierarchy such as the human division between kings, subjects, and slaves. We must, therefore, understand how members of a community are recognized as an authority and how that authority maintains community cohesion. The benefits of cohesion may also cross the boundaries of the different groups, allowing for interaction between the divine, spirit, and human communities. The amount and variety of communities can be endlessly subdivided. Wallerstein postulates one social system — the world system — which simplifies his study into manageable units that can be explained by the one world system.22 Similarly, this study looks at the dominant understanding of illness and health care across the ancient Near East that integrated body and communication as a form of community cohesion. In this regard, the communities of the divine, spirit, and human encompass the world as the ancients saw it. The study then analyzes specific subdivisions within the human communities of Egypt, Mesopotamia, and Israel as to their The phrase “world system” is borrowed from the politicaleconomic studies of Immanuel Wallerstein but adapted with some modification for use in a socio-religious analysis; see Immanuel Wallerstein, The Modern World System I: Capitalist Agriculture and the Origins of the European World-Economy in the Sixteenth Century (New York: Academic Press, 1974). 22 Wallerstein, The Modern World System I, 7. 21

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expression of this world system. Israel will be the most closely examined in terms of how body and communication defined and maintained the community. Wallerstein describes the world system as having “boundaries, structures, member groups, rules of legitimation, and coherence… forces which hold it together… and tear it apart.” 23 The world system of the ancient Near East had boundaries and balance between the natural and supernatural communities expressed through the ideological structures of Egyptian mɜʿt, the Mesopotamian hierarchy of wills, and Israelite covenantal monotheism, which used the body as a communicative tool to legitimate and cohere groups. These ideological structures functioned as a method of understanding and accessing the power necessary to cross the boundaries of the divine, spirit, and human communities. Yet, these same ideological structures and the process of illness as communication could easily disbar someone from membership, rupturing community cohesion. There is a division of labor within this world system creating the medical pluralism seen in the various ancient Near Eastern societies. The distinction between the titles for healers such as the Egyptian swnw, wʿb priest, and zɜw is not based upon simply the techniques of accessing power but the type of community which is the focus of communication. An episode of illness may destroy the bonds within just the human community, or the interaction of divine and human communities. The healer directs the communication either horizontally or vertically depending on which community is in need of a healing cohesion. This study is divided into three chapters, dedicated to Egypt, Mesopotamia, and Israel. Each chapter assesses the underlying principles of health care in that society: the function of the body within the world view which determines what constitutes illness and healing and who is recognized as an authority in health matters within the integrated world system. Egypt is presented first as the groundwork for the basic principles of community cohesion and horizontal and vertical communication. Unlike the other societies, the Egyptian texts can be divided between readily recognizable 23

Wallerstein, The Modern World System I, 347.

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medical papyri and other forms of literature. This makes it easier to see the horizontal mode of communication used by the swnw in conjunction with the vertical mode of the wʿb priest and zɜw. Mesopotamia is the focus of the second chapter. It is in this section that we can see the role of prophecy as vertical communication in the form of the āšipu and bārû paralleling the horizontal mode used by the asû. The study concludes with an analysis of health care in the Hebrew Bible. Like Mesopotamia, the Israelite prophet uses the vertical mode of communication. Whereas the neighboring societies placed horizontal communication in the hands of a seemingly secular specialist, swnw or asû, it is the Israelite priest that communicates horizontally. This is important to understanding that horizontal and vertical communication was not a dividing line between secular and religious approaches in ancient medicine. Rather, the integration of communities making up the natural and supernatural worlds served as the basis for all health care techniques. A few words should be mentioned about the nature of the sources. Most of the available evidence from the three societies comes from courtly records. Although in some cases the literature describing the common people is used, this still attests more to the perceptions of the literate elite rather than the commoners themselves. This holds true for biblical Israel as well. More often than not, the Hebrew Bible speaks more towards the courtly/priestly ideal of Israelite behavior than the actual practices of a common villager or nomad. It should also be noted that based on the linguistic analyses carried out by Hurvitz,24 Rendsburg,25 and Zevit,26 this study uses a pre-exilic sitz im leben for the Priestly source. The character of medical practices among the priests and prophets of Israel during the pre-exilic period matches the conceptualization and behavior of 24 A. Hurvitz, “The Evidence of Language in Dating the Priestly Code: A Linguistic Study in Techinical Idioms and Terminology,” RB, no. 8 (1974): 24–56. 25 G. Rendsburg, “Late Biblical Hebrew and the Date of P,” JANES, no. 12 (1980): 65–80. 26 Z. Zevit, “Converging Lines of Evidence Bearing on the Date of P,” ZAW, no. 94 (1982): 481–511.

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healing practitioners in Egypt and Mesopotamia for the same time period. In this light, I am also following Cross in taking the primary edition of the Deuteronomic History as a pre-exilic work.27 Even if one were to take P and Dtr as post-exilic works, the comparative analysis of healers as diviners engaged in horizontal and vertical communication should still hold true.

27 Frank Moore Cross, Canaanite Myth and Hebrew Epic (Cambridge: Harvard University Press, 1973), 274–89.

EGYPTIAN HEALING Scholarship on medicine in ancient Egypt tends to separate the medical practices from the culture’s religious life1 despite the overlap between Egyptian healers and the priesthood as well as the frequent use of incantations and imagery drawn from the stories of Horus and Seth. This dichotomy stems from the conceptualization of the two fields. Medicine, typically, is viewed as scientific, that is rational and empirical, whereas religion is thought of in terms of faith and not subject to an empirical method. Therefore, many works on Egyptian medicine begin with an overview of the medical papyri as if the ancient Egyptians divided the topics and wrote manuals aimed solely at a medical audience. Once the medical texts are established, these works then move on to describing the practices of the swnw, commonly translated as “physician.” The other titles for healers, wʿb priest and zɜw, and the religious influences on their practices then become an adjunct or even a corruption described in terms of magic2 rather than an integral part of ancient Egypt’s foundational concepts of physiology and disease etiology. As we shall see, the ancient Egyptians understood the body to function on the basis of a natural order or balance (mɜʿt) dictated by the gods. This balance governed the relationships among several communities. It regulated behavior between humans as well as the relationship of humans to gods. A balance also existed for the relaWarren R. Dawson, “The Egyptian Medical Papyri,” in Diseases in Antiquity (ed. Don R. Brothwell and A.T. Sandison; Springfield: Bannerstone House, 1967), 98–111; John Nunn, Ancient Egyptian Medicine (Norman: University of Oklahoma Press, 1996). 2 James Henry Breasted, The Edwin Smith Papyrus (Chicago: University of Chicago Press, 1930), 217. 1

15

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tionship of spirits to humans and spirits to the divine. Illness is a form of communication, a message essentially, indicating a disruption in the natural balance of these various communities. Given the tendency to divide the fields of medicine and religion, scholars have traditionally categorized only eleven papyri as medical (in chronological order): the Kahun, Ramesseum, Edwin Smith, Ebers, Berlin, Hearst, London, 3 Chester Beatty, Carlsberg, Brooklyn and the London-Leiden Papyrus.4 The earliest papyrus, Kahun, dates to the 12th dynasty during the reign of Amenemhat III (1843–1798 BCE) while the latest, London-Leiden, roughly dates to the late 2nd or early 3rd century CE.5 Typical, but dubious, claims of greater antiquity can be found within these medical papyri. A date from the 6th dynasty (2350–2190 BCE) is based upon a passage in section LXVI.15 of the Ebers papyrus in which a prescription claims to have been originally prepared for “Shesh, the mother of his majesty the King of Upper and Lower Egypt Tety, the justified.”6 Another passage in section CIII.01 claims that it was “found in a writing under Anubis’ feet in Letopolis; it was brought to his majesty of Upper and Lower Egypt Usaphais.”7 This would indicate a rather remarkable date in the 1st dynasty (3000–2840). These two prescriptions may originally date from the Old Kingdom period; it is more likely, however, that these claims were made by a later scribe in order to provide a sense of authority to the prescriptions. The Ebers and Edwin Smith Papyri receive the greatest attention. Most of the medical papyri contain duplicates of cases found in the Ebers Papyrus that treat a range of ailments from diarrhea to greying hair and even mold on the walls of a house. The Ebers PaBM 10059. BM 10070. 5 The most comprehensive translation and analysis of the eleven medical papyri plus relevant ostraca can be found in the German series Grundiss der Medizin der alten Ägypter; see Hermann Grapow, ed., Grundiss der Medizin der alten Ägypter (Grundiss der Medizin der Alten Ägypter; Berlin: Akademie-Verlag, 1954–73). 6 B. Ebbell, The Papyrus Ebers (Copenhagen: Levin and Munksgaard, 1937), 79. 7 Ebbell, The Papyrus Ebers, 119. 3 4

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pyrus also contains passages that come closest to explaining ancient Egyptian concepts of physiology. Ebers 854–8568 describes how a system of mtw (vessels) runs throughout the body carrying various substances. This work provides suitable evidence for formulating an outline of how Egyptians understood the body’s function in a world system cohering the natural and supernatural. The Edwin Smith Papyrus owes its popularity to the types of cases treated, trauma, and its approach to therapeutics. With one exception, the forty-eight trauma cases in the Smith Papyrus use only physical manipulations, bandages and sutures for treatment rather than incantations hence it acquired the appellation The Surgical Papyrus. This gives it a character far more akin to modern medical texts than the other papyri which allows for an understanding of the physical rite in the Egyptian healing process. The London-Leiden Papyrus, by contrast, is often omitted from the list of medical papyri because the therapies are almost exclusively magical in nature even though the types of cases it addresses, such as dog bites, eye problems and fever, can be found in the other papyri. Yet, a source like the London-Leiden Papyrus indicates a focus on the oral rite in healing. Although consensus centers on these eleven papyri, there is a degree of flexibility as to what exactly constitutes a medical papyrus. The researcher may focus on a range of criteria from the types of ailments addressed to the assessment of therapies as either empirical or magical, unduly manipulating our understanding of ancient Egyptian medicine. This study will use all medical papyri written within the time frame of the 19th–6th centuries BCE without bias towards types of healing techniques. The goal is to develop a picture of ancient Egyptian healing that incorporates both instrumental and symbolic methods into one system.9

Commonly referred to as the Book of Vessels. Treatments focusing on physical and pharmacological effects are classified as instrumental whereas therapies that address religious or emotional concerns are referred to as symbolic; see Cecil G. Helman, Culture, Health and Illness (Boston: Butterworth Heinemann, 2000), 151–52; Arthur Kleinman, Patients and Healers in the Context of Culture (Berkeley: University of California Press, 1980), 207–8. 8 9

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EGYPTIAN WORLD SYSTEM For ancient Egyptians, health and illness were manifestations of a person’s relationship with the universe around him, which included not just people and animals but communities of spirits and gods as well. Although they did perceive a distinction between the natural and supernatural worlds, an interchange between these worlds was fairly frequent. Egyptian literature, including the medical texts, indicates that this interchange or communication blurs the distinction between the categories of science and magic. For ancient Egyptian medicine, the communities of human, spirit, and the divine interacted based on the concepts of obedience and consideration that created cohesion within and between the different communities. It is the nature of communication between the different realms or communities that draws a distinction between the different titles for healers, the swnw, the wʿb priest and the zɜw. The wʿb priest and the zɜw focus their communication on the relationship between humans and the divine (referred to here as vertical communication). The swnw, in contrast, concentrates on the physical manifestations of the communication (or the horizontal relationship) in terms of how humans understand the message encoded in illness. The idea that a certain justice or balance, order, and harmony governed relationships is called mɜʿt. The goddess Maat personified harmony and the divine order of the universe. The gods ordained the rising and setting sun, regular inundation of the Nile, and the role of the king, all which fall under the control of Maat. She governed not just natural phenomena but social relationships. From king to peasant, one should follow mɜʿt through honesty, justice, clemency, and respectfulness. But, according to The Teaching for King Merikare, it was especially the king’s ability to govern properly, a sign of mɜʿt, which had a direct effect on the welfare of Egypt by ensuring the continued presence of the gods. Enrich your mansion of the West, Embellish your dwelling of the necropolis With uprightness and with the observance of Ma’at, for in this (men’s) hearts are confident. The character of him who is upright of heart Is more acceptable than the (sacrificial) ox of him who does wrong. Act on behalf of God — and he will do likewise for you — With offerings/ such as enhance the altars and with inscriptions.

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This is an assurance of your name, And God takes note of him who acts on His behalf.10

Mɜʿt explained how the proper political order of Egypt should function; a just balance was the principle behind the relationship between the king, his subjects, and the gods. In order to see this interaction between the different communities at work, let us first look at cases of trauma that seemingly have a natural etiology and lend themselves more readily to instrumental treatments. Although the Edwin Smith Papyrus treats trauma cases, it does not mention how the trauma occurred. To gain a better understanding for the causes of trauma, we must look at other forms of Egyptian literature such as the tale of Reddedet’s maidservant from King Cheops and the Magicians.11 Reddedet, the wife of a wʿb priest, is having a difficult delivery; the goddesses of childbirth appear and act as her midwives. Reddedet gives birth to three sons. Knowing the boys will eventually become kings of Egypt, the goddesses secretly fashion three crowns, hide them in the house, and depart. While preparing for the fourteen days of purification that normally follows a birth, Reddedet and her maidservant discover the crowns in a grain storage bin. The maidservant swears to her mistress she will not reveal the secret of the crowns. But all is not well in the household. After a few days, the maidservant argues with Reddedet and receives a beating. In retaliation, the maidservant threatens to tell King Khufu about the three crowns and runs from the house. She finds her brother and, in a crying fit, explains everything to him. When she is done he starts to beat her for disobedience and betrayal of her mistress. The maidservant then flees from her brother. Worn out from all the beatings, she stops along the banks of the Nile to refresh and recuperate. A crocodile suddenly jumps from the waters, snatches the maidservant and drags her below.

Simpson, Literature of Ancient Egypt, 164. William Kelly Simpson, ed., The Literature of Ancient Egypt: An Anthology of Stories, Instructions, Stelae, Autobiographies and Poetry (New Haven: Yale University Press, 2003), 21–24. 10 11

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The story acts as a cautionary tale teaching one to know one’s place and keep one’s promises. Both beatings and the animal attack, cases of trauma, are punishments for the maidservant’s ethical transgressions. The maidservant has moved outside of her normal role by quarreling with her mistress, thus disrupting the cohesion of the household. This is underscored by her threat to inform the king of the three crowns. The maidservant potentially can fracture the entire kingdom. Her beatings by human agents serve as a typical warning message not to disturb community cohesion. Ultimately, though, the crocodile attack represents divine punishment for her continued obstinacy in wanting to destroy the community. Crocodiles often serve as symbols or agents of Sobek whose association with royal power makes the attack on the maidservant a clear message from the divine community. If a person’s actions work against the natural harmony of the human community’s cohesion, the divine community may inflict trauma and death as a punishment for the unjust deed. In this manner, the divine community acts in order to maintain cohesion within the human community. Battle injuries and work-related accidents also exhibit the interaction of the spirits and the divine with human communities. In The Capture of Joppa, the Rebel of Joppa tries to negotiate with the king’s representative, Djehuty, for a cessation of hostilities. The Rebel of Joppa offers Djehuty a beautiful woman in exchange for the baton of the king, a symbol of royal power. Djehuty appears to agree to these terms and brings the baton to the Rebel of Joppa. But when he brings out the baton, Djehuty exclaims, Look at me, O Rebel [of Joppa! Here is] King Menkheperre,12 l.p.h., the fierce lion, Sakhmet’s son, to whom Amon has given his [strength. And he] lifted his hand and smote upon the Rebel of Joppa’s temple so that he fell/ [sprawling] before him.13

According to Djehuty’s speech, the baton is more than just a symbol of the king; it actually embodies the king (“here is King Menkheperre”). Simultaneously, the baton also embodies the god Amun. Djehuty reports to Thutmose III, “Amon, your good fa12 13

Thutmose III (1479–1425). Simpson, Literature of Ancient Egypt, 73.

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ther, has delivered to you the Rebel of Joppa.” 14 Djehuty does not claim he killed the Rebel, but rather a god caused the Rebel’s death. Similarly, Djehuty’s reference to “Sekhmet’s son” shows that it is not just one god that ensures cohesion of the proper human community under Egyptian rule but that the reigning king represents the divine community as a whole. Like Sobek, Sekhmet symbolizes royal power as well as sickness and healing. A punishment from the king is a punishment from the divine. Obeying Egyptian suzerainty not only coheres the human community but reinforces the bond between the human and the divine communities. In the case of the Rebel of Joppa, the blow from the baton was punishment for the rebellious behavior: the leader of Joppa should have remained a faithful vassal of Thutmose III. But an injury could just as easily come from the capricious nature of a spirit inhabiting an object. A relief at Deir el-Medina of the tomb worker Ipwy shows a variety of injuries that could befall the necropolis workers. For example, a man chiseling away on the top of a structure causes debris to fall into the eyes of a second man who, in his temporary blindness, drops a mallet on his own foot. The humorous tone of the scene underscores the whimsical nature of spirits to cause grief for humans. In this case, the injuries do not act as punishments for human transgressions. Instead, the mischievous nature of the spirits causes disruptions to the human community. In The Contendings of Horus and Seth,15 Isis commands her harpoon and the barb is anthropomorphized as “biting” first Horus, on accident, and then Seth. The creation of an object, like speech and writing, infuses it with a life force or spirit. As we shall see, such oral rites played an important part not only in the cause of trauma and illness but also in healing strategies. This belief in animism would explain to the Egyptians the source of an injury. The spirit within the object acted either on its own or in response to a command from a more powerful authority. For the ancient Egyptians, mɜʿt also guided their explanation as to how the body’s physiology functioned, why a person became 14 15

Simpson, Literature of Ancient Egypt, 74. Simpson, Literature of Ancient Egypt, 118.

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ill and what constituted effective healing strategies. The body, as a microcosm mirroring the greater universe, had its own balance. Illness indicated that the body had an imbalance and possibly in one’s relationships as well. Healing, therefore, centered on restoring the balances, or mɜʿt, to one’s life. The system of mtw-vessels most readily exhibited the role of mɜʿt in human physiology. According to the Ebers Papyrus, the body contains twenty-two mtw-vessels that link up at critical junctures such as the heart and the anus.16 The soul of a person was seated in the heart and during the Judgment of the Dead one’s heart was weighed against the Feather of Maat. The anus functioned as one of the natural points where the mtw-vessels opened to the outside world allowing for the passage of substances into and out of the body. A quick survey of treatment measures shows that a number of medications were either applied as enemas or at least caused an evacuation of the bowels. Other natural openings included the eyes, ears, nose and mouth. Wounds also permitted matter, usually toxic, to enter or exit. The mtw-vessels acted essentially as canals through which various substances regularly flowed and irrigated the body. Egyptian healers often felt the pulse to determine if the mtw-vessels were clear. Health depended upon the balance of this movement just like Egypt itself depended on the regularity and order of the Nile flooding and irrigating the crops. Illness signaled disruption in the body’s own mɜʿt. This could easily happen if substances clogged the mtw-vessels. An improper diet often resulted in either a slowing or quickening of digestion which then manifested as constipation, diarrhea, or difficulty in urination. Even Herodotus reported that the Egyptians regularly engaged in a clearing out of their systems, “They purge themselves for three consecutive days of every month; they make emetics and douches their means of pursuing health.”17 Foreign, noxious substances such as wḫdw18 could block the mtw-vessels as well. These Ebers 854–856; see Ebbell, The Papyrus Ebers, 114–20. II, 77; see Herodotus, The Histories (trans. Robin Waterfield; Oxford: Oxford University Press, 1998), 124–25. 18 This term is related to the verb wḫd meaning “to suffer” and has been variously translated as “painmatter” or “purulency”; see Herman 16 17

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can enter through wounds or the natural openings, thus causing symptoms like pus and fever. Trauma itself could also break the flow in the mtw-vessels. Case 31 in the Smith Papyrus describes paralysis from a spinal injury, “a man having a dislocation in a vertebra of his neck, should you find him unconscious of his two arms and his two legs on account of it.”19 Egyptians apparently used mtw to refer to any long thin structure that carried substances, whether it was intestines, blood vessels or nerves. In these cases, the balance of matter in the mtw-vessels sounds predictable, empirical, and obviously treatable by instrumental methods. Yet, substances blocking the mtw-vessels, throwing off the natural balance, may be a result of a disruption of mɜʿt caused by something other than just the mechanics of human physiology. Most medical papyri refer to disease etiology in a brief and oblique manner with the most frequent phrase, “caused by a god or a dead man.” Seemingly natural substances, like wḫdw, can originate with the gods or the deceased and not simply as a result of putrid substances in the digestive tract.20 Incantation for purulency [wḫdw]: It is purulency which shall come out as bkn… I will go up to heaven and see what is done there, (for) nothing is done in Abydos to expel afflictions (caused) by a god or a goddess, by all kinds of purulency, by dead man or woman etc., afflictions and all evil things that are in this my body, in this my flesh and in these my limbs.21

Grapow, et al., Übersetsung der medizinischen Texte: Erläuterungen (Grundiss der Medizin der alten Ägypter; Berlin: Akademie-Verlag, 1958), 7–15; Ebbell, The Papyrus Ebers, 38. Since the exact nature of the matter cannot be determined, I have left it untranslated, a tactic used by some others; see A-P. Leca, La Médecine Égyptienne au Temps Des Pharaons (Paris: Roger Dacosta, 1988). 19 Breasted, Edwin Smith Papyrus, 324. 20 Robert O. Steuer, “Wḫdw: Aetiology Principle of Pyaemia in Ancient Egyptian Medicine,” Bulletin of History of Medicine Supplement 10 (1948): 1–36. 21 Ebers 131; trans. Ebbell, The Papyrus Ebers, 42; see also Grapow, et al., Grundiss IV, 14.

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This incantation illustrates that instrumental treatments such as keeping to a proper diet and regular purges did not guarantee health. The introduction of wḫdw into the mtw system may just as easily stem from the displeasure of a deity, spirit or sorcerer. The phrase “I will go up to heaven” indicates the necessity for vertical communication in order to restore balance and cohesion between the human and divine communities. Likewise, treatment must involve symbolic techniques as a means of communicating vertically in addition to the instrumental method of clearing wḫdw from the body. One of the more common illnesses in the medical papyri is the ʿɜʿ-disease22 which also possesses both natural and supernatural origins. Ebers 62 links the ʿɜʿ-disease to a specific type of worm, “…eaten by a man in whose belly there are ḥrrw-worms; it is haematuria (ʿɜʿ) that produces them…”23 The association of ʿɜʿ with the ḥrrw-worms makes the disease sound natural, leading many modern scholars to believe it was haematuria.24 But passages in the Egyptian medical papyri, such as Ebers 225, Hearst 83, Berlin 58 and London 38 indicate that, for the Egyptians, a supernatural connection also existed for the ʿɜʿ -disease. The Grundiss der Medizin series uses Samen or Giftstoffe as a translation and explains that ʿɜʿ is semen or a toxic substance from an incubus.25 The idea that ʿɜʿ is semen derives from the verb ʿɜʿ meaning “to discharge semen.” Like trauma, disease may be the result of a capricious spirit rather than a direct punishment from the divine. Once a victim is violated by an incubus, the semen or toxic substance then spreads throughout the body via the mtw-vessels. Although it comes from a supernatural entity, ʿɜʿ seems to behave as a natural substance, much like Aaa-disease. F. Jonckheere, Une Maladie Égyptienne, l’Hématurie Parasitaire (Brussels: Fondation Égyptologique Reine Elizabeth, 1944). 24 B. Ebbell, The Papyrus Ebers (Copenhagen: Levin and Munksgaard, 1937), 20; G. Lefebvre, Essai sur la Médecine Égyptienne de l’Époque Pharaonique (Paris: Presses Universitaires de France, 1956), 152–55. 25 H. von Deines and W. Westendorf, Worterbuch der medizinischen Texte, Erste Halfte (Grundiss der Medizin der alten Ägypter; Berlin: Akademie-Verlag, 1961). 22 23

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wḫdw. The wḫdw and ʿɜʿ -diseases show that a natural-supernatural dichotomy did not constrain the Egyptian concept of disease causation but rather that an episode of illness can straddle both categories. Because illness was simultaneously natural and supernatural, healers had to address the intersection between the various communities of humans, spirits, and the gods. In this capacity, illness acts as a message indicating the status of the afflicted within the different communities. Whether taking the form of a punishment from the gods, a reminder of one’s social obligation, or simply an outright attack by a malicious or capricious entity, the afflicted is reminded of his position in a universal hierarchy. Since the body functioned as an indicator of relationship status, purity was needed in order to maintain a proper balance. The need to be pure, though, was limited to those coming into contact with the divine. Purity, then, is mostly discussed in relation to the priesthood. The process of purification centered on the body which consisted of washing, shaving all hair, circumcision, and sexual abstinence while working at a temple; some districts even instituted dietary restrictions. 26 The lowest level of temple officials would have the title wʿb priest indicating that they met the minimum purity requirements for service. This purity ensured the perfection of all the rituals performed at the temple. Any lapse in the integrity of the rituals could offend the gods and cause them to abandon Egypt. The body itself influenced the attitudes of the divine toward the mortal world; purity, as expressed through the body, maintained mɜʿt. In this regard the body could send messages to the divine and spirits. By submitting to purification rituals, humans conveyed their obedience to and acceptance of a universal hierarchy. Symbolic anatomy, in addition to mɜʿt, mtw, and purity, functioned as a point of intersection between the divine, spirit, and human communities. Canopic jars reflect the link Egyptians made between organs and deities. The liver was linked to Imsety and Isis, the lungs with Hapy and Nephthys, the stomach with Duamutef and Neith, and finally the intestines with Qebehsenuef and Serqet. 26 S. Sauneron, The Priests of Ancient Egypt (Ithaca: Cornell University Press, 2000), 36–40.

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As the deceased (especially royalty) crossed from the human to the divine community, these gods protected specific components of the body. The importance of the body in community cohesion did not end with one’s physical death. Symbolic anatomy as a means of transcending community boundaries also found expression in the Book of Going Forth by Day where body parts and deities were matched in protective spells. “My eyes are Hathor, my ears are Wepwawet… my lips are Anubis, my molars are Selket…”27 causes Hathor or Anubis to embody the eyes or lips. Similar pairings also exist for the protection of cats. Spell 3 of the Metternich Stela reads: “O cat, your eyes are the eyes of the Lord of the Glorious Eye… O cat, your nose is the nose of Thot…” 28 For the Egyptians, speech had the power to create. Such spells accessed and manipulated the power that normally sets apart the human from the divine and spirit communities. Besides entities from the communities of spirits and gods, others with access to ḥkɜw (magic power) could manipulate the interaction of the different communities to cause illness. Like mɜʿt, ḥkɜw is both a concept and a personification: the god Heka. According to the Coffin Texts Spell 261, Heka existed even before creation and it was his power that infused and protected not only the act of creation but nature itself. It is this power that ultimately sets apart the divine, spirit, and human communities. The protective aspect of ḥkɜw maintains the boundaries or integrity of each group. But when cohesion is necessary between the various communities, ḥkɜw facilitates the interaction. Ḥkɜw, then, is not necessarily good or bad but can be used by anyone with the skill to do so. The tale of the chief lector priest Webaoner from King Cheops and the Magicians illustrates how ḥkɜw can work in the case of trauma to maintain the proper relationships within the human community.29 Webaoner’s wife repeatedly rendezvoused with a townsman 27 Raymond O. Faulkner, trans., Carol Andrews, ed., The Ancient Egyptian Book of the Dead (London: British Museum, 1985), 62. 28 Nora E. Scott, “The Metternich Stela,” Bulletin of the Metropolitan Museum of Art 9 (1951): 206. 29 Simpson, Literature of Ancient Egypt, 14–16.

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at her greenhouse. The gardener reports the wife’s drinking and carousing to Webaoner who creates a wax crocodile, awakens its spirit by reading magical words and then deposits it in the lake near the greenhouse. After one of the trysts, the townsman jumps into the lake to bathe and is promptly devoured by the crocodile. Webaoner uses ḥkɜw to create and animate the crocodile while the animal attack, much like in the case of Reddedet’s maidservant, restores the mɜʿt disrupted by the behavior of his wife and the townsman. Since illness is a message that mɜʿt and community cohesion has been disrupted, healing strategies demonstrate the afflicted’s obedience to the natural balance of relationships by evoking consideration from the gods and spirits to help restore the balance. Ḥkɜw is the system that both elicits consideration as well as shows obedience to the natural order in hopes of restoring cohesion amongst the various communities. Even in its medical context, the accessing of ḥkɜw, or use of magic, has three basic components: the oral rite, charged substances, and the physical rite.30 The oral rite consists of reciting incantations. These typically are written, as in the case of Webaoner who read the magical words, but not necessarily so. Reliefs in tombs dating as early as the Old Kingdom show that illiterate shepherds and farmers could recite spells to protect herds and crops. But a substantial body of sacred manuals, kept at the temples, developed for transmitting the incantations as well as the particulars for the rituals, including ingredients. Within this collection of sacred manuals are the medical papyri. There is a tendency to divide the manuals into three distinct categories, šśʾw as magical rituals or collections of knowledge, phrt as medical prescriptions, and rw as religious texts.31 This modern classification system developed from the variation in the opening lines for each case in the manuals. Some Robert K. Ritner, “Magic,” in The Oxford Encyclopedia of Ancient Egypt (New York: Oxford University Press, 2001), 321–36. 31 Ian Shaw and Paul Nicholson, The Dictionary of Ancient Egypt (New York: Harry N. Abrams, 1995), 167; John Nunn, Ancient Egyptian Medicine (Norman: University of Oklahoma Press, 1996), 27; Stephen Quirke, Ancient Egyptian Religion (New York: Dover Publications, 1992), 111. 30

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begin with šśʾw, the Egyptian word for instruction; others open with either phrt (remedy) or rw (spell or speech). A medical papyrus is not limited in the type of phrase used to introduce its cases but rather has the initial words for instruction, remedy and spell peppered throughout the manual. Also, a case may begin with a term such as šśʾw (instruction) yet have the treatment consist of a rw as in case no. 9 in the Edwin Smith Papyrus. The ancient Egyptian healer apparently did not finely distinguish the categories of spell, ritual, and prescription but blended them in the process of using ḥkɜw. The incantations can focus on the illness, the remedy, the patient, or the gods in a variety of combinations. Additionally, spells can apply generally to healing rather than to a specific therapy. The Ebers Papyrus begins with three general spells, one for bandaging, one for drinking and one for any remedy, all of which can be used in conjunction with any of the hundreds of treatments found throughout the manuscript. These spells charged either people or items, infusing them with their therapeutic power. A bandage or drink may not heal based solely on its ingredients. Four literary devices can make up an incantation: a call for protection, a recounting of myths, a command, and a description. These may be used singularly or in any combination. Each type of incantation either forces the attacking entity, whether sorcerer, spirit, or even a god, to reconsider his actions thus ceasing the attack. It can also direct the remedy, perhaps Maat herself, to consider the situation and restore the proper balance of health. Protection spells call upon the gods on behalf of the patient, “I am under the protection of Isis; my rescue is the son of Osiris.”32 This therapeutic tactic announces a powerful alliance. The implication is that the entity attacking the patient must take this relationship into consideration. It is no longer just the human but the community of human and god that now stands against the affliction. The effectiveness of the protection incantation comes from invoking a god more powerful than the entity that initiated the illness. Some spells are directed at a specific type of ailment such as a scorpion bite or a difficult pregnancy. In these cases, 32

rus, 220.

