Although the various cultures of the ancient world had different expressions for symbiotic anatomy, they all understood the body as a messaging system between the different communities of the anatomy, the supernatural realm, and humans. Whether it was an animal attacking a person, a curse from an angry neighbor, or an attack from a ghost after wandering into the wrong place, all derived from the supernatural world sending a message to the afflicted. It is important not to assume these were necessarily punishments but signs that a normal social order had broken down.
See Also: Ancient Medicine: From Mesopotamia to Rome (Eerdmans, 2019).
By Laura Zucconi
Professor of History
Stockton University
January 2020
Introduction
Histories of ancient medicine tend to focus on just the Greco-Roman world, ancient Egypt, or Mesopotamia. They often lack an integrative approach analyzing how the medical cultures of the Ancient Near Eastern societies intermixed and carried through to the Mediterranean world. The brevity of this article means that certain cultures like the Hittites and Persians will be omitted but can be found in books such as Ancient Medicine: From Mesopotamia to Rome (Zucconi 2019). This article will focus on contextualizing Israel/Canaan within the greater Ancient Near Eastern and Greco-Roman traditions and the ideological trajectory of those traditions.
Regardless of the culture, there is a tendency in modern scholarship only to look at successful diagnoses and treatments that lead to continued improvements in medicine. Therapeutic measures labeled as “failures” are relegated to amusing oddities to underscore the great advancements in modern medicine, particularly. More recently, the History of Medicine discipline has moved away from the “great men of science” model tracking who made key discoveries to a more nuanced analysis of the interplay between healers, patients, and disease vectors. This approach rests on the assumption that the only way to approach medical culture is through its own scientific verification of practices. History is still written according to the principles used in medicine itself.
Medical anthropology uses a different tactic focusing on the cultural context that defines key elements of disease and illness, health, healers, and patients in a given society. The medicalized definition of health is optimal functionality in terms of physiology and/or psychology (Stedman 2000). However, a person’s understanding of how the body functions is itself culturally determined. Anthropological definitions see health as a balance between people, nature, and even the supernatural (Helman 2000). Both definitions target a person’s ability to fit cultural norms, whether in personal perception or within a larger communal sphere. Some type of recognized authority must confer the designations whereby one is diseased or ill. A variety of healers can be a recognized authority in health matters; this is known as medical pluralism. Anthropology illuminates a hierarchy of resort in that one type of healer may be casually consulted during the onset of symptoms, such as a mother or friend, but as the ailment progresses, more authoritarian figures tied to larger power structures are sought, such as priests or board-certified physicians. When a recognized authority confirms the presence of illness or disease, a person is said to take on the sick role. This patient status can be temporary with attempts at healing or restoring a person to a previous healthy state. The disruption to the personal and/or communal sphere may also become permanent, transforming the status from sick to disabled. In the case of disability, restoration is a matter of reintegrating the person into society without achieving the culturally defined norm of healthy. The limitation of such an anthropological approach is that it concentrates on a single moment in time.
By combining both medical anthropology and the history of medicine, we can trace the cultural context of medical practices shifting over time. This illuminates important aspects of ancient medical cultures: symbiotic anatomy, obedience and consideration, and finally, community cohesion.
Symbiotic Anatomy
Unlike modern medicine, the ancient world did not separate anatomy from physiology. The structures or organs themselves were intimately linked to their function within the human body as well as to each other. The connection between anatomy and physiology depended upon each culture’s cosmology. For most of the Ancient Near East, this finds expression as symbiotic anatomy (Zucconi 2019). In symbiotic anatomy, a body part has its own relationship with other body parts, the person they are all attached to, and other entities in the world such as the supernatural forces of spirits and gods. The more well-known conception of a person and their anatomy being one is a cultural belief that originally developed within the Greco-Roman world as it increasingly valued individualism.
