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In studying the organization of the diagnostic/prognostic series, much can be learned about the teaching and practice of medicine in ancient Mesopotamia. Anatomy is the dominant structure, especially visible in Tablets III to XIV.1 Listing texts in head-to-toe order facilitated the physician’s search for relevant texts. Modern medical texts all have an index to help find items of interest, but indices are a relatively recent invention. Other principles of organization include ordering entries in accordance with the number of days a patient had been sick. This facilitated the addition of later material, as in Tablet XVI, where a section organized by the number of five-day weeks a patient had been sick (lines 52⬘–60⬘) was apparently inserted, set off by paragraph lines, into the approprate slot (between lines 46⬘–51⬘ [more than five days] and lines 61⬘–75⬘ [more than six days]). Within each category, there are other types of organization. Texts that refer to a single disease are clustered together (sequenced references; see Introduction) for the likely purpose of providing the physician with an understanding of the variations in signs and symptoms that may be seen in a particular disease. Modern textbooks of medicine typically provide detailed information about the frequency and severity of signs and symptoms of a specific disease. It must be remembered, of course, that the amshipu’s syndromes or diseases areinsomecasesgroupsofdiseasesthatmodernphysicianssubdivide.Somepassagesinthe diagnostic/prognostic handbook were apparently intended as a differential diagnosis for spirits,as,forexample,TabletIV,lines7–18,whichattemptstosortoutallthedifferenttypes of headaches attributed to ghosts. Another important use of this ancient “textbook” is for comparisons between different diseases with overlapping signs or symptoms. By placing these references side-by-side (contrasted references; see Introduction), the physician and physician-in-training were able to easily make comparisons and to understand significant differences. Particularly interesting in this regard are sections discussing the progression of arthritis from pain to swelling and sluggishness to immobilization of the joints (Tablet XI, lines 99⬘–102⬘) or attemptingtoexplainthedifferencebetweengastrointestinalulcersandobstructiononthe one hand (Tablet XIII, lines 42–43) and between bleeding ulcers and liver problems on the other (Tablet XIII, lines 82–92). Chart Showing the Arrangement of Entries in the Diagnostic/Prognostic Series Texts with differing signs and symptoms and degrees of severity were also juxtaposed to illustrate how these differences affected prognosis. For example, Tablet XII, lines 70–81, shows how varying degrees of back (kidney) pain influence the outcome of the illness, and TabletXVI,lines65⬘–72⬘,explainswhichsignsandsymptomsinbiphasicfeveraregraveand which are not. Particularly interesting are references appearing in one section of Tablet XVIIwhichmightbesubtitled:“it’snotwhatyouthink!”Examplesincludenotatrueseizure (lines 15–16), not a coma (line 18), and not a stroke (lines 30–31). These same approaches are used in all modern medical texts. There can be no serious doubt that the diagnostic/prognostic series constitutes the earliest recorded medical textbook . Key to the Chart In the following tables, the left-hand column indicates the line number on the original tablet of the diagnostic/prognostic handbook. For Tablets XV to XXXIII, the numbers are thosegivenintheeditioninHeeßel,AOAT43.Fortheremainingtablets,thenumbergiven is the actual line number of the main text as cited in the body of the book. The second column contains the ancient diagnosis, if any. Broken entries are indicated by [. . .]. The third columncontainsthemoderndiagnosiswherethishasbeenascertained.Justificationforthe attribution is to be found in the cited chapters. The central column contains an abbreviated description of symptoms. The fifth column contains the ancient prognosis, if any. The last column tells where in the body of the current work this entry is cited. The first number is the numberofthechapter.Thenumberthatfollowstheperiodisthenumberofthequotedpassage within the chapter. For example, 20.26 would be the twenty-sixth quoted passage in Chapter 20. An “n” after the number indicates that the entry is cited in an endnote attached to the relevant quoted passage; “d” indicates that the entry is cited in the text that discusses the quoted passage; “dn” indicates that it is cited in an endnote to this discussion; “pn” indicates that the entry is cited in an endnote in the general discussion preceding and “fn” in an endnote in the general discussion following the quoted passage. A single horizontal line across the chart indicates subsections marked by paragraph lines on the original tablets. To aid the reader in appreciating the way in which the diagnostic/prognostic handbook was used to train students of medicine, we have made the organizing principles explicit and have marked sequenced or contrasting references off from the body of the text and from...

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