Edwin Smith 9; translation from Breasted, Edwin Smith Papy-

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goddesses such as Selqet or Tawaret are more commonly mentioned given their personal connection, hence power over, these situations. Any god may be invoked to provide protection but the mythic cycle of Horus was a popular motif, “Do you recall that Horus and Seth were brought to the great palace at Heliopolis when the testicles of Seth were negotiated with Horus… and he was new like one who is on earth.” 33 Seth’s frequent attacks on Horus make for a handy parallel to the plight of the patient while the helpful actions of Isis compare with the healing effect of the treatment measures. Essentially, the spell draws upon a divine precedent. Justice reigns when Horus is helped in his struggle against Seth. If the patient equates to Horus than he, too, should be healed as a matter of justice. In this particular incantation, the remedy, or charged substance, is asked to consider the situation and act according to justice (mɜʿt).34 A command spell simply consists of directions and frequently appears alongside recipes for instrumental treatments, “Come remedy, come who removes (bad) things in this my heart and in the parts of my body.”35 Since the accessing of power (ḥkɜw) is neither good nor bad per se, the use of charged substances as an instrumental healing technique has no guarantee of being effective. Charging a substance essentially imbues it with a spirit of its own. This, in turn, creates the potential for the charged substance to cause harm given the capricious nature of spirits. The command style incantation directs the remedy to act with justice thus harnessing the power of the infused spirit. Similarly, a descriptive incantation specifies the actions that will occur during the healing process, “the burdens are relaxed, and

Ebers 3; translation from Ebbell, The Papyrus Ebers, 30. Some uses of the Horus cycle are not directed at the remedy but just recount the story, perhaps as a general call to Maat herself to consider the afflicted’s plight and restore the proper balance. 35 Ebers 3; translation from Ebbell, The Papyrus Ebers, 30. 33 34

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the weakness departs that is located in my36 belly.”37 In this case, the illness is the focus of the spell. For the Egyptians, the disease itself has an animating power behind it, whether a god, spirit, or sorcerer, since it functions as a message between the various communities. The descriptive spell allows the healer to assume authority over the affliction. When a healer takes control of a disease, he has the opportunity to recast the message sent to an individual. The message inherent in healing may be sent back to the originator of the illness or it may be broadcast to the human community at large. All of these incantations implicitly ask the animating spirit to consider its actions in accord with justice and a natural balance. The need for maintenance of mɜʿt between the divine, spirit, and human communities is the ultimate message. As we saw with the command and descriptive incantations, charged substances, the second aspect of accessing ḥkɜw was intimately linked to the oral rite. Typically, charged substances take the form of amulets or talismans. One such amulet found in a 12thdynasty tomb is a figurine of a man carrying a calf to help protect the shepherd and animal while fording a river.38 When reading the medical papyri, though, the magical act of charging substances can be easily overlooked in favor of the instrumental healing techniques. Several of the recipes have accompanying spells that charge the substances used in these instrumental remedies. For example, an incantation for the ingredients used to heal an illness causing a “buildup of water” in the eyes: Come green eye make-up (malachite), come green eye makeup, come green one; come discharge from the Horus eye, come excretion from the eye of Atum, come fluid that came from Osiris. It came, it removed the water, the pus, the blood, the weak-sightedness, the bjdj-eye disease, the blindness, the veil, the influence of a god, a dead man, a dead woman, a masculine pain-matter, a feminine pain-matter, any evil thing that 36 Although the incantation uses the phrase “my belly,” its recitation is not restricted to just the patient. A healer may say the spell on behalf of the patient, or even a god, spirit, or the illness itself. 37 Ebers 61; translation from Ebbell, The Papyrus Ebers, 35. 38 Ritner, “Magic.”

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is in both eyes. Recite over green eye make-up pounded with fermented honey, pounded with gjw (nut), applied to the eyes.39

Frequently, though, recipes in the medical papyri do not give a specific spell, rather they simply state the ingredients such as “another for the removal of the what-disease in both eyes: black eye makeup, red ochre, ochre, red natron; apply to the outside of both eyes.”40 Most of the cases in the medical papyri simply have a title listing the main symptom and the recipe, like Ebers 346. This format leads many to conclude that some Egyptian medicine is completely devoid of magical practices and they look for a secular healer akin to the modern physician. But this style of writing cases is actually a truncated form, obscuring the extent to which incantations were used with these recipes and the relationship between human and the divine so integral to the practice of ancient Egyptian medicine. A complete form for the medical cases contains a title, examination with symptom description, a diagnosis with prognosis, and a treatment.41 The title gives the location of the injury or illness with its main symptom. Often cases with similar titles are grouped together in one papyri. The following is a brief example of how the Ebers Papyrus organizes its cases (in order): the belly, intestinal worms, skin afflictions, the anus, heart, remedies for gods, the head, urine, and cough. There is no apparent flow connecting one group cases to another. The Berlin Papyrus contains many of the same cases as Ebers but organizes them as: mtw, breasts, contraception and fertility tests. Whereas Ebers seems to be an all-purpose text, Berlin focuses on gynecological cases. The examination contains the main symptom repeated from the title with additional ailments that can further refine the diagnosis. This section also gives alternative appearances for the symptoms or allowance for second and third examinations after the passage of some time. Taken together, it seems that the title functions as an indexing system while the examination section details the Ebers 385; translation from Ebbell, The Papyrus Ebers, 73. Ebers 346; translation from Ebbell, The Papyrus Ebers, 69. 41 Breasted, Edwin Smith Papyrus, 36–61. 39 40

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more pertinent information for carrying out the specific healing practices. The diagnosis declares the nature of the ailment either by the main symptom or a specific entity such as wḫdw or ʿɜʿ-disease. The phrase ḏd.jnk r.f (“then you say about him”) introduces the formal declaration of illness from a recognized authority. Once the illness is acknowledged by the human community, the afflicted then takes on the sick role and may relinquish community responsibilities such as work duties. The diagnosis section of the case also contains one of three prognoses: mr jr.y (“an ailment which I will treat”), mr ʿḥʾ ḥnʿ (“an ailment with which I will contend”), and mr n jrw ny (“an ailment not to be treated”). These phrases indicate what will happen with the patient’s status in the sick role. If the healer declares mr jr.y, then the status is temporary; the patient can be reintegrated with the human community upon healing and pose no further threat to the human-divine bond. For mr ʿḥʾ ḥnʿ, the status is in doubt until the illness clears. If healing cannot be achieved, the person moves from the temporary sick role to the more permanent designation disabled or even deceased. The last phrase, mr n jrw ny, means the afflicted bypasses the temporary status of the sick role for either disabled or deceased. The disability of the afflicted poses new problems as to how the society either reintegrates or expels the threat to the human-divine community.42 The treatment then follows the cases that have prognoses stating either to treat or contend. These treatments can be a simple list of ingredients, such as Ebers 346, or have complete instructions on how to apply the medicants with accompanying spells or other rituals. It is difficult to tell which treatments each of the various Egyptian healers preferred. Therapies from basic surgery to incantations appear in the repertoire of all three, the swnw, wʿb priest, and zɜw. Recipes for purgatives are frequently found in the papyri; many have statements such as “causes vomiting” or “to open the bowels.”43 Other treatments in this category include diuretics44 and 42 An analysis of ancient Egyptian cultural attitudes towards disability goes beyond the scope of this study. 43 Ebers 7.

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anti-diarrheals.45 This type of treatment coincides with the physiology of the mtw system. If the body works as a plumbing system, clearing out the pipes should get the system running again. Similarly, poultices and fumigations act to expel an abnormal illnesscausing agent. Ebers 245 reads, “all sick places in afflictions caused by a god and all evil things are bandaged.”46 These treatments still rely on the irrigation model of the mtw. Fumigations and medicated bandages forced the malevolency out of the patient as a physical substance was exuded. By choosing a laxative, emetic, fumigation, or even a bandage, the healer appears to focus on the blockage of the mtw rather than the supernatural origin of substances like wḫdw. Since an episode of illness is multi-causal, we must not assume that the use of a purgative implies that the healer (or the afflicted) sees only a natural etiology and instrumental treatment. Any one case in the medical papyri speaks to a moment in time for a particular illness. Unfortunately, we do not have actual patient histories; the text cases are only templates. When addressing the amorphous “evil” in the prescriptions, the ancient Egyptian healer acknowledged the dualistic etiology of physical blockage as well as the interplay of the supernatural community with humans. The efficacy of such prescriptions in Egyptian medicine and their world system can be found in the frequent use of the phrase šś ḥḥ sp (found effective a million times) in the treatment section of the cases. The tendency for cases to use an abbreviated format of just title and treatment plus the existence of catch-all spells at the beginning of some papyri, or even sections of a papyrus, does not preclude that all Egyptian medical practices used some form of accessing ḥkɜw in order to establish mɜʿt as expressed in their religious practices. With a world system based on the interaction of divine, spirit, and human communities, the Egyptian healer and/or scribe would not need to write down these connections for every case. Spells not only charge substances but can also impart power to actions, that is the ritual component of accessing ḥkɜw. The HarEbers 27. Ebers 44. 46 Ebbell, The Papyrus Ebers, 58.; the Hearst Papyrus contains similar phrases. 44 45

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ris Magical Papyrus suggests that a shepherd gestured as part of the physical rite in conjunction with the duties of a magical specialist.47 Similarly, the general spell, “speech for loosening any bandage,”48 gives power to the final act of healing, a critical time when the determination would be made as to whether or not the patient recovered and order had been restored. Rituals commonly involved actions such as making knots, breaking pottery as in the execration texts or drawing a protective circle with an ivory wand. Just as many of the medical cases lack an obvious incantation, there is little in the way of directions for an obvious ritual such as in the London-Leiden papyrus, [A]nother talisman for the foot of the gouty man: you write these names on a strip of silver or tin; you put it on a deerskin; you bind it to the foot… “Let N. son N. recover from every pain which is in his feet and two legs.” You do it when the moon is in the constellation of Leo.49

The conjunction of incantations and charged substances in the medical treatments indicates that the therapeutic acts like bandaging or drinking a remedy in themselves may constitute the ritual performance. Ebers 568 in its section on swellings gives the truncated format, “another remedy: 1 flour of ʿm ʿʿ-part of emmer; 1 animal skin fat; 1 clay of bricklayers; 1 šbb-plant; forced through sediment of sweet beer; the swelling is bandaged with it.” 50 The ancient Egyptian healer can use the title as an index to find the appropriate remedy/ritual for a patient’s swelling. The case then lists the ingredients needed for the charged substance followed by the final application of the ritual, a bandage of the charged substances. So even the truncated case formula of just a title, recipe, and directions for application still contains the ritual component of accessing ḥkɜw.

Ritner, “Magic: An Overview.” Ebers 2; translation from Ebbell, The Papyrus Ebers, 29. 49 F. Ll. Griffith and Herbert Thompson, eds., The Leyden Papyrus: An Egyptian Magical Book (New York: Dover, 1974), 183. 50 Ebers 568; Grapow, et al., Grundiss IV, 231. 47 48

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Since illness indicates a disruption in the natural order of community cohesion, the ritual acts in treatment measures demonstrates the afflicted’s willingness to obey that natural order as a means of restoring mɜʿt. The exact mechanism by which certain rituals demonstrate obedience is not entirely clear. One such process may be sympathetic magic. By using items similar to parts of the human body, the afflicted acknowledges and uses a natural order to trigger beneficent consideration from either a spirit or a god. You should51 prepare for him the egg of an ostrich, triturated with grease (and) placed in the mouth of his wound. Now afterward you should prepare for him the egg of an ostrich, triturated and made into poultices for drying up that wound. You should apply to it for him a covering for physician’s52 use; you should uncover it the third day, (and) find it knitting together the shell, the color being like the egg of an ostrich.53

The use of an ostrich egg in the medicant coupled with the description of the skull as a shell the color of the ostrich egg shows the Egyptian healer’s use of sympathetic magic. Breasted dismisses this particular treatment as “dictated by the current superstitions of the day”54 based upon sympathetic magic and the inclusion of a spell to make the treatment effective. Other head wounds with skull fractures have more simple treatments such as sitting on supports and applying grease to his head,55 waiting for a decisive moment to apply binding strips,56 making a bite block and fruit drink,57 or even

I have slightly updated the language of Breasted’s translation from “thou shouldst” to “you should.” 52 The common translation for the Egyptian term swnw. 53 Edwin Smith 9; translation from Breasted, Edwin Smith Papyrus, 219–20. This is a treatment for a “wound in the forehead producing a compound commuted fracture of the skull.” 54 Breasted, Edwin Smith Papyrus, 220. 55 Edwin Smith 4; see Breasted, Edwin Smith Papyrus, 149–50. 56 Edwin Smith 6; see Breasted, Edwin Smith Papyrus, 171. Note that this particular treatment is similar to the one in case 9 but lacks a description of what the skull should look like as it heals as well as the specific ingredients for the binding plaster. Some indication of the items used in 51

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abstaining from any treatment.58 What Breasted sees as a corruption in the otherwise scientific surgical treatise of the Edwin Smith Papyrus is actually a clue as to how medical treatments worked within the religious culture based on balance and order between the various communities of the world system. As already seen, Egyptian medical cases were often written in a brief format, therefore it is not surprising to see most of the cases in Edwin Smith list ingredients and basic actions without any indication of how they relate to the natural order. Not every physical rite served the purpose of showing obedience to the natural order. The execration texts used to defeat an enemy do not show obedience on the part of the person performing the ritual. Although ancient Egyptian medicine makes use of oral and physical rites as well as charged substances to express the underlying concepts of consideration and obedience necessary for community cohesion and healing, it does not mean that every use of magic expresses these very same ideals.

EGYPTIAN HEALERS The use of ḥkɜw in effecting a cure basically reversed the process by which someone contracted an illness, and hopefully reestablished mɜʿt. Whether a person, spirit, or god, all would use ḥkɜw to create and send the affliction. The healer then must also have had access to ḥkɜw to assume control over and dissipate it. Both the sending and curing of illness communicated the status of individuals in the various communities. Becoming afflicted signaled a disruption of mɜʿt as well as a lack of ḥkɜw. Curing afflictions restored mɜʿt and asserted one’s ability with ḥkɜw. The need to manipulate ḥkɜw influenced who was considered a healer in ancient Egyptian society. The titles appearing in the medical papyri are: swnw (physician), wʿb (pure) priest, and zɜw (magician). Attempts have been made to see the swnw as not just a physician but a surthe plaster, such as meat, honey, grease, and lint can be found in other cases; see Edwin Smith 2 in Breasted, Edwin Smith Papyrus, 121. 57 Edwin Smith 7; see Breasted, Edwin Smith Papyrus, 183–84. 58 Edwin Smith 6 and 8; see Breasted, Edwin Smith Papyrus, 170, 209.

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geon treating mostly trauma cases59 while the wʿb priest and zɜw focus on the more mysterious internal disorders and as a result relied on magical practices.60 But the strict use of “physician” for swnw and “magician” for wʿb priest and zɜw not only reinforces the artificial dichotomy of medicine and religion as distinct activities among the Egyptians but also obscures the communicative aspect of illness. The first case in the Edwin Smith Papyrus states, “now if wʿb (pure) priests of Sekhmet or a swnw places his two hands…” indicating that both types of healers equally used the prescriptions from the papyrus. The treatment of trauma cases was not limited to just the swnw-healer. Similarly, the Ebers Papyrus claims, “if any swnw, any wʿb priest of Sekhmet, any zɜw give both his hands…” also showing the overlap of practices among the three healers in treating internal disorders.61 In light of the use of spells in the Ebers Papyrus and its reference to the swnw healer, Breasted’s dismissal of the spell in the Edwin Smith Papyrus case no. 9 62 in explaining that the swnw was a surgeon who would not normally employ incantations becomes untenable. The swnw, just like the wʿb priest and zɜw, accessed ḥkɜw in order to provide a cure, restore the natural order, and maintain cohesion of the community. Since three types of healers frequently resorted to the same treatments, therefore the differences in the meaning of their titles should be sought in the communicative aspect of illness, especially to whom the communication was directed. Medical anthropology divides health care into three sectors — popular, folk, and professional — based upon these criteria: explanatory model of illness,63 practices, remuneration, and educaBreasted, Edwin Smith Papyrus. Nunn, Ancient Egyptian Medicine, 56. 61 Ebers 854a; see Ebbell, The Papyrus Ebers, 115. 62 Breasted, Edwin Smith Papyrus, 217. 63 An explanatory model of illness is how one understands the conjunction of the three elements of physiology, disease etiology, and treatment measures. These concepts are culture bound. Specific details concerning physiology, etiology, and treatment may differ from illness to illness, but an underlying ideology is at work; see Kleinman, Patients and Healers, 104–18; Helman, CHI, 85. 59 60

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tion. Popular health care makes up the largest sector in most societies. It consists of non-professionals and non-specialists who initially define and treat the sickness.64 Their credentials derive from experience rather than specialized education, status, or powers. Folk health care consists of non-professional specialists whose practice of medicine more closely approximates popular health care.65 Sometimes this category is further subdivided into sacred and secular, but such a distinction is difficult to see in practice. Folk healing can be manifest in several forms from shamanism and herbalism to traditional surgical and manipulative treatments as well as exercise regimens. Types of folk healers also vary widely from bone setters and midwives to shamans and clairvoyants. Studies of health care systems start with the assumption that western biomedicine is the model for professionalization; therefore, any system functioning outside of this must be popular or folk and heavily dependent upon religious/spiritual beliefs. Professional health care is an organized system of medicine sanctioned by the political, legal, and/or religious authorities in the community. 66 Professionals tend to have a higher social status and income relative to the rest of the community. Their rights and obligations are clearly defined and they can handle special, powerful, and/or forbidden substances. Professionals also have the power to pronounce patients as being of a certain status thus removing certain rights and obligations form the afflicted. The type of medicine seen as professional always matches the beliefs and values of the society. 67 The available evidence would have us classify the swnw, wʿb priest, and zɜw in the professional sector. Our concern then, if they are all professional healers, is the mode of communication each used to warrant separate titles. The wʿb priest has an obvious connection to the religious authorities in Egyptian society. As previously mentioned, the title wʿb (pure) can refer to even the most novice member of a temple’s personnel. The priest’s role, as representatives of the deified king, is to maintain the integrity of the divine ensuring mɜʿt especially within Kleinman, Patients and Healers, 50. Kleinman, Patients and Healers, 59; Helman, CHI, 53. 66 Kleinman, Patients and Healers, 53; Helman, CHI, 58. 67 Kleinman, Patients and Healers, 55. 64 65

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the temples.68 This is evident in the daily cult ritual of feeding and clothing the statue of the deity. The wʿb priest bridges the physical human world with the realm of the gods, essentially vertical communication. In a medical context, the title frequently appears as “the wʿb priest of Sekhmet.”69 Plagues were often referred to as “messengers of Sekhmet” highlighting the importance of the communicative function of illness. Her priests then performed rituals called “appeasing Sekhmet” in order to ward off seasonal epidemics. Appeasing the goddess underscores not just the vertical communication but the necessity to show obedience when humans interact with the divine. Ultimately, by appeasing Sekhmet, she is to show consideration towards the less powerful group. The wʿb priest’s association with temples might lead to the assumption that they could only affect healing through vertical communication while at a sacred site. Or that a patient could only demonstrate obedience at a temple. Numerous documents attest to the wʿb priest’s attachment to the pr ʿnḫ. But other textual sources indicate that a wʿb priest could just as easily be attached to the harem or a work site.70 The ubiquity of the title and the rotational basis of serving the temple created a situation in which the wʿb priest could easily have made “house calls.” The wʿb priest of Sekhmet, mentioned in funerary contexts, is frequently connected to either the royal family or the nomarch, quite often as a relative. Thirteen sources dating from the Old Kingdom show the wʿb priest exclusively under the patronage of the king.71 We have six sources from Sauneron, The Priests of Ancient Egypt, 34; Siegfried Morenz, Egyptian Religion (trans. Ann E. Keep; Ithaca: Cornell University Press, 1992), 100. 69 Von Känel argues that wʿb and swnw are synonyms meaning “physician,” with swnw being the more general form; see Frédérique von Känel, Les Prêtres-Ouâb de Sekhmet et les Conjurateurs de Serket (Paris: Presses Universitaires de France, 1984), 251–52. At times the translation “surgeon” is used based on the logic that since wʿb precedes swnw in the Smith Papyrus, which is considered a surgical treatise, then wʿb must mean “surgeon”; see Breasted, Edwin Smith Papyrus, ?? 70 Känel, Les Prêtres-Ouâb de Sekhmet et les Conjurateurs de Serket, 246. 71 Känel, Les Prêtres-Ouâb de Sekhmet et les Conjurateurs de Serket, 1–16. 68

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the Middle Kingdom, all showing the wʿb priest attached to a nomarch.72 By the New Kingdom the wʿb priest of Sekhmet is attested as part of the temple. 73 From the Theban necropolis, the 19th Dynasty (1295–1186 BCE) tomb of Amenwahsu lists his titles as wʿb priest of Sekhmet as well as sš pr ʿnḫ (Scribe of the House of Life) for the Temple of Amun. 74 Similarly, Sobekhotep is referred to as wʿb priest of Sekhmet for the mortuary cult of Amenhotep III.75 Another indication that the wʿb priest of Sekhmet may act independently of the king, nomarch or even a temple is the use of the title wʿb in the Ebers76 and Edwin Smith77 papyri. As the provenance of the Chester Beatty Papyrus has shown, Egyptian medical texts were not exclusive to the swnw or a temple. From this, we can conclude that the wʿb priest’s ability to communicate vertically was not tied to a location but rather to his accessing of ḥkɜw. Although a temple does function as a conduit between the divine and human worlds, the person of the wʿb priest also bridges the two communities. As we have seen, the therapeutic practices of the wʿb priest do not significantly differ from the swnw or zɜw. The wʿb priest assessed symptoms and pronounced prognoses according to the various medical texts. His diagnosis and prognosis essentially affirmed to the patient the message from the displeased gods or other power. The medical texts do not link particular transgressions of mɜʿt with specific diseases; their exact nature is not the concern for the wʿb healer. Instead, healing is based upon the patient’s willingness to either obey/appease the higher power or ally himself with an even more powerful entity. The wʿb priest would apply charged substances in the form of bandages, laxatives and other therapies to demonstrate to the gods the patient’s obedience.

Känel, Les Prêtres-Ouâb de Sekhmet et les Conjurateurs de Serket, 17–27. Känel, Les Prêtres-Ouâb de Sekhmet et les Conjurateurs de Serket, 29–69. 74 Känel, Les Prêtres-Ouâb de Sekhmet et les Conjurateurs de Serket, 45–47. 75 BM 5627; see Känel, Les Prêtres-Ouâb de Sekhmet et les Conjurateurs de Serket, 66–69. 76 Eb 854a and 855. 77 Smith C. 1, I 6. 72 73

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By engaging in healing practices, the wʿb priest restores mɜʿt not just in the body of the afflicted but also between the communities that the priest represents. In this capacity, the wʿb priest focuses on what can be described as the vertical relationship between gods and humans. The linking of the wʿb priest with vertical communication stems from his function within the religious system and the ancient Egyptian world view. The vertical communication of the wʿb priest as healer centered on conveying a message of obedience from the human to the divine. A second title appearing in the medical texts is zɜw. Only about fourteen documents attest to the specific title zɜw of Serqet.78 The title first appears in the 5th Dynasty (2500–2350 BCE) in the mastaba for Khepseskaf-Ankh at Giza. In addition to being a wʿb priest for the king, he is also noted as a zɜw of Serqet for the Residence. Only one other mention of a zɜw appears in the Old Kingdom, also connected to the royal family. Four inscriptions using the title come from the Middle Kingdom. Three of these come from expeditions to the Sinai during the reign of Amenemhat III (1843– 1798 BCE). It is in these inscriptions that we first see the association of the zɜw and the swnw.79 Three references dated to the new Kingdom, one of which is in the Ebers Papyrus. The title appears a few times in tombs but only in connection with the dragging of the tknw statue during the funeral procession. The remaining four references date to the Late and Ptolemaic periods. Von Känel notes that a 26th Dynasty statue lists both the title zɜw and swnw.80 The title zɜw derived from zɜ, the Egyptian word for “amulet” or “protection.” Because of this, the translation of zɜw as “magician” has come under question. More recent suggestions for a translation are “protector” or “amulet-man.”81 The term “amulet78

31.

Känel, Les Prêtres-Ouâb de Sekhmet et les Conjurateurs de Serket, 225–

Ghalioungui, The Physicians of Pharaonic Egypt, 24, 46. Vatican 166; see Känel, Les Prêtres-Ouâb de Sekhmet et les Conjurateurs de Serket, 193. 81 Stephen Quirke, Ancient Egyptian Religion (New York: Dover Publications, 1992), 116; J. F. Borghouts, “Witchcraft, Magic, and Divination in Ancient Egypt,” in Civilizations of the Ancient Near East (ed. Jack M. Sasson; 79 80

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man” may not be accurate as it implies the zɜw only worked with amulets rather than the other types of therapies outlined in the medical papyri. The title zɜw typically appears in conjunction with Serqet the scorpion goddess. Like Sekhmet, Serqet embodied both the dangerous aspect of the scorpion as well as the ability to heal the scorpion’s sting. The protective role of Serqet is attested as early as the Old Kingdom in the Pyramid texts.82 By the Middle Kingdom, her protective role expanded to include guarding the canopic jar holding the intestines of the deceased. Perhaps it is best to translate zɜw as “protector,” highlighting the healer as an extension of Serqet’s protective role without limiting his therapeutic strategies. Further complicating the matter is the use of zɜw to designate a troop in the military sense. This plays a significant role in the debate as to whether medical personnel were assigned to the military, since the titles zɜw and swnw can appear in conjunction. However, its military use may also reinforce the protective aspect; one function of the army is to protect the interests of the king. Although zɜw does not appear as a title for functionaries within the temple, they seem to have the same role as the wʿb priest in terms of healing. The zɜw, as a protector, focuses on the vertical relationship especially the benevolence of the gods towards humans. Where the wʿb priest conveyed obedience, the zɜw communicates the more powerful entity’s consideration of humans. The zɜw’s diagnosis also confirms a negative message for the patient. Yet, their use of medicated bandages and other charged substances in the ritual of healing communicated the gods’ consideration of the afflicted’s predicament. We saw with the wʿb priest that treatment measures conveyed human obedience. The same act, though, can also represent consideration. The vertical relationship allows for communication in both directions, human to god and god to human, without necessitating a different vehicle of communication. The gods send messages in the form of afflictions, the charging of the substance, and ultimately the final act of being Peabody: Hendrickson, 2000), 1783–84; Robert K. Ritner, “Magic,” in The Oxford Encyclopedia of Ancient Egypt (New York: Oxford University Press, 2001), 326. 82 PT 1375.

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healed. Healers then can communicate also using diagnosis, rituals to charge substances and declaring patients healed. These multiple messages from the gods are not simply a redundancy. The first message encoded in the illness may not always be from a god but rather a malevolent spirit or sorcerer with greater access to ḥkɜw than the victim. The therapies of the zɜw gain effectiveness because of his relationship with a greater power such as Serqet which in turn increases his ḥkɜw. Because of this relationship, the god considers the afflicted. The final outcome as to whether or not the god allies with the afflicted and wishes to reestablish a bond happens with the actual cure. If the god does not want the relationship, then the consideration shown in the therapy is withdrawn and the treatment eventually fails. Consideration does not always mean acceptance is demonstrated in the prognosis mr ʿḥʾ ḥnʿ (an ailment with which I will contend). The world system of the ancient Egyptians sees a relationship between the three communities of the gods, spirits, and humans. Yet, the healing processes of the wʿb priest and zɜw seem focused more on the individuals afflicted and the specific goddesses of Sekhmet and Serqet. These goddesses function as representatives of the divine community by virtue of Egyptian religion’s syncretism.83 In this regard, the goddesses signal to the human community the cohesiveness of the deities in ensuring mɜʿt and the world system. The medical texts give no indication of the identity of the patient beyond gender in certain cases. The afflicted then stands as a representative of the community as a whole. This is especially true when we take into consideration the zɜw’s presence in the royal court. When the king suffers an illness, as representative of the Egyptian people to the gods, so too does all of Egypt suffer. This representation extends to all of the royal court serviced by the zɜw’s healing. Even for non-royal patients, a person’s illness signals a disruption of mɜʿt that can spread throughout the human community eventually destroying its bonds as well as the bond between the

83 Stephen Quirke, Ancient Egyptian Religion (New York: Dover Publications, 1992), 17; Siegfried Morenz, Egyptian Religion (trans. Ann E. Keep; Ithaca: Cornell University Press, 1992), 139–42.