The cosmology of Mesopotamia centered on the belief that all entities possess a will or conscious power (Frankfort et al. 1977). Humans simply have less power than supernatural entities. Yet, there are times when the more powerful (i.e., water or earth) will submit to humans as in farm irrigation or exert their own force like storms, floods, and earthquakes. This plethora of wills functions in a hierarchical system. The hierarchy of wills is not limited to humans, spirits, and gods, or even kings, freemen, and slaves. The anatomy of a person, i.e., their body parts, has its own will distinct from the person and each other but must work together in a system. This is the result of humans being formed from a sacrificed god as attested in the stories Enuma Elish and Atrahasis. Many Mesopotamian incantations work on this principle of anatomical structures having independent relationships with each other and the gods (Collins 1999; Pritchard 1969).
Physiologically, the Mesopotamians understood the body as a net of veins, muscles, and tendons stretched over a skeletal frame and filled with organs. Substances like blood move through the body, but how that movement is affected is never delineated apart from the various structures working in conjunction; meanwhile, disease and trauma disrupt such harmonious functioning.
The Egyptians worked with a symbiotic anatomy similar to the Mesopotamians. Various incantations in Egyptian texts invoke the gods not just to protect but to be different body parts, such as the eyes, ears, and tongue (Faulkner and Andrews 2010; Griffith and Thompson 1985). The ancient Egyptians did not value the independent wills of various entities but rather focused on the balance between entities as expressed by maat, the word for balance, order, or justice and personified as the goddess Maat. This concept of maat governed the political world of a king overseeing his subjects, the regular inundation of the Nile, and even the physiology of humans. The Ebers Papyrus outlines the mtw system (a series of tube-like structures than can be veins, tendons, and nerves) through which vital substances like blood move. At the heart of this is the necessity to keep the moving substances in balance. Disease results from either excessive flow or blockage.
The Canaanites include not just the Israelites but other Levantine ethnic groups, such as the Edomites, Moabites, Ammonites, and Phoenicians. Our largest body of textual evidence comes from the Israelites, though, in the form of the Hebrew Bible. The human body itself is a combination of the natural world in the form of dust and the breath of God (Gen 2:7). The term nefesh used in Genesis also appears in Deuteronomy in reference to blood (Deut 12:23); therefore, the most vital aspects to physiology are air and blood. The kidneys are an important organ for channeling the nefesh, whether air or blood, and from this, it regulates thoughts and emotions. Another similarity the Israelites have with the rest of the Ancient Near East is the concept of symbiotic physiology. Because the body was created as a physical entity before God breathed life into it, the anatomy exists without the soul; that is the person. A similar situation exists with idols who never receive a soul, thus lack the important relationships (Ps 115 and 135). Many passages referring to God’s hardening of the pharaoh’s heart (Exod 7:3) or one’s kidneys admonishing a person for bad behavior (Ps 18:7) attest to the independence of the body parts.
Students of Greek medicine concentrate on the tradition of philosophical inquiries, such as Dogmatism, Methodism, or Empiricism, eschewing the religious foundations for many of the medical practices. They set up Hippocrates and the iatroi (physicians) as a contrast to Asklepios and his priests. However, underpinning the philosophical quest for natural laws is the belief that they are established by a single, unifying force: the gods. Two critical factors to Greek cosmology are, first, the idea that the gods embody the same emotions—jealousy, anger, and love—that affect humans. Second is the concept that the universe has a fixed order expressed by Destiny or Right. No one, not even the gods, is above Destiny or Right. The natural laws, therefore, follow the principle of Destiny or Right and favors those who do not give in to emotions. If a god such as Zeus wishes to use his thunderbolts in anger against the principle of Destiny, then the universe will act to correct his injustice. It is this system that drives the actions of the gods and their effects on humans in epics such as the Iliad and the Odyssey.
Hesiod has the earliest explanation of anatomy and physiology, but he notes that these change during different ages. People are made of gold in the Golden Age, silver in the Silver Age, and pastured earth in the Age of Heroes. Across all of these, anatomy and physiology reflect a declining moral character by a degradation of materials. Alcmaeon (ca. 450 BCE) investigated medicine with eight basic questions centered on reproduction, development of the embryo, seat of the intellect, and the physiology of perception. His answer to the last question connecting the sense organs to the brain becomes the basis for the person and their organs being the same rather than two distinct entities. Yet, the theories of Anaxagoras and Empedocles (both 5th c. BCE) in answer to the same eight questions can be used to assert that a person and the organs are different entities. Despite these and other variations in the particulars of Greek philosophers/healers, they all worked with the understanding that the key to proper physiology was the movement of vital substances (eventually settled as blood, phlegm, black and yellow bile), which was, in turn, affected by diet and environment.
