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chapter 19 Ancient Etiologies: The Naming of Disease Patterns ThischapterwillexploretheapproachesusedbyancientMesopotamianphysicianstoidentify and name syndromes or patterns of disease (ancient etiologies). Although ancient Mesopotamian medicine was remarkable for its foundation in prior observations, the ams hipu was still an intellectual. He was expected to be well versed in the scribal arts, Sumerian, classics of literature, and a wide variety of “magical” rituals in addition to the forty tablets of the diagnostic/prognostic handbook and innumerable therapeutic texts. Moreover, like intellectuals everywhere, it was not possible for him to approach a medical problem without bringing to it a bit of preconceived theory. This is particularly noticeable in his determinationtoseesigni ficanceinright/leftvariationsinsignsorsymptoms(seeIntroduction).The amshipu was also predisposed to explain illness in terms of the influence (“hands”) of the various gods/goddesses, ghosts, demons/demonesses, and demonic forces such as curses and sorcery that populated his spirit world. In part, this was simply his way of dealing with broad categories of disease such as mentalillness ,neurologicconditions,arthritis,skindiseases,heartandcirculatoryproblems,illness due to trauma, and fevers. Ancient Mesopotamian religion was polytheistic, with many gods/goddesses already present and the possibility, by divination, of establishing new gods/goddesses at will. Thus, his religion provided the amshipu with a relatively flexible system for the assignment of diseases to causal agents. If the amshipu so desired, there were methods of divination that could have been used to assign his patients’ medical problems to “hands” of gods/goddesses or demons/ demonesses in a perfectly arbitrary fashion. What is interesting, therefore, is the apparent reluctance of the amshipu to allow his theories to run roughshod over observed realities. He seems not infrequently to have been unhappy with the attribution of specific problems to any of the spirits or demonic forces known to him.1 In some of these cases where known gods/goddesses or demons/demonesses were not invoked as causal agents, associations were made with anatomic areas. If diagnosis by this method did not seem appropriate, a set or several sets of connected symptoms might be given a name that referred to some characteristic of the disease (see below under Specially Named Syndromes). Some of these specially named syndromes evolved, over time, into demonic forces in their own right (see below under Named Syndromes That Evolved into Demons). As a rule, syndromes identified by the ams hipu as “sick x or y body part” or by a syndrome name are much easier for the modern observer to puzzle out than those attributed to “hands”ofancientMesopotamiangods/goddessesordemons/demonesses.However,with some syndromes attributed to divine or demonic “hands,” we may not be able to identify every individual reference, but the organizing principle that inspired grouping all of the attested references under one diagnosis is still relatively clear (see below under Clearly Organized Syndromes Attributed to Divine or Demonic “Hands”). An interesting example is a set of diagnoses that seems collectively to have been the ancient equivalent of our category of “unknown etiology” (see below under Ill-defined Syndromes of the Sort Gods/ Goddesses Might Cause and Mystery Syndromes). Atleastinpart,“hands”aremoredifficulttopindowntoasinglediseaseorsetofrelated syndromes.Asanintellectual,theamshipuwillhavebeeninclinedtotrytomakethingsuncomplicated and with the fewest number of causal agents possible. Also, at least in theory, there should have been a tendency for independent-minded gods and demons to cause a variety of different problems. Even so, with some of the better-attested gods/goddesses and demons/demonesses, reasons logical, exegetical, or theological can still be found to explain why at least some of the syndromes were attributed to that particular god/goddess or demon/demoness (see below under Syndromes Assigned in Accordance with Known Predilections of Specific Gods/Goddesses or Demons/Demonesses). Part of the difficulty in puzzling out the godly and demonic “hands” is that there are many gods/goddesses or demons/demonesses that have only one or two associated references or who are given as causal agents for syndromes that we have been unable to identify (see below under Problem Syndromes Due to Insufficient Information). It is always possible that our inability to identify syndromes attributed to divine or demonic “hands” is simply due to the fact that the attribution was determined by divination. However, there are enough gods/goddesses where the attributions seem to make sense in modern terms or where reasons can readily be generated for the attribution of specific syndromes to particulardivinitiestosuggestthatweshouldgivetheancientsthebene fitofthedoubtandtosuppose that if we knew as much about these divinities as the ams hipu, we would better understand why particular gods...

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