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human and the divine communities, as in the case of Reddedet’s maidservant. Where the bond between humans and the divine is the concern of the wʿb priest and the zɜw, the cohesion of the human community itself is the focus of the swnw’s healing practices. In essence, the swnw uses horizontal communication. When discussing Egyptian medicine, scholars tend to concentrate on the practices of the swnw. This title appears approximately 150 times in tomb biographies, stelae, graffiti, and various other papyri dating from the 4th (2649–2513) to the 27th dynasties (525– 405).84 Sixty-two of the swnw references date to the Old Kingdom and 1st Intermediate (2700–2160 BCE); almost half of them have a royal connection with the swnw burials around Memphis. Fifty-one references, the next largest grouping, can be found for the New Kingdom and Second Intermediate (1550–1069 BCE); Thebes was the site of these swnw burials. This leaves about thirty-seven references for the Middle Kingdom (2106–1786 BCE); their burials were at Beni Hasan and Abydos. The Late Period (1069–332 BCE) had burials scattered throughout most of Lower Egypt. This distribution pattern indicates that a swnw was typically buried near the Residence of other locus of power, most likely following his patron. Unlike the titles of wʿb priest and zɜw, gods themselves can hold the title swnw; Amun is called the “swnw who removes trouble and suffering,”85 Horus is called the “great swnw,” of an unnamed deity86 as well as the House of Re,87 and Min is the “good swnw.”88 Additionally, there are prescriptions for gods by gods. 89 This use of swnw indicates that the title applies to healers who work towards communication within a community rather than bridging two groups. The human swnw thus mirrors the practices of the divine

84 For a complete list see Paul Ghalioungui, The Physicians of Pharaonic Egypt (Cairo: Al-Ahram Center for Scientific Translations, 1983), 16–37. 85 Amonshymn Leiden Papyrus. 86 Totb. Spruch 17; Papyrus Turin. 87 Papyrus Turin P. u. R. 88 Urk. II 65. 89 Ebers XLVI–XLVII.

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swnw. The human swnw derived his knowledge from the gods, “he (Thot) gives to the swnw… skill to cure.”90 Debate surrounds the origin of the title. The most common hieroglyphic form simply uses an arrow. An example can be found on a wood panel of Hesy-Re.91 Some conjecture that this sign originated as an ideogram implying that the swnw was skilled in removing arrows from soldiers.92 The fullest hieroglyphic form is an arrow93 with a pot or bowl94 and a seated man as the male determinative. Similar assumptions have been made about this form, trying to match the arrow to the doctor’s lancet and the pot to a medicine jar.95 Nunn is quick to point out this is not an accurate interpretation because the hieroglyph clearly represents an arrow and not any other tool.96 The arrow is frequently used in non-medical contexts to represent the triliteral swn and the pot is the biliteral nw, thus forming the word swnw without imparting any other meaning.97 The Berlin Papyrus uses swnw with the meaning of “illness.”98 It has been conjectured that the noun swnw derived from the Egyptian words swny.t (pain) and swn (affliction) and may indicate that the title swnw developed as a designation for someone who treats these.99 Yet, a similar word, swn, means “to barter.”100 This term, in Ebers 1; see Ebbell, The Papyrus Ebers, 29. Found in his personal mastaba at Saqqara dated to the 3rd Dynasty on which Hesy-Re is given the title of “Chief of Dentists and Doctors (swnw)”; Cairo Museum jDE 28504. 92 B. Mays, et al., “Treatment of Arrow Wounds by Nineteenth Century USA Army Surgeons,” Journal of the Royal Society of Medicine 87 (1994): 102–3; Nunn, Ancient Egyptian Medicine, 115. 93 T.11 94 W.24 95 For a discussion of F. von Oefels’s theories, see F. Jonckheere, “Le Cadre Professionnel de Médecins Égyptiens,” Chronique d’Égypte 52 (1951): 237–68; cf. Grapow, Grundiss III, 87. 96 Nunn, Ancient Egyptian Medicine, 115. 97 Alan H. Gardiner, Egyptian Grammar (London: Oxford University Press, 1957), 512, 530. 98 Berlin 161. 99 F. Jonckheere, “A la Recherche Du Chirurgien Égyptien,” Chronique d’Égypte 51 (1951): 28–45. 90 91

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conjunction with the Coptic SOWNT (purchase), gives swnw the possible meaning of “tax valuer.” Almost every general study of Egyptian medicine mentions Herodotus’ description of specialists; he lists doctors for the eyes, head, teeth, stomach, and “illnesses whose provenance is obscure.”101 In fact, the Egyptians did use titles such as swnw ir.ty (“swnw of the Two Eyes”), wr ibḥy (“Chief of the Teeth”), swnw ht (“swnw of the Belly”) and swnw ɜʿʿ ḥmw.t štɜt (“swnw Interpreter of the Secret Craft”). These titles mostly belong to the Old Kingdom; three exceptions come from the Late Period.102 Apparently, the custom of using specialist titles fell out of use for centuries, only to be revived by the time Herodotus made his trip to Egypt in the 5th century BCE. The Late and Hellenistic periods’ revival of Old Kingdom customs, including the use of titles, may account for the appearance of “specialists” in Herodotus’ writing without the healers actually engaging in specialized practices. Another theory to explain the phenomenon is that Egyptians originally thought of each limb as a separate entity; thus specialists were designated by simply qualifying swnw with the name of a body part. Over time, the concept of wḫdw flowing through the mtw created a sense of a unified body and thus specialization decreased.103 The Egyptian conception of physiology, however, was not based upon discreet systems, but rather upon the idea of mɜʿt governing the interaction of systems within the body as well as the entities outside the body. Grapow sees the use of specialized titles as a way of communicating that the swnw can treat various illnesses.104 This would explain how men like Irenakhty could hold the titles of swnw ir.ty, swnw ht, and nrw pḥwt (“Shepherd of the Anus”). Von Känel sees the repetitive use of swnw with body parts as a way of clearing up confusions, since the term swnw by itself is generic and synonymous This word ends with the sign Y.1 rather than G.36; see Gardiner, Egyptian Grammar, 589. 101 Herodotus, Histories, II.84. 102 Ghalioungui, The Physicians of Pharaonic Egypt, 44. 103 Ghalioungui, The Physicians of Pharaonic Egypt, 44. 104 Grapow, Grundiss III, 98. 100

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with the wʿb priest.105 So, the evidence cautions against making a direct correspondence between the swnw ht or swnw ir.ty and the modern gastroenterologist or ophthalmologist. There is considerable overlap between the use of swnw and other titles denoting a religious function. Four individuals held the title swnw as well as “Overseer” in temples to Amun, Khnum, and Ptah.106 Prophets (ḥm-nṯr) of Heka, Aten, Dwaw and Horimyshent could also be swnw.107 Magicians (hry-ḥb) for Serqet combined with swnw and there are seventeen cases of the title scribe (sš) used in conjunction with swnw.108 Other cases show that the title wʿb was coupled with swnw. Two reliefs from the 5th Dynasty (2500–2350 BCE) show a swnw overseeing the butchery of sacrificial cattle. Irenakhty is depicted in the tomb of Ptah-hotep declaring pure blood from a sacrifice.109 Similarly, Wenen-nefer in the tomb of Ptahhotep II inspects the blood of a sacrificed bull.110 A stele from the 6th Dynasty (2350–2190 BCE) also shows a swnw overseeing cattle butchery.111 All of these figures, in addition to holding the title swnw, have the title wʿb. The act of a wʿb swnw inspecting cattle shows a horizontal focus. As a wʿb priest, he is concerned with purity but as a swnw he concentrates on its physical display so that the human community can understand and use signs from the divine. The swnw does not make the sacrificial cattle pure, he simply reads the signs of purity on its physical body, a form of mediumistic divination, and assures the human community involved in the sacrifice that the animal is not offensive. The swnw as healer similarly focuses on the physical 105

294.

Känel, Les Prêtres-Ouâb de Sekhmet et les Conjurateurs de Serket, 251,

Ghalioungui, The Physicians of Pharaonic Egypt, 47. Ghalioungui, The Physicians of Pharaonic Egypt, 48. 108 Ghalioungui, The Physicians of Pharaonic Egypt, 48–50. 109 Jonckheere, Les Médecins de l’Égypt Pharaonique, 24; Ghalioungui, The Physicians of Pharaonic Egypt, 4, 17. 110 Jonckheere, Les Médecins de l’Égypt Pharaonique, 31; Ghalioungui, The Physicians of Pharaonic Egypt, 18; J. Leibovitch, “Une scene de sacrifice rituel chez les anciens egyptiens,” JNES 12, no. 1 (1953): 59–60. 111 Jonckheere, Les Médecins de l’Égypt Pharaonique, 77–78; Ghalioungui, The Physicians of Pharaonic Egypt, 23. 106 107

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display encoding a message from the gods, spirits, or even sorcerers. The swnw’s use of mediumistic divination may also explain the Old Kingdom use of titles denoting specific body parts. It was not that he specialized in treating certain organs, but that he was adept at reading signs in them. It is still unclear, though, to what extent these were ranking titles based more upon Egyptian culture’s value for specific organs than actual divinatory skill. Therapeutic actions then reassured the human community that the disruption of mɜʿt was being addressed. The treatment measures of the swnw did not differ in form from that of the wʿb priest or zɜw, but the significance imparted to those actions are distinctive. The diagnosis set apart the individual from the community by casting him in the sick role. The use of the three prognoses signaled to the individual, hence the community, how mɜʿt may be restored either through healing or death. Although the afflicted is not physically removed from the human community as in biblical Israel, there was a definite relaxation of social obligations. The attachment of swnw to work sites shows a concern for the health and formal recognition that on occasions of illness or injury one can suspend duties. The swnw Neferher listed in a ship’s log and the graffiti from Hatnub quarry show that swnw could be a part of a labor force. When applying bandages or laxatives, the swnw still accessed ḥkɜw by the use of charged substances thus demonstrating to the human community his power. The swnw’s treatments though allowed the group to read both the signs of obedience conveyed to the gods as well as the consideration the gods bestowed on the afflicted. By enabling the human community to understand the messages transpiring in vertical communication, the swnw reinforced the idea that mɜʿt is at work, assuring them of the stability of the Egyptian world system thus the human community can remain cohesive. The swnw’s function in horizontal communication stems from interpreting his other duties and not simply the cases in the medical texts. Given the swnw’s method of mediumistic divination and his horizontal mode of communicating, one might assume the swnw works outside the temple when practicing medicine. The institutional setting is not clear from the medical papyri alone. The description of the cases in the title and examination sections indicates that some cases were severe enough that the patient could not

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move himself. But, this does not mean the healer always went to the patient; he may have been brought to the healer. The titles of swnw give some clue as to where they may have practiced. Epithets such as the swnw pr ʿɜ (swnw of the Great House) show that they were attached to certain locations not solely vested in health care and not necessarily temples. Whether a special place within the Residence was set aside for the swnw is still not known. Similarly, the title wr swnw m st mɜʿt (“Chief swnw of the Place of Truth”) gives us no information about where exactly the Place of Truth was located. The Egyptian swnw making a house call is not unusual; several literary sources make reference to the summoning of a healer. Also, letters attest to the traveling of swnw to foreign courts in order to provide medical services. From these sources, it appears that the swnw worked more or less on a patronage system and practiced in a location for which they were hired. Yet, some titles stand out as an exception to the standard patronage mode of operation. If the ḥw.t ʿnḫ (“Mansion of Life”) is a place of healing, then the title wr swnw n ḥw.t ʿnḫ is evidence that specific areas may have been established for the purpose of healing, at least from the New Kingdom onwards. Additionally, the practice of temple swnw is unclear in this period. There is evidence that the ill went to temples seeking medical assistance, making them in part, sanatoria. According to wall graffiti, the funerary cult of Amenhotep, son of Hapu the architect of Amenhotep III, located in the temple at Deir el-Bahri, became a center for the ill to gather for cures.112 But such activity for the funerary cult, especially hydrotherapy, is often looked upon as a later, Ptolemaic practice. The stele of Qenherkhepeshef mentions sleeping in a temple for prophetic dreams, but the use of such dreams as a therapeutic practice is typical of the Coptic period (3rd c. CE), not the 19th Dynasty (1295–1186 BCE). We do not know to what extent the temple personnel assisted in the healing process. Debate surrounds the pr ʿnḫ as to whether it functioned as a medical school and hospital or if it was simply a scriptorium housing medical texts.113

112 113

Sauneron, The Priests of Ancient Egypt, 159. Sauneron, The Priests of Ancient Egypt, 157.

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Ample evidence links the swnw with the erudite classes of Egypt. “I will save him from his enemies, and Thoth shall be his guide, he who lets writing speak and has composed the books; he gives to the skilful [sic], to the physicians who accompany him, skill to cure.”114 This connection between literacy and healing reaches back into the early history of Egypt. Manetho states that Aha wrote a treatise on anatomy, and the Berlin Papyrus claims to date back to the reign of Den (ca. 2900 BCE). The use of papyri as a reference for symptom descriptions and therapeutics requires the healer to be literate. Of the fourteen scribes holding the title swnw, an interesting case is the Middle Kingdom figure Imny.115 A stele from Abydos bears a relief with the inscription sš pr ʿnḫ Kkw sɜ Imny swnw which can be translated two ways: 1. scribe of the House of Life Kkw son of Imny the swnw, 2. scribe of the House of Life, Kkw’s son, the swnw Imny. In this one inscription, we have a link between the swnw, the scribe, and the pr ʿnḫ but it does not clarify just how the three elements are related to each other. The pr ʿnḫ was part of the larger temple complex with references found for the temple of Osiris at Abydos, as well as temples in Bubastis, Sais, Edfu, and el-Amarna.116 Unfortunately, none of these sites have an intact pr ʿnh from which we can investigate its exact function; the only physical remains come from el-Amarna but are limited to a few bricks with the stamp pr ʿnḫ. Ghaliounghui sees it as a scriptorium and draws parallels with the later Alexandrian μουσειον. Although he is reluctant to state that the pr ʿnḫ is a medical school, he does stress the instrumental healing of the swnw in opposition to symbolic intervention done by the wʿb priest in a temple. From this, he claims a difference in the education of the swnw from the wʿb priest and zɜw though he neglects to outline any specific differences between their education.117 Translation from Ebbell, The Papyrus Ebers, 29. Jonckheere, Les Médecins de l’Égypt Pharaonique, 22; Ghalioungui, The Physicians of Pharaonic Egypt, 23. 116 Paul Ghalioungui, House of Life: Magic and Medical Science in Ancient Egypt (Amsterdam: B.M. Israel, 1973), 68. 117 Ghalioungui, House of Life: Magic and Medical Science in Ancient Egypt, 63. 114 115

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Adherents to the theory that the pr ʿnḫ was a formal medical school base much upon the inscription of Udjahor-resnet from the 26th Dynasty (525–404 BCE). The Majesty of King Darius (may he live eternally) ordered me to return to Egypt… for restoring the departments(s) of the House of Life (consecrated to) medicine118 after which (they have fallen into) ruin… because he knew the utility of this art to give life to those who are sick.119

Gardiner argues against the pr ʿnḫ as a medical school proper, citing the same inscription of Udjahor-resnet, “I furnished them with all their staffs120 consisting of persons of rank, not a poor man’s son among them.”121 The key to this passage is the understanding of ṯt; it has been variously translated as “staff,” “gang,” or “students,” thus coloring the overall interpretation of the pr ʿnḫ as a medical school or even a hospital setting. The curious title wr swnw n ḥw.t ʿnḫ (“Chief swnw of the Mansion of Life”)122 leaves much debate as to what exactly is the ḥw.t ʿnḫ. Junker equates this with the pr ʿnḫ123 while Gardiner sees it as a separate place where the king ate.124 Confounding the issue is a prayer to Khnum, “how beautiful is your face when you are in the ḥw.t ʿnḫ, healing the sick, and driving away evil from those who pray to you.”125 This suggests the ḥw.t ʿnḫ was a health care facility of some sort rather than a repository of books or medical school as the pr ʿnḫ is thought to be. Crossover in the practice of the swnw, scribe, wʿb priest, and zɜw make it only logical that any repository of The original text reads: [n] ir(t) swnw. Translation from G. Lefebvre, Essai sur la Médecine Égyptienne de l’Époque Pharaonique (Paris: Presses Universitaires de France, 1956), 19. 120 The original text reads: ṯt. 121 Alan H. Gardiner, “The House of Life,” Journal of Egyptian Archaeology 24 (1938): 157–79. 122 Florence No. 10.481. 123 H. Junker, Giza, XI (Vienna: Rudolph M. Rohrer, 1953), 83. 124 Alan H. Gardiner, “The Mansion of Life and the Master of the King’s Largess,” JEA 24 (1938): 83–91. 125 Serge Sauneron, Les Fêtes religieuses d’Esna aux derniers siècles du paganisme (Cairo: IFAO, 1962), p. 160. 118 119

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their knowledge would in effect be a place of learning as well as a clinical setting. It is a common cultural practice for a craftsman to pass on his knowledge to his son. Such a method of training healers is reinforced by the passage, “thou shalt prepare for him the secret remedy to the one who is under the physician [swnw] except thy own daughter.”126 This passage indicates an apprenticeship, likely within the family, as the form of education for Egyptian healers, especially the swnw. The context of the Chester Beatty Papyrus suggests this is not the only way though. Found at Deir el-Bahri, it belonged to a family that, as far as can be ascertained, did not contain a swnw. Additionally, works such as the Satire on the Trades shows that apprenticeships were not limited to the family. There does not appear to have been a standard form of training for the Egyptian healer, but rather the information and thus access to ḥkɜw was available to the literate.

CONCLUSION The presence of three distinct titles for healers and their association with the religious structure of ancient Egypt brings up the question as to what, if any, difference existed between the swnw, wʿb priest, and zɜw. Perhaps the difference does not lie in the separate categories of religion and medicine but rather in how each type of healer used a combination of physical and oral rites with charged substances to help the patient communicate his obedience to the natural order either to the gods or to the rest of the human community. Illness as a form of communication from the divine can be approached in two ways. One can focus on the divine aspect, what problems does a god see or why is the god communicating. The other focus can be on the mortal aspect of the communication, that is, the physical manifestation in the form of symptoms. The wʿb priest and zɜw who typically acted on behalf or as an extension of the divine appear to have focused on the divine aspect of the illness. In contrast, the swnw who oversaw the mortal, physical world in activities such as the inspection of sacrificial cattle may 126

Ebbell, The Papyrus Ebers, 54.

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also have concentrated on the physical manifestation of symptoms. The swnw, wʿb priest and zɜw regularly employed the religious ideology of balance and order (mɜʿt) in order to help the afflicted restore community cohesion. This ideology explained that although illness ultimately was a message from an entity with access to ḥkɜw, symptoms arose through a disruption of mɜʿt and could eventually be restored by ḥkɜw.

MESOPOTAMIAN HEALING Mesopotamian medicine is often described as having multiple healers: the asû (physician), āšipu and mašmaššu (magician/exorcist) as well as the bārû (diviner). The common translation for these titles gives the impression that Mesopotamian medicine was divided along the lines of instrumental and symbolic healing.1 Yet, these may not represent such competing medical systems nor a hierarchy of practitioners,2 which then raises questions as to why there were so many different titles for healers and what was their relationship to each other. Scurlock attempts to clarify the roles of the different healers by proposing that the asû is a technician more analogous to the European pharmacist while the āšipu is a diagnostician.3 Although these terms highlight the collaborative nature of the healers in Mesopotamian society, it still does little to explain how exactly the asû, āšipu, and bārû functioned since the asû could make diagnoses.4 Additionally, both types of healers had equal access to the materia medica. To think of the asû as a technician also runs the risk of inadvertently placing him in a subordinate position to the āšipu or diagnostician since our modern medical system uses such a hierarchy for these terms. These problems aside, the translations of 1 Following the terminology of Arthur Kleinman, Patients and Healers in the Context of Culture (Berkeley: University of California Press, 1980). 2 Robert D. Biggs, “Medicine, Surgery, and Public Health in Ancient Mesopotamia,” in Civilizations of the Ancient Near East (ed. Jack Sasson; Peabody, Massachusetts: Hendrickson, 1995), 1911. 3 JoAnn Scurlock, “Physician, Exorcist, Conjurer, Magician: A Tale of Two Healing Professions,” in Mesopotamian Magic: Textual, Historical and Interpretative Perspectives (ed. Tzvi Abusch and Karel van der Toorn; Groningen: Styx Publications, 1999), 78. 4 SA.GIG XVIII 3,14; XXXII 53–54.

55

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“technician” and “diagnostician” divorces ancient Mesopotamian healers and their art from a world system that understood illness as a message from the divine. Further complicating our understanding of Mesopotamian healers is the modern classification of documents relating to health care. These are typically divided into two main groups: the diagnostic and therapeutic. Modern scholarship often views these as magico-religious and scientific respectively. Although some overlap between the texts is acknowledged, many discussions focus on the correlation of the diagnostic texts with the āšipu and the therapeutic tablets with the asû. Unlike Egyptian texts, the documents from Mesopotamia are not conveniently located in a dozen distinct papyri. Rather, they are collections of tablets which are collated into a particular “book” by editors. This editing process may have occurred in the ancient world, such as the SA.GIG series, 5 but other sources were compiled by modern editors such as the Assyrian Medical Texts (AMT).6 These compilations include tablets that modern editors assign to a particular series, based on a common theme, i.e. utukku limnūti or UDUG.ḪUL.A.MEŠ (ghost trouble). In the end, a tablet may be published in one or more collections of medical texts or in works on magic and divination. The six most frequently consulted medical collections are: SA.GIG, AMT, Babylonischassyrische Medezin (BAM),7 Beitrage zur Kenntnis der Assyrischbabylonischen Medezin,8 Keilschrifttexte medezinischen Inhalts (KMI),9 and the Sultantepe Tablets (STT)10 as well as the turn of the last century publications by von Oefele. René Labat, Traité Akkadien de Diagnostics et Pronostics Médicaux (Leiden: E. J. Brill, 1951). 6 R. Campbell Thompson, Assyrian Medical Texts (London: Oxford University Press, 1923). 7 Franz Köcher, Die babylonisch-assyrische Medizin in Texten und Untersuchungen (Berlin: Walter de Gruyter & Co., 1963–80). 8 Friedrich Küchler, Beiträge zur Kenntnis der assyrisch-babylonischen Medizin (Leipzig: J. C. Hinrichs, 1904). 9 Erich Ebeling, “Keilschrifttafeln medizinischen Inhalts,” Archiv für Geschichte der Medizin 13, no. 1 (1921): 1–78. 10 O. R. Gurney and Herbert Thompson, eds., The Sultantepe Tablets I (London: British Institute of Archaeology at Ankara, 1957); O. R. Gurney 5

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The SA.GIG is comprised of tablets ranging from the late Middle Babylonian period (1595–1000 BCE)11 to the reign of Artaxerxes I (464–424 BCE). The oldest datable fragments come from the reign of Adad-apla-iddina (1067–146 BCE);12 the majority, however, are from the library of Assurbanipal (668–627 BCE). A colophon added to the beginning of the collection suggests that an ancient scholar, Esagil-kin-apli, grouped together the forty tablets that now make up the SA.GIG. This collection survived in practical use until the Persian period (525–404 BCE). Babylonian catalogues cite the collection with the short title sakikkû (symptoms). Part I consists of a list of omens that the āšipu may encounter on the way to the house of the sick. Part II begins with a brief description of prophylactic measures for the āšipu before he approaches the sick. The remainder of the second part gives a series of symptoms for various anatomical locations but they are not followed by any therapeutic measures. Part III starts with prognoses grouped according to the duration of the sickness from least to greatest and concludes with a list of symptoms attributed to spells, lovesickness, venereal disease, diseases from deities and ghosts, and manifestations of mental illness. Part IV provides a list of injuries with therapeutic measures and a discussion of how one illness may and J. J. Finkelstein, eds., The Sultantepe Tablets II (London: British Institute of Archaeology at Ankara, 1964). 11 A fragment from Nippur dated to the Middle Babylonian period may be from the Diagnostic Handbook collection but was unavailable to Labat for publication. A second tablet from Sultantepe from the NeoAssyrian period (744–612 BCE) may also belong to this collection. Further information about these tablets can be found in Martin Stohl, Epilepsy in Babylonia (Groningen: Styx, 1993). The Sultantepe tablet has been published as STT 1 89 in Gurney and Thompson, The Sultantepe Tablets I. 12 This date is from Stohl, Epilepsy in Babylonia; according to Labat, the oldest datable fragment for the “canonical” text is from the reign of Marduk-apla-iddina (721–710 BCE); see Labat, TDP. The Mesopotamian scribe, like the Egyptian, will make claims to greater antiquity as a means of lending authority to the texts. K. 4023 (AMT) mentions “the ancient rulers before the flood which was in Shurippak” and dated to the second year of Enlil-bani, King of Isin (2201–2177 BCE). It is not clear, however, if the 7th c. scribe was copying a reasonably older source.

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transform into another due to a malignant force. Part V deals with gynecology, obstetrics, and nursing infants. The multivolume series BAM provides reproductions of tablets from Assur, Nineveh, Nippur, and Babylon. In addition to the reproductions, Köcher briefly summarizes each tablet with information on dating, format, and content. When a symptom description is lacking, he suggests the text is of practical use for making remedies whereas the presence of symptoms indicates the text is used for teaching purposes. Many of the cases give recipes for the head, eyes, mouth, teeth, skin, respiratory problems, kidneys, liver, gall bladder, stomach, bowels, urology, foot disorders, paralysis, fever, birth and supernatural influences. A number of these are also published in Keilschrifttexte aus Assur religiösen Inhalts (KAR).13 Köcher views many of these repeated cases as more supplemental insofar as they have a magical nature (such as amulets). He has also included fragments from the series abnu/šammu šikinšu (“appearance of stone/plant”) and the diagnostic omens as well as the muššuʾu (“rubbing”) texts. In the first volume of STT, tablets 89–111 are listed in the medical section but grouped as religious texts are tablets 57–59 and 72–73 which give treatments and prayers for diseases as does the namburbi (“apotropaic”) texts in tablets 63 and 64. Volume II lists the medical texts as tablets 279–299. Yet, again, other sections contain the namburbi texts, incantations against šimmatu (“paralysis”), headache, samānu (“unspecified disease”), evil eye, bedwetting, childbirth, sorcery causing sickness, and diseases of the anus. In addition, the collection has tablets in the series utukki limnūti (“ghost trouble”) and omen texts for ṣibtu (“seizure”). This brief overview for a few of the compilations shows that cases may be organized by a variety of principles such as symptoms like šimmatu, omens as in abnu šikinšu, or etiology like utukki limnūti. Some may have therapeutic recipes attached while similar cases in another compilation do not. Although the SA.GIG is our only ancient grouping of cases, it appears that the āšipu was not limited to certain types of afflictions or even specific remedies. To under13 Erich Ebeling, Keilschrifttexte aus Assur religiösen Inhalts (Leipzig: J. C. Hinrichs, 1919).

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stand the roles of the asû, āšipu, bārû and mašmaššu, we need to closely examine the interplay of Mesopotamian religious ideologies with disease etiology and health care practices.

MESOPOTAMIAN WORLD SYSTEM The body itself often acts as a microcosm of the world system. As we saw in ancient Egypt, the body was governed by the principle of mɜʿt which found expression in their physiological concept of substances flowing through the mtw. Mesopotamian texts lack any such clinical descriptions of human physiology. Likewise, literature is also reticent about the appearance of the human body. They do note when one’s physical appearance or actions no longer suit the norm by describing particular symptoms. But they neglect to outline a specific standard for the structure and function of the body. The Epic of Gilgamesh is typical in that the literature concerns itself more with the adventures of larger-than-life gods and kings than with stories about daily activities.14 Gilgamesh is described as “lordly in appearance,” and his physical prowess is outlined in terms of strength and sexuality, but again, this is to impart a heroic character, not to portray accurately daily life of the common man. From the epic’s descriptions, one can glean the ideal traits of strength and sexuality and the association of excessive hair with wildness. The opposites are also described: emaciation and a haggard appearance for depression or grief. These are only vague impressions lacking clinical value for ascertaining the Mesopotamian body image. Artistic representations then become another avenue to understanding Mesopotamian notions of physiology. Yet, in Babylonia and Assyria, they are not as informative as in Egypt for determining the ideal healthy body image. The Ubaid period (c. 4000 BCE) is nearly devoid of any human representation.15 The Early 14 Although we have stories centered on the plight of commoners, they tend to rely on stock phrases such as, “his insides burned craving for bread/his face was wretched, craving meat and good drink” from The Poor Man of Nippur; see Benjamin R. Foster, From Distant Days: Myths, Tales, and Poetry of Ancient Mesopotamia (Bethesda, Maryland: CDL Press, 1995), 357. 15 André Parrot, Sumer: The Dawn of Art (New York: Golden Press, 1961); André Parrot, Arts of Assyria (New York: Golden Press, 1961); H.

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Dynastic periods (2900–2300 BCE) used geometric forms merely suggesting the human shape.16 During the second millennium, wall paintings from Assyria also reduced human figures to geometrical forms and placed them repetitiously to create a patterned effect.17 This indicates not only that the overall aesthetics were of importance, but also emphasizes the group over individualism. An exception is the well-muscled depictions of gods and kings from the reign of Sargon and throughout Akkad’s prominence (2300– 2230 BCE).18 The Mesopotamian artist also portrayed muscles and tendons when depicting the death of a lion during the hunt. This attention to detail shows an anatomical awareness but more importantly, for the Mesopotamians, it conveys a great sense of power which seems to have been the artwork’s ultimate objective rather than realism for its own sake. In addition to conveying a sense of the king’s awe and power, many reliefs show the king as well as priests and even deities in the role of intercessor.19 The votive statues from Tell Asmar attest to the idea that the human body functioned as a communicative object.20 The role of intercessor similarly appears in texts such as the Code of Hammurabi which declares: When lofty Anum… and Enlil… determined for Marduk… the Enlil functions over all mankind… established for him in

W. F. Saggs, The Greatness That Was Babylon (New York: Hawthorn Books, 1962), 18; Henri Frankfort, Art and Architecture of the Ancient Orient (New Haven: Penguin, 1995). 16 Saggs, The Greatness That Was Babylon, 476; Parrot, Arts of Assyria 17 Saggs, The Greatness That Was Babylon, 481; Frankfort, Art and Architecture of the Ancient Orient; Parrot, Sumer: The Dawn of Art; Parrot, Arts of Assyria 18 Saggs, The Greatness That Was Babylon, 66; Parrot, Sumer: The Dawn of Art; Parrot, Arts of Assyria 19 Saggs, The Greatness That Was Babylon, 475; Frankfort, Art and Architecture of the Ancient Orient; Parrot, Sumer: The Dawn of Art; Parrot, Arts of Assyria 20 The divinatory practices of inspecting animal entrails provide ample evidence that the gods communicated through the use of bodies.