Studies of Roman medicine often suffer from being treated as simply a continuation of Greek practices. Originally, Etruscan cosmology held greater similarities with Ancient Near Eastern cultures: the gods worked in councils across sixteen celestial divisions and the intent of the gods came through divinatory practices, such as reading the liver of cattle or the movement of birds. By the start of the Roman Republic, the celestial divisions were reduced to four: negative readings from the left and positive on the right. Blood libations for chthonic deities indicated a connection between living things, including humans, and the earth itself.
The aniconism of Etruscan religion and the gods’ ability to either switch genders or appear genderless make it difficult to determine an over-arching concept of anatomy and physiology for the culture. By the late Republic, Roman art emphasized realism, which highlights a belief that also influenced Roman attitudes toward anatomy and physiology—the body is subject to individual contexts. The physical appearance of the body thus betrayed an inner moral character. This understanding of anatomy reinforced Etruscan liver divination and the use of other auspices in Roman medical practices. Decoding the individual body rested on the over-arching physiological principles that humoral substances needed to move through and be balanced in the body.
Like Greek medicine, Romans shifted between concepts that indicate a symbiotic anatomy such as the “wandering womb” and the use of votives for specific body parts and ideas that argue against it, like the theory (espoused by Asklepiades of Bithynia) that atoms made up all of the body; therefore, nothing has an independent relationship, and by extension, a difference really does not even exist between males and females. Whether or not a Roman healer worked with the idea of a symbiotic anatomy, the body’s relationship to the gods was always fixed and predictable. Eventually, this permanence eroded the symbiosis since manipulation of the anatomy and physiology relies on a mechanistic/hydraulic understanding in order to effect healing.
Obedience, Consideration, and Community Cohesion
Although the various cultures of the ancient world had different expressions for symbiotic anatomy, they all understood the body as a messaging system between the different communities of the anatomy, the supernatural realm, and humans. Whether it was an animal attacking a person, a curse from an angry neighbor, or an attack from a ghost after wandering into the wrong place, all derived from the supernatural world sending a message to the afflicted. It is important not to assume these were necessarily punishments but signs that a normal social order had broken down.
In Mesopotamia, the tale of Atrahasis demonstrates the social disruption of excessive noise that prompts the god Enlil to send the shuruppu disease; meanwhile, a worm simply makes a request of the gods for a mouth to reside in and cause a toothache (Pritchard 1969). A common disease agent in Egyptian texts is wehedew (purulency). Yet the Ebers Papyrus describes wehedew as simultaneously a natural and supernatural agent; its supernatural aspect comes from the sexual promiscuity of a spirit entity preying on unsuspecting humans. The story of Reddedet’s maidservant suffering a crocodile attack has its origins in a rebalancing of social relationships (Simpson 2003).
Like Egypt and Mesopotamia, the Canaanites attributed disease and illness to the degradation of relationships. This network of relationships is navigated by a system of contracts and law codes as well as patronage. The Hebrew Bible outlines the most significant covenants for the Israelites: God promises Noah that he will not destroy the earth and listen to supplicants; the Abrahamic covenant guarantees God’s patronage for the Israelites; the Mosaic covenant establishes the obligations the Israelites have toward God and each other. The story of King Azariah illustrates that the sufferer does not have to be the transgressor of the covenants; however, as king, his duty to prevent others from sinning makes his body the vehicle of communication between God and the community (2 Kgs 15). But illness is not simply a punishment. Job underscores the communicative nature of illness: Job’s body and his behavior in the face of misfortune acted as a medium of communication between God and ha-Satan.