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its midst an enduring kingship, named me to promote the welfare of the people…21

A function of these works was conveying ideas about power; gods are the most powerful and, in turn, delegate some of that power to kings and priests. Such portrayals lead to the conclusion that the functional aspect of physiology was inextricably linked to communicating with or on behalf of the divine. In essence, the body’s form and function is understood as a type of symbolic anatomy. Biggs is quick to point out that there is no evidence of collaboration between physicians and diviners or of human dissection, thus he divorces the Mesopotamians’ knowledge of anatomy from their health care practices.22 Detailed anatomical descriptions of the liver, intestines, lungs, and gall bladder are limited to those of sheep because of sacrifices. Bottéro noted that deductive divination operated on the principle that the gods inscribed future events on an animal’s anatomy.23 This deductive divination functions similarly to the medical concept of symbolic anatomy as evidenced by the SA.GIG series24 of diagnoses and other physiological omens.25 Just as the internal organs of small cattle impart the will of the deities, so too can the workings of human intestines. Symptoms such as fever, sweating, and diarrhea, allow the messages to be read without opening up the afflicted and looking at his liver. Typically, a symbolic anatomy links a body part with a particular deity. Such lists do not appear in the corpus of Akkadian texts. Rather, the link between the body and the supernatural can be found in the diagnostic and prognostic tablets. A diagnosis such as šumma ina qaqqadišú ša imitti maḫiṣ qāt dAdad (“if his head on the

21 James B. Pritchard, Ancient Near Eastern Texts Relating to the Old Testament (Princeton: Princeton University Press, 1969), 164. 22 Robert D. Biggs, “Medicine in Ancient Mesopotamia,” History of Science 8 (1969): 101. 23 Jean Bottéro, Mesopotamia: Writing, Reasoning, and the Gods (Chicago: University of Chicago Press, 1992), 125–37. 24 Labat, TDP 25 J. V. Kinnier Wilson, “The Nimrud Catalogue of Medical and Physiological Omens,” Iraq 24 (1962): 52–62.

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right side is struck, hand of [the god] Adad”)26 shows how a specific deity is associated with a body part. This association is not simply naming a disease (diagnosis) after a god, but indicates the symbolic function of the body in conveying a divine message from Adad. Omens reinforce this idea: šumma šinnēšu […bī]s-su issapaḫ (“if his teeth […]his house will disperse/fall into ruin”)27 connects the teeth with supernatural influence over one’s entire fortune, not just personal health. Medical therapies and other social practices indicate that the Mesopotamians did have an understanding of some basic anatomical structures. Medications were often introduced to the body via the urethra or nostrils. The pulse had been observed and castrations performed. The term šerʾānu can be translated as vein, muscle, or tendon,28 indicating that knowledge of the human body was not limited to symbolic anatomy. Yet, no discussion exists as to how the šerʾānu functioned in the body or its role in health and illness. To ancient Mesopotamians, features or elements of the environment were personified as powerful entities or wills. But rather than a chaotic clash of ambitions, the universe was an ordered system “achieved through a continual integration of the many individual cosmic wills”29 producing social groupings such as the family, the community, and even the state. Essentially, this development of relationships with the gods allowed access to their qualities and, in turn, provided safety, protection, and health for humans. One must know the character and power of the different wills in order to effectively form these alliances. Ancient Mesopotamians expressed their relationships with personified nature in terms of their own hierarchical society: the state, free men, and slaves. Man’s position in the hierarchy of the universe directly paralleled the slave’s posiSA.GIG III. 73; see Labat, TDP, 26–27 SA.GIG VI.39; see Labat, TDP, 60–61. 28 Kinnier Wilson, “The Nimrud Catalogue of Medical and Physiological Omens,” 60–62; Biggs, “Medicine in Ancient Mesopotamia”. Cf. mtw in the Egyptian texts. 29 Thorkild Jacobsen, “Mesopotamia: The Cosmos as a State,” in The Intellectual Adventure of Ancient Man (Chicago: University of Chicago Press, 1977), 127. 26 27

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tion in the hierarchy of earthly, human society. Essentially, the Mesopotamian world system consisted of three groups, the divine, spirits, and humans. In order for the world system to function smoothly, cohesion amongst the different groups was important. As slaves obey freeman and they, in turn, follow the king, so too should humans pursue a proper course of action with regard to the spirits and gods. But unlike Egypt, Mesopotamian religion did not personify such balance and order as a deity. Typically, justice was ensured by several gods such as Enlil, Utu, or Enki. Consequently, this ordered world system expressed more directly the primary value of obedience among the weaker wills and consideration on the part of the stronger wills. The ideology of obedience and consideration is articulated in stories such as Atrahasis in which the Igigi, feeling oppressed, rebel against the god Ellil: Every single one of us gods declared war! We have put a stop to the digging. The load is excessive, it is killing us! Our work is too hard, the troubles too much! So every single one of us gods Has agreed to complain to Ellil.30

After debate amongst the Anunnaki, the gods Enki and Nintu create humans to fulfill the needs of both groups. But such an interchange of complaint and resolution was not limited to the realm of the gods. The story continues: 600 years, less than 600 years passed And the country became too wide, the people too numerous. The country was as noisy as a bellowing bull. The God grew restless at their racket, Ellil had to listen to their noise. He addressed the great gods, “The noise of mankind has become too much,

30 Stephanie Dalley, trans., Myths from Mesopotamia (New York: Oxford University Press, 1989), 12.

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CAN NO PHYSICIAN BE FOUND? I am losing sleep over their racket. Give the order that šuruppu-disease31 shall break out.”32

It is important to note that even when a god is distraught he does not take unilateral action but seeks agreement within the community of the gods. Before any attempts could be made to ensure proper interaction between the divine and human communities, there first needs to be cohesion among the gods. Unity of action allows a punishment to be effective. When divine cohesion breaks down, as we shall see, individual gods can be manipulated and punishments lifted. Like the Igigi before them, humans also have the ability to sway the intentions of a god. Now there was one Atrahasis Whose ear was open to his god Enki. He would speak with his god And his god would speak with him.33

Enki tells Atrahasis how to instigate a rebellion by having the people withhold their reverence and prayer to the gods but only give an offering to the god Namtar, generator of the šuruppu-disease. The ploy works: The flour offering reached him. And he was shamed by the presents. And wiped away his ‘hand.’ The šuruppu-disease left them, The gods went back to their regular offerings.34

Enki breaks the cohesion of the divine community by explaining how the god Namtar can be manipulated. The key here is not the demonstration of obedience to all the gods but to just one. By withholding the sacrifices, the human community sends a message of disobedience to the gods. Yet, the act of sacrifice to Namtar shows the human community wishes to maintain an obedient relaŠuruppu is commonly translated as “shivers” or “chills.” Dalley, Myths from Mesopotamia, 18. 33 Dalley, Myths from Mesopotamia, 18. 34 Dalley, Myths from Mesopotamia, 20. 31 32

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tionship with the divine, Namtar predictably responds by considering the sacrifice, especially in relation to its effect on the divine community. It is the consideration of inter- and intra-community relations expressed as shame that finally convinces Namtar to lift the šuruppu-disease. The ordered world system is not merely the exercising of a powerful will over a weaker one but rather incorporates community consensus and appropriate reciprocity. The tale of Atrahasis through compliant and resolution outlines the foundational principles of obedience and consideration for the relationship between humans and deities, as well as among the deities themselves. Atrahasis also sheds light on Mesopotamian ideas of disease causation. The šuruppu-disease does have a supernatural origin, coming from the hand of Namtar, but it is not a punishment tied to a specific sin. Instead, the disease merely functions as a reaction stemming from the general dissatisfaction of Enlil.35 A common understanding of how ancient people interpreted physical afflictions is either as a divine punishment or an omen of impending disaster stemming from divine disfavor.36 Typical cases cited to support this view include Ludlul bēl nēmeqi37 and Man and his God (The Babylonian Job).38 Both of these cases neglect to name a specific transgression; instead they describe the general dissatisfaction within the divine realm. From the day the Lord punished me And the warrior Marduk became furious with me My own god threw me over and disappeared My goddess broke rank and vanished.39 Enlil and Ellil are the same deity. K. van der Toorn, Sin and Sanction in Israel and Mesopotamia (Assen, Netherlands: Van Gorcum, 1985), 56–57; Robert Garland, The Eye of the Beholder: Deformity and Disability in the Graeco-Roman World (Ithaca, New York: Cornell University Press, 1995), 69. 37 Pritchard, ANET, 596–600; William W. Hallo and Lawson Younger, eds., The Context of Scripture: Monumental Inscriptions from the Biblical World (Boston: Brill, 2003), 486–92 38 Pritchard, ANET, 589–91; Hallo and Younger, COS, 573–75. 39 Hallo and Younger, COS, 487. 35 36

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As long as the sufferer sufficiently repents and supplicates the gods, the specific sin never has to come to light to affect healing. My god… after you will have my eyes recognize my sins… His words of supplication which the young man expressed And the pure prayers pleased the flesh of his god like fine oil Thereupon his god withdrew his hand from the evil matter.”40

Such stories highlight not only the punishment aspect of illness but also the apparent capriciousness of what gods may find offensive. Ancient Mesopotamians also had to contend with demonic attacks from entities seemingly more capricious than the gods and acting at times of their own volition. A terrifying description of such behavior can be found in incantations against the demoness Lamaštu who lurked around the birth of children ready to snatch them away. She is furious, she is uncanny, she has an awful glamour, She crossed a watercourse and made its water muddy, She leaned against a wall and smeared it with filth… Because you have come, you seize the form of his features, You seize the limbs, you destroy the members, You consume the sinews, you twist the muscles. You make the face pale, you distort the countenance, You cause depression, you burn the body like fire!41

Obedience and appeasement through offerings may work for the gods, but are not particularly effective against demons because they do not have to exercise consideration for humans as a means of maintaining their place within a community. Unlike Namtar, a demon such as Lamaštu would not feel shame over receiving gifts without exhibiting the proper reciprocity for them. Demons are powerful entities who stand outside of the community formed by humans and gods. Essentially a third community of spirits existed with powers greater than humans but lesser than the gods. Conse-

Hallo and Younger, COS, 574. Benjamin R. Foster, Before the Muses: An Anthology of Akkadian Literature, 3rd Ed. (Bethesda, Maryland: CDL Press, 2005), 984. 40 41

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quently, someone suffering from a demon-caused illness must find another form of therapy. The best way to cure a patient of a demon attack is to overpower and ultimately drive away the demon. This can be achieved in several ways: the use of prescriptions, rites, and/or incantations, all of which may invoke a more powerful entity, either the healer himself, another demon such as Pazuzu, or, preferably, a god. Therapeutic tablets such as šumma amēlu muḫḫašu umma ukâl (“if a man’s head is feverish”) make liberal use of plants and other substances formed into various applications to aid healing, including those ailments caused by the alû-demon.42 “Cress seed you will grind into well water, fish brine and vinegar spoon into it with a potsherd, and leave overnight under the stars.”43 The prescription continues with directions on how the patient is to apply the salve to his mouth. The instrumental intervention of the prescription would seem incongruous with the supernatural cause of the illness. Yet, many of these instrumental prescriptions also incorporate ritual acts, “red wool you will spin, seven and seven knots you will tie… the charm seven times you will recite…”44 as well as an incantation to counteract the demon’s activities, “the head is affected by evil sickness; by Marduk, the son of Eridu, may you be exorcised, that you be assuaged.”45 Although modern scholars make the distinction between instrumental and symbolic healing, the combination of the two in these prescriptions indicates that the ancient 42 Although the alû is variously referred to as a demon or a ghost, this study classifies it as a demon; see J. V. Kinnier Wilson and E. H. Reynolds, “On Stroke and Facial Palsy in Babylonian Texts,” in Disease in Babylonia (ed. I. L. Finkel and M. J. Geller; Boston: Brill, 2007), 67–99; JoAnn Scurlock, Magico-Medical Means of Treating Ghost-Induced Illnesses in Ancient Mesopotamia (Boston: Brill, 2006) and CAD. 43 K 2418+ and AMT 78,1 translation from Kinnier Wilson and Reynolds, “On Stroke and Facial Palsy in Babylonian Texts,” 75–76; see also R. Campbell Thompson, “Assyrian Prescriptions for Treating Bruises and Swellings,” AJSL 47, no. 1 (1930): 1–25. 44 AMT 79,2, 14 translation from R. Campbell Thompson, “Assyrian Prescriptions for the Head,” AJSL 54, no. 1 (1937): 31. 45 AMT 13,5, 10 translation from Thompson, “Assyrian Prescriptions for the Head,” 33.

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Mesopotamians did not necessarily see such a distinction. When the materia medica is linked to obvious rituals and incantations, their effectiveness against afflictions of supernatural etiology seems clear enough. Cases that present only instrumental recipes still work against demon inspired diseases. The ingredients of some prescriptions call for noxious substances such as animal excrement (dreckapotheke), which tend to offend the demons causing them to leave. Dreckapotheke was not, however, the only operative principle for instrumental treatments. This is especially true when looking at recipes with more palatable ingredients as in K 2418. These therapies ultimately are making use of charged substances that convey a message of obedience to greater powers that will hopefully drive away the demonic afflictions. Ritual actions also communicated to the gods the willingness of humans to obey certain rules governing human-divine relations. Like the substances in the prescriptions, the acts become charged with power. The ritual act of applying a poultice aids the charged substance of the recipe. Similarly, ritual acts like knotting red wool become further charged by an accompanying incantation. The incantations, also, often rely on the ideas of obedience and consideration. In command formula incantations, such as AMT 13, the healer, or even the patient, assumes a more powerful role forcing the demon to swear an oath not to further afflict the patient. Under the oath-curse formulas, the demon must obey the command, May he go to where the sun sets. May he be entrusted to Bidu, great doorkeeper of the Netherworld… Let him be put under your oath; Let him be put under the oath of Ea and Asalluḫi. Let him be put under the oath of the gods of heaven and earth. Let him not come near me; let him not come close to me.46

46 KAR 267 and BMS 53; translation from Scurlock, Treating GhostInduced Illnesses, 363.

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Although the demon stands apart from the human community, it still has a relationship (in essence their own community) with the gods, thus making the oath effective. Incantations placing a demon under the oath of a god are particularly reassuring when using the more palatable medicants. Such ingredients might be appeasing to the demon but that does not guarantee consideration and eventual departure from it. The oath places responsibility on the god(s) to ensure the demon behaves properly. Apart from command formulas, healing incantations also invoke the more powerful gods to be mindful of their role in protecting humans and maintaining the human-divine relationship. Šamaš, judge of heaven and earth, foremost of the Anunnaki; Šamaš, judge of (all) lands; Šamaš, foremost, resplendent one, you are the one who keeps them (the ghosts) in check; Šamaš, judge, (you bring) the things above below…47

His role of judge requires Šamaš to consider the afflicted’s plight. The incantation, even by itself, indicates human obedience to the gods. Demon attacks are not necessarily the direct result of a god punishing an erring Mesopotamian; nevertheless, they do highlight a breakdown in the interaction between the human and divine communities that needs to be addressed. Such an invasion by a demon induces the people to neglect the standard forms of obedience properly due to the gods. The tale of Atrahasis shows that humans, under the duress of illness, can withhold the all-important offerings. It is in the god’s best interest to listen to the supplication of a patient and exercise his protective authority in the humandivine relationship. Besides demons, the spirit community also included beings such as the eṭemmu (“ghosts”) who may be acting on behalf of a god or otherwise protecting community interests when sending afflictions. For the ancient Mesopotamian patient, discovering the cause of the ghost’s agitation takes on as much importance as the task of

47

es, 178.

AfO 29/30.4 12–13; see Scurlock, Treating Ghost-Induced Illness-

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overpowering it. If the ghost acts as an agent of the gods 48 or is provoked by other social concerns, a simple exorcism may only temporarily relieve the patient of symptoms since the underlying cause of the affliction still exists. The more common deities sending out their ghostly deputies to seize a particular person are Ištar, Šamaš, and various city-gods in retaliation for transgressions that are not always clear.49 As in illnesses directly from the gods, it is sufficient for the patient to recognize he has upset the community’s balance of obedience and consideration. One person’s transgression had the potential to drive away a god from protecting the entire human community. If the transgressor was the king, technically a priest ex officio, the threat to the community was only that much greater. Other ghostly attacks arise from the displeasure of spirits for the manner of their death such as by drowning 50 or fire51 and even including their own murder. 52 The afflicted patient is not always guilty of neglect or murder but simply wandered into a dangerous area outside the protective bounds of the community. “If his face twists… hand of a roving ghost in the hinterland seized him.”53 Once again, the ghost regulates the behavior of community members ensuring not just proper relations among the living, but also that the living take care of the dead in the form of offerings and burial rites. Just as the gods use ghosts and demons to act out their will, humans through kišpū (“sorcery/witchcraft”) can harness supernatural powers to cause illness. At times, witchcraft can directly seize someone, awīlu šū kišpū ṣabtūšu.54 Additionally, the sorceress can magically charge substances, often garlic, which an unwitting victim then consumes. “She has fed me her no-good drugs/ She

48 E.g. BAM 482; SA.GIG 4, 10; see Scurlock, Treating Ghost-Induced Illnesses, 293 and Labat, TDP, 33. 49 SA.GIG II 1, 29. 50 SA.GIG IX 2,75. 51 SA.GIG IX 2, 76. 52 SA.GIG XI 2, 40. 53 SA.GIG IX 2, 62. 54 K 2478 (AMT 50/3).

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has given me to drink her life-depriving potion.”55 The bewitchment produces not just physical symptoms but, more importantly, severs the relationship between the afflicted and the divine.56 Common to all the ancient Near Eastern cultures was the need for physical purity. Mesopotamian priests needed to be free from physical defects, to bathe, shave, and abstain from certain foods during special occasions. Interestingly, the king has to refrain from eating garlic when undertaking a namburbi ritual.57 These taboos could also extend to the laity, especially when engaging in private prayer. Many prescriptions counteract the ill effects of ingesting bewitched food by inducing an emetic58 or laxative effect.59 Just as the cure for demon attacks forced the entity to flee from the patient, the laxatives and emetics dispelled from the body the bewitched substances, which, in turn, helped the patient reconcile with his personal god. Once the body was cleansed of its impurity, the gods were more apt to reform a human-divine community. Appeasement through offerings to the witch was not a common therapeutic option; the afflicted sought recourse from an entity more powerful than his attacker. One would think the sorcerer or witch, as members of the community, should be bound by the principles of obedience and consideration, only acting in accord with community consensus and proper forms of reciprocity. The practitioner of kišpū, though, sits in a liminal position within society. Like the ghost tormenting his murderer, an incantation may be addressing a previous wrong. 60 In these situations, the negative charge of witchcraft is not always BRM 4, 18: 2–3; translation from Tzvi Abusch, “Witchcraft, Impotence, and Indigestion,” in Disease in Babylonia (ed. I. L. Finkel and M. J. Geller; Boston: Brill, 2007), 153. 56 Tzvi Abusch, “Witchcraft and the Anger of the Personal God,” in Mesopotamian Magic: Textual, Historical, and Interpretative Perspectives (ed. Tzvi Abusch and Karel van der Toorn; Groningen: Styx, 1999), 81–121. 57 Šurpu III 44; see Toorn, Sin and Sanction, 33. 58 BAM 190. 59 K 8469. 60 KAR 71, rev. 1–8 and ARI I, 13 show how demons and physical discomfort can be deployed against one’s adversary during legal proceedings. 55

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apparent and may be considered as a parallel to the punishment or warning message of a god. But many of the cases recorded indicate that the witch, like the demon, acts of her own malicious will; in this regard the witch has removed herself from the community. An occurrence of sorcery becomes an opportunity for the community to break down by infecting it with impurities. While the human victims suffer in an unclean state, the gods are repelled by that uncleanliness. The key protagonists in the human-divine relationship can no longer function together, thus destroying their community. Just as sorcery can directly seize a person, a god can directly dispel the witchcraft, “May Girra, the warrior, dissipate their spells.”61 Maqlû shows the types of therapies, besides laxatives and other substances, used to cure sorcery induced illnesses that ultimately draw upon the principles of obedience and consideration. A prayer beseeches the gods of the night to: Stand by me, oh great gods, hear my complaint, Judge my case, learn of my proceeding. I have made a figurine of my sorcerer and of my sorceress, He and she who contrive against me, I have set (them) before you, I plead my case… May the full-crowned tamarisk absolve, purify me, May the palm that withstands all winds absolve me, May the …-plant, full of pulp, cleanse me, May the pine cone, full of seeds absolve me. Before you I have become pure as the grass, I have become clean and pure as soap plant.62

This indicates that the patient hopes, if not expects, the gods to consider his plight and to take action based on his proper conduct. His impurity stems not from his own actions or transgressions, but the sorcery has imparted it to him: Because a sorceress has bewitched me, They have driven away from me my (personal) god and my

61 62

Foster, Before the Muses, 720. Maqlû I 1–36; translation from Foster, Before the Muses, 666.

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(personal) goddess, I have become obnoxious to whoever sees me.63

The supplicant claims that certain charged substances have restored his purity making him worthy of the gods’ consideration and help. By seeking such restorative aids, the patient has shown his obedience to the gods and willingness to maintain their relationship. Traumas such as wounds and animal bites may first appear as cases of natural etiology that stand apart from the hand of a god, demon, or sorcery that would allow for a more scientific basis to some aspects of Mesopotamian medicine. Animal bites, like some attacks of demons, ghosts, and sorcerers, occur because of the volition of the animal. Since the animal is an entity that occupies a position outside of the community formed by humans and deities, treatment measures are essentially identical to these categories. An incantation against the bite of a rabid dog illustrates this. In his teeth is carried his semen, Wherever he bit he will leave behind his child. O Damu, lord of life, For curing he has appealed to Šala, O Adad, may they take up the appeal. May he be cured…64

Once again, the afflicted relies on the human-divine relationship with the efficacy of the incantation resting upon the appeal to deities that can exercise their will and power over the dog and his “child,” i.e. rabies. Note that there is no attempt at appeasing the dog itself. The first god addressed, Damu, is known for driving away demons as well as binding torn sinews. Such a combination underscores the Mesopotamian belief in the supernatural world interacting with the human community and the body as its signifier. Damu, in turn, works with Adad and his consort Šala indicating the consideration and consensus amongst the gods themselves. Maqlû I 1–36; translation from Foster, Before the Muses, 666. BM 79938; translation from Irving L. Finkel, “On Some Dog, Snake and Scorpion Incantations,” in Mesopotamian Magic: Textual, Historical, and Interpretative Perspectives (ed. Tzvi Abusch and Karel van der Toorn; Groningen: Styx, 1999), 213–42. 63 64

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Apart from therapeutic ritual incantations, Mesopotamian medical texts also contain diagnostic/prognostic information. Quite often this is presented in the form of omens. As in Egypt, it is interesting to note the role of diagnosis in Mesopotamian health care. In the diagnostic texts, where one would expect to see its function most clearly, the diagnosis does not provide a separate, distinct name for the illness. Where western biomedicine labels illnesses as cancer of giardiasis, Mesopotamian diagnostics refer to many illnesses by the action that caused them. Labat lists the most frequent terms used for diagnostics: qāt (“hand”), ḫaṭṭu ša (“staff of”), maḫāṣu (“to smite”), ṣabātu (“to seize”), mašādu (“to bruise”), lapātu (“to touch”), and kašādu (“to conquer”).65 These are often followed by a divine name or attributed to ghosts, other malevolent spirits, and magicians. The diagnosis merely informs the patient and others which powerful entity is sending the message. Not all diagnoses, though, contain a specific divine name. In the absence of such names, it becomes apparent that the focus is equally on how the entity exerts his power. For the most part, the therapeutic texts lack a diagnosis. They move from symptom descriptions to remedies. Essentially, the symptoms provide enough information as to the nature of the illness in order to proceed with a remedy. Adequate treatment does not hinge upon proclaiming a proper diagnosis. Mesopotamian instructional literature, like that of Egypt, does not concern itself with explaining the ideology behind the actions suggested in the texts. One might be tempted to interpret the presence of a diagnosis as an indication that certain Mesopotamian healers viewed illness in a more scientific manner as something separate from the patient. But this is not the case. The diagnosis reinforces the notion that the afflicted, and his illness, form a community with the divine by describing how another entity has directly affected that person. The nature of the illness to some degree has become the nature of the patient; he exists in the grip of a god. This changed nature then impacts the afflicted’s relationship within the human community.

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Tablets in the SA.GIG series follow the format of other omen texts with a protasis designating the sign and the apodosis stating the prognosis. The medical omens can rely on events external to and seemingly disconnected from the ailing person, “if you observe either a black dog or a black boar, the sick man will die.” 66 While other medical omens refer to a physical condition of the patient: “if his right thumb (lit. “great finger”) is rigid, the sick man will die in seven days.”67 Many other omen texts focus on matters of politicomilitary importance, “if a sheep bites his right foot — raids of the enemy will be constant against my land.”68 At first, the omens appear to be a non-sequitur; how does the behavior of livestock affect enemy troop movements or one’s health? To the ancient Mesopotamians, all observable phenomena can transmit messages from the divine.69 A protasis can serve as an indication for different types of apodoses; the same sign can impart meaning to either an illness or a military campaign, “if the oil divides itself into two — the sick man will die; the army will not return” which provides a clue as to the seemingly disparate elements of the omen. 70 The Mesopotamian diviner interpreted the fractured nature of the oil in water as analogous to a negative outcome whether for an individual or an army. The diviner could also draw upon culturally symbolic colors when reading omens for health care. The similarity between the nature of the events allows for their juxtaposition and thus the prediction. Although the logic behind the separation of oil seems clear enough, we are at a loss as to the symbolic meaning and therefore logic governing the analogy of sheep bites and other protases.

SA.GIG I 1,8. SA.GIG I 1,4. 68 Hallo and Younger, COS, 423. 69 For a discussion of Mesopotamian use of oppositional or complementary statements to disseminate knowledge, see Jean-Jacques Glassner, “The Use of Knowledge in Ancient Mesopotamia,” in Civilizations of the Ancient Near East (ed. Jack Sasson; Peabody, Massachusetts: Hendrickson, 1995), 1815–23. 70 Hallo and Younger, COS, 423. 66 67

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Although Mesopotamian omen literature did not specifically subdivide the practice into categories, scholarship often discusses solicited and unsolicited omens.71 As the name implies, the solicited omen requires some action on the part of the diviner such as slaughtering sheep as part of the rite in asking a specific question of the gods. In turn, the gods write the answer on the entrails of the sacrifice.72 Unsolicited omens simply need the diviner to “read” the signs present around him rather than actively evoking a response. The behavior of animals, monstrous births, and the like can all be construed as divine communication. A third category can be added, mediumistic divination,73 which uses people as the vehicle for the divine message. The more common forms of mediumistic divination are dreams or even necromancy but it is not limited to these. Ecstatic prophecy or inspired speech was more prevalent at Mari as well as during the Neo-Assyrian reigns of Esarhaddon (680–669 BCE) and Assurbanipal (668–627 BCE) than other periods of Mesopotamian history. Mediumistic divination can require specialized knowledge in conjunction with actions (solicited omens) as in the case of necromancy, whereas dreams can be thought of as unsolicited, although still necessitating some degree of specialized knowledge in its interpretation. The overlapping of divinatory categories can also apply to cases of illness. Many of the omens in the SA.GIG series fall into the category of unsolicited omens. The āšipu simply reads the signs manifesting around the patient and declares their proper interpretation. A letter from the āšipu Marduk-šakin-šum reassures Esarhaddon that “there is no cause for concern” (ḫīṭu laššu) with regard to the origin of his illness74 but it is unclear if this was established 71 Walter Farber, “Witchcraft, Magic, and Divination in Ancient Mesopotamia,” in Civilizations of the Ancient Near East (ed. Jack Sasson; Peabody, Massachusetts: Hendrickson, 1995), 1895–1909. 72 The purposeful evoking of an answer may also be referred to as impetrated divination; see Ann K. Guinan, “Divination,” in The Context of Scripture (ed. William W. Hallo and K. Lawson Younger; Boston: Brill, 2003), 421–22. 73 Guinan, “Divination,” 421. 74 Parpola, SAA X 180.

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through unsolicited omens or if the āšipu directly inquired of the gods through some ritual of soliciting omens. There are records of lecanomancy (reading water, usually with stones in it, in a basin) in the omen texts for determining a patient’s prognosis.75 Direct use of a body as a divinatory mechanism in solicited omens tends towards practices such as extispicy (reading animal entrails) with sacrificial animals. The use of a patient’s body in a similar manner for soliciting a prognostic omen would simply be counterproductive. Any solicited omens in connection with illness would necessitate the use of other mechanisms such as oil and be likely to appear in the omen texts rather than medical ones. Treatment of the ill as a form of mediumistic divination mostly aligns with the category of unsolicited omens. The healer inspects the body, reading its signs already written by the gods. From the therapeutic texts it appears that the āšipu and the asû aim their rituals at healing the patient rather than discovering the nature of the illness. The rituals serve as a form of communicating with the gods or other powerful entities but not necessarily asking questions of them. Mesopotamian religious practices allow for communication with the gods in more ways than just soliciting omens through a physical rite. We have already encountered prayers and incantations that beseech the gods to take notice of the plight of their human subjects. Like incantations, ritual acts can demonstrate obedience and beseech the gods to maintain or reform the human-divine bond. Sacrifices are the most obvious form. But, apotropaic rituals commonly target health concerns for the entire human community. Royal letters report on “ceremonies against the appearance of fever and epidemic” including images of Namtar and corpses. 76 Although we lack the details of these particular ceremonies, the actions and materials ultimately convey to the gods the desire of the royal court, and by extension the whole human community, in forming a relationship with the divine. In addition to these physical and oral rites, charged substances, ranging from apotropaic figurines to red string, or even running water, also exert the influential force of kišpu on the various causes 75 76

Hallo and Younger, COS, 423. Parpola, SAA X 218; K. 950.

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of disease. The essential function of charged substances is fairly obvious when encountered in rituals against demon attacks. Incantation against Lamaštu its procedure: a lump of salt/ in a garment you tie up on his neck you tie (it)/ he will be well.77

In this case there is no question of the salt acting as a charged substance necessary for kišpū to be effective. Similar use of charged substances can be found in prescriptions for trauma: [Y]ou take some clay and rub the outer surface of the wound (with it) you fashion a dog from the clay you place it on the north wall directly in the sun you recite this incantation three times over it…78

This prescription relies on sympathetic magic, as the clay dries out so will the wound from a dog bite. It is not too far of a stretch then to see the materia medica in other prescriptions as charged substances and their applications as physical rituals. By combining the oral and physical rites with charged substances, the diviners, priests and other religious functionaries developed a system of communication with the supernatural (i.e. kišpū) that not only could read messages or ask questions but also convey human obedience and even exercise commands. Mesopotamian healers, whether asû, āšipu, bārû, or mašmaššu drew upon these three basic forms to communicate with the supernatural. Yet the technical nature of the therapeutic texts would seem to complicate the image of Mesopotamian medicine as a unified system having a basis in religious practices, whether the healer is an asû or āšipu. The asû appears more as a physician grounded in a sci-

77 YBC 8041, 5–9; see William W. Hallo, “More Incantations and Rituals from the Yale Babylonian Collection,” in Mesopotamian Magic: Textual, Historical, and Interpretative Perspectives (Groningen: Styx, 1999), 277. 78 BM 28944, 7–11; see Finkel, “On Some Dog, Snake and Scorpion Incantations,” 220.

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entific approach with pragmatic treatments since the therapeutic texts list symptoms and mostly materia medica. When a man is sick with coughing, you should grind dried epitâtu-seed and boil in cold cassia juice. He should drink it without hesitation so that he will have an opening, then he will be healthy.79

But the therapeutic texts also contain incantations and rituals that accompany many of the otherwise pragmatic treatments. You should grind white ‘dog’s tongue’80 drop in oil, recite the incantation, anoint him so that he will recover. Incantation: …the heart is strong, the heart is mighty like a lion…81

The therapeutic texts indicate the asû combined both the oral and physical rites with charged substances. At first, the pairing of the three parts of magical practice with the recipes from medical cases seems counterintuitive, but a closer analysis shows that the treatments align with charged substances and physical rites as well as making use of the oral rites. The materia medica acts as the charged substances at times even needing the recitation of a spell over them in order to be effective as a prescription to improve hair growth shows, [B]efore the ‘foremost’ star… lay down a mersu-cake of honey and butter… mix ‘wood of release’, rosemary(?), bat dung, imḫur-ešrā plant and ‘sailor’s dung’ (plant) with oil. Lay it before the star, recite three times the incantation: You, O star, that gives light to […]… may these plants destroy my complaint.82 79 K 2414, 10–11; see Erich Ebeling, “Keilschrifttafeln medizinischen Inhalts,” Archiv für Geschichte der Medizin 13, no. 1 (1921): 1– 78. 80 Many plants used in these prescriptions have yet to be precisely identified and thus remain in their colloquial form. 81 KK. 191+201+2474+3230+3363, col. III, 64–65; see Friedrich Küchler, Beiträge zur Kenntnis der assyrisch-babylonischen Medizin (Leipzig: J. C. Hinrichs, 1904). 82 K 2354+, col. III 49–54; trans. Martin Worthington, “Edition of UGU 1 (=BAM 480 Etc.),” JMC, no. 5 (2005): 21; see also R. Campbell

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The property of the ingredients themselves may even have a natural charge allowing for the omission of a spell in the therapeutic text. “The ḫašûtu-plant with seven heads from the wall of the temple of Marduk…”83 Other ingredients, such as urine, may be naturally repellent which also accounts for the lack of a written incantation accompanying the recipe that would otherwise charge the substance with a repellent property. Scholars readily acknowledge that physical rites occasionally appear in therapeutic texts in the form of tying knots in red string and other practices obviously akin to cultic rituals.84 The most common physical rites appearing in the therapeutic texts, though, are regularly overlooked as such — applying medications and bandaging. These practices give the texts their pragmatic, even scientific appearance due to our modern understanding of cause and effect. If a man’s head burns with sētu-fever and his skin hurts him, his head being swollen, dry, crush, sieve branches of magantree, knead flour of chick peas, flour of lentils, tappinnu-flour, ennenu-cereal together in beer dregs, shave, ditto [ki.min].85

Like Egyptian medical texts, Mesopotamian prescriptions frequently appear in truncated forms using ki.min (“ditto”) in the sections for symptom descriptions as well as treatment applications. Given this tendency of Mesopotamian scribes, we should not limit our understanding of charged substances and ritual to those prescriptions that explicitly state an incantation. Thompson, “Assyrian Prescriptions for the Head,” AJSL 53, no. 4 (1937): 234. 83 K 16764; see Thompson, “Assyrian Prescriptions for the Head,” 33. 84 In the “mouth-washing” ritual that transforms the statue of a god from carved wood (gisštuppu) to an active embodiment of the deity, red wool is tied around the right hand of the craftsman symbolizing the blood when it is ritually severed; see Thorkild Jacobsen, “The Graven Image,” in Ancient Israelite Religion (Philadelphia: Fortress Press, 1987), 15–29. 85 UGU 1 150, iii.17; see Worthington, “Edition of UGU 1 (=BAM 480 Etc.)”.

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Ancient Mesopotamian healers functioned with a different rational process for cause and effect. For them illness and cure were not simply a matter of biochemical reactions. Since illness was a manifestation of divine/supernatural communication, cures must then communicate back in a logical manner that the supernatural entities would understand. The rational process of prayers, incantations, and rituals becomes the basis of treatments. To this end, the act of applying charged substances (i.e. medications) is the necessary physical rite whether ingested or a plaster. Even casts for fractures contained charged substances such as animal dung that aided in the healing process. 86 Just as rituals in a more direct cultic setting convey human obedience to the divine ensuring their mutually beneficial relationship, the act of taking one’s medicine similarly indicates that the human patient is submitting himself to the stronger powers in hopes of maintaining his place in the universal community. Patient treatment, as noted above, is not simply appeasing an angered god but may also require overpowering and dispelling the malevolent forces of demons and sorcery. The charged substances found in the medicines repel the evil afflicting the patient but do not do so alone. The physical rite of the application of medicine reinforces the effectiveness of the substances but also directs it at the specific problem: the attacking spirit/power causing a degraded relationship between the patient and the more powerful gods. Abusch addresses the theological problem inherent in the idea that witchcraft can alienate its victim from his personal god. 87 Not only is it a puzzle as to why the gods, supposedly the most powerful entities, are subject to the power of the witch, but that the healers also sway the actions of the gods. Although powerful, the gods seem easily duped. Rather than questioning the power or the intelligence of the gods, the explanation for the effectiveness of the witch and the healer can be found in the system of communication between gods, spirits, and humans. Sorcery disrupts the lines of communication by making the victim odious to the divine. This can be accom86 87

BAM 124 iii 57; BAM 125:28; BAM 413 12’; BM 309 18:32. Abusch, “Witchcraft and the Anger of the Personal God.”

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plished by bringing accusations against the victim, “a deceitful woman has lied about me.”88 In these cases the gods, who are not necessarily omniscient, find the victim’s behavior unacceptable until further information, provided by the healer, indicates the patient is not only worthy but in need of divine protection. Often, though, sorcery directly affects the victim by imparting to him an uncleanliness visible not only to the gods but to others within his earthly community, “through witchcraft I have received contamination… I am sickening to those who see me.”89 As mentioned earlier, sorcery disrupts the cohesion of the human community, but for the Mesopotamians any incident of illness potentially breaks down relationships not just among humans but with the gods as well. In these cases, the healer is removing the taint that would then allow the gods to resume their interaction with the patient. Regardless of the source of the affliction, the healer responds by reopening the lines of communication allowing the gods to see that the patient is truly an obedient member of all the communities.

MESOPOTAMIAN HEALERS You know all about incantations and the healing of bites, You are a physician, an omen expert, a healer O Gula. I went before you. I bemoaned my life which… I have taken up my Lady’s life-giving drugs, I took up the drugs, the plant, the wood, the stone — all of them. Its ritual: you recite the incantation three times over namruqqu, and the patient should drink it and he will recover.90

In this incantation the goddess Gula is referred to as both an asâtu (“physician”) and a bārâtu (“diviner”), underscoring not only the combination of an incantation, ritual, and drugs within one treatment but that each title is not exclusively aligned with seemingly scientific or magico-religious practices. “My Lady’s life-giving Maqlû I 5. Maqlû II 86, 88. 90 U. 30655; translation from Finkel, “On Some Dog, Snake and Scorpion Incantations,” 222. 88 89

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drugs” indicates that rites, spells, and medicants can be found in the repertoire of any of the healers. In light of the evidence that both the asû and the āšipu used magical means to heal their patients, it is difficult to assign a particular style of text to each practitioner. The assumption that the diagnostic series were meant for the āšipu alone stems from the opening lines, “when the āšipu goes to the house of a sick man…”91 Although the asû is not directly addressed, his literate status would make the diagnostic texts available to him. The āšipu may have had professional secrets, but much of his knowledge was kept by the simple fact that the vast majority of the population was illiterate and not by a restriction of the texts to a special class of healers. The library at Tell Haddad contains many texts, including medical, perfect for the collection of an āšipu. Yet it appears that none of the residents of the houses were professional exorcists with the title āšipu indicating the secrets of the āšipu were to some degree open to anyone in the literate class.92 Other secrets would not have been written down but passed from one generation to the next through an apprenticeship thus maintaining the distinct category of healer — the āšipu — but it is not solely dependent on the texts and the types of practices therein. Little is actually known about the education of Mesopotamian healers. One theory holds that many healers were trained in a school such as the “Faculty of the town of Isin.” 93 Isin was noted for its temple to Gula, the goddess most commonly associated with healing practices. The link between Isin and healers appears also in literature, such as The Poor Man of Nippur, in which Gimil-Ninurta, disguised as an asû, claims to be from Isin. But these associations do not conclusively prove that a medical school with set examina-

SA.GIG I 1,1. Antoine Cavigneaux, “A Scholar’s Library in Meturan?” in Mesopotamian Magic: Textual, Historical, and Interpretative Perspectives (ed. Tzvi Abusch and Karel van der Toorn; Groningen: Styx, 1999), 251–73. 93 Jean Bottéro, “Magic and Medicine,” in Everyday Life in Ancient Mesopotamia (trans. Antonia Nevill; ed. Jean Bottero; Baltimore: Johns Hopkins University Press, 1992), 163. 91 92

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tions existed at the temple of Gula or anywhere else in Isin. 94 Undoubtedly, the reputation of healers from Isin speaks to some type of training taking place there, but this may just as well have been an experienced asû acting as a master, passing on his technical knowledge to disciples without recourse to an established school. A master-apprentice system would also account for the training of healers geographically removed from the temple of Gula at Isin. Despite Bigg’s dismissal of stories such as Why Do You Curse Me, they can illuminate the education/training of healers. As Foster points out in his commentary on the above mentioned tale, a priest of Gula (it is not clear if he is an asû or āšipu) is expected to have a basic level of knowledge concerning languages in addition to his healing arts.95 The healer was thought of in Mesopotamian society as an erudite person, and not just a technician following traditional procedures. The priest’s inability to understand Sumerian shows that this expectation is not always accurate. Such a story indicates that it must have been possible for healers to learn their trade in a technical manner without an extensive, literary-based education. The practices of the āšipu may have necessitated a level of literacy not demanded of the asû. This theory is predicated on the hypothesis that the āšipu as a religious functionary needed to consult extensive omen literature and that he would have undergone the typical scribal education of priests working in a temple. Biggs notes, though, that the āšipu could have easily memorized the more common omens, rituals, and incantations and not have been trained as a scribe. This would especially hold true for priests working outside of urban centers or the royal court. 96 A lack of evidence definitively attaching the asû or āšipu to a temple leaves us with the possibility that a number of healers may have been trained through an apprenticeship without any education in literacy. The reputation

Contra Biggs, see Robert D. Biggs, “Medicine, Surgery, and Public Health in Ancient Mesopotamia,” in Civilizations of the Ancient Near East (ed. Jack Sasson; Peabody, Massachusetts: Hendrickson, 1995), 1919. 95 Benjamin R. Foster, From Distant Days: Myths, Tales, and Poetry of Ancient Mesopotamia (Bethesda, Maryland: CDL Press, 1995), 363. 96 Biggs, “Medicine, Surgery, and Public Health,” 1920 94

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of the healers as men of learning or wisdom may derive from their skills in healing rather than a formal scribal education. The historical development of both the titles as well as the therapeutic and diagnostic texts contributes to the idea that they were divided between the two types of healers. The Akkadian word asû developed from the Sumerian A.ZU which is attested as early as the Ur III period (2100–2000 BCE). During this period we find the earliest medical texts that only consist of treatment recipes without symptom descriptions.97 Evidently, this type of text served as a memory aid to the asû who does not need to consult a text to understand symptoms but simply to reference the materia medica or charged substances. A lack of signs or symptoms should not be taken to mean that the asû practiced without any knowledge of them, but rather, the more likely scenario, that some of his knowledge is kept solely in his head. This may indicate, though, that during the Ur III period the asû relied more on an apprenticeship than studying texts as a means of learning his craft. The asû does not seem to have held any priestly titles in Mesopotamia. The Sultantepe tablets include the asû in a list of professionals.98 Prima facie, this would indicate the asû was a technical pragmatic healer separate from religious ideology. But let us place the asû in his cultural context and see if other technical and pragmatic occupations existed without a basis in religious ideology. Even an activity as straightforward as farming connects to the gods; the gods allow the crops to grow and the farmer appeases the gods with offerings from his yield and this is all without officially being part of the temple personnel — the most basic level of kišpū available to everyone in the community. As discussed above, the asû would similarly understand his treatments to work because the substances have an ability to communicate with the gods to affect the desired result. Yet, even the basic sacrifices of a peasant farmer or herdsman under certain circumstances may require the assistance of more specialized professionals such as a priest.

97 Michel Civil, “Prescriptions Médicales Sumériennes,” Revue d’Assyriologie et d’Archéologie Orientale 54, no. 2 (1960): 57–72. 98 STT 383 ii 10.

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The Old Babylonian period (2000–1600 BCE) experienced a shift in the writing of therapeutic texts in that symptoms begin to appear, in essence, a diagnosis. Eventually, separate diagnostic manuals emerged in the Middle Assyrian and Middle Babylonian periods (1600–1100 BCE). It is thought that during this period the āšipu developed as a distinct healing practitioner. The āšipu is attested as having direct connections to the temple structure, “tablet of Kiṣir-Aššur, exorcist of the temple of Aššur, son of Nabû-bēssun, exorcist of the temple of Aššur.”99 Like the asû, the āšipu most likely had specialized knowledge passed down in an apprenticeship. With the advent of noting symptoms or signs, healing was no longer restricted to just communicating through charged substances and their ritual application but rather healing could develop into a more nuanced system of communication thus allowing for the professional religious functionary to become a healer in his own right.100 The new focus within the medical texts resulted in a new approach to healing. Unlike the new approach of Hippocratic medicine in Greece, the development of the āšipu as a healer did not place him in direct competition with the asû. Letters from the archives of Esarhaddon (680–669 BCE) and Assurbanipal (669–627 BCE) show that both asû and āšipu were in official employ of the king. Some may argue that this is only because Esarhaddon consulted both types of healers as a way of covering all bases, scientific as well as magical. Yet, the asû Urad-nanāya directed the king to, “let the haruspices (bārû) perform an exorcism on account of this.”101 From this we can deduce that, at least at court, the asû had no qualms about using other types of healers. Another possible scenario that scholars rely upon when describing Mesopotamian medicine is the presence of a hierarchy of healers. Scurlock sees the asû as taking a subordinate position and Köcher BAM 303:25f. Rimah 65; see Stephanie Dalley, The Old Babylonian Tablets from Tell Al Rimah (London: British School of Archaeology in Iraq, 1976). In this regard, not only is the āšipu an acceptable healer but now also the bārû (diviner) can be classified as a type of healer. 101 Parpola, SAA X 246. 99

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only diagnosing complex cases with the cooperation or consent of an āšipu.102 The only support offered for this view, however, is BAM 578 iv 45–46, [I]f a man is sick with aḫḫazu and his head, his face, his whole body, and the base of his tongue are affected, the asû is not to lay his hands on that patient; that man will die; he will not live.103

Earlier, Scurlock noted that several prognoses were available including “he will die” which she noted as signifying “a hopeless case.”104 It is not clear why the directive to the asû in BAM 578 “to not lay his hands on that patient” is anything more than a reinforcement of the prognosis “that man will die” which immediately follows, especially considering the sentiment is again reiterated with “he will not live.” The āšipu is not the only practitioner that can make a diagnosis as to the nature and course of a disease, as indicated by BAM 578 and SAA X 246, in which Urad-nanāya states, “I could not clarify his symptoms. Now, however, I am sealing and sending a letter: it should be read to the king, to inform the king, my lord.”105 In this case an asû made a diagnosis but unfortunately we cannot tell whether it was a simple or complicated one. The inclusion of an asû among the āšipu and bārû in the list of practitioners in SA.GIG (XVIII 4) further underscores the idea that the asû can diagnosis without the oversight of an āšipu.106 Rather than looking for differences between the asû and āšipu based solely on therapeutic measures, texts, or even diagnostic ability, we should start to investigate the differences in how the Mesopotamians communicated with the gods and other supernatural entities. A brief look at Mesopotamian divinatory practices shows 102 JoAnn Scurlock and Burton R. Andersen, Diagnoses in Assyrian and Babylonian Medicine (Chicago: University of Illinois Press, 2005), 10. 103 Scurlock and Andersen, Diagnoses in Assyrian and Babylonian Medicine, 10 n.34. 104 Scurlock and Andersen, Diagnoses in Assyrian and Babylonian Medicine, 9. 105 Parpola, SAA X 246. 106 SA.GIG XVIII 3, 14.

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that a variety of prophets easily co-existed. Three titles can be definitively classified as prophets in Mari. The āpilu (“answerer”) is associated with a particular deity and, as the name implies, responds to a direct inquiry typically of state concerns. Although the answerer can solicit omens, no surviving texts describe the particular method used. Also associated with state affairs is the nabû (“prophet”) but, again, little is known of the actual practices. The most common title is muḫḫû (“ecstatic”) who is affiliated with certain deities such as Nergal and Dagan. The ecstatic engaged in various practices such as drinking beer, eating raw lamb, and possibly self-wounding before giving messages from the divine. A ubiquitous form of prophecy, but lacking a title, is dream interpretation. According to the extant records, dream interpreters were employed by the royal household and tended to be women. 107 Assyria of the 7th c. BCE provides more fruitful information on prophetic activity. Here, we see the maḫḫû (ecstatic) again. In Assyria, the ecstatics were predominantly male, could participate in rituals, and even derive messages from dreams. The raggimu (“proclaimer”) is another title connected with state affairs and royal rites, such as the substitute king ritual, but little is known of his method of divination. The šabrû (“revealer”) is linguistically related to bārû (“to look”) although he seems to have some overlap with the proclaimer in terms of function. But like the Assyrian ecstatic, the revealer can use dream interpretation. In addition, there is the šāʾilu (“dream interpreter”) who works with the bārû. The term šāʾilu is related to “ask” and appears as a complement to bārû meaning “inspect.” This type of dream interpreter relies on the use of incense; it might be that the incense is a form of offering to the spirits of the deceased. In comparison to the titles used at Mari, it seems that the Assyrian prophets had more fluidity in terms of associated practices. The Assyrian cases also point towards a cultural tolerance for a variety of prophets who are not in competition with one another nor set in a rigid hierarchy.

107 Annette Zgoll, Traum und Welterleben im antiken Mesopotamien: Traumtheorie und Traumpraxis im 3.1. Jahrtausend v. Chr. als Horizont einer Kulturgeschichte des Träumens (AOAT; Munster: Ugarit-Verlag, 2006), 433–38.

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Rather than drawing analogies with our modern medical system, a more accurate reflection of Mesopotamian healing practices would be to think of the asû and āšipu as titles for prophetic types. The asû-healer originally practiced with the application of charged substances, as evidenced in the earliest therapeutic texts. Although these texts later developed a catalogue of symptoms or signs, the asû seems to have retained his focus on reading and responding through the body. In essence, the asû practiced a form of unsolicited mediumistic divination. Ultimately, the body was a vehicle by which the gods and other more powerful entities communicated. Illness is not a private matter between the one sending the malignancy and the one receiving it. Anyone can see a person’s affliction, and any god can intervene for the patient. The message is public. When a god or other entity, using kišpū, conveyed dissatisfaction by marring the body, the human community became not only aware of it but frightened that the anger of the gods could be transmitted to the rest of the community. 108 The potential harm to the human community would bar the afflicted from certain activities such as work109 and especially cultic participation. We can establish the home as the primary setting for health care based upon the frequency of house calls in the medical tablets as well as literary sources. Cases in SA.GIG and The Poor Man of Nippur indicate that the healer, whether āšipu or asû, went to the patient rather than having the afflicted brought to a special location controlled by the healer. He also did not always need to visit the afflicted. Some of the letters between King Esarhaddon and the asû Arad-Nana indicate that the diagnosis and treatment measures were carried out solely through correspondence. “Concerning the condition of the tooth of which the king wrote me…”110 In this case, the asû never physically examined Esarhaddon. Avalos attributes the frequency of home care to the social stigma of illness. A healer’s house call protected the patient from

As we saw in Maqlû II, 88 “I am sickening to those who see me.” NBC 555 AS.01 and NBC 10891 AS.06. 110 K. 532, rev. ll. 1–5, “ina muḫḫi bulṭi ša šini ša šarru išpurani rešu anaši madu bulṭi ša šini.” 108 109

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public scorn for immoral actions that caused the illness.111 This conclusion, however, presupposes that all illnesses were viewed as divine punishment112 and that the healer intentionally acted in a manner to protect the afflicted from this humiliation. If health care strategies were developed to protect the afflicted’s social status, then why doesn’t the healer come in disguise? The Poor Man of Nippur describes how a shaved head is the typical look of an asû, and this is used to gain easy entry into the house. It would seem obvious then that the bald asû seen approaching someone’s home would impart a similar stigma as the patient walking through the city to a healing center. A more likely motive for the frequency of house calls is the idea of ritual impurity.113 Several texts recount the divine and social rejection of an ill and impure person. 114 A house call removes the possibility of spreading the contamination or having the patient incur further difficulties for violating prohibitions on entering sacred areas while impure. Most likely, the healer operated with society’s perception of illness as a divine message, rather than working against it. As the body signaled problems, a healthy one could then indicate reconciliation with the gods and reintegration with the human community. The asû then used the body to respond in an attempt to maintain the individual as part of a cohesive community. Although the asû conveyed the patient’s obedience to the gods, his reading and manipulating the body’s physical signs makes it seem as though this type of healer was limited to instrumental treatments when his concern ultimately would have been maintaining the cohesiveness of the human community. 111 Hector Avalos, Illness and Health Care in the Ancient Near East: The Role of the Temple in Greece, Mesopotamia and Israel (Atlanta: Scholar’s Press, 1995), 177–80. 112 For an alternative view of qāt DN as analogous to ša qāti, see Toorn, Sin and Sanction, 78. 113 Avalos cites this reason, although briefly; Avalos, Illness and Health Care in the Ancient Near East: The Role of the Temple in Greece, Mesopotamia and Israel, 180–81. 114 VAT 7525; CT 39, 45:28.

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In any case of illness, there is usually a hierarchy of resort in which certain treatments are tried first and then others are sought once the initial treatment has failed. The hierarchy contains popular, professional and folk medicine. Patients tend to consult popular and folk medicine before turning to the professional sector. 115 The āšipu-healer becomes more prominent in a healing context after the development of symptoms or signs in the medical literature. Like the bārû, an āšipu typically focused on signs whether they were integral to the body or external. The new presence of the āšipu in a medical context does not indicate a shift from a scientific basis to a magico-religious one in the healing arts but that by the Middle Assyrian period there was an expansion in how Mesopotamians may have communicated with more powerful entities. With the advent of the āšipu, there is a recognition that messages sent through the body, i.e. illness, can be interpreted by other types of diviners and not just those specialized in a particular type of mediumistic divination, such as the asû. The āšipu reads the signs and responds by demonstrating the patient’s — and human community’s — obedience through the appropriate rituals and incantations in the hopes that the gods will readmit the patient to the humangod community. The practices of the āšipu stand out as something significantly different from the asû because the āšipu had a longstanding tradition of magical procedures apart from a medical context and it is this familiar tradition that the āšipu brought to the treatment of illness. Just as the increase in writing signs/symptoms allowed the āšipu to become a medical practitioner, it also allowed for a new form of response more akin to the rituals and incantations found in other religious contexts. The reading of omens, as well as rituals and incantations, directed the attention of the āšipu towards the divine realm. Although the risk of the human community breakdown is still present, the reason why the affliction was sent was of more importance. This would explain the link between the appearance of the āšipu with symptom descriptions in the medical texts. The āšipu focused on understanding disease etiology, not 115 N. J. Chrisman, “The Health Seeking Process: An Approach to the Natural History of Illness,” Culture, Medicine and Psychiatry 1 (1977): 351–77; Kleinman, Patients and Healers, 49–70.

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because his job is that of a diagnostician, but because he ultimately must craft a response that appealed to the gods, rather than the human community. In this manner, the practices of the āšipu focused on the vertical form of communication. The asû and āšipu as diviners were distinguished by their use of horizontal and vertical forms of communication respectively; this would then classify both types of healers as professionals. Given the tendency to label the asû as scientific based on instrumental treatments and the āšipu as magico-religious, one might want to classify the asû as part of the professional sector, while the āšipu would fall into the folk or popular sector. A professional status for the asû can be derived from two sources. First, Esarhaddon consulted an asû, thus indicating a royal sanctioning; recognition from a political authority constitutes professionalization. Second, legal codes that delineate the rights and responsibilities of the asû show a sanctioning by the legal/political authorities, again conferring professionalization. In contrast, the āšipu is not referenced in legal codes. But, Esarhaddon’s use of an āšipu makes it a position sanctioned by the government and part of the professional sector of health care. Similarly, the association of the āšipu with temples gives him sanction by the culture’s religious authority, thus conferring professionalization. To understand the asû and āšipu as healers in the professional sector, let us contrast them with another type of healer found in Mesopotamian society — the king. We have letters and prayers placing the king in the position of healer. K577 is a plea from Nergal-sharrani that his healing has not been effective and that the king must act in order for health to return. The supplication only uses lēpuš (“act”) with no other indication as to what exactly the king is expected to do. It is assumed that the king is to act as an intercessor with the divine realm on behalf of the afflicted man. A similar situation arises in a Psalm to Ishtar of Assurnasirpal I. Here, the king lists his accomplishments on her behalf and asks her to “drive out” his illness. Assurnasirpal is acting as his own intercessor.116 The king is not a professional healer in the same manner as the asû or āšipu, but there is a recognition that his special position in 116

Foster, Before the Muses, 327–30.

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society, to guide and protect the population as an intermediary with the gods (a priest ex officio), translates into the ability to help people with medical issues. As far as we know, the king does not perform rituals, make prescriptions, or otherwise follow the same practices as the asû and āšipu. His medical abilities derive from the public’s perception of his role as king.

CONCLUSION Much like their Egyptian counterparts, the asû and āšipu share many traits. Both use the same explanatory model of illness based upon the idea that illness is a message between human and divine communities as well as that health depends upon appeasing more powerful entities. The key to understanding the clinical reality for the two healers lies in their approach to the body as a communicative tool. The question then is how does each type of healer read and respond to the message expressed as illness. The asû approached the message from the human point of view. He tried to ascertain the impact of the affliction on the body and the human community. This explains the asû’s apparent focus on physical symptoms. He then treated the physical symptom not only as a means of communicating with the divine, but to remove the outward signs of divine displeasure from the human community. The āšipu approached the message from a different perspective. For him, the world around the patient indicated the position of the divine. His method of treatment communicated directly with the gods in order to re-establish a human-divine community. These different strategies for healing do not indicate a competitive or hierarchical relationship between the asû and the āšipu. Instead, both healers worked equally within the same society; they drew upon and reinforced the religious values of illness, health, and importance of community among humans and gods.

HEALING IN THE HEBREW BIBLE

Unlike the Egyptians and Mesopotamians, the ancient Israelites did not produce a substantial body of distinct medical literature that has survived. The few inscriptions available do not shed much light on the practice of medicine. For example, one bulla simply reads: “(Belonging) to [Tobshalem] son of Zakkur, the physician (rofe).”1 The Hebrew Bible remains our only recourse to investigating the concepts germane to health care in the Pre-exilic period. There are numerous references to plague and tales of disease sufferers, yet few contain enough information to develop a clinical picture of health care, especially when trying to determine the different healers available in ancient Israel. The only passages that give a sufficient amount of detail enabling an analysis of healing practices center on the activities of priests and prophets. For this study, I have limited my analysis to cases of morbidity. Although medicine may resuscitate, it does not resurrect. In keeping with an anthropological approach, I have omitted cases of resurrection such as Elijah with the widow of Zarephath’s son2 or Elisha and the Shunammite woman.3 I take the author’s word at face value that a person is dead and refrain from conjecture that someone was in a coma or the like. To investigate resurrection would take us into the study of 1 This bulla comes from a collection most likely from Jerusalem dated to the 8th–6th c. BCE; see William W. Hallo and Lawson Younger, eds., The Context of Scripture: Monumental Inscriptions from the Biblical World (Boston: Brill, 2003), 200; Nahman Avigad and Benjamin Sass, Corpus of West Semitic Stamp Seals (Jerusalem: Israel Academy of Sciences and Humanities, 1997), 177. 2 1 Kgs 17:17–24. 3 2 Kgs 4:17–37.