The story of Job illuminates another important aspect of communication in ancient medicine—obedience and consideration. The sufferer must communicate back to the supernatural world that s/he is obedient to the power hierarchy, thus restoring the proper relationships. In turn, those more powerful must consider the supplicant. Job accomplishes this in the form of a lawsuit based on the covenant structure (Job 31). Similarly, the isolation from the community of those declared unclean, such as in the case of skin afflictions (Lev 13:5), demonstrates not only the obedience of the sufferer but of the entire human community. In these cases, God indicates he has considered their obedience by restoring the fortunes of Job (Job 42:10) or healing the skin affliction (Lev 13:6).
Mesopotamian and Egyptian medicine also engaged in the process of obedience and consideration in the form of sacrifices and other offerings as well as ritual practices. A ritual practice consists of a physical rite and an oral rite that charges a substance, thereby making it effective in healing. Rituals using incantations are easily recognized (Hallo and Younger 2003; Foster 2005; Scurlock 2006). More difficult to discern is the ritual nature of actions in Mesopotamia and Egypt where healing techniques, such as poultices and fumigations, were used to apply medications that appear more akin to modern instrumental therapies (Thompson 1937; Grapow 1954–1973). This has caused scholarship to characterize these cultures with a false dichotomy of competing magical and scientific forms of medicine. The medical texts in each society clearly show both incantations and instrumental techniques being used in conjunction and by the same type of healers. The first medical case in the Edwin Smith Papyrus describes palpation for both the wab priests of Sekhmet and the swnw (commonly translated “physician”). The use of medicants is, in essence, a physical rite with a charged substance whether or not the more common oral rite of an incantation appears alongside it. It is through these ritual acts or patient compliance that the Mesopotamian or Egyptian patient shows obedience to the proper order of social relationships. Gods then show their consideration through either removing the physical symptom or allowing it to continue.
Even within the Hebrew Bible, the story of Naʾaman’s skin affliction highlights the ritual nature of instrumental healing and its function of communicating obedience and consideration between the human and supernatural world (2 Kgs 5). The prophet Elisha directs Naʾaman to bathe in the Jordan; he balks at the idea, expecting, like a modern scholar, to see a more obvious religious ritual. Once god healed Naʾaman, the Canaanite general vowed only to recognize the Israelite god. This also indicates another important aspect of healing in the Ancient Near East—community cohesion.
When the gods consider the outward signs of obedience from the afflicted, they are ultimately determining a course of action to reestablish community cohesion. If illness, disease, and trauma signal a break down in social relationships, then restoration of health allows a person and the anatomy to reintegrate with the human community as well as a religious congregation. But not every illness is healed. Death of the afflicted indicates that the removal of the person entirely is the best path to community cohesion. This leaves the issue of disability. Chronic conditions necessitated a reorientation of social relationships. The anatomy itself forces a change between humans and their resultant relationship with the supernatural in order to maintain cohesion. Lev 13:12-13 illustrates the acceptance and reorientation of the community for one whose skin affliction permanently covers the entire body.
Early Greece had a similar confluence of obvious ritual practices with the more subtle instrumental therapies as a way of demonstrating obedience, particularly with the incubation process in the asklepieion. It is not clear when and how during the Classical period that Hippocratic medicine began to divest itself of incantation based ritual practices (Sherwin-White 1978). Some argue that Hippocratic medicine developed as a techne (craft) and only later incorporated religious ideologies (Longrigg 1993). By the end of the Classical period, the two-step process of restoring health and reintegrating with the community collapses into one action. The work of the iatros (physician) restoring a physical condition automatically reintegrates someone with their community. This rests upon the ideas that the gods only mechanistically respond to a set order for physiology and that the iatros has sole authority in the relationship between anatomy, humans, and the gods.
As Roman medicine developed from Etruscan practices, it adopted the Greek philosophical tenets of Dogmatism, Methodism, and Empiricism, all of which advocated the mechanistic approach to physiology. Along with Greek practices, Roman medicine began reorienting obedience to patient compliance to the healer’s instructions, thus reducing the gods to a more passive role. The medicus, like the iatros, became the authority on reintegrating sufferers primarily with their human community. The anatomical and supernatural entities lost their volition in the social relationships. As Christian and Rabbinic medical cultures developed within a Greco-Roman context, the tripartite relationship of anatomy, humans, and god started to give way to the nascent mind-body dualism in Greco-Roman medical practices.
References
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