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death and the afterlife, issues related to but distinct from medicine per se. I exclude analyses of circumcision and pregnancy. The Hebrew Bible lacks details concerning both circumcision and childbirth, making it difficult to examine either as a case study. Because the biblical accounts of circumcision lack clinical information, it is often viewed as a theological issue. Although modern medicine provides arguments for circumcision as a preventative measure with regard to hygiene, it is difficult to make a clear connection between the biblical ideas of purity/cleanliness and the modern medical notion of hygiene. Since my primary focus is on cases of morbidity and the act of circumcision does not restore health, it falls outside the scope of this current work. Similarly, I omit pregnancy because the ancient accounts do not report it as a disruption of a normal state. Barrenness can be an occasion for healing, but, once again, the texts lack enough information to study its clinical treatment. Childbirth is slightly different. Like circumcision, parturition lacks sufficient detail. The aftereffects of childbirth, however, do represent a disruption of a normal state that is addressed much like other cases of morbidity. Apart from Leviticus 12–15, there do not appear to be any texts that discuss the diagnosis and/or treatment of illness in the form of a medical manual. These chapters, in outlining procedures for the priest to inspect skin afflictions, discharges, and infections of the house to determine if they are clean (ṭahor) or unclean (ṭame), read similarly to the therapeutic texts from Mesopotamia and Egypt in that they give detailed descriptions of symptoms followed by therapeutic directions for the afflicted. The issue of impurity, though, tends to obscure the medical nature of these passages, just as the omen characteristic originally overshadowed many medical cases in the Mesopotamian texts. Part of the difficulty in assessing the role of healers in ancient Israel stems from the fact that the Hebrew Bible does not use specific titles for them; there are no terms akin to the Egyptian swnw and zɜw or the Akkadian asû and āšipu. The term rofe is commonly translated as “physician” but its uses in Gen 50:2, Jer 8:22, Job 13:4, and 2 Chr 16:12 only convey a general sense of healer rather than a specific type. Some see rofe as the designation for a foreign healer such as in Gen 50:2 where the Egyptian embalmers are called ha-rof ʾim. Others stress the non-Yahwistic belief of the heal-

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ers in 2 Chr 16:12, interpreting them as a type of “witch-doctor” relying solely on magic.4 Yet the term rofe can also refer to acceptable healing practices as in Exod 21:19 and Jer 8:22 as well as for God himself in Exod 15:26 and Ps 103:3. Kee notes a change from negative to positive in the Hebrew Bible’s attitude towards the rofe after the spread of Hellenism in the area.5 He claims that the older passages of the Hebrew Bible typically condemn the practices of the rofe, but by the time of the composition of the wisdom of Ben Sira, the rofe heals by divine authority.6 The more pejorative references to the rofe in the older passages of the Hebrew Bible may in fact be admonitions against using the healers of the surrounding cultures. This idea is reinforced by passages such as Elijah’s declaration that King Ahaziah will die since he inquired of Baal-zebub of Ekron rather than Yahweh about his health.7 But the use of rofe in the imagery of Yahweh as healer8 speaks against its exclusive connotation as a pejorative term.

WORLD SYSTEM IN THE HEBREW BIBLE The Hebrew Bible’s depiction of healing practices and even disease etiology relies upon a world system ideology that sees the relationship between Yahweh and the Israelites as governed by covenants. Within this relationship, illness served as a message from God to the Israelite. As in Egypt and Mesopotamia, healing, that is reading and responding to messages encoded in the body, rested upon the fundamental concepts of obedience, consideration, and community Raymond E. Brown, et al., The New Jerome Biblical Commentary (Englewood Cliffs, NJ: Prentice Hall, 1990), 377; see also George Arthur Buttrick, The Interpreter’s Bible: The Holy Scriptures in the King James and Revised Standard Versions with General Articles and Introduction, Exegesis, Exposition for Each Book of the Bible (New York: Abingdon-Cokesbury Press, 1951), 487; Jacob Myers, II Chronicles: Translation and Commentary (New York: Doubleday, 1965), 95; Hans Stoebe, “Rapa, Heilen,” THAT 2 (19): 806. 5 Howard C. Kee, “Medicine and Healing,” in Anchor Bible Dictionary (New York: Doubleday, 1992), 661. 6 Sira 38:15. 7 2 Kgs 1:1–4. 8 Exod 15:26. 4

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cohesion. In order to understand who healers were and how they functioned, we must first look at the system of covenants in the Hebrew Bible and how they express these underlying ideas. Covenants, like the grant and suzerainty treaties among the other ancient Near Eastern cultures, ensured a well-ordered relationship between God and the Israelites. This well-ordered system begins with the Noahic covenant9 which establishes God as the recognized force behind all natural disasters but also that God will not destroy all living things simply because humans have upset Him.10 I give my bow in the cloud and it becomes a covenant sign between me and the land. And I gather clouds over the land and the bow appears in the clouds, I remember My covenant between Me and you and all breathing life among all flesh, and the waters (will) not be, again, for a flood to destroy all flesh. And the bow is in the clouds, and I see it to remember forever the covenant between God and all breathing life in all flesh which is on the land.11

The reiteration that the bow stands as a reminder (zəḵer) indicates the element of consideration as a key to the system of covenants. This is in contrast to Enlil who sent the šuruppu-disease as retaliation for the excessive noise of humans. Although the plague eventually abated, the gods made no promise to refrain from such actions again.12 God’s sense of consideration for humans is reinforced in other biblical passages, such as when Abraham exhorts God to spare the righteous from the destruction of Sodom. 13 In order for God to fulfill his part of the contract, He must heed the plight of humans, especially supplicants. 9 As a way of understanding the ideal world system of the biblical Israelites, the covenants are presented in the order found in the Hebrew Bible and not in chronological order of composition. 10 Gen 8:21; 9:8–17. 11 Gen 9:13–16. 12 Stephanie Dalley, trans., Myths from Mesopotamia (New York: Oxford University Press, 1989), 18–20. 13 Gen 18:22–32.

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The Abrahamic covenant stipulates that all the Israelites, as descendants of Abraham, enjoy the rewards of a relationship with Yahweh. Although the original form of the covenant may have been limited to a monarchical or priestly line,14 by the reign of Josiah (ca. 640–609 BCE), the promise was understood to extend to the entire population and bore a physical mark in the form of circumcision.15 The Abrahamic covenant essentially establishes the Israelites as being in a special community with God, a congregation (qahal). The physical sign of the covenant also sets apart the Israelites from the rest of the Syrio-Canaanite population as a distinct community or camp (maḥane). Biblical Hebrew allows for the overlap of definitions between the terms qahal and maḥane but for our purposes, it is best to use them separately to designate the community between humans and God (qahal) and the community amongst just humans, specifically the Israelites (maḥane). Success of the covenant depends on the cohesion of both the congregation and the camp. The Mosaic covenant highlights a third component intrinsic to the world system that governs healing in the Hebrew Bible — obligation. The contract at Sinai reinforces the idea that Yahweh alone is the deity with which Israel has a special relationship and that particular behaviors are now required of them in return for God’s protection.16 Guinan sees this as manifest in two types of relationships: vertical to describe the God-human relationship and horizontal to describe the human-human relationship.17 Israel owes obligation to Yahweh, but also to each other. It is their obligations within the maḥane that act as signs to God of their obedience to Him and willingness to maintain the qahal.

14 Gen

15. Gen 17; see George E. Mendenhall, “The Nature and the Purpose of the Abraham Narratives,” in Ancient Israelite Religion: Essays in Honor of Frank Moore Cross (Patrick D. Miller, et al.; Philadelphia: Fortress Press, 1987), 346–47. 16 Exod 19–24. 17 Michael D. Guinan, “Mosaic Covenant,” in Anchor Bible Dictionary (New York: Doubleday, 1992), 907. 15

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The covenants in the Hebrew Bible created a world system based on monotheism in which Yahweh is the only deity that the Israelites may worship. Consequently, all illnesses and healing were not only limited to the actions of God alone, but depended upon the exact status of Israel’s relationship with Yahweh. Jer 30:12–17 best illustrates the Hebrew Bible’s ideal of both etiology and therapeutics within the system of covenantal monotheism: For here the Lord said: Your fracture is incurable, Your wound severe; There is no pleading the cause of your wound,18 Medicine, healing, there is none for you. All your lovers forget you, they do not care for you, For I have struck you with the wound of an enemy, With cruel correction, Because great was your iniquity, Vast were your sins. Why cry out over your fracture, Your incurable pain? I did these things to you… But I will bring restoration to you And from your wounds I will heal you.

Disease and injury result from violation of the covenant but these are not the only results. Abandonment by lovers and the strike of an enemy indicate that violation of the covenant places one outside the human community of the maḥane, leaving a person vulnerable. The phrase “your lovers” (ohaveḵa) refers to the nations with which Judah tried to form alliances. In essence, Judah tried to expand the human community beyond the scope intended by the Abrahamic and Mosaic covenants, an act that could ultimately remove Judah from its unique relationship with Yahweh — the qahal. This newlyexpanded human community, caring for the welfare of Judah through a typical political treaty system, is ineffective since they do not plead to Yahweh on behalf of the afflicted. The worship of JPS translates Jer 30:13 as “No one pleads the healing of your sickness.” 18

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other deities among the surrounding Canaanites would place them outside the qahal thus also excluding them from the maḥane. By association then, Israel’s reliance on Canaanite politics disrupts the maḥane and eventually excludes them from the qahal. The juxtaposition of the lines, “there is no pleading the cause of your wound” with “medicine, healing, there is none for you” indicates healing is tied to demonstrations of appeasement and obedience. Once someone is an outcast, he has no chance of being healed. Whether it is from the patient himself or a healer, a supplication normally must be made to God before He takes action. The catch is that once you are no longer part of the human community, you are also outside the community with God; therefore He does not have to consider your plea. Jeremiah’s point, though, is that God upholds His part of the covenants even when humans breach the contract and will heal the afflicted thus bringing them back into both the maḥane and the qahal. Understanding how the Bible portrays the structure and function of the body helps explain the Israelite etiological belief that God sent illnesses as a message to His community the qahal which would also be understandable to everyone in the maḥane. Several passages depict a life force entering the body as a breath through the mouth and/or nose, 19 but nothing of what happens to the air once inside; there is no description of vessels analogous to the Egyptian mtw or Mesopotamian šerʾānu and no real discussion of physiological processes. There is a concern for skin and body fluids per se, but not for how they function physiologically. This lack of systems and processes indicates that the body is conceptualized as a whole. While an illness may be visible only in a particular place, such as the skin or a limb, it is the entire body that suffers. 20 The Hebrew Bible portrays the body as symbolic. This is in contrast to the use of symbolic anatomy found in Egypt and Mesopotamia where body parts were linked with particular deities. The body, 19 Gen

7:22; Isa 42:5; 57:16, etc. This is quite different from the Reductionist/Causation view in which a diseased organ is often disassociated from the rest of the body; see Cecil G. Helman, Culture, Health and Illness (Boston: Butterworth Heinemann, 2000), 27. 20

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then, should be analyzed with respect to how it functions within a larger structure such as a human community or its relationship with the divine; it should not be reduced to mere organs and systems relying solely on instrumental treatments for healing strategies. Leviticus’ concentration on skin afflictions and discharges in terms of clean (ṭahor) and unclean (ṭame) illustrates how the biblical authors understood the relation between the health of the body and the religious community. Skin appearance and body odor typically act as strong indicators of someone’s health with discoloration, eruptions and/or foul smells usually resulting from a disease process. It is precisely these symptoms that Leviticus codifies as signs of religious impurity. By doing this, the Hebrew Bible links outward signs of health to public expressions of religiosity, namely participating in cultic functions as well as residing in the maḥane. Since the maḥane is comprised of members of the qahal, essentially a sanctified group, anyone suffering from ṭame must be excluded from both communities. The case of “snow white” Miriam provides an example of ṭame contaminating the human community and its relationship with Yahweh. Physical restrictions on the priesthood21 can apply to the general Israelite population22 as well as to sacrificial animals all of who have an impact on the wellbeing of the maḥane as a whole and, in turn, the qahal.23 Stories of illness in the Hebrew Bible, frequently connected to religious behavior as a consequence of transgression, illustrate the importance of this community cohesion. 24 The kings of Israel and Judah provide two such examples. Abijah, the young son of King Jeroboam of Israel, fell ill so the king sent his wife, in disguise, to the blind prophet Ahijah for a prognosis. In spite of the gifts sent with the wife, Ahijah informs the woman that her son’s sickness is a direct result of Jeroboam’s breaking the covenant and worshipping other gods; Abijah will die as soon as she returns home. The Lev 21:5, 16–21; 22:4–7. 12–15. 23 Lev 22:21–25. 24 Although Deut 28 lists many curses, including graphic descriptions of illness, it highlights more the individual responsibility rather than the community (qahal or maḥane) as a whole suffering. 21

22 Lev

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cutting off of Jeroboam’s line directly results from the king turning his back on God.25 The health of Abijah’s body is integral to the life and actions of his father, symbolizing the health or cohesion of the maḥane, just as the actions of Jeroboam are important to God in maintaining the qahal. The fact that the son suffers an illness, rather than the father himself reinforces the idea that the body simultaneously symbolizes and functions as part of the maḥane and the qahal. Use of the body to communicate God’s displeasure over someone’s actions is not limited to the family. The king’s body, as head of the maḥane, functions as a message to that community regardless of his own personal adherence to the covenant. Although King Azariah of Judah is noted as doing “what was pleasing to the Lord,”26 he was guilty of failing to remove the shrines to other gods throughout his kingdom, thus allowing his subjects to disobey the covenant disrupting the cohesion of the qahal. As punishment for this transgression, Azariah suffered from some form of skin affliction (ṣaraʿat). This disease did not kill him, but forced Azariah to live in isolation from the human community and not actively govern the kingdom.27 In this case, the body and its health depend upon the proper behavior of the entire community of Israelite. God manifests through illness important messages for the cohesion of the community, but the exact message conveyed is not always clear. The authors of the Hebrew Bible struggled with the idea that illness simply functioned as a divine punishment, as evidenced by Job’s contention with Eliphaz, Bildad, and Zophar. The three friends attribute Job’s misfortune to an unknown transgression; this position fits well with Mesopotamian concepts of disease etiology.28 Job insists that he has done nothing wrong and wishes 1 Kgs 14:1–14. 2 Kgs 15:3. 27 2 Kgs 15:1–7. 28 For Mesopotamian variations of this story, see Samuel Noah Kramer, “A Man and His God,” in Ancient Near Eastern Texts Relating to the Old Testament (ed. James B. Pritchard; Princeton: Princeton University Press, 1969), 589–91; Benjamin R. Foster, “Just Suffer Compositions,” in The Context of Scripture (William W. Hallo, et al.; Boston: Brill, 2003), 485– 95. 25 26

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to make his case in God’s court. Job’s protestation of piety/innocence rests upon a known standard, perhaps the Mosaic covenant, against which he can be judged. Yet, the story of Job illustrates that the proper relationship between God and humans (qahal) is not the only community that can effect one’s health. God, by recounting all of His creation through rhetorical questions, reminds Job that there is a world outside of his perception 29 which eventually Job acknowledges, “Indeed I spoke without understanding/ Of things beyond me, which I did not know.” 30 With this “other world” in mind, the role of the divine council or sons of God (bəne ha-ʾelohim) described in the beginning of the story becomes more clear. God and the divine council form yet another community. Although humans are not a part of the bəne ha-ʾelohim, they live within the same world system and are therefore subject to decisions made by other communities. The human body can serve as a message between God and the bəne ha-ʾelohim, and not necessarily messages to the qahal or the maḥane. For the Israelite, the plethora of disease causation found in other ancient Near Eastern cultures, such as sorcerers, demons, and various deities, is reduced to just Yahweh. Although references to Asherah and the use of high places in the Hebrew Bible suggest a polytheistic religious culture for ancient Israel, they are not connected directly to the idea of healing. Baal worship is denied efficacy in healing, as Ahaziah discovered after a fall when he tried to consult Baal-zebub of Ekron.31 Even trauma, seemingly of a natural etiology, stems from God. When the boys of Bethel tease Elisha about his baldness, the prophet curses them and they are mauled to death by bears.32 During the Exodus, serpent bites result from the people’s complaint about the hardships of their journey. Relief only

The use of “where were you” (efo hayita) in Job 38:3 stresses Job’s ignorance of all things in the world and not necessarily his lack of power to create the world. 30 Job 42:3. 31 2 Kgs 1:1–16. 32 2 Kgs 2:23–24. 29

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comes once Yahweh directs Moses to fashion the bronze snake (nəḥuštan).33 The sending of disease and the act of healing ultimately being attributed to Yahweh places the issue of healers in a vague state. Some are seen as “divinely empowered agents,”34 but little else is discussed as to how they functioned within Israelite culture. Scholars often describe the prophet as the only mediator between humans and God when it comes to healing, completely dismissing the role of the priest.35 As we shall see, the activities of both prophets and priests place them in the role of healers. Like the healers in Egypt and Mesopotamia, the prophet and priest co-existed as complements within a unified system of belief that illness and healing functioned as messages from God. The difference in healing strategies for the prophet and the priest lies in how they received and communicated the messages inherent in illness and healing. Scholars looking at healing in the Hebrew Bible tend to miss some of the operative practices of the healers. Studies will often use a dichotomy between symbolic and instrumental healing as their basis.36 They ignore how the physical practice of applying a poultice or the like is part of a healing system that also incorporates symbolic practices such as praying and may even be a symbolic gesture in itself. When the symbolic and instrumental are joined in analysis of biblical medicine, weight is given to the symbolic, espe33 Num

21:5–9. Kee, “Medicine and Healing,” 659 35 Klaus Seybold and U.B. Mueller, Sickness and Healing (trans. Douglas W. Scott; Nashville: Abingdon, 1978), 35; Julius Preuss, Biblical and Talmudic Medicine (ed. and trans. Fred Rosner; New York: Sanhedrin Press, 1978); Michael L. Brown, Israel’s Divine Healer (Grand rapids: Zondervan, 1984), 53; Jacob Milgrom, Leviticus 1–16: A New Translation with Introduction and Commentary (Anchor Bible Commentaries; New York: Doubleday, 1991), 817, 888. 36 Symbolic healing relies solely on language, ritual, and manipulating cultural symbols without the use of physical and pharmacological treatments. Instrumental or somatic healing focuses only on the physical and pharmacological; see Arthur Kleinman, Patients and Healers in the Context of Culture (Berkeley: University of California Press, 1980), 207–8; Helman, CHI, 151–52. 34

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cially concerning the purity laws.37 By attributing healing to the divine, typically biblical healing becomes classified as “magic.” Someone pronounces the afflicted as healed, as in the case of the prophet Isaiah informing Hezekiah of his restored health,38 thus the physical healing is labeled a miracle. This may be accompanied by a sign such as the shadow receding on the steps.39 Similarly, a priest makes the declaration of cleanliness (ṭahor)40 with the final declaration following a sacrifice.41 Although the Hebrew Bible mentions instrumental healing practices, the physical act of applying fig cakes and the like are downplayed in comparison to the moral/theological importance of prayers to God. 42 We should remember though that magic has three components: the oral rite, the physical rite, and charged substances. The oral rite acts as either a direct plea and/or charges substances that are used in the physical rite which in turn effects the desire of the magical practice. The oral rite in the form of incantations and prayers is obvious enough in Egyptian and Mesopotamian medical literature. For these cultures, the charging of substances is integral to the actions of a healer beseeching, threatening, or otherwise influencing a more powerful entity, ultimately desiring the manipulation, ḥkɜw or kišpū, of the more powerful to consider the patient and act on his behalf. As a direct supplication to Yahweh for healing, the oral rite can be found in several prayers throughout the Hebrew Bible. It seems, however, that the Hebrew Bible lacks the oral rite as a means of charging substances.

Manfred Waserman and Samuel Kottek, Health and Disease in the Holy Land: Studies in the History and Sociology of Medicine from Ancient Times to the Present (Lewiston, New York: Edwin Mellen Press, 1996); Mary Douglas, Purity and Danger (New York: Routledge, 1989). 38 2 Kgs 20:5–6; Isa 38:5. 39 2 Kgs 20:8–11; Isa 38:7–8. 40 Lev 13–15. 41 Lev 14:1–32. 42 Brown, et al., The New Jerome Biblical Commentary, 183; Buttrick, The Interpreter’s Bible, 306; Mordechai Cogan and Hayim Tadmor, II Kings: A New Translation (Anchor Bible Commentaries; New York: Doubleday, 1988), 255. 37

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Who exactly charges substances differs when looking at the medical culture of ancient Israel. In the Hebrew Bible, prophetic healers do not have the power to charge substances. This power only belongs to God. This point is illustrated when the Aramean general, Naaman, seeks healing for his skin affliction (ṣaraʿat) from the prophet Elisha. And Elisha sent to him a messenger saying: “go and bathe seven times in the Jordan and your flesh will be returned to you and be clean.” And Naaman became angry and went out and said: “behold I thought he would go out indeed and stand and call in the name of Yahweh his god and wave his hand on the spot and remove the skin affliction. Are not the Amanah and Pharpar and the rivers of Damascus better than all the waters in Israel? Could I have not bathed in them and be clean?” And he turned and went with wrath.43

The namburbi texts attest to the use of running water in medical treatments in Mesopotamia;44 it would not be a far stretch to imagine the Canaanites had similar practices. Incantations give running water the power to remove the affliction. The ritual for removing “evil of a dog” attests to this: You go to the river and immerse yourself seven times facing upstream, seven times facing downstream. Incantation: Enki, king of the Apsû, king of Eridu are you. May the evil portent of the dog which confronts you not come near him!45

Naaman’s complaint highlights the fact that Elisha’s treatment lacks this important ritual element. Elisha does not perform an oral rite as a direct plea to God, “call in the name of Yahweh his god and wave his hand on the spot.” Nor does Naaman see a difference between the Jordan and the other rivers since it has not been charged, “could I have not bathed in them and be clean?” The Jor43 2

Kgs 5:10–12. Caplice, The Akkadian Namburbi Texts: An Introduction (Los Angeles: Undena Publications, 1974), 9–10. 45 Or 36 (1967) 1–8; translation from Caplice, The Akkadian Namburbi Texts: An Introduction, 16–17. 44 Richard

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dan, historically and symbolically significant to the community of Yahweh (qahal), derives its power directly from Yahweh rather than a magical incantation. Naaman eventually learns that Yahweh’s actions, not a human, charges the substance. This is a significant difference between the practices of healers in the Hebrew Bible and the surrounding ancient Near Eastern cultures. Rather than directly charging a substance, the oral rite’s efficacy is in demonstrating obedience thus persuading God to consider the plight of the afflicted; the oral rite reminds God of His promises to the qahal. The oral rite without the use of a charged substance is demonstrated by Hezekiah, [H]e turned his face to the wall and prayed to the LORD saying, please LORD, please remember that I walked before you in faithfulness with a sound heart and did good in your eyes and Hezekiah greatly weeped… Return and say to Hezekiah ruler of my people, thus says the LORD God of your father: I heard your prayer, I saw your tears. Behold, healing you on the third day you will go up to the house of the LORD.46

For this part of the treatment, the healer’s role is to point out when the prayers are necessary as in the case of Isaiah and Hezekiah.47 Although a prophet may pray on behalf of the afflicted, the Hebrew Bible does not see him as manipulating Yahweh as healers in other ancient Near Eastern cultures would use ḥkɜw or kišpū. The locus of responsibility of care examines who exactly carries out the prescribed treatment. 48 Ultimately, Yahweh does the healing but it is contingent upon the proper conduct of the patient. Yet, the prophets and the priests share in the responsibility of care. The Hebrew Bible portrays the function of the prophets and priests as guiding the Israelites in the proper conduct that will maintain both the qahal and the maḥane. Responsibility of care then falls to whomever can ensure the cohesion of the community, whether patient, healer, or even someone else in the community. 46 2

Kgs 5:2–3 and 5. Kgs 20:1; Isa 38:1. 48 For a more detailed explanation on various loci of responsibility of care, see Kleinman, Patients and Healers, 207–8. 47 2

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In the case of Hezekiah and Isaiah, the locus of responsibility appears to fall upon several people. It is the prophet’s duty to make a prognosis and to ensure that the prophecy is acted upon. In this regard, the locus of responsibility is on Isaiah as practitioner. He must deliver both messages to Hezekiah and see to it that the proper treatment is applied to allow Hezekiah’s recovery. But Hezekiah also bears the burden. Isaiah warns him to “order your house,” to which the king responds with prayer. Finally, the attendants, presumably of Hezekiah, have the responsibility to prepare the fig-cake according to the command of Isaiah. In Israelite medical culture, the prophet as practitioner has the responsibility to see to it that the afflicted understands and accepts the message. The patient also has a responsibility to acknowledge the ultimate source of illness and health — Yahweh. Without either of these acts, the physical treatment of fig-cakes would be ineffective. In part, the story of Naaman’s skin affliction is a tale of the patient being responsible for his own well-being. This does not detract from the idea that Yahweh is ultimately the one who dispenses health and illness, but rather reinforces it because only through the proper conduct of the afflicted will Yahweh heal. When Elisha asks that Naaman be sent to him, one might expect the responsibility to be his. But, the decision to follow the prescription rests with Naaman himself, not king nor prophet. Interestingly, Naaman arrives at the proper decision only after advice from his servants. This indicates that the locus of responsibility rests in part with the human community. Naaman’s servants, both at the beginning of the story and at the end, help Naaman come to the right decision in treating his skin affliction. One might assume Naaman, as an Aramean, is outside of the maḥane, but as an instrument of Yahweh, he is very much a part of the qahal. Therefore, his Israelite maidservant acting to maintain the cohesion of the qahal also treats him as one of the maḥane. Both Hezekiah and Naaman show responsibility lies with the patient, but the actions of Naaman’s servants also indicates that the patient is never wholly divorced from the maḥane. Similarly, Hezekiah is not simply healed, but as part of that healing, Jerusalem is spared the might of the Assyrian army. Like the oral rite, the physical rite also functions as a means for the afflicted to demonstrate his obedience to Yahweh. The physical rite usually appears as instrumental forms of healing. The

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ritual nature of applying poultices, or other activities, is more obvious in the Hebrew Bible when comparing it to the medical texts of Egypt and Mesopotamia. Bathing as a somatic treatment may help a skin affliction but the necessity of dipping specifically seven times in the Jordan River has ritual significance. Naaman must undergo this physical rite in order to be cured. Naaman’s servant even stresses the importance of the physical rite suggested by Elisha with the line: “if the prophet spoke a great word to you, would you not do it?”49 As he learns in the story, God does not heal simply in response to the invocation of His name. Naaman’s cure happens only after he gives up his Aramean expectations and indicates his submission and obedience through an action — ritually bathing in the Jordan — thus signifying his participation in the qahal. A physical rite occurs even in stories that appear simply as miraculous healing through God’s pronouncement. In the case of Hezekiah, God hears (considers) the king’s prayer and has Isaiah announce that Hezekiah will be cured. Yet the story preserves a detail of the physical rite, the application of fig cakes.50 The timing of the instrumental healing technique is important, it occurs after the pronouncement of Hezekiah’s restoration. Buttrick sees the passage in 2 Kgs 20 as dislocated in comparison to Isa 38 but does not offer a satisfactory solution as to why the fig cakes or a second sign is needed to assure Hezekiah of his healing.51 Buttrick interprets the passage as a reminder that Yahweh, rather than the figs, are the key to Hezekiah’s cure. Ironically, though, he does admit that symbolic and instrumental healing are both needed.52 In this regard, Buttrick takes the prayer as symbolic and the fig cakes as 49 2

Kgs 5:13. Kgs 20:7; Isa 38:21. 51 Buttrick, The Interpreter’s Bible, 306. Cogan and Tadmor understand the use of fig cakes as a later tradition that attempts to cast Isaiah “as a healer and wonder-worker, in the style of Elijah and Elisha.” They also indicate that the earliest written sources contain the use of fig cakes, whereas only later versions at Qumran omit it but, even then, it is added as a marginal gloss; see Cogan and Tadmor, II Kings, 255–57. Although problematic, the use of fig cakes as an instrumental healing technique seems to have been an original element of the story. 52 Buttrick, The Interpreter’s Bible, 306. 50 2

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instrumental when a more appropriate reading would be that the prayer and the fig cakes both fall into the category of symbolic, the former as an oral rite and the latter as a physical rite. Just because an instrumental treatment may have some physical efficacy, does not automatically exclude the same practice from having a culturally symbolic significance as well. One would expect that the ritual with fig cakes would happen beforehand, and the pronouncement of health would follow this sign of Hezekiah’s obedience. Hezekiah had already indicated obedience through prayer (the oral rite) which effected his cure. But submitting to the instrumental healing/physical rite after Isaiah declares his return to health shows Hezekiah’s continued obedience; he does not change his behavior upon immediate verbal reassurance of his health. Following the fig cake plaster, a second sign of God’s benevolent act of curing comes in the form of the shadow receding on the steps. A series of reassurances between humans and gods is not unusual in the ancient world. Isaiah’s pronouncement of God’s reconsideration and subsequent cure for Hezekiah may be suspect; he had already announced that Hezekiah would die. In the face of conflicting reports from the same prophet, a safeguard would be a physical demonstration. The use of fig cakes as a charged substance in a physical rite that cures the physical sign of the ailment acts as an outward sign to the maḥane that the latest pronouncement by Isaiah is the correct one. The receding shadow further affirms that the charged substance and healing come from Yahweh lest anyone think another supernatural entity, or Isaiah himself, is the effective power in the treatment. This may also explain why Hezekiah had a choice in the direction of the shadow’s movement. By responding to Hezekiah’s choice, God once again shows that He takes into consideration the members of His community. The physical rite, like the oral rite, is intimately tied to the idea of the charged substance. While the physical rite demonstrates obedience by a member of the qahal, the efficacy of the charged substance as an instrumental healing technique, indicates to the afflicted that God has considered his plea and responds favorably. Since an illness tends to place one outside of the qahal and maḥane, a sign is needed to show that at some point the afflicted can be reintegrated with both of the communities. Numbers 12 legitimates

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for the Israelites the idea of a physical ailment necessitating temporary banishment. And the cloud turned aside from upon the Tent, and behold Miriam with a skin affliction like snow and Aaron turned toward Miriam and behold (the) skin affliction. And Aaron said to Moses, “I pray my lord, I pray do not lay hand upon us (for the) sin which we foolishly committed and which we sinned. I pray do not have her become as the dead who comes forth from his mother’s womb with half his flesh devoured.” And Moses cried out to Yahweh, saying, “I pray do not do this, heal her, I pray.” And Yahweh said to Moses, “if her father indeed spat in her face, is she not shamed for seven days? She (will) be shut up seven days from outside the camp, and afterwards she (will) be brought home.” And Miriam was shut up from outside the camp (for) seven days; and the people did not journey until Miriam was brought home.53

In response to Miriam’s complaint against Moses, Yahweh strikes her with a skin affliction (ṣaraʿat). Both Aaron and Moses cry out to God; the prayers act as the oral rite showing obedience on the part of Aaron and by association Miriam. Moses as intercessor reinforces this demonstration of obedience with his own prayer. God then considers the overall plea and indicates that Miriam will be cured. Miriam’s cure is to wait seven days outside the camp (maḥane) for the humiliation/skin affliction to be finished.54 The physical rite showing Miriam’s obedience to wait outside the camp and the charged substance, a key to the communication process of illness, is the skin itself. Interestingly, there is no mention of the physical cure of the appearance of the skin but we are left to assume that once the waiting period is over, Miriam’s appearance will return to normal. As God has declared in this passage, once the entire proNum 12:10–15. This passage has some lines from the E source, but perhaps others from the more controversial P source; see Richard Elliott Friedman, Who Wrote the Bible (San Francisco: HarperCollins, 1987), 76–79; Baruch A. Levine, Numbers 1–20: A New Translation with Introduction and Commentary (New York: Doubleday, 1993), 328–33. 54 Num 12:14–15. 53

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cess of ailment, demonstration of obedience, and consideration is accomplished, the cure or end of humiliation is complete with the afflicted’s reintegration with the maḥane. As seen in the previous examples, a charged substance can indicate one’s obedience to God, like it does for the Egyptians and Mesopotamians. Yet, a charged substance can also serve the purpose of indicating God’s consideration. Like the illness itself, the charged substance conveys a message. This stems from the fact that God, rather than a healer or a patient, charges the substance. What is unique about the charged substance in comparison to the illness, is that it allows for two-way communication. The illness only conveys a message from God to His qahal and the maḥane. The charged substance allows the afflicted to communicate to God his obedience by submitting to the ritual involving the charged substance. While at the same time, the efficacy of the charged substance to work as an instrumental healing technique allows God to convey another message: his consideration and acceptance of the patient back into the qahal. Through the physical healing, the maḥane also gains reassurance that the afflicted is now safe to readmit.

HEALERS IN THE HEBREW BIBLE This system of messages between Yahweh and the qahal is rather complex, fraught with questions as to the exact reason for the illness, the appropriate charged substance to use, as well as when and how one can be reintegrated with the maḥane. The answers lay with the healers, who, in the Hebrew Bible, are the prophets and priests. Since illness and healing are essentially messages, the use of prophets and priests as healers is a natural outgrowth of their function of communicating with the divine. The healing practices of the prophet seem obvious enough. He declares the message behind the illness such as the transgressions of Jeroboam or the Judahite kingdom’s failings as with Azariah. He gives a prognosis whether favorable as with Hezekiah or unfavorable such as the death of Abijah. The prophet even uses instrumental healing techniques in the form of fig-cake plasters or running water. The priest, though, does not appear to heal. He does not declare a message from God as to the reason behind the illness. And there is no evidence of the priest using instrumental healing. Yet, he does declare a message to the maḥane and he does

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convey messages of obedience to God through sacrifice. The priest, like the prophet, is a healer but his specialty, so to speak, is different from the prophet. We tend to think of the medical specialist in modern terms of systems and organs such as the gastroenterologist or the neurosurgeon. But, as shown, the Hebrew Bible does not portray the body so much as discreet parts. Instead, the body functions as a whole within a community in order to convey messages. The specialty in this medical culture is a matter of communication: how messages are read and to whom they are conveyed. The difference between the priest and prophet as healers is in how and to whom they communicate. Prophetic healing can be characterized by a focus on illness as a message to the qahal as well as the use of what, at best, can be termed intuitive prophecy (whether ecstatic or visionary prophecy) in interpreting the message. Priestly healing concentrates on illness as a message to the maḥane and only uses mediumistic divination as the interpretive method. Before addressing prophetic healing as a form of vertical communication through intuitive prophecy, let us first take a step back and look at the variety of ways in which the ancient Israelite could communication with the divine. One system of classification is to look at the communication as either solicited or unsolicited omens; if humans initiate the contact it is solicited, if contact comes from the divine, the omen is unsolicited. Solicited omens can take highly ritualistic forms such as sacrifice and reading of entrails or even just simple prayer. The unsolicited omen is a matter of reading the “signs” in the surrounding nature such as lightening forms or bird flight, even dreams. Mediumistic divination also falls into the category of unsolicited omens. Rather than any animal or element of nature, the human body itself acts as the vehicle conveying the message from the divine; illness is a form of mediumistic divination. In the other ancient Near Eastern cultures, the ability to read these signs comes from training, typically through the priesthood. The Hebrew Bible, though, allows for another form of communication with the divine — intuitive prophecy.55 The D. Miller, The Religion of Ancient Israel (Louisville, Kentucky: Westminster John Knox Press, 2000), 185. 55 Patrick

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prophet receives messages directly from the divine rather than having it manifest in a physical form, whether a human body or animal entrails. Intuitive prophecy also bridges the divide between solicited and unsolicited since in some cases the prophet is asked to “inquire of Yahweh”56 while in others it is God that initiates the contact.57 Blenkinsopp outlines the definitions of prophecy as, “prediction, emotional preaching, social activism, the ability to enlighten and communicate insight, the founding of a new religion… or the leadership of a cult group.”58 These activities center on the correct relationship between humans and the divine, the congregation (qahal), in terms of what a person does to communicate his obedience to God and what sign is given that the divine accepts or rejects the relationship. 59 Although prophecy can involve all of these definitions, not every prophet, in every context carries them out. Only the functions of prediction, social activism, the leadership of a cult, and the ability to enlighten and communicate insight have a role in the prophetic healing depicted in the Hebrew Bible. Prediction typically refers to the forecasting of events such as the outcome of a battle or destruction of a kingdom. In the medical context, it is limited to the act of prognosis. The prophet predicts whether or not the afflicted will live which essentially declares God’s acceptance of the individual or not. In the case of Hezekiah, Isaiah initially predicts death or God’s rejection of Hezekiah. Later, Isaiah changes the prediction to life since God eventually considered and accepted Hezekiah’s prayer.60 For Abijah, the prediction of death stays in place, indicating the rejection of Jeroboam’s dy56 2

Kgs 8:8. Kgs 20:1. 58 Joseph Blenkinsopp, A History of Prophecy in Israel (Louisville: Westminster John Knox Press, 1983), 27. 59 This is also is described as the prophet acting as the representative of the divine king to humans, proclaiming the requirements of the covenant, and announcing God’s interventions; see Miller, The Religion of Ancient Israel, 186; Frank Moore Cross, Canaanite Myth and Hebrew Epic (Cambridge: Harvard University Press, 1973), 228–29. 60 2 Kgs 20:1–5. 57 2

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nastic line from leadership of the maḥane as well as the qahal.61 At first, the prediction seems to concern Jeroboam’s relationship with his kingdom, essentially the maḥane, since Ahijah recounts the establishment of the dynastic line and gives details as to how the dynasty will come to an end. But within this, Ahijah explains that Jeroboam’s idolatry is the reason behind the illness and destruction.62 Essentially, the prognosis contains the diagnosis of an improper relationship with God, a disruption in the cohesion of the qahal. Whereas prediction conveys the message of God’s anger, social activism focuses on the human side of the relationship. Scholarship frequently discusses the social activism of a prophet, especially in terms of his critiquing the monarchy. Here, the goal of the prophet is to maintain the cohesion of the qahal by ensuring that the king and, in turn, the people obey the stipulations of the covenant. The prophet as social activist exhorts the people to change their behavior and maintain their end of the covenant. Isaiah warns Hezekiah to “order your house.”63 This may be interpreted as simply settling affairs in terms of inheritance or other such domestic concerns, but the phrase can also mean that one should take care that the behavior of the household, and perhaps extending to the maḥane, is in keeping with the covenant as evidenced by Hezekiah’s immediate response of prayer, reminding God that he “walked before you in faithfulness with a sound heart and did good in your eyes.” 64 In social activism as a means of healing, the prophet urges the afflicted to address the root of the illness, a disruption in the cohesion of the qahal. As a social activist, the prophet also takes on the role of cult leadership in the sense that the function of the leader is to ensure the cohesion of the maḥane. Disease within the human community disrupts its cohesion. In other ancient Near Eastern cultures, the

61 1

Kgs 14:10–12. 1 Kgs 14:9. 63 2 Kgs 20:1; Isa 38:1. 64 2 Kgs 20:3; Isa 38:3. 62

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king, as leader, can also act as a healer.65 The story of Naaman illustrates that this is not the case in the Hebrew Bible. The letter went to the king of Israel saying, “and now I sent this letter to you, behold I sent to you my servant Naaman and remove his skin affliction.” And it happened when the king of Israel read the letter and he said, “Am I God, to cause death and to cause life, that this was sent to me, to remove a man from his skin affliction? For, please know and see that, he seeks an occasion to quarrel against me.” And it happened when Elisha, the man of God, heard that the king of Israel tore his clothes and he (Elisha) sent to the king saying, “Why have you rent your clothes? Let him come to me and he will know there is a prophet in Israel.”66

This passage highlights a significant difference between the medical culture of the Aramean world and that of biblical Israel. For these other cultures, the king acts as an intermediary with the gods. The Israelite king, despite his role as guide and protector of the people, does not have the ability to communicate with God as would a healer. Since healing only comes from God, someone is needed that can communicate directly with God. Elisha’s response underscores the idea that the communicative function of the prophet allows him the capacity to effect healing which subsequently maintains cohesion of the maḥane, the ultimate goal of a leader. Although an Aramean, Naaman’s skin affliction does disrupt the relationship between God and His community (qahal). God acts through Naaman, “for in him Yahweh gave victory to Aram,”67 thus making the foreign general a part of the community. All members of the congregation must be clean (ṭahor) or risk no longer being a part of that community. The story of Naaman indicates that one may be a part of the community with God (qahal) without necessarily being a part of the human community (maḥane) specially designated through the Abrahamic covenant. Naaman, himself, 65 K 577 is a plea from Nergal-sharrani that the king must act in order for his health to return. 66 2 Kgs 5:6–9. 67 2 Kgs 5:1.

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does not seem particularly concerned with the technicality of purity but his Israelite slave, and the author of the passage, must rectify the inconsistency of a skin-afflicted individual working on behalf of God. It is the prophet Elisha that, in essence, heals not only Naaman but the qahal. Prediction, activism, and leadership are all important abilities but at the core of prophetic healing is the fact that these skills ultimately enlighten and communicate. How the prophet enlightens and communicates through intuitive prophecy sets him apart from the practice of priestly healing. Enlightenment is directed at the qahal rather than the maḥane and communication is similarly directed. To this end, the mode of communication is focused on, as Guinan called it, the vertical relationship which can manifest as ecstatic or visionary forms of prophecy. 68 Much is made about the nuances of ecstatic prophecy in contrast to visionary prophecy, with the former labeled “primitive” and the latter seen as “classical.”69 Similarly, Mowinckle distinguishes between ecstatic prophets, possessed of a spirit (ruaḥ), and reforming prophets whose words come to them “as moral and religious apprehensions of inexorable facts” or “whispered to them by a divine being, or saw them in ‘visions of the night.’”70 Although these distinctions among types of prophecy may help us eventually to understand why some prophets have a healing tradition and others do not, for this present study, it is more important to separate the communication techniques between the prophet and priest, that is, between intuitive vertical prophetic healing and mediumistic horizontal priestly healing. At first, it appears counterintuitive that priests heal, especially using horizontal forms of communication. They employ sacrifice as a means of vertical communication with God and they never use instrumental healing techniques. They also refrain from pronouncing that someone will die or is healed like the prophets do. But on 68 Ann K. Guinan, “Divination,” in The Context of Scripture (ed. William W. Hallo and K. Lawson Younger; Boston: Brill, 2003), 421–22. 69 Blenkinsopp, A History of Prophecy in Israel, 36. 70 Sigmund Mowinckle, The Spirit and the Word (Fortress Classics in Biblical Studies; Minneapolis: Fortress Press, 2002), 87.

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closer examination, the priests do make a diagnosis, if not a prognosis, and they use sacrifice as a means of symbolic healing. It is through diagnosis and symbolic healing that priestly activity can be categorized as mediumistic and horizontal healing. Leviticus calls for people and items affected with some sort of affliction to be reported to the priests for inspection.71 Depending on the specific appearance of the afflicted, the priest then makes the pronouncement that the person is either ṭahor or ṭame. The message inherent in illness manifests on the body itself which the priests reads directly. He is not given knowledge of the affliction through direct communication with Yahweh. The Hebrew Bible mentions no other divinatory technique such as the urim and thummim or the ephod. In some ways the message inherent in illness is the same whether intuitive prophecy or mediumistic divination is used to discover it. Ultimately, God communicates the existence of a problem. But, as the story of Job indicates, who exactly has the problem and why is not always clear. Intuitive prophecy focuses on the relationship between humans and the divine, the cohesion of the qahal as the problem. Mediumistic divination emphasizes the relationship among humans, the maḥane.72 First, the problem is brought to light by inspecting its bodily/human manifestation. Second, the pronouncement of purity, based on bodily inspection, has a direct effect on the afflicted’s interaction with the rest of the maḥane. If one is ṭame, he must be removed from the camp; “he will dwell in isolation, his dwelling will be outside the camp.”73 The removal of someone from the maḥane immediately causes a disruption which can then affect the cohesion of the qahal. In order to save Israel’s relationship with Yahweh, there must be a system in place to restore the maḥane. 71 Lev

13:2, 9, 19, 25, 30, 39, 43, 49; 14:2, 35. Just because the priest highlights a problem for the camp, does not mean that is the only problem. One’s illness can simultaneously indicate a problem for the congregation as well as the camp. But in contrast to the prophet, priestly healing centers more on communicating the message of illness to the camp. 73 Lev 13:46. 72

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Priestly healing, like prophetic, relies on the same principles of obedience, consideration, and community cohesion. Once the individual is diagnosed through mediumistic divination, the healing process can begin. By submitting to the expulsion from the camp, the afflicted shows his obedience to God. Likewise, the community enforcing the expulsion shows that they, too, willingly submit to their part of the covenant. This dwelling outside the camp functions as one of the physical rituals, just like Miriam’s temporary banishment, that is necessary to show obedience. Priestly healing, though, places the locus for the responsibility of care on the maḥane which must show obedience by maintaining a boundary of purity (ṭahor). This distinguishes priestly healing from prophetic healing, in which only the individual needs to show his obedience to God. The labeling of problems is not only in the hands of an authoritative source such as the prophet or the priest. In the case of Naaman, the initial recognition of məṣoraʿ comes from the Israelite slave girl. Both the Aramean and Israelite kings as well as Elisha legitimate this label. A member of the popular sector initially recognizes a problem and labels the individual as sick.74 Such practices existed in Mesopotamia in the labeling of workers as sick75 and petitions to the king of for healing.76 The Israelite servant girl is the first character to mention that a cure for Naaman can be found with a prophet in Israel. The identification of Naaman’s skin affliction and a curative suggestion from a servant would not be out of the ordinary in the ancient Near East. The uniqueness of the situation is that the skin affliction signaled a significant problem for the Israelite, but apparently not for Aramean society. The Israelite slave labels Naaman, effectively placing him in the sick role from an Israelite perspective.77 This is an important point for the coherence 74 N. J. Chrisman, “The Health Seeking Process: An Approach to the Natural History of Illness,” Culture, Medicine and Psychiatry 1 (1977): 351– 77; Kleinman, Patients and Healers, 49–70. 75 NBC 555 AS.01 and NBC 10891 AS.06. 76 K 577. 77 “A person is defined as being ‘ill’ when there is agreement between his perceptions of impaired wellbeing and the perceptions of those around him. In that sense, becoming ill is always a social process which

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of the Israelite community, especially the qahal. All members of the qahal should have a concern for purity regardless of whether their social station is a slave or a foreign general. If Yahweh acts through you, you are now part of His community. Priests are easy to classify as part of the professional sector of health care. They possess specialized skills in the form of identifying certain conditions as either ṭame or ṭahor and in performing sacrifices. They are legitimated by the religious authorities as well as the political and legal. The Hebrew Bible portrays the prophets as operating in connection, although not always in agreement with, the kings and priests. This would classify the prophets as part of the professional health sector. The priest repeatedly inspects the area at seven day intervals to monitor the progression, or lack thereof, of the affliction. 78 God exhibits His consideration and acceptance of the individual by the eventual healing of the illness. There is no mention of how the conditioned is physically healed, much like the story of Miriam which lacks a direct statement about her skin returning to a normal color. During this interim period one may have only prayed to God or sought the healing practices of a prophet or even some other healer that may have had the designation rofe. The omission of how the physical change occurred is in keeping with priestly healing which focuses on the meaning of the physical affliction for the community and not how to effect a physical change. The diagnosis, like a prophetic pronouncement, acts as the oral rite. The declaration of unclean points out a problem within the cohesion of the maḥane and instigates the physical rite of expulsion from the camp. The combination of the oral and physical rites ideally act as signs of involves other people besides the patient… people who are so defined are temporarily able to avoid their obligations towards the social groups to which they belong… at the same time, these groups often feel obligated to care for their sick members…” Helman, CHI, 85. For further discussion of the sick role, see Howard Brody, Stories of Sickness (New York: Oxford University Press, 2003); Sol Levine and Martin A. Kozloff, “The Sick Role: Assessment and Overview,” Annual Review of Sociology 4 (1978): 317–43; Talcott Parsons, The Social System (Glencoe: Free Press, 1951). 78 Lev 13:6, 16–17, 23, 27–28 and 34.

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obedience that remind God of the covenants, thus sparking His consideration of the afflicted. The designation of ṭame places the afflicted in the sick role which derives from a person’s transgressions.79 In this role, the maḥane designates the individual as being unable to fulfill certain obligations. For the Hebrew Bible, this specifically means cultic obligations or participation in the qahal. The sick role, by placing one outside community obligations, carries an inherent danger of fracturing the maḥane. Leviticus’ isolation of the afflicted symbolically performs this potential danger, thus lessening it. Two ideas can be conveyed to the community by isolation. First is the cautionary example in which one learns not to behave as the afflicted or risk the same fate. As the passage from Jer 30:12–17 indicates, isolation from humans and separation from God can only mean incurable pain. Second is to signal disruptive elements that one should avoid, in essence a contagion or impurity (ṭame). A behavior is less likely to be imitated if it is not modeled.80 The healing process allows for an absolution from transgression and reintegration with the human community. In order to accomplish this, the sick person must seek a remedy from a socially approved authority. In the case of biblical Israel, the presentation of one’s symptoms for inspection by the priest, dwelling in isolation outside the camp, as well as performing the sacrifices, constitute the remedy. The sick role signals to the maḥane disruption and potential restoration of community cohesion. The priest in diagnosis (ṭame) and declaring (ṭahor) focus on a horizontal form of communication; he is essentially making announcements to the maḥane. Upon the declaration of cleanliness (ṭahor), it seems as though the individual may be readmitted to the camp. “On the seventh day the priest shall examine him again: if the affection has faded and The Social System; Levine and Kozloff, “The Sick Role: Assessment and Overview”; Brody, Stories of Sickness, 54–56; Helman, CHI, 85 80 For more on the philosophy of solitary confinement, see Michael Meranze, Laboratories of Virtue: Punishment, Revolutions, and Authority in Philadelphia, 1760–1835 (Chapel Hill: University of North Carolina Press, 1996), 167–69, 194–96. 79 Parsons,

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has not spread on the skin, the priest shall pronounce him clean.”81 But a clean diagnosis by itself does not suffice to gain readmission to the maḥane and participation in the qahal. Where the declaration of unclean enacted a physical rite of expulsion, the appearance of being healed or clean, in turn, prompts another physical rite — the sacrifice. The ritual act of sacrifice must be carried out in order to complete the definition of cleanliness as well as the process of reintegration. This process, as evidenced in Leviticus 14, involves several sacrifices as well as several declarations of cleanliness. And the priest sees and behold the mark of the skin affliction has been healed from the one with the skin affliction, the priest will order and take for the one to be cleansed two live clean birds, and cedar wood, crimson stuff, and hyssop… and will sprinkle it on the one to be cleansed from the skin affliction seven times and cleanse him… the one to be cleansed will wash his clothing and shave all his hair and bathe in water and he will be clean. And it will be on the eighth day he will take two young whole rams and one whole ewe in its first year and three-tenths of an ephah of fine flour for a meal offering mixed with oil and one measure of oil… And the priest will bring up the burnt offering and the meal offering on the altar, and the priest will atone for him and he will be clean.82

The first sacrifice appears to function much in the same way as the ritual of the scapegoat with the live bird being set free after being dipped in the blood of the slaughtered bird to carry away the impurity. Milgrom stresses the similarity between this Levitical passage and purification rituals of the Mesopotamians and Hittites, concluding that the priests have incorporated a “pagan” ritual without fully converting it to the sin offering (ḥaṭṭat).83 Neither the sacrifice nor the sprinkling of the blood mixture on the afflicted causes the cleansing. In its Mesopotamian context, the ritual slaughter charges the substances thus giving it the power to remove the contamination. Under covenantal monotheism, only God can charge sub81 Lev

13:6. 14:3–4, 7, 8, 10, and 20. 83 Milgrom, Leviticus 1–16, 834. 82 Lev

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stances and remove impurity. Therefore, rather than risk a misattribution of power to the priests, cleansing only occurs after the afflicted submits to additional signs of obedience to God, washing, shaving and waiting outside his tent but inside the camp (maḥane). This waiting period not only shows obedience to God, but also signals to the maḥane itself that the individual is undergoing preparation for reintegration, a partial healing of community cohesion. Although the bird may have carried off the impurity, allowing him to physically interact with the human community, there remains the problem that the impurity makes the person ineligible to participate in the community with God (qahal). Remaining outside the tent symbolizes this remaining problem. In order to be fully integrated with both the camp and the congregation, the afflicted must undergo additional sacrifices. On the eighth day the afflicted brings lambs, flour, and oil for the burnt offering (ʿolah) as well as the meal offering (minḥah). Both the burnt and meal offerings act as sacrifices of atonement. There has been some discussion of the burnt offering functioning as an introductory ritual, making God aware of the supplicant before actually announcing his concerns. Other theories see the burnt offering as a celebration of a joyous occasion or more simply as an expiation.84 Leviticus 14 encapsulates the burnt and meal offerings with the terms for the sin (ḥaṭṭat) and reparation or guilt (ašam) offerings. These terms underscore the function of the sacrifices as necessary rituals to reintegrate the individual and restore community cohesion. The sin offering typically acts as a purification rite for the sanctuary but can also purify an individual or the entire community.85 The reparation offering compensates for the violation of sanctified space.86 The affliction initially fragments both the maḥane and the qahal by violating the sacred space with an impurity. Upon completion of all the sacrifices, the priest can finally declare the previously afflicted as ṭahor. The sacrifices and declaration comThe Religion of Ancient Israel, 108–9. The Religion of Ancient Israel, 114. Miller, The Religion of Ancient Israel, 117; Milgrom, Leviticus 1–

84 Miller, 85 Miller, 86

16, 856.

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municates a final message to the maḥane; the impurity is gone, the sin is atoned and the communities are made whole again. Ritual sacrifice as a form of communication has a dualistic function. It does bridge Yahweh with the qahal but it also brings together the members of the maḥane. Douglas outlined how official religion separates categories of clean and unclean, creating boundaries that are symbolically significant and ritually enforced with the hope of maintaining a safe cohesive community with the divine.87 But rituals associated with the categories of clean and unclean, such as sacrifice, also create solidarity with a group identity and not just with the divine.88 The Levitical sacrifices performed after suffering from discharges or skin afflictions not only satisfy both purposes but in effect bridge them by being a form of symbolic healing, not just of the individual but for the entire camp. The act of healing reinforces religious values that express a particular view of the world system and often is limited to those already classified as elites in the society. This could lead one to assume a formal system of education for the healers. For ancient Israel, no such system appears to have existed. There is no debate surrounding a pr ʿnḫ or the “Faculty of the Town of Isin” as we find in Egypt and Mesopotamia. As already noted, the references to rof ʾim are too limited to tease out any information regarding their education. This leaves us with an investigation of the education of the prophet and priest. Prophets in Israel do not come from a particular social background; they could be priests, scribes, or even sheepherders and farmers. Their power to heal derives solely from their personal connection to God. The selection of prophets was not completely random. The story of Elisha’s discipleship with Elijah indicates a selection process. One cannot avoid the simple assumption that a prophet’s knowledge of instrumental healing practices would be passed down to any of his disciples. In this manner, the medical education of a prophet can be described as a type of apprenticeship 87 Douglas does point out that in some ways violation of these rules in actuality helps maintain the community by becoming part of ritual reenactment; see Douglas, Purity and Danger, 196–220. 88 Miller, The Religion of Ancient Israel, 122–24.

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rather than a formal school system. But most prophets in the Hebrew Bible lack a period of discipleship to another prophet. For these healers, how they arrived at their medical knowledge, apart from divine inspiration, can only be guessed. As with the prophets, the selection criteria for priests ensures that their medical activities reinforce cultural norms. It does not appear that priests underwent a specialized medical training but rather received a typical education, most likely at the Temple itself, in reading, writing, and religious traditions. It is in this last category, religious traditions, that the priest would gain his medical knowledge. The instructions in Leviticus 12–15 would serve as his textbook. This is not to say that the Temple functioned as a medical school in its modern sense, but only that the priest acted as a healer in fulfillment of his many duties.

CONCLUSION From the available evidence, it appears that the ancient Israelite could have consulted either a priest or prophet in a time of illness. Both priests and prophets drew from the same explanatory model, that illness is a divine message and the restoration of health means reintegration with the various communities of the world system. Covenants establish relationships with the maḥane and the qahal. The body serves as a messaging system within these communities. The link between illness and ethical transgressions, i.e. breaking covenant stipulations, indicates a threat to these communities. Yet, through the healing practices of the priest and prophet, community cohesion can be maintained. The priest and prophet could bestow a negative label such as “unclean” or “going to die” and then remove that label. Their ability to diagnose and treat a condition arose from their unique relationship with God. Yet there is an appreciable difference between the priest and the prophet, even in their healing strategies. The priest, like the swnw and the asû, focused his attention on the physical symptoms of illness and the ramifications of the message on the human community. Treatment then was directed at restoring an individual to the maḥane by the physical rites of isolation and sacrifice as a demonstration of obedience. In contrast to the priest, the prophet approached illness from the divine perspective. He explained the divine message in terms of its impact on the qahal much like the divinatory practices of the wʿb

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priest and the āšipu. The prophet’s direct communication from God obviated the need for a physical inspection. Treatment measures centered on demonstrations of obedience in the form of direct prayers to God, but the use of physical rites or instrumental healing could also be incorporated as signs of obedience. Like their counterparts in Egypt and Mesopotamia, the priest and prophet as healers make use of the oral and physical rite as well as charged substances in order to demonstrate obedience and evoke divine consideration. For the ancient Israelite wishing to follow covenantal monotheism, the Hebrew Bible offers therapeutic tactics through the priest that center on healing the divisiveness suffered by the human community (maḥane). There is also the ability of the prophet to heal the dissolution of a relationship with Yahweh (qahal). The particular culture of the Hebrew Bible directs medical concepts about illness and healing popular throughout the ancient Near East towards reinforcing covenantal monotheism. The Hebrew Bible’s depiction of God as the ultimate source of healing mitigated the potential conflict between priest and prophets as different healers within the same society.

ANCIENT NEAR EASTERN SUPRA- AND SUBCULTURES The comparative approach for assessing medical pluralism in Egypt, Mesopotamia, and the Hebrew Bible has allowed for an understanding of both a supraculture as well as particular subcultures in the ancient Near East. Traits common to all three cultures include: an ideological basis for medical treatment grounded in the particular cultural understanding of the world system, the belief that illness is a message, the need for purity, healing as an attempt to restore community cohesion, communication among the different communities inhabiting the universe, and finally those who have special communicative abilities acting as healers. These six categories form the basic characteristics of ancient Near Eastern medical culture. Yet someone traveling between Egypt, Mesopotamia, or the Israel of the Hebrew Bible would have noticed variations in the type of treatments available to him, such as what Naaman encountered when moving from Aram to Israel for treatment of his skin affliction. Although all the societies share the trait of basing medical treatments on their world system ideology, it is this very characteristic that allows for individual cultural variation within medical practices across all six of the categories outlined above. Each society has its own subculture for medicine as well as being a part of the ancient Near Eastern medical supraculture. The guiding principle for Egyptian medicine was balance (mɜʿt). Just as all the cities of Egypt were ideally kept in balance by the actions of the pharaoh, the communities of human-god and

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human-spirit1 must also achieve a balance. This is not to say they had equality; Egyptians accepted a hierarchical power structure. Those possessing greater power, though, had a responsibility towards individuals and groups with lesser power. By ensuring a proper balance, the abuses of stronger powers that fragment the communities could be avoided as evidenced by wisdom literature such as The Teaching for King Merikare. Egyptian healers attempted to restore balance within the individual as well as among the communities of the world system. Maintaining a proper hierarchy within and between the human and divine communities was the focus for Mesopotamian medicine. Disruption of the various communities occurs when someone steps outside of the bounds of the divinely ordained hierarchical system. The goal of Mesopotamian healers was to reinstate the afflicted to their proper place in the hierarchy thus restoring community cohesion. The Hebrew Bible, like Egyptians and Mesopotamians, acknowledges the existence of a definite power structure in the world system. Biblical healers concentrated on the covenantal relationship with God in order to maintain cohesion in both the camp (maḥane) and the congregation (qahal). Illness functioning as a message highlights the supracultural belief that the universe is inhabited by a plethora of entities from humans and gods, to animals, spirits, and demons. Each of these groups form various communities that must communicate with one another. The message inherent in illness as well as healing itself helps regulate the relationships among these communities. The exact meaning of the message, though, changes depending on the subculture in which the affliction had occurred. In Egypt and Mesopotamia, diseases and even trauma often served as a punishment for offensive behavior. Someone may have violated the social norms governing human relations, as in the case of Reddedet’s maidservant. He may also have acted in a way that upset human-god or human-spirit relations. The inscription on a 19th Dynasty (1295–1186) memorial stela from Thebes gives the

In this context, spirit is used broadly to include ghosts, demons, and other supernatural entities not typically classified as gods. 1

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cause of an illness as “the power of Amon because of his cow.”2 Although the exact nature of the transgression is vague, it does convey the sense that the afflicted, Nakht-Amon, upset the cohesiveness between himself and his god. The existence of spirits and demons as distinct entities with their own communities gives an additional meaning to illness; the spirit or demon may simply wish to exercise their authority over humans without any provocation from the person suffering the illness. The demoness Lamaštu’s predation on newborns is an example. These types of messages are accounted for in the Egyptian world view of mɜʿt and the Mesopotamian belief in a hierarchy of wills. As a punishment, illness begins the process of correcting the balance of a situation or reminding one of their subordinate station in a hierarchy. The proper order or hierarchy is not fully established until the afflicted completes his healing. When illness occurs due to the capricious nature of demons, spirits, or ghosts, it causes a disruption in the communities that only becomes corrected, once again, when healing is completed. Monotheism in the Hebrew Bible removes the ability of independently-willed spirits and demons to directly afflict humans. This creates the impression that illness only serves to punish humans for behaviors offensive under the covenantal system. Yet, the story of Job contains remnants of the supraculture’s view that communities exist among just the spirits and the divine; these relationships are subsumed under the control of Yahweh, thus barring any community formation between humans and spirits or other gods. Even though humans are not directly part of the spirit-god community, they can still suffer illness as a form of messages sent between God and other supernatural entities. The same principle that governs how each subculture understood illness as a message, also colors how they viewed human physiology. The hierarchy of wills in Mesopotamian culture has the same result as monotheism in the Hebrew Bible, the human body ultimately is under the control of the more powerful partner in any 2 Berlin 20377; see James B. Pritchard, Ancient Near Eastern Texts Relating to the Old Testament (Princeton: Princeton University Press, 1969), 380.

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given relationship. This makes the body as a whole important in conveying messages to an entire community. To this end, Mesopotamian texts and the Hebrew Bible do not describe the physiological function of individual organs. Body parts are not discussed beyond general ideas like emotions or thought originating in the liver and heart. In contrast, Egyptian medical texts give quite a lot of detail as to how certain physiological processes work, especially the mtwvessel system. This mirrors the daily life of Egypt in which the vitality and balance of many communities depended upon and were linked by the Nile. The distinct parts of the human body become a unified whole kept in balance by the flow of substances through the mtw-vessels. Since ancient Near Eastern supraculture views the body as a communicative tool for the gods, it also demands some level of purity for the body. A person suffering from an illness offends the gods, driving them away, which could potentially sever the humangod link for the entire community. The supracultural concept of purity integrates the individual human-god relationship with the communal human-god relationship. One of the objectives of healing, then, became the re-establishment of personal purity in order to maintain community cohesion. Egyptian purity was contingent upon the concept of mɜʿt; to be pure ensured a balance. Those coming into closest contact with the divine such as the priesthood must follow a stricter form of physical purity than the laity of Egyptian society. For the priests to lapse in their individual physical purity risked offending the gods, subsequently placing all of the community in jeopardy. Those outside of the priesthood still had to demonstrate a level of purity by maintaining a natural balance in their personal activities, to ensure the cohesion of the human community. A lack of mɜʿt among the laity posed the same threat of abandonment by the gods. Mesopotamian culture also required that the laity have a level of personal purity in order not to offend the gods. However, unlike Egyptian mɜʿt, Mesopotamia lacked a particular mediating expression for ensuring purity. Activities, or just states of being, were simply and directly noted as offensive. As in the case of bewitchments, ingesting a substance could suddenly render someone impure and offensive. The direct expression of impure or offensive highlights the hierarchical nature of the wills. Those with more

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power have the ability to remove themselves, and the benefit of their power, from communing with offensive lesser beings. The covenantal system of the Hebrew Bible acts as a meditating expression, like Egyptian mɜʿt, for the ideological basis of biblical healing. The Abrahamic covenant extended the necessity of purity to the entire Israelite community or maḥane. The Mosaic covenant outlines that which might offend God thus dissolving His relationship with the qahal. Simultaneously, the Mosaic covenant’s form as a vassal treaty reinforces the hierarchical nature of the qahal. Biblical healing must therefore address violations of the covenant as both personal impurity as well as the potential for it to contaminate the maḥane and the qahal. The integration of personal purity with community cohesion demonstrates that the supraculture of the ancient Near East contained an inherent tension between the individual and the community. The individual, both as body and personality, functioned on behalf of the human community, and especially the community between humans and gods, making his health an important sign of community cohesion. Healing was a method of restoring proper relationships among humans and the supernatural communities by treating the individual. The Hebrew Bible underscores this integration of individual behavior and community cohesion by nearly eliminating the communities formed by supernatural entities other than God while placing greater responsibility on the individual for correct behavior. Egypt and Mesopotamia, though, allowed for a human-spirit community that could effect the cohesion of the human community and human-god community thus comparatively diminishing the responsibility of the individual. If, for all the ancient Near Eastern cultures, illness conveyed the message that something had disrupted community cohesion, it stands to reason that healing, in turn, acted as a means of communicating an appropriate response to that message. Healing, as a response, demonstrated the afflicted’s wish to maintain his relationship with the divine. Hezekiah’s prayer exemplifies this for the Hebrew Bible. Even though the illness may have originated with a demon or sorcerer, it was usually the evoking of the human-god community that resulted in a positive outcome. Incantations from Egypt and Mesopotamia demonstrate how the recollection of the Horus cycle or a plea to a personal god could thwart the disruptive activity of malicious spirits and persons. Those who possessed a

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special ability to communicate with the divine or other supernatural entities would then serve as healers. Although communication with the divine characterized all healing in the ancient Near East, who exactly could accomplish this was subject to cultural variation grounded in the guiding principles of either mɜʿt, hierarchy of wills, or covenantal monotheism. Egyptian healers held titles such as wʿb priest, zɜw, and/or swnw. As a primary duty, the priest carried out actions that would ensure the proper balance in the world and the gods’ continued presence in Egypt. The priest accessing ḥkɜw (power) constituted the performance of these actions. Essentially, the use of ḥkɜw achieved mɜʿt. The wʿb priest uses this same process when carrying out treatment measures whether it appears as instrumental healing with charged substances and physical rites or the more obvious employment of somatic healing with incantations. The zɜw and swnw, likewise, access ḥkɜw, thus restoring mɜʿt by the same type of healing techniques. Tomb biographies and other inscriptions attest to the overlap of titles between temple priests and the zɜw and swnw. But a healer did not necessarily need to be a part of the temple structure in order to hold the titles zɜw or swnw. The literate class could restore balance with ḥkɜw; literacy gave them the ability to communicate with the gods. Which communities each healer communicates with may be a distinction between the wʿb priest, zɜw, and swnw. By virtue of his position in the priesthood, the wʿb priest seems to focus mostly on the vertical communication between humans and gods thus his healing practices were directed towards maintaining cohesion of the human-god community. Similarly, the zɜw’s emphasis on evoking the protective ability of specific gods, such as Serqet, worked towards the proper balance of the human-god community. The swnw stands out as a healer that concentrated more on the physical expression of messages from the divine since this office seems to have also overseen the purity of sacrificial animals. By ensuring the physical expression of purity, health, and above all mɜʿt, the swnw ultimately communicated not just with the gods but also with the rest of the human community; the swnw helped maintain the cohesion of the human community. A similar division existed in Mesopotamia between healers focused on maintaining either the purely human community or human-god communities which centered on reading omens sent by the various wills, in effect forms of prophecy. Mesopotamian heal-

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ers did not have a mediating expression such as balance, rather they worked directly with the displeasure and appeasement of the more powerful wills that form the various communities. The āšipu and bārû could read signs both external and integral to the human body permitting them to use solicited, unsolicited, and mediumistic divination. This variety of techniques allowed for a great range of vertical communication with the divine or other spirits, in receiving the messages inherent in illness. In turn, they could then use magical (kišpû) practices of physical and oral rites as well as charged substances in order to demonstrate the afflicted’s obedience in the hierarchy of wills. The āšipu and bārû as healers helped restore the human-god relationship. The asû, primarily, could only read signs communicated through mediumistic divination. In a set hierarchy of wills, the asû was limited to the physical world. In addition to only reading the physical signs on the body, the early texts associated with the asû concentrate on the use of charged substances in a physical rite. These actions helped demonstrate to the immediate human community the removal of the affliction and eventually reintegration of the patient with the rest of society. Thus his focus would be on the cohesion of the human community. The Hebrew Bible, within its system of covenantal monotheism, also drew upon the use of prophecy in healing as a means of distinguishing its different types of healers. Monotheism outlined by the covenants essentially made obsolete a magical system that negotiated between the spirit and divine worlds. Illness, then, coming only from God necessitated that healers have a special connection exclusively to Yahweh. Intuitive prophets, such as Isaiah and Elisha, became one type of healer due to their unique ability to know the messages sent by God. The prophet received but also facilitated vertical communication in the form of prayers by the afflicted. In this regard, the prophet acted on behalf of the humangod relationship. Despite the undermining of a need to magically thwart the actions of spirits and/or sorcerers, covenantal monotheism still made use of the basic magical practices of physical and oral rites and charged substances as a means for two-way communication between humans and God. The prophets prompt prayers, the oral rite, while applying an instrumental treatment, the physical rite, which derives its efficacy, charged substances, from the power of Yahweh. Such ritualistic healing was not limited to the prophet.

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The priest also used these methods, reinforced by covenantal monotheism, to focus healing activity on the cohesion of the human community. The declaration of clean or unclean is an oral rite that signifies to the community a disruption in their cohesiveness. Mediumistic divination, rather than intuitive prophecy, reveals the message. Once the afflicted no longer presents a physical sign, the process of becoming clean then uses the physical rite and charged substances in the form of sacrifices. Although sacrifice is a form of vertical communication, the priestly use of it in conjunction with illness indicates that is also serves to bring together the human community. The focus of the priest on maintaining purity within the maḥane of the Israelites would classify his healing as a horizontal form of communication. By recognizing the elements for an ancient Near Eastern supraculture, and possibly an eastern Mediterranean one, we can better understand the mechanism for cross cultural exchange. The traits common across the different regional societies would allow for the borrowing of therapeutic tactics but would also help to explain how the new treatments were integrated with an existing medical system. Evidence of this type of exchange appears in the London Medical Papyrus, nos. 27–33.3 The Northwest Semitic passages are incantations with the names of gods such as the Phoenician Eshmun. Steiner concludes that the incantations originated with the Phoenicians and came to Egypt by way of the Arameans. 4 No. 27 directly states that the incantation comes from “those who dwell beyond the desert edge.” The mobility of these incantations attests to the existence of a medical supraculture that relies on the idea of using oral rites that evoke gods and demonstrate human obedience. The supraculture also seems to have functioned with the idea that showing obedience entails preserving the linguistic preference of the deity being beseeched. As a result, the medical papyrus retains the deities’ names, as well as the entire incantation, BM 10059; see Walter Wreszinski, Der Londoner Medizinische Papyrus (British Museum No. 10059) und der Papyrus Hearst in Transkription, Ubersetzun und Kommentar (Leipzig: Hinrichs, 1912). 4 . Richard C. Steiner, “Northwest Semitic Incantations in an Egyptian Medical Papyrus,” JNES 51, no. 3 (1992): 191–200. 3

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in their original language rather than being replaced by Egyptian deities. If the divine wishes to be referred to as Eshmun in order to treat a certain disease, then so be it. Likewise, an exchange of medical practices may have occurred between Egypt and ancient Greece. An Egyptian test for a woman’s fertility calls for her to place an onion in her vagina overnight. If her breath smells like the onion in the morning, she is able to conceive.5 The odor of the onion travels from one part of the body to another through the mtw-vessels thus indicating there is no blockage that would stop the semen; the woman’s body has the proper balance and flow (mɜʿt). A similar fertility test exists in the Hippocratic corpus but calls for the use of garlic rather than an onion.6 Hippocratic medicine bases the efficacy of this test on tubes (φλεβος) that connect the uterus to the rest of the body as well as a proper balance of substances throughout the body that would allow semen to travel unhindered. The use of onion or garlic seems to be a subcultural preference. Although there is no direct evidence of the Greeks borrowing this medical practice, by recognizing similarities in the ideological basis for the efficacy of the therapy, we can begin to understand why certain treatments did cross subcultural boundaries. Medical practices grounded in the fundamental beliefs of the supraculture, or that share particular elements between subcultures, are more likely to travel. In contrast, therapies that require adherence to rather unique elements of a subculture have less likelihood of being shared. For example, Naaman needed to recognize the sole power of Yahweh, in essence adopting the Israelite culture, in order to have his skin affliction healed. Not just anyone could bathe in the Jordan, or would even try, without first undergoing a shift in subcultural practices. This comparative study of medical culture reveals people of the ancient Near East viewed illness and healing as a two-way communication system that bridged the communities of humans and the divine as well as spirits into one fluid mosaic. All of these groups functioned together due to a recursive relationship that ex5 Kahun 6 Aph.

28 (3, 17–19) and Carlsberg IV (1, x+4 – x+6). V, LIX.

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isted between the pairings of individuals to their community and communities to their gods. Healers mediated the communication between these groups expressing obedience on behalf of the afflicted and consideration by the gods. How individuals, their communities, and gods acted and reacted to one another determined cohesiveness or fragmentation of the mosaic. This outlook ultimately influenced the development of a supraculture for the region that impacted the exchange of peoples and ideas that reinforced certain subcultural traits of Egypt, Mesopotamia, and biblical Israel.

BIBLIOGRAPHY Abusch, Tzvi. “Witchcraft and the Anger of the Personal God.” In Mesopotamian Magic: Textual, Historical, and Interpretative Perspectives, edited by Tzvi Abusch and Karel van der Toorn, 83–121. Groningen: Styx, 1999. ——. “Witchcraft, Impotence, and Indigestion.” In Disease in Babylonia, edited by I. L. Finkel and M. J. Geller. Boston: Brill, 2007. Abusch, Tzvi, and Karel van der Toorn, eds. Mesopotamian Magic: Textual, Historical, and Interpretative Perspectives. Groningen: Styx, 1999. Allen, Thomas G. The Book of the Dead. Chicago: University of Chicago, 1974. Assman, Jan. Akhanyati’s Theology of Light and Time. Jerusalem: Proceedings of the Israel Academy of Sciences and Humanities, 1992. Avalos, Hector. “Ancient Medicine: In Case of Emergency, Contact Your Local Prophet.” BR, no. 11 (1995): 27–35, 48. ——. Illness and Health Care in the Ancient Near East: The Role of the Temple in Greece, Mesopotamia and Israel. Atlanta: Scholar’s Press, 1995. Avigad, Nahman, and Benjamin Sass. Corpus of West Semitic Stamp Seals. Jerusalem: Israel Academy of Sciences and Humanities, 1997. Baer, Klaus. Rank and Title in the Old Kingdom: The Structure of Egyptian Administration in the Fifth and Sixth Dynasties. Chicago: University of Chicago Press, 1960. Barns, J. W. B. Five Ramesseum Papyri. Oxford: Oxford University Press, 1956. Berkow, Robert, ed. Merck Manual 16th Edition. Rathaway: Merck, 1992. 139

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INDEX Acceptance, 25, 43, 113, 115, 121 Afflicted, 3, 5–6, 25, 27, 29, 32– 33, 35–36, 41–43, 48, 53, 61, 69–71, 73–74, 89–90, 92, 96, 100–101, 106, 108–119, 111, 113, 115–116, 118–120, 123– 124, 130–131, 133, 135–136 Affliction, 23, 30, 33, 36, 42, 45, 58, 68, 70, 82, 89, 91, 93, 119, 130, 135 skin affliction, 11, 31, 96, 102–103, 107, 109–110, 112, 117, 123, 125, 129, 137 Aramean, 107, 109–110, 117, 120, 136 Authority, 1, 11–12, 16, 21, 32, 57, 69, 92, 122, 131 Balance, 6, 16, 24–25, 36, 63, 70, 130, 135 mɜʿt, 10, 12, 15, 18–19, 21– 23, 25–27, 29–30, 33–36, 38, 40–41, 43, 46, 48–49, 53, 59, 129, 131, 134, 137 Body, 4, 5, 10–11, 22–24, 26– 27, 30, 33, 35, 41, 46–48, 66, 71, 73, 77, 87, 89, 90–91, 93, 95, 97, 102, 104, 115, 119, 126, 131–133, 135, 137 function of, 1, 12, 15, 17, 21,

25, 59–62, 101, 103, 114 image, 59 Camp, 99, 112, 119–122, 124– 125, 130 Canaanite, 11, 99, 101, 107 Causation, 8, 25, 101, 104 Circumcision, 25, 96 Childbirth, 5, 58, 96 Clean, 5, 72, 96, 102, 107, 117, 123, 125, 136 Community, 1, 3, 8, 62, 71–72, 81, 85, 99–100, 104, 111, 114, 122, 131, 138 cohesion, 5, 6, 11, 12, 20, 26–27, 35–36, 37, 44, 53, 82, 102, 108, 116, 120, 122, 126, 129–130, 132– 133, 136 covenantal, 5–6 divine, 20–21, 26, 32, 43, 64– 65, 71, 93 human, 4, 11–12, 20–21, 26, 28, 30, 32, 43–44, 47–48, 52, 64, 66, 69–71, 73–74, 77, 82, 89–93, 99–103, 109, 116–117, 122, 124, 126–128, 132–136 spirit, 66, 69 Communication, 11, 16, 38, 45, 53, 76–77, 79, 81–82, 86, 113–114, 126, 128–129, 134,

155

156

CAN NO PHYSICIAN BE FOUND?

138 vertical, 4–6, 10, 12–14, 18, 24, 39, 41–42, 48, 92, 99, 114, 118, 134–136 horizontal, 4–6, 10, 12–14, 18, 44, 48, 92, 118–119, 136 Complaint, 63, 72, 79, 104, 107, 112 Congregation, 99, 115, 117, 119, 124, 130 Consideration, 18, 27, 28, 35– 36, 42–43, 48, 63, 65–66, 68– 73, 97–98, 111–113, 120– 122, 127, 138 Covenant, 98–100, 102–104, 116–117, 120, 126, 133 Demon, 4, 66–73, 77–78, 81, 104, 130–131 Diagnosis, 31–32, 40, 42–43, 48, 61–62, 74, 86–87, 89, 96, 116, 119, 121, 123 Diagnostic texts, 56, 74, 83, 85 Disease, 1, 4, 7–9, 30, 31, 40, 57, 58, 62, 78, 87, 95, 100–102, 105–106, 116, 130, 137 ʿзʿ, 24–25, 32 etiology, 15, 23, 37, 59, 68, 91, 97, 103–104 Hansen’s Disease, 8–9 šuruppu, 64–65, 98 wḫdw, 23–25, 32, 46 Discharge, 5, 24, 30, 96, 102, 125 Divination, 56, 61 mediumistic, 4, 47–48, 76– 77, 88–89, 91, 114, 119– 120, 135–136 Diviner, 4, 14, 55, 61, 75–76, 78, 82, 86, 91–92

Education, 38, 50, 52, 83–85, 125–126 Enki, 63–64, 107 Enlil, 57, 60, 63, 65, 98 Exorcist, 55, 83, 86 Explanatory model of illness, 37, 93, 126 Ghost, 56–58, 67, 69–71, 73– 74, 130, 131 God (Elohim), 2, 5–6, 18–19, 63, 65, 97–101, 103–108, 110–114, 116–125, 126–127, 130–131, 133, 135 Gula, 82–84 Healer(s), 1, 4, 6, 14, 22, 30–32, 38, 67–68, 101, 105–108, 110, 113–114, 117–118, 127, 129–130, 135 Egyptian, 2, 6, 22, 28, 32–36, 52, 130, 134 swnw, 2, 5, 7, 12, 15, 18, 32, 35–38, 40–42, 44, 46–47, 49–50, 52, 96, 126, 134 wʿb priest, 2, 12, 13, 15, 18, 19, 25, 32, 36–44, 47, 48, 50–53, 126, 134 zзw, 2, 12, 13, 15, 18, 32, 36–38, 40–44, 48, 50– 53, 96, 134 folk, 3, 38 Israelite, rofe, 95–97 king, 92 Mesopotamian, 6, 56, 74, 78, 81, 83–84, 130, 134 āšipu, 2, 55 asû, 2, 5, 7, 13, 55, 56, 59, 77–79, 83–93, 96,

INDEX 126, 135 bārû, 13, 55, 59, 78, 86– 88, 91, 135 mašmaššu, 55, 59, 78 professional, 3, 38, 91–92 Healing, 2, 7, 10, 12, 14, 21, 28– 29, 31, 33–37, 40, 43, 48–50, 51, 66, 69, 77, 81–83, 85, 86, 90, 93, 96, 99–102, 105, 107– 109, 113, 117–118, 125, 129– 131, 134–135, 137 folk, 3, 38, 91–92 instrumental, 3, 4, 6, 29–30, 50, 55, 102, 105–106, 109–111, 113, 118, 127, 134–135 practices, 5, 32, 41, 44, 83, 89, 95, 97, 106, 113, 121, 125–126, 134 pragmatic, 79, 85 priestly, 114, 118–119, 120– 121 process, 17, 29, 49, 81, 120, 122 professional, 3, 37–38, 91, 92, 121 prophetic, 114–115, 118, 120 ritualistic, 135 somatic, 105, 110, 134 strategies, 5, 6, 21, 22, 27, 102, 105, 126 symbolic, 17, 25, 50, 55, 67, 105, 110, 119, 125 Health, 1–2, 4, 18, 22, 24, 28, 61–62, 75, 77, 93–96, 102– 104, 106, 109, 111, 117, 126, 133, 134 care, 3, 6, 8, 10–13, 37–38, 49, 51, 56, 59, 61, 74–75, 89–90, 92, 95, 121

157 Herodotus, 22, 46 Hierarchy, 3–4, 10–12, 25, 55, 62–63, 86, 88, 91, 130–131, 134–135 Horus, 15, 21, 29, 30, 44, 133 House of Life, 40, 50–51 Illness, 1, 4, 7–12, 16, 18, 21–22, 24–28, 30–33, 35–37, 39, 43, 45–46, 48, 52–53, 56–57, 62, 66–67, 69, 70, 72, 74–77, 81– 82, 89–93, 96–97, 100–103, 105, 109, 111–114, 116, 119, 121, 126–127, 129–133, 135– 137 Impurity, 5, 71–72, 90, 96, 102, 122, 124–125, 133 Incantation, 4, 15, 17, 23–24, 27–31, 34, 37, 58, 66–69, 71, 73–74, 77–82, 84, 91, 106– 108, 133–134, 136 Ingredient, 27–28, 30–32, 34– 35, 68–69, 80 Injury, 21, 23, 31, 48, 100 Integration, 4, 13, 62, 90, 113, 122, 124, 126, 133, 135 Intercessor, 60, 92 Isin, 57, 84, 127 Isis, 21, 25, 28–29 Job, 65, 96, 103–104, 119, 131 King, 18–21, 38, 40–43, 51, 60, 63, 70–71, 86–89, 92–93, 102–103, 109, 115–117, 120 Lamaštu, 66, 78, 131 Leiden Papyrus, 1, 16, 17, 34, 44 Leprosy, 8, 9 Leviticus, 5, 96, 102, 119, 122– 124, 126 Magic, 2, 4, 18, 26, 56, 106 ḥkзw, 26–30, 33–34, 36–37, 40, 43, 48, 52–53, 106,

158

CAN NO PHYSICIAN BE FOUND?

108, 134 kišpū, 70–71, 77–78, 85, 106, 108, 135 oral rite, 11, 17, 21, 27, 30, 36, 77–79, 106, 107–109, 111–112, 121, 127, 135– 136 physical rite, 11, 17, 27, 34, 36, 52, 77–81, 106, 109– 112, 121, 123–124, 126– 127, 134–136 charged substance, 27, 29– 30, 34, 36, 40, 42, 48, 68, 73, 78–81, 85–86, 89, 106–108, 111–113, 127, 134–136 sympathetic, 35, 78 Magician, 36, 37, 47, 55, 74 Marduk, 60, 65, 67, 80 Materia medica, see Medication Medical papyri, 13, 15–17, 23– 24, 27, 30–31, 33, 36, 42, 48 Ebers Papyrus, 16, 17, 22, 28, 31, 37, 41 Edwin Smith Papyrus, 1, 16– 17, 19, 28, 36, 37 Medical pluralism, 3–4, 12, 129 Medical school, 49–51, 83, 126 Medication, 22, 62, 80–81 Message, 4–5, 10–11, 16, 18, 20, 25, 27, 30, 40–43, 48, 53, 56, 62, 64, 68, 72, 74, 76, 89, 90, 93, 97, 101, 103–104, 109, 113–114, 116, 119, 125–126, 129–136 Monotheism, 10, 12, 100, 123, 127, 131, 134, 135, 136 Mtw–vessels, 17, 22–25, 31–33, 46, 59, 62, 101, 132, 137 Namtar, 64–66, 77

Natural, 6, 10, 12–13, 15–19, 20, 23–25, 27, 30, 33, 35–36, 37, 73 Namburbi texts, 58, 71, 107 Obedience, 11, 18, 25–27, 35– 36, 39–41, 42, 48, 52, 63–66, 68–71, 72, 77–78, 81, 90–91, 97, 99, 101, 108–114, 120, 122, 124, 126–127, 135–136, 138 Obligation, 25, 38, 48, 99, 121– 122 Offering, see sacrifice Omen, 65, 82, 96 texts, 1, 58, 75–77, 84 solicited, 76–77, 114, 135 unsolicited, 4, 76–77, 89, 114–115, 135 Osiris, 30, 50 Physician, 2, 7, 15, 31, 35, 37, 50, 52, 55, 61, 78, 82, 95–96 Physiology, 15, 17, 21–23, 37, 59, 61, 131 Plague, 9, 39, 95, 98 Power, 10–12, 20–21, 26, 28– 30, 33–34, 38, 40, 42–44, 48, 60–61, 62, 67–68, 73–74, 81, 104, 107–108, 111, 123–125, 130–131, 133–137 Prayer, 51, 58, 64–66, 71–72, 77, 81, 92, 106, 108–112, 114– 116, 127, 133, 135 Pregnancy, 28, 96 Prescription, 16, 27–28, 33, 37, 44, 67–68, 71, 78, 80, 93 Priest, 2–3, 5–6, 12–13, 15, 18– 19, 25–26, 32, 36–44, 47–48, 50–53, 70, 84–85, 93, 96, 105–106, 113–114, 118–127, 134, 136

INDEX Prophet, 2–3, 5–6, 13, 47, 88, 95, 102, 104–111, 113–121, 125–127, 135 Prophecy, 13, 109 ecstatic, 76, 88, 114, 118 intuitive, 114–115, 118–119, 135–136 visionary, 114, 118 Protection, 26, 28–29, 41, 62, 82, 99 Prognosis, 31, 40, 43, 75, 77, 87, 102, 109, 113, 115–116, 120 Purity, 5, 25, 47, 71, 73, 96, 106, 118–121, 129, 132–133, 134, 136 Reductionist, 2, 101 Remedy, remedies, 1, 3, 28–29, 30–31, 34, 53, 58–59, 74, 122 Ritual, 4–5, 28, 33–36, 39, 42, 68, 74, 77, 80, 82, 86, 88, 90, 105, 107, 110–111, 113, 123– 125 Sacrifice, 5, 47, 61, 64–65, 76– 77, 85, 106, 114, 118–119, 123–125, 128, 136 SA.GIG series, 55–58, 61–62, 70, 75–76, 83, 87, 89 Science, 2, 4, 8, 18 Scribe, 16, 33, 40, 47, 50–51, 57, 84 Sekhmet, 21, 37, 39, 40, 42–43 Semen, 25, 73, 137 Serqet, 25, 41–43, 47, 134 Seth, 15, 21, 29 Sick role, 32, 48, 120–122 Signs, 47–48, 76–77, 85–86, 89– 91, 93, 99, 102, 114, 121, 124, 127, 135 Sorcerer, 24, 28, 30, 43, 71, 73,

159 104, 133, 135 Sorcery, 58, 70, 72–73, 81–82 Spell, 26–31, 34–35, 37, 79–80 Subculture, 129–131, 137 Supernatural, 5–6, 8, 10, 12–13, 17–18, 24–25, 33, 58, 61–62, 65, 67–68, 70, 73, 78, 81, 87, 130, 131, 133 Supraculture, 129, 131–133, 136–138 Symbolic anatomy, 25, 26, 61, 62, 101 Symptom, 6, 9, 23, 31–32, 40, 50, 52–53, 57–59, 61, 70–71, 74, 79–80, 85–87, 89, 91, 93, 96, 102, 122, 126 Temple, 6, 20, 25, 27, 38–40, 42, 47–50, 80, 83–86, 92, 126, 134 Jerusalem, 3, 6, 7 Trauma, 17, 19–21, 23, 24, 37, 73, 78, 104, 130 Treatment, see Healing Therapeutic texts, 56, 67, 74, 77–80, 85–87, 89, 96 Unclean, 72, 82, 96, 102, 121, 123, 125–126, 136 Utu, 63 Wills, 10, 12, 62–63, 131–132, 134–135 Witch, 71–72, 81 Witchcraft, 70–72, 81–82 World system, 11–12, 17, 33, 36, 43, 48, 56, 59, 63, 65, 97– 100, 104, 125–126, 129–130 Yahweh, 97, 99–100, 102, 104– 113, 115, 117, 119, 121, 125, 127, 131, 135